Brian Othmer Foundation

The Emerging Frontier of Neurofeedback

By Siegfried Othmer, Ph.D.

The great revolution of the past fifty years, with respect to the problems of human behavior, has been the realization that these are not first and foremost the result of moral failings or of deficiencies of the will. Rather, they are biologically-based disorders that call for physiologically-based remedies. Of course moral failings and deficiencies of the will exist as well, but for the moment these will not be our focus. Over the last few decades, a scientific model has emerged in which we organize our understanding of brain behavior in terms of our neurotransmitter systems. These are then managed with an increasing variety of medications, which in turn supports the basic model. After every such major step forward in science or medicine, there follows a period of consolidation around the new model before we are in a position to take another major step forward.

By now we know that the neurochemical model has its limitations. The various medications that have been developed to regulate the principal neuromodulator systems have not led to a resolution of the major mental health issues that plague mankind. And the neurochemical model is incapable of explaining the complexity of human behavior. Over the last thirty or forty years, evidence has gradually accumulated to make the case for a new, complementary model of brain function. This model is one based on the bio-electrical activity of the brain rather than the neuro-chemical activity. Such a model does not immediately have to be better than the old. It just has to explain some things that the old model can’t explain. And if the new model also leads to new therapies, then that is likewise supportive, and will draw further interest. Eventually, we end up with a new model that can stand on its own in the world.

The role of the brain is largely regulatory in character, and that involves communication. Such communication is largely organized through our neuronal networks. These are characterized by a basic architecture, the structural network. And upon that structure a functional network develops and matures over time. Brain behavior then plays out within the bounds of the functional network, what we call brain dynamics. At the microscopic level, our brain has a telegraphic, pulsatile communication system to handle rapid information transport from point to point. In generality, bits of information are pretty useless by themselves. They acquire meaning only in context. So the real issue of communication in the brain wraps around how information is imbedded in context, and how context is preserved and communicated. For that, we need to look at group behavior of neurons rather than individual behavior. We need to understand the organization and management of neuronal assemblies.

The brain has the advantage of large numbers. We have some 10 billion neurons in cortex. These have to be organized in such a way that we can react very rapidly to events. The answer lies in parallel processing: neurons act collectively to perform their roles. This places a tight constrain on the timing of events. The brain organizes all this in the realm of frequency. Neuronal assemblies coordinate in the frequency domain and thus are able to play their unique roles without interference or disruption—when things are working properly. This organization becomes visible to us through the electroencephalogram, the EEG. So we get to see the brain in action regulating its own affairs just by watching the EEG. What we get to see is the context of brain activity, not the specifics of what is being communicated. We are witnessing the brain regulating its own activity. Something quite remarkable happens when we allow the brain to witness its own EEG. It is effectively looking at itself in a mirror. Watching that activity, it does not take long for the brain to recognize its connection to the signal on the screen. It is witnessing its own neuronal dance, and that provides a basis for the brain improving on its dance. Neurofeedback, then, is nothing more than a guided way for the brain to improve its own function based on the information it is getting on its own activity.

This technique was actually discovered some forty years ago. But from the very beginning it was obvious that this was a discovery that had been made before its time. The discovery was accidental. There was no basis within science to understand what was going on, so this field ended up as a kind of orphan therapy, by analogy to orphan diseases. In the face of the appeal of psychopharmacology, competitive technologies were nudged off the stage and starved for funding. There was another problem, and that is the absence of patents. No one could own the basic neurofeedback technique. In that regard matters are much like they are with dietary supplements. These are not systematically researched because they cannot be patented.

As a result of the above factors and others, the field has developed largely at the hands of scientist/practitioners. And in the absence of funding to chart a particular path forward, there has been a proliferation of different approaches to training the brain toward better function. Looking back on all this, we can see that all these developments were quite healthy. We now know that there are many ways to train the brain. And by now the neurosciences have matured to the point where neurofeedback is right in line with modern thinking about brain organization. We are starting to see a flood of studies using modern imaging techniques in feedback configuration. And sure enough, all that has been previously found using the EEG is now being validated with functional magnetic resonance imaging.

At the same time, we are coming to the realization that psychopharmacology has not lived up to its promise. Drug companies are retreating sharply in their research into this area. The disappointments are mounting, and the negative fallout of over-reliance on drugs is accumulating. Something else is needed, and it is neurofeedback. The problem has quite simply been an excessive reliance on drugs. They are being asked to do more than they can. On the other hand, with the addition of neurofeedback, medication dosages can be dialed back to play only their appropriate role, and the combination can do much more than each one can do alone.

We can now look forward to a golden age of mental health and of optimum functioning.

The Early History of Neurofeedback

By Siegfried Othmer, Ph.D.

The book Brian’s Legacy tells the story of how my wife Susan Othmer and I originally came to be involved in neurofeedback. In this article, we provide some background about what led us to this novel therapy, along with the history of the field itself.

Neurofeedback belongs to the class of techniques known as biofeedback, which covers all those methods in which a person is made aware of aspects of his body’s regulatory responses for the purpose of altering them. Typically, a particular measure of psychophysiological functioning is tracked with an instrument, and the trainee then witnesses the progression of the resulting signal over time. The signal will undulate between movements in a preferred direction and movements in the opposite direction. The trainee will feel positive about any movement in the preferred direction, and over time the likelihood of movement in that direction is expected to increase. If this process is repeated over a number of sessions, the trainee’s nervous system may then acquire new habits of functioning that are closer to the regulatory ideal.

Neurofeedback is nothing more than biofeedback based on the electroencephalogram, or EEG, as a measure of the brain’s ongoing self-regulatory activity. At first it was even referred to just as “EEG biofeedback,” and that term can still be heard today. It was actually EEG biofeedback that motivated the formation of the first biofeedback organization, the Biofeedback Research Society, in the U.S. The year was 1969. The early excitement was around the training of the famous alpha rhythm, the dominant rhythmic activity in the EEG that had already been identified by the original discoverer of the EEG, Hans Berger. The training of this rhythm, which appears at about 10 Hertz (cycles per second), gave promise of a powerful application to regulate anxiety states.

This effect of alpha training had been the original discovery of Joe Kamiya, whose interest was the understanding of human behavior, not the development of a therapy. Specifically, he was interested in the physiological manifestations of psychological states. For example, could the existence of bursts of alpha activity in the human cortex be related to particular feeling states? It turns out that it could. An individual could be trained to judge correctly whether an alpha burst was or was not present in his EEG at a particular instant, just by tuning into his own feeling states. This was a truly ground-breaking finding. Could a person train to alter the incidence of alpha bursts and thus alter their own state? That turned out to be possible as well, and thus EEG biofeedback was born.

Things did not go well soon after the formation of the new organization, however, principally for two reasons. The first is that the results were mixed when alpha training was subjected to controlled studies in academia. The second is that the alpha training became popular in the drug culture of the time. This came at the peak of the psychedelic age, after all. Word got around that alpha training was a way to replicate the effect of LSD without the risk of nasty after-effects. This premature popularization of the technique poisoned it for serious academic interest.

The biofeedback field nearly died as a result of these two calamities, and only picked itself up by resorting to measures of peripheral physiology such as skin temperature, sweat gland activity, muscle tension, heart rate, blood pressure, etc. These all had good “face validity” in terms of reflecting the state of our autonomic nervous system. The main agenda was to tame the flight-fight response, to calm our tendency toward over-activation of our sympathetic nervous system, and to moderate our stress reactivity. The goal was improved “homeostasis,” the ability to maintain a proper, stable operating point in our nervous system through thick and thin. However, the popular association became that of “relaxation training.” This unfortunately trivialized what was actually being accomplished, so biofeedback had yet to achieve its proper place in health care. In fact, it settled in as a kind of adjunct to “real” medicine, with medical professionals acknowledging its claims in principle but neglecting it in practice.

Biofeedback then came to be associated exclusively with measurements of peripheral physiology. When EEG biofeedback re-entered the picture later, it naturally came to be seen as just one more branch of the biofeedback tree, when in fact it had started out as the trunk. And since the field of medicine was largely ignoring the biofeedback tree in its orchard, the new EEG biofeedback branch was unlikely to make much difference. When Sue and I came along later, we promoted the adoption of the term neurofeedback to induce healthcare professionals to take a fresh look at what was being discovered.

EEG biofeedback was reintroduced to the biofeedback community through an entirely new development that had little in common with the old alpha training. The new development also came about quite by accident. Barry Sterman, a research psychologist in the Department of Psychiatry at UCLA, was pursuing behavioral research on cats with a primary interest in sleep. He was working at the Sepulveda Veterans Administration Hospital when he discovered yet another special EEG rhythm, what he came to call the sensorimotor rhythm (or SMR for short). This activity consisted of brief bursts of an EEG frequency that lay just above the alpha rhythm, at about 13 Hertz. This activity only made its appearance while the cat was physically still, and it only showed up at the motor cortex.

When the appearance of this bursting activity was reinforced with a food reward, the cats changed their behavior toward greater calmness and their sleep improved. In a subsequent unrelated experiment, these same trained cats were found to be more resistant to chemically induced seizures. This seminal development came about quite by accident. Sterman was researching cat behavior under the influence of a common rocket fuel, monomethylhydrazine. The interested party was NASA. The agency was confronting the puzzle of astronauts exhibiting episodes of diminished cognitive function on space missions. The leakage of toxic rocket fuel into the space capsule had been fingered as the culprit.

Obviously this kind of problem needed to be investigated in animals who didn’t object to being probed with toxic chemicals. When Sterman analyzed his data, it turns out that the cats did not react uniformly. Their behavior was tightly distributed at the outset, but about an hour into the experiment half of the cats went into seizure, as expected, but the other half had their seizures considerably delayed or they did not seize at all. The results fell into two distinct groups, which meant that the group of cats was inhomogeneous in some significant respect. When the history of these cats was investigated, it became apparent that the two groups of cats had had different experiences with EEG training of the sensorimotor rhythm. The conclusion appeared inescapable: prior SMR training had altered the seizure threshold of the cats.

No one in his right mind would have posed this hypothesis at the time, and no one would have gotten research support to prove it. This just had to happen by accident. Even better, the experiment met the highest research standards of being a fully controlled design without anyone having planned it. The experiment had involved two different groups of cats, but this did not get clarified until after the results were in. This means that the researcher could not have been biased in any way throughout the study.

The world of science, however, was not quite ready for these results. The findings regarding sleep were indeed published in the premier journal Science, and the epilepsy work was published in the neurology journal Epilepsia, among others. A number of replications of the work were instigated in research centers ranging as far away as Italy and Scandinavia. However, there was no groundswell of general interest.

The explanation for this neglect goes back to the fact that the EEG was not well understood at the time, so there wasn’t an established core of scientists who would just soak up this information and run with it. As Albert Einstein said, “It is the theory that tells us what we may believe,” and as yet there was no theory to explain these bizarre findings. A second reason is that the work with seizures had to find its niche within the field of neurology, and that was unlikely to happen at a time when neurologists were absorbed with the joys of pharmacology. Neurology was at the threshold of discovering miracle drugs (such as Tegretol), and would not be diverted. A third reason is that when all is said and done, we are still talking about a behavioral technique here, and that is just not part of the culture of medicine. For all the above reasons and more, the graft did not take.

And then there was the field of psychology, which at the time was home to all funded research on sleep. Quite simply, seizure disorders were not on psychologists’ worksheet. First, the field of psychology had carefully carved out its turf so as to be non-threatening to medicine. Second, psychologists had only the barest training in physiology. And third, the discipline of psychophysiology was still emerging. As late as 1974, B.F. Skinner insisted that the root of behavior should be looked for in the person’s interaction with his environment, not within the brain. By that time, the first paper on neurofeedback for seizure management had already seen print. The work was based on Skinner’s own operant conditioning methods. Such irony: Skinner’s own central tenets were being dismantled by means of experimental procedures he had developed.

Margaret Ayers
Margaret Ayers was a graduate student at the International University in San Diego when her major advisor suggested that she work with Barry Sterman for her dissertation. Sterman agreed to take her on as a student in his laboratory at the Sepulveda Veterans Administration Hospital. To earn her keep, she became a caregiver for a youngster in a wheelchair who had been brought by her family from South America to undergo the neurofeedback training with Sterman for a head and spinal cord injury.

Ayers and Sterman did not get along, however, and after some time Sterman terminated the arrangement. By that time, however, Ayers had witnessed the power of neurofeedback and decided to set up shop in Beverly Hills to offer the training. This was Sterman’s worst nightmare, because he had seen what happened when Joe Kamiya’s alpha training was prematurely popularized. The last thing he wanted was for his discovery to be offered to the public before the foundation was prepared with solid research—and particularly not by a person in whom he did not have high confidence.

Sterman had given his technician, Sidney Ross, instructions to design a suitable laboratory instrument for the training of human subjects. Unbeknownst to him, Ross had gone ahead and patented the design, and also claimed inventorship of the entire neurofeedback process in the bargain. This was of course a false claim on all counts. The technician was not the inventor, and he could not claim to be the owner of the patent either. That belonged either to the government or to UCLA. When Sterman got wind of all this and had recovered from his irritation, he struck an agreement with Sidney. He would not make an issue of the patent claim if the technician would allow him—Sterman—to approve all sales of the instrumentation. In this manner, Sterman could assure that the only sales would be to established research institutions.

When Ayers approached Ross for an instrument to work with, he simply sidestepped the agreement by arranging for a lease rather than a purchase. Over the succeeding years, Sterman never ceased in his efforts to put a stop to Ayers’ work. We, of course, have to be grateful for the way things turned out, because Ayers was the one who introduced our family to the value of neurofeedback. But one marvels at the degree to which our whole developmental path over the last quarter century has depended on so many unlikely events.

In retrospect, it is very clear that Ayers quickly developed a broad competence in using Sterman’s method, and she indeed had an understanding of the technique that was unmatched anywhere at the time. “I am the only one in the world doing this work clinically,” she would tell clients, and indeed that was the case. When we came along some ten years after she had first opened her office, we soon noticed the handicaps under which she was operating. Her equipment was the original instrument that she was still leasing. Meanwhile the world was turning to computer-based instrumentation.

In unbounded gratitude for what Ayers was doing for our family, I suggested that I could be helpful in bringing her instrumentation into the modern world. Initially, my overtures were not all that welcome, which mystified me. We talked things over for several months. Ayers saw her existing instrument as the key to her uniqueness, which she greatly valued. Once a new instrument was built, there would not be just one…. Ayers also found it difficult to trust people, given the fact that she was surrounded by a hostile mainstream and hounded by an adversarial Barry Sterman.

Eventually, however, a three-way partnership was formed between Ayers, myself, and the software engineer I had recruited to the task, Edward Dillingham. The deal was as follows: we would build the instrument entirely on spec, subject to Margaret’s approval. If she liked the instrument, then we would organize to go into business to promote it. If not, she had no further obligation. The deal was sealed over a meal at the original Cheesecake Factory in Beverly Hills in the fall of 1985. We then went back to Margaret’s office and she invited us into a mutual ceremonial hug. Edward and I, both of us left-brained aerospace engineers, were a bit uncomfortable with the atmospherics. Neither of us was prepared for that moment. But I also welcomed that rare expression of warmth from the Margaret that we had come to know. It was an auspicious and hopeful beginning. Our son Brian had been training for about six months, and the rest of the family had benefited from the training as well, each of us for different issues. Ed Dillingham then committed what turned out to be nearly three years to the software development task—all without pay.

By the end of 1987, the first working unit was sitting in Dillingham’s development studio at his home in Pacific Palisades, and Brian had his first training experience on it. By early 1988, Ayers approved the design and installed the first system in her office. By late 1988, however, our partnership had fallen apart. Good will all around was not enough to hold it together once it came time to make the hard decisions. Forming a business brought a lawyer into the discussions, and he pointed out to Ayers that under a partnership arrangement she would not have the absolute control that she cherished. Hers would just be one vote out of three. That brought the whole budding enterprise crashing down around our ears. Retaining absolute control of the business she had created was of utmost importance to her.

I should have known! After all, she was a lone ranger in her office. This was not a person who partnered well. By this time, of course, we were so thoroughly committed to this field that we could no longer just walk away. I also felt the pressure of having gotten Ed Dillingham involved, and felt it was high time for him to draw an income from his project. The instrument was sitting in our living room with no place to go. The Dillinghams and the Othmers jointly resolved to continue. That meant that Ayers was now interested in our failure to the same degree that Sterman was interested in hers. We represented the very threat that she had feared from the outset—competition that knew what she knew. There were now two people in the world who knew how to do this work, and somehow the world wasn’t big enough for both of them. It was a Greek tragedy, with everyone carrying out their character-bound roles. An arbitration proceeding resolved the issues between us and all parties were able to move forward unencumbered.

The fracturing of the relationship was also painful on a personal level. We were very mindful of just how much we owed Ayers for her help to our family. Our highest dreams had been thoroughly intertwined for three years. We so counted on success that there had been no Plan B.

Ayers went on to have yet another instrument built, based on our design, and over time she became widely known for her work with traumatic brain injury and stroke. After all, the world was full of head-injured people who were being ignored by standard medicine. Their functional deficits were typically not being acknowledged if they weren’t backed up by evidence of structural injury. That did not really change until our servicemen started coming back from Iraq in great numbers with blast injuries. Their troubles were obvious, but their injuries weren’t. Finally the full-blown problem of traumatic brain injury could no longer be ignored. The emotional and cognitive deficits were functionally mediated rather than structurally based, but they were nonetheless real. Ayers had been working on what medicine had been treating as a non-problem. With word spreading through the informal network, however, the head-injured found their way to her office by the thousands from all over the world, until her death in 2008 at the age of 62.

Ayers was the first person to grasp the broad potential of neurofeedback in application to mental disorders, learning disabilities, attentional deficits, behavioral problems, and even neurological problems such as cerebral palsy. The health care field was just not ready to hear it. Ayers’ pioneering role in the development of this field deserves to be recognized.

Other Major Figures
When we began training at Margaret’s office in the spring of 1985, it was our perception that her office constituted the entire world of clinical neurofeedback. Margaret certainly encouraged that view. Her approach was indeed unique to her, but she was not the only one engaged with the development of neurofeedback at the time. In the following, brief introductions are given to the other major figures who were active in the field during its formative stages.

Joel Lubar, Professor of Psychology at the University of Tennessee, had come to work with Barry Sterman for some time in order to learn the method. During that interval, they observed that children who responded to the neurofeedback for their seizures also moderated their hyperactivity, if that had been an issue. Why, they asked themselves, wouldn’t the technique work with children who were just hyperactive but didn’t have seizures?

Lubar took the method back to the University of Tennessee, and then became the singular outpost within academia where neurofeedback was systematically evaluated in application to what later became known as Attention Deficit Hyperactivity Disorder (ADHD). Unfortunately, what stood in the way of this development was the Ritalin juggernaut. Neurofeedback was a clear threat to the pharmaceutical industry. This made it difficult to secure funding for research through the NIH, which was effectively in a state of mind-meld with the drug companies. After all, the neurochemical model of brain function was the established model. It ruled essentially without challenge. Lubar labored under adverse conditions, but he persisted in this focus. He was hounded by other psychologists who were defending the standard drug-based model, and the resulting brouhaha was enough to convey to other researchers that if they cared about their professional reputations, they should not get involved in this field.

Work also continued at a low level on the other side of the house, following on Joe Kamiya’s pioneering work with alpha training. The key figure here is Elmer Green, whose first career had been in physics and engineering. His parents were spiritualists, and so he was open to that dimension of existence. His spirit guide at one point upbraided him for wasting his talent at the Naval facility China Lake designing weaponry. He then got interested in the alpha research and decided to become a psychologist. Opportunity came his way when Karl Menninger, the Grand Old Man of psychiatry at that time, invited him to open a research center at the Menninger Foundation in Kansas. Elmer Green formed an interest group that met annually around the topic of alpha training, and that led to the formation of the first biofeedback organization, the Biofeedback Research Society, in 1969.

Barbara Brown was perhaps the best known figure connected with the alpha work. She was a neuroscientist at UCLA, and ended up working at the same facility where Sterman did his research, the Sepulveda Veteran’s Administration Hospital in the San Fernando Valley of Los Angeles. Brown lectured widely on the topic of her research, and published a number of popular books. This did not endear her to her academic colleagues, and in one famous incident she was physically dragged off the podium at the Neuropsychiatric Institute by a well-known colleague when she broached the topic of her research. “We won’t be listening to this rubbish,” she was told. That speaks volumes about the climate of the day. The very notion that brain function could be altered by reinforcement was just preposterous. Brown’s adversary was the famous H.W. Magoun, founder of the UCLA Brain Research Institute.

Les Fehmi was a graduate student in psychology at UCLA when he got interested in the possibilities of alpha training. In true scientific spirit, he set up a system to try the training himself. Through a number of trials he came to the realization that he could not by force of will or effort or anything else bring about the desired outcomes. He simply had to let go entirely and let matters proceed without top-down control. Alpha bursts were directly dependent on his physiological state, and he just had to yield to the process in order to get there. This was a crucial lesson to learn for someone who lived by his left brain—along with most of his academic colleagues.

After getting his Ph.D., Fehmi took up a position at Stony Brook University on Long Island, but he was unable to secure funding for his alpha-related research projects, and so abandoned academia and set up a private practice in Princeton, New Jersey. This allowed him the freedom to pursue his interests, with the resources made available through his private practice.

All of the researchers involved with alpha training were interested in the implications for the exploitation of human potential and in the understanding of our psychophysiological states. This group included Jim Hardt, who had also migrated from the physics and engineering world to research alpha training. After a transformative experience with the alpha training on his own head, he became a graduate student under Joe Kamiya. Jim Hardt has continued with this work ever since.

Other organizations picked up the training approach developed at Menninger with addictions treatment in mind, and early success was in fact achieved. This intrigued Eugene Peniston, a psychologist working with Vietnam-era veteran alcoholics at the Fort Lyon VA Medical Center in Colorado. He had also suffered the personal loss of a brother who had succumbed to alcoholism. His spectacularly successful research with the Menninger protocol was unfortunately rejected by both the VA and the biofeedback community. The results were simply too good to be believable! No U.S.-based journal accepted his papers. They ended up being published in Canada and Australia. The VA, in its infinite wisdom, moved this trouble-maker into a desk job in Texas until his retirement. The biofeedback community had already decided long before that alpha training had been discredited, and they were not interested in hearing about it again.

Finally, there was in this time-frame also a German university-based research effort, under the direction of Niels Birbaumer at the University of Tübingen. His research group was working with very low frequency information in the EEG. Results were published on seizure management, migraines, and even schizophrenia. Birbaumer found also that these results were not welcomed by the research community. He motored on by using the method to allow locked-in patients to communicate using their brain wave activity. Locked-in patients are almost totally paralyzed and unable to communicate verbally. This work did not threaten anything, and was even graced with a research award of several million dollars by the German government. At the time of my writing, at least five German universities are conducting research into neurofeedback—more than in the United States.

The Future Role of Neurofeedback in Education and Health Care

By Siegfried Othmer, Ph.D.

When we entered the field of neurofeedback in 1985 with Brian, we certainly did not expect that we would still be looking for mainstream acceptance of neurofeedback after a quarter-century. Would we have entered the field had we known it would take this long? Without question, the answer is yes. But we would have chosen a different course. We would not have chased after mainstream acceptance early on. Such acceptance was not forthcoming. It became clear that we just had to bring this field to maturity largely on our own.

Even a conservative view of the potential of neurofeedback in exploiting brain plasticity holds out the hope for major inroads to some of our most intractable societal problems. This is occurring at a time when strain is showing in the cohesion of our societies. Right now even our governmental institutions are in a rather pessimistic frame of mind with respect to the problems of criminality, of addictions treatment, of school failure, of the health care crisis, and of the mental decline of the aging. We are merely trying to manage these problems rather than solving them.

Major changes are in store if we start looking at criminality as a brain-based problem rather than as a moral issue. The same goes for addictions treatment. The problem of school failure, both with respect to dropout rates and academic failure, also should be seen in the perspective of brain function. Amazingly, more than ten years after the decade of the brain, the entire educational enterprise, from the Department of Education down, has not even considered the potential role of the neurosciences in education. In the field of health care, no account has been taken of the key role played by disregulation of brain function. Finally, the mental decline of the elderly is seen exclusively in medical terms that focus on structural issues rather than functional models.

The Mental Decline of the Elderly
Let’s start with mental decline, since we’ll all be facing that issue sooner or later. Here the essential fact is that damage is cumulative throughout life. The functional aspect of brain injury is recoverable, as we now know, so the best we can do is to recover such function before we experience yet another insult to the brain. We see the natural recovery processes at work in boxers (between bouts), in football players who have suffered concussions, in recovery from minor automobile-related injuries, and in combat-related PTSD among our soldiers.

Referees at boxing matches have learned to stop a fight immediately once mental function is in question. Even one more blow to the head under such conditions can be devastating. It is a costly error to send a concussed football player back onto the field prematurely. Unfortunately, the players are often co-conspirators with the coaches, because they usually prefer to be in denial about the possibility of lingering head injury. Their deficits may also not be immediately obvious. Hospitals, doctors, and insurance companies are still in denial about the effects of minor head injuries, so the accident victim is encouraged in the false belief that nothing is really amiss. And soldiers in combat are drilled in the belief that they must master their problems. Denial is all around.

Most of us are neither boxers nor football players nor fighters, but many of us did go through some of those stages in childhood, and nearly all of us suffered normal childhood accidents. Or there were emotional traumas, which for present purposes amount to the same thing. Resilience in our maturity is likely to be constrained by events in our childhood that we may not even recall. And the lingering effects of such “Adverse Childhood Events” (ACE’s) are best addressed with neurofeedback.

It is the existence of our natural recovery processes that allow us to assume that all is well after we have apparently recovered from physical or emotional insults. But that is not necessarily the case. In a study of soccer players it was found that beyond a certain incidence of headers players eventually looked like they had suffered a concussion. At a lower than threshold rate of headers, that was not observed. Hence there is a carryover effect between insults that may lie beneath detection. This effect is greater if there is insufficient recovery time between events. With neurofeedback we can abet and accelerate the natural recovery process. The mechanism, after all, is the same.

If a person comes to us with initial symptoms of mild dementia and asks whether neurofeedback might be helpful, we would really like to have started his neurofeedback training years before. The degenerative process has long been underway by the time symptoms first become obvious. Since dementia is a realistic prospect for the majority of us at some point in our lives, it behooves us to take precautionary measures well before we are prompted by declining function. Realistically, however, since we have a hard enough time keeping the flossing of teeth in our routine, most folks will not take measures now that may have a payoff many years hence. Something else has to motivate that kind of dedication.

Fortunately, the case is easily made. What we get for our efforts is better brain function! The payoff for dedicated brain training is rather immediate. First of all, the training will help with the existing consequences of prior traumas, both physical and emotional. This is the means by which the later onset of dementia may be forestalled. The mechanism here is simply improved communication among our neural networks. That process can fruitfully continue in an optimum performance frame. For such a purpose, a slightly different mindset is appropriate.

When we are deficit-focused we envision a finite interval of training until the deficit is remediated, and then we close our checkbooks and find different ways to spend our time. This is neurofeedback by analogy to physical rehabilitation for the brain. In an optimum performance frame, on the other hand, we train our brains episodically to maintain optimal levels of functioning. The analogy here is to physical fitness training. The most obvious application here is to sports performance, and indeed we have used our methods with both sports figures and performance artists over the years. A golfer can benefit from routine brain training as well as from training just before a tournament. Actors can calm their butterflies with brain training, etc. These are obvious cases where the person is utterly dependent on good brain function. What about the rest of us? Can we be persuaded to regard routine brain training as important?

At the EEG Institute in Los Angeles we get to see this future in microcosm with our own employees, because all have free access to neurofeedback and their gym membership is paid. All the employees have taken advantage of the offer of neurofeedback—more than have taken advantage of the gym membership. Very few of them are chasing symptoms. Most are doing this in an optimum performance frame. They know that a neurofeedback session now and then just helps them do a better job and have a happier life. It’s a countervailing force against the stresses of life that eventually wear people down. It’s training in resilience, that reservoir of function when we are up against the stops. So we have some evidence already that if the barrier is not too high then folks will take the trouble to do neurofeedback brain training on a maintenance basis.

The Problem of School Failure
The learning capacity of the human brain is amazing, almost universally so, since nearly everyone manages to acquire language. Nothing presented in elementary school comes close to the complexity of learning the essentials of language. One may therefore argue that if children do not master what is on offer in elementary school, then something is amiss. The difficulties lie either in the intellectual or the social realm, and neurofeedback can help with both.

The grim reality is that once a youngster starts falling behind because of brain-based dysfunctions, he is unlikely to catch up. A high premium should therefore be paid to effect early remediation with those who are falling behind. If there is any substantial likelihood of success, then this is also the most cost-effective solution for society. Neurofeedback holds out that promise.

The cost-benefit ratio is even greater if the academic shortcomings lead to behavioral problems and ultimately an exit from the educational track. Society pays dearly for such failure, quite aside from the consequences for the person involved, which are likely to be dire. Once it is recognized that behavioral problems are largely grounded in brain-based dysfunctions rather than deficiencies of the will, our obligation to intervene acquires a moral basis in addition to cost-benefit considerations.

Behavior problems very likely originate in early childhood trauma, an encompassing category that includes parental neglect as well as physical trauma. They are likely to involve problems of early bonding (the technical term is attachment), and these we know to be trainable.

If we now shift from the deficit perspective to an optimum functioning model, the case for neurofeedback training of children becomes even stronger. A deficit focus implies the need for a threshold to determine who qualifies for the training and who does not. Those who fall just short of qualifying will likely see a much more circumscribed life trajectory than those who do. That cannot be seen as just.

Moreover, there are many children who are in the middle of the pack academically, yet suffer many of the consequences of brain-based dysfunction acquired early in life. They do “okay,” but they are not who they could be. What a colossal societal waste, when all that might be needed is a course of neurofeedback training. And what about the high fliers? Often they exhibit rather one-dimensional profiles, with diminished capacity for graceful social interactions.

Once the door is opened to neurofeedback for school children, it is difficult indeed to justify excluding anyone. We simply do not know what someone’s intrinsic competences are until the brain is trained. No known test tells us ahead of time how much might be gained. Offering neurofeedback training to all our children is not only the most cost-effective but also the most ethical way to proceed.

A good analogy is to gym class in elementary school. Everyone is included. Gym class is not physical therapy, for which you have to qualify. Neurofeedback is gym class for the brain. Everyone should be included.

It should be said, this is not a formula for baby Einsteins. The training allows each child to eliminate known barriers to achieving his native potential. It is also not a formula for homogenizing people according to an educator’s view of how children’s development should be guided. This training allows children to discover who they really are, if their development has been constrained by dysfunction.

In the early seventies, a Canadian psychologist working at an Ontario prison happened to hear Barry Sterman talk about neurofeedback for seizure disorder. He immediately saw the relevance to violent offenders in his prison, so he set out to try the method with that population. In a study documenting his results he showed that recidivism was reduced among his trainees from the expected 65% to twenty percent. He carried on this work for some twenty-five years, training some 2700 inmates, according to a colleague. This work only got published in 2005, and the psychologist, Douglas Quirk, died soon thereafter of lung cancer. He had intended to publish more during his retirement years.

We now strongly suspect that the violent behavior in these inmates is largely traceable to traumatic brain injury experienced earlier in life, most likely with an admixture of emotional trauma. Ideally one would want to start with juvenile offenders, well before they mature into hardened criminals, or even earlier. Some of the worst crimes are not detected until the criminal is late in his career: serial killers and pedophiles and arsonists are cases in point. At present, society has no remedy for such cases. We do, however, have neurofeedback. If individuals at risk of such a career have the benefit of early neurofeedback training, they may well be redirected from their criminal trajectory.

Excellent results have been shown for neurofeedback in application to addictions. Even homeless cocaine addicts have responded well in a comprehensive recovery program structured around neurofeedback. With the addition of infra-low frequency training the results could be even better. But the case was already made before we came on the scene with our latest methods. With the addition of neurofeedback, the abysmal record of standard addictions treatment can be turned around.

The addiction model can be applied to behaviors beyond the abuse of illegal drugs. The model also applies to prescription drugs such as anti-anxiety medications, pain medications, and sleep medications. All of the affected populations would be better off with neurofeedback than with their medication dependencies.

Beyond the drugs, licit and illicit, we also have gambling to consider, as well as behaviors like addiction to video games, food, and pornography. All the addictions involve the same drive circuitry and reward system in the brain. All are trained nearly identically with neurofeedback.

And then there is the matter of nicotine addiction. This one is perhaps the toughest of all to deal with using conventional approaches. That is because most smokers actually function better when they are smoking, or over time they need to smoke just to maintain function. In either case, they are getting a brain function payoff for their habit. The first objective in neurofeedback is therefore to improve brain function to the point where nicotine no longer makes a significant difference, and only then we can we expect to deal successfully with the addiction.

One schizophrenic veteran surprised himself in the first session of training when he did not feel the urge to smoke after his session. After a mere four sessions, he quit smoking entirely—even though he had had no intention to stop. In schizophrenia, nicotine administration can be beneficial to function, so not only did the training have an effect on his nicotine dependence, it also must have had an effect on the schizophrenia.

Health Care
It is axiomatic in the field of medicine that some 85% of medical conditions are either exacerbated by stress, or even caused by it. At issue here is not stress itself, which is what life dishes out to one and all, but rather the reaction to stress. Bad stress reactivity we identify with brain disregulation. So to rephrase the issue: Some 85% of medical conditions are either exacerbated by brain disregulation or caused by it. If that is indeed the case, then a remedy for brain disregulation should be front and center in our considerations for relief.

Instead, what do we do? The premier symptom of the brain in distress is a headache, for which we routinely apply a headache remedy. High blood pressure is met directly with a medical response to bring it down. We supply sleep aids for those with irregular sleep. We offer antacids for those with problems of reflux. We have stool softeners for constipation. We supply insulin to counter high blood-glucose conditions. And of course we have a whole raft of anti-anxiety medications and anti-depressants as well as what we now call “mood stabilizers.” We are targeting symptoms to make people feel better rather than targeting the underlying condition of a distressed or out-of-control nervous system, the condition we call disregulation.

The existing medical strategy is not innocuous. We are silencing the messenger to whom we would otherwise be inclined to pay attention. The symptoms notify us of our disregulated status, and they should be attended to as such. If the symptoms are managed by suppression, the underlying condition of disregulation does not get resolved, and in the course of time is likely to get worse. The disregulated brain is biased toward a downward path. A persistent symptom pattern tells us that the brain is incapable of maintaining proper balance. Disregulation begets further disregulation. By the time a person is over 65 years of age in the United States, he is gulping down an average of seven medications to manage his various ills. Cumulative and compounded disregulation has a lot to do with that.

By way of comparison, my own mother-in-law lived to the age of 95, taking no medications at all in her last years. She did, however, routinely train her brain. Likewise my father-in-law did neurofeedback nearly every day near the end of his life to ward off encroaching dementia and Parkinson’s. Reflecting on her life as it was drawing to a close, my mother-in-law said: “I owe my happy life to a good husband—and to neurofeedback.” Her husband, in turn, owed being an agreeable companion in his last years to neurofeedback.

The field of medicine is oriented toward serious medical issues that deserve the full attentions of the medical professional. Diabetes is a case in point. We now know that hypoglycemia is a condition that frequently eventuates in full-blown diabetes, but it is not usually the target of an intervention. In the disregulation model we would argue that glucose disregulation was likely observable for many years before the diagnosis of diabetes was justified. That was the occasion of real opportunity to put matters back on track.

In what we call the Disregulation Model we make brain regulation the first objective of therapeutic intervention. With regard to headaches (including migraines, and what are called tension headaches), we have known for fifty years that biofeedback techniques are more availing than any known medication. As medical remedies have improved over time, so have the biofeedback methods. With the recent progress in neurofeedback techniques, results far exceed what can be accomplished with standard medical remedies. Neurofeedback is also very helpful with insomnia and other sleep disorders. It is also routinely helpful with reflux, with asthma, and with constipation. The Disregulation Model is validated by the clinical demonstration of systematic efficacy in working with these conditions.

If the Disregulation Model is adopted in our healthcare system we should see major reductions in the burden of medical expenditures along with substantial enhancements of quality of life. The latter follows from the fact that neurofeedback is always targeting better brain function in first instance. Symptom abatement follows as a secondary consequence. The primary effect is going to be a brain that works better.

If disregulation becomes a primary target of intervention in health care, how early in life can we expect to rely on this remedy? It turns out that the human brain is trainable at any age. The process involved here is not different, after all, from the way the brain learns generally. So there is no barrier to inserting this method as soon as it is needed. This should be welcome news to the pediatrician. There are so many issues in early child care where the pediatrician is limited in the scope of interventions. There is the reluctance to label children early on, and there is a wholesome reluctance to intervene too early with medications. And fortunately for us, many of the problems that show up early in infancy are problems of disregulation. If the infant is colicky, doesn’t sleep, cries incessantly and appears to be inconsolable, the neurofeedback training can be brought to bear. It has been used successfully with infants as young as three months of age. The goal is to get the child back to a well-regulated path of development.

Over the last few years, the evidence that our trajectory through life in terms of both physical and mental health is substantially determined by our early life experience has solidified. We also know that mental disorders have a typical time course. Pediatric seizures may not show up until six or eight years of age. Bipolar Disorder and Schizophrenia may not be diagnosed until the early twenties. In these cases, however, precursor conditions can usually be observed. Insertion of a self-regulation remedy as soon as that occurs may well steer the person on a healthier course.

The best case in point is the autism spectrum. By now it is possible to discern brain differences in children at risk for autism by six to twelve months. But what is one to do? Fortunately neurofeedback is already a viable and worthwhile option. One doesn’t even have to be certain of the diagnosis. It’s just brain training, after all.

Confronted with escalating healthcare costs, planners have often expressed the hope that prevention strategies would be effective in reducing overall medical costs. By and large, those hopes have thus far been disappointed. For example, early detection of cancers has not proved to be very promising to date. In neurofeedback we have a true prevention strategy. Moreover, it is one that offers the trainee an immediate payoff in terms of better brain function.

The Self-Care Model
Brain training with neurofeedback will become a central component of a growing self-care model of health maintenance. If Brian had entered a world in which we had been aware of the disregulation model, then neurofeedback would have been introduced the very first time we observed his sleep-walking, or with the night terrors. Or it might have been triggered when he threw himself on the ground at T-ball in that bizarre temper tantrum.

Anticonvulsants might have been recommended the first time Brian reported seeing auras, rather than a year later when his seizure-like activity was more pronounced. Or they might even have been introduced when we first reported the night terrors. As soon as anticonvulsants were found to be helpful, dietary measures would have been indicated to support healthier brain function.

When it was realized that his immune system was immature, action would also be taken to counteract the deleterious effects of all the antibiotics that were being pumped into him for his numerous ear infections. Measures would have been taken to maintain healthy gut biota.

In school Brian would have learned about our capacity to affect nervous system status through control of the breath. Our breathing is under the control of both our voluntary nervous system and the autonomic. Through our deliberate control of the breath, we can affect the state of the autonomic nervous system. He might have found this useful in calming himself whenever he saw his nervous system becoming unstable.

Children would be taught about mindfulness and Open Focus and various other meditation techniques, opening the door to enhanced awareness of self and of the other. Many would find those techniques directly useful to manage their own squirrelly nervous systems. Children would then come to a more natural understanding of the diversity in our human characteristics, and of their variability, allowing them to be more tolerant of anomalous behavior in some of their classmates.

Giving children an understanding regarding their own physiology will have two principal effects. It will empower them in the same manner that Brian was empowered by his experience of EEG training. And it will influence their developing moral sense through a better understanding of how physiology constrains our choice-making.

Our great regret with regard to Brian is that at the very moment when he first had to come to terms with his own unruly brain we had no help to offer him. On the contrary, we were the primary influence on him that limited his horizon to a model of behavior that was inoperative. It held no explanatory power for him. That placed a heavy burden on an eight-year old boy. We have now moved beyond that point, and our mission is to help the society at large make that same transition.