The following story was written by Jody Jaffe and appeared in the January 2006 issue of the Washingtonian Magazine. This is the unedited version of the article. The final published version was edited by the Washingtonian staff to fit into the space allotted.
Pumping Neurons by Jody Jaffe
Last spring, when Lori S. told her 15-year old son, Jeff, to write up his Odyssey notes for English class, he ran to the kitchen and grabbed a knife; first pointing it at himself, then turning it on his mother. “If you won’t let me kill myself,” he screamed, “I’ll kill you.”
Then he fell to the floor and cradled his head between his hands. “I can’t stop it! My head, my head,” he kept moaning as he rocked back and forth.
Suicide threats, violent outbursts, uncontrollable behavior. This was business as usual in Lori’s Northern Virginia house. She couldn’t remember a time when her younger son had been happy. He’d been going to psychotherapy since he was 11 years old. He’d been on three types of medications, tried individual and group therapy. Nothing was working.
“I know what hell looks like,” says the 47-year-old mother of three. “It looks like something you can’t control. It’s your child. . . .” She struggles to finish the sentence. “This time last year, I would have sworn to you I was going to be burying my child. He wanted out and he was planning it.”
Then Dr. Michael Anderson, a McLean psychiatrist who was seeing Jeff, suggested he try something called neurofeedback training. It had helped his daughter with her Attention Deficit Disorder as well as many of his patients who hadn’t responded to medication for a variety of other problems.
On Anderson’s recommendation, Lori took Jeff to Deborah Stokes, an Alexandria neurofeedback therapist. Jeff went, begrudgingly.
“I was skeptical of it because I’d tried a lot of things and nothing seemed to work,” says Jeff. “It was really hard for me. Every day was a battle, emotional and physical.”
After fifteen sessions, he noticed a difference. “I wasn’t as stressed out and stuff and depressed.”
One year and 45 sessions later, “I have a normal 16-year-old,” Lori says. “He has his moments, but nothing you wouldn’t expect from a normal teenager. He’s happy, he smiles. He’s off anti-depressants for the first time since fourth grade.
“He’s got a life ahead of him, where I didn’t think he had one before.”
Jeff’s story was one of many I heard while researching neurofeedback training and its tangent therapy, EEG (electroencephalography) Stimulation. A Northern Virginia boy’s Tourrette’s syndrome symptoms were reduced dramatically; a man with Lyme disease can now sleep through the night; a musician with debilitating headaches is not only pain free, but hears the bass notes better; several Montgomery County golfers are playing better; and 97 students at London’s Royal College of Music improved their performances in exams by as much as one full grade.
And I have a story of my own, though not as dramatic as Jeff’s. Now I can finally find my keys.
Neurofeedback training is a kind of biofeedback therapy. But instead of controlling your breathing or body temperature, as with traditional biofeedback therapy, you learn to control your brain waves.
It started in the late ‘60s with cats and rocket fuel. Dr. Barry Sterman, a UCLA sleep researcher, discovered that a certain kind of brain wave – called SMR – was associated with the reduction of muscle tension in cats. He taught the cats to increase this brain wave. Right after that study, NASA commissioned him to research the toxic effects of the rocket fuel monomethyl hydrazine. Among the test cats were some who’d been trained to increase their SMR waves.
Those were the ones who didn’t have seizures after being exposed to the rocket fuel. Further research showed that humans could benefit, too.
Sterman tested people with epilepsy who weren’t responding to medication. He found a 60% reduction in seizure activity for those who were taught to increase this SMR brain wave. Researchers soon found that controlling brain waves worked for all sorts of things.
For instance, those 97 musicians who are now performing better. They were part of a 2003 Imperial London College study that tested neurofeedback training and its effect on musical understanding and imagination, and communication with the audience.
“This is a unique use of neurofeedback,” said Dr. Tobias Egner, one of the Imperial London College authors of the study. “It has been used for helping with a number of conditions such as attention deficit disorder and epilepsy, but this is the first time it has been used to improve a complex set of skills such as musical performance in healthy students.”
John Gruzelier, the senoir author of the study said, “These results show that neurofeedback can have a marked effect on musical performance…… While it has a role in stress reduction by reducing the level of stage fright, the magnitude and range of beneficial effects on artistic aspects of performance have wider implications than alleviating stress.”
Neurofeedback training has been clinically available for more than 25 years. But it’s only been with the exploding interest in mind-body medicine that it’s started to attract mainstream attention. Advocates say it helps everything from epilepsy to a bad game of tennis, with stops along the way at headaches, insomnia, diminished memory, chronic fatigue syndrome, fibromyalgia, depression, anxiety, chronic pain, Obsessive Compulsive Disorder, Attention Deficit Disorder,
lackluster job performance, and head injury.
Frank H. Duffy, a Harvard University professor and pediatric neurologist wrote in the 2000 issue of the journal Clinical Encephalography that neurofeedback therapy “should play a major therapeutic role in many difficult areas. In my opinion, if any medication had demonstrated such a wide spectrum of efficacy it would be universally accepted and widely used.”
And its 1998 consensus report on ADHD, the NIH found “there are several promising pilot trials” concerning neurotherapy. Mostly recently, an article in the January issue of Child Adolescent Pyshciatric Clinics North America, found that neurotherapy should be considered “probably efficacious” for the treatment of ADHD, based on efficacy guidelines established by the International Society for Neuronal Regulation. It went on to state “that research findings
published to date indicate positive clinical response in approximately 75% of patients treated in controlled group studies.”[Ed note: In 2013 the The American Academy of Pediatrics “Evidence-based Child and Adolescent Psycho-social Interventions” elevated biofeedback to “Level 1 — Best Support” as an intervention for Attention & Hyperactivity Behaviors]
Despite these and more studies, Anderson, the McLean psychiatrist who says neurofeedback therapy has helped 18 of the 20 patients he’s recommended it to, is in the minority among his colleagues.
“I generally have been in the closet about it (neurofeedback) with psychiatrists,” Anderson says. “Occasionally I’ll bring it up (with other doctors) and get polite attention and then the subject quickly changes to something else. They think it’s quackery. But I’ve seen the research, and it’s very rewarding because people are getting better.”
Michael Sitar is a Bethesda psychologist who uses neurofeedback for 90 percent of his practice. He sees it as similar to physical therapy.
“If you’ve got a weak muscle,” Sitar says, “you work to strengthen it. If your brain is under- or over-producing, you work to fix that.” Neurofeedback training is, in Sitar’s words “going to the gym to pump neurons.”
“I had a middle-aged woman who was having trouble remembering phone numbers,” he says. “After a few sessions, she finally remembered numbers.”
Consider neurofeedback training a kind of brain gym, except there’s no going for the burn. It’s not only painless, but it’s fun, bordering on amazing the first time you do it – which was a big draw for the kids, and adults, I spoke to who’d gone through the training. You play a video game without a joystick or keyboard. You move the images around by thinking.
“What the client is looking at on the computer screen is their brain wave activity translated into a video game,” says Deborah Stokes, the Alexandria neurotherapist, who uses both neurofeedback training and EEG stimulation in her practice.
Neurofeedback training is completely noninvasive. The closest anyone comes to you during treatment is to stick electrodes on your head and neck with a white paste. These electrodes read the electrical output of your brain’s neurons, which form patterns called brain waves. Generally speaking, the slow waves – delta, theta, and alpha – are associated with daydreaming, sleep or distraction. They’re fine if you’re meditating or meandering through the woods, but can be debilitating if you’re trying to finish a task or concentrate. You need the Beta and SMR waves to get things done. But if
you have too many of those, you could become agitated. It all comes down to balance, says Stokes.
A treatment session goes like this: You sit in front of a computer screen, with the electrodes pasted to your head and neck reading your brain waves and translating them into a video game for you to play. In my case it was three rockets chasing an asteroid.
Treatment takes anywhere from 20 to 100 sessions. Over its course, the therapist ratchets up the difficulty of the game. That forces your brain to work harder, much like your quadriceps would have to work harder if you added more weight to the quad press.
“Neurofeedback works because it mirrors the client’s own brain activity back to them in the form of a video game,” says Stokes. “The client is asked to change a part of the video game; for instance, to make one rocket ship go faster and one slower. This enables the client to decrease brainwave amplitudes that may be too strong and increase others that are too weak. Flexing the brainwaves is like weight lifting and seems to have an overall strengthening effect on mental and emotional processes such as mood, anxiety and cognitive processing.”
While you’re playing the video game, the therapist monitors another screen, adjusting the game to make it harder or easier for you to move things around, depending on which brain wave she’s trying to adjust.
“Make it go faster,” Stokes said to me when I tried it.
“How?” I said.
“Only adults ask that question,” she said. “Kids can figure it out.”
I channeled my thoughts to the rocket ships and suddenly they were going faster. When my mind wandered, they slunk backward. I channeled my concentration again, and they zoomed forward. When I was finished, I was relaxed and I remembered the feeling of zooming myself into concentration. But my life didn’t change dramatically. I went home and promptly lost my keys.
Neurofeedback training is nicknamed brain gym for a reason. You can’t go to the gym, do one set of leg lifts and expect thin thighs. It took Jeff 15 sessions to notice a difference.
For both therapies, the first step is to get what’s called a brain map. It’s just like going to the cardiologist for an
electrocardiogram (EKG), except the electrodes are stuck to your head instead of your chest. Like an EKG, the EEG
machine reads electrical output. The therapist can see how your brain is – or is not –working and determine which waves need to be suppressed or increased. A well-functioning, uninjured brain works with all the waves playing together in concert, according to Angelo Bolea, an Annapolis psychologist who uses neurofeedback training. Imagine an orchestra in which the string instruments drown out the wind section or the percussion is the only thing you can hear. That’s a brain out of whack. Depending on your brain’s discord, the consequences range from simple forgetfulness, to cloudy thinking, to headaches, to depression to autism. Brain injury can be caused by anything from a difficult delivery, to a chronic infection, to chemotherapy, to a plain old whack on the head. Pair an injured brain with genetic tendencies and you’ve got a very troubled kid. Like Jeff,
the Virginia teen who, according to his mother, had been making suicide threats since he was three years old. He’s got mental health issues on both sides of his family, his mother says; plus, when he was four, he ran his bike into a parked car, leaving an egg-shaped bump on his forehead.
Neurofeedback training and EEG Stimulation, sometimes in conjunction with each other, are used to treat the same
ailments, basically anything that involves a poorly functioning brain.
“Neurofeedback therapy is the only thing I know of that brings executive functioning back on line,” says Anderson, the psychiatrist who treated Jeff. By executive functioning, he means prioritizing, sequencing, and shifting thoughts, the necessary tools to navigate through school, work, and life.
Anderson introduced neurofeedback training into his practice about five years ago after a psychologist friend told him about it. “I thought it was a little weird,” he says. Then he read the bible of neurofeedback therapy, “A Symphony in the Brain,” by Jim Robbins, went to a neurofeedback conference and became a believer.
“I went there and it all made sense,” Anderson says. “This was not hocus pocus. There was very comprehensive research that overwhelmingly demonstrated the effectiveness of neurofeedback therapy. I thought, this is science. This is not made-up crystal stuff.”
As a result, he sent his teenaged daughter to Stokes, the Alexandria neurofeedback therapist who later treated Jeff, and to Esty, the Chevy Chase neurotherapist who uses EEG Stimulation. The results, he says, were remarkable.
“She said it was like her brain suddenly woke up,” Anderson says.
I know the feeling. When the therapists I interviewed for this story would tick-off the symptoms of brain injury – fatigue, memory loss, dizziness, intolerance to cold, sensitivity to bright light and noise, — I’d say, “Got that, got that, got that.” It turned out I was among the walking wounded.
As an infant, I fell off the changing table, head first. It later became the family joke whenever I did something weird. No one ever made the connection between the fall and my restlessness and disruptive behavior in school. That was 40 years ago when the letters ADHD were just a jumble of capital letters.
“In my perfect world,” said Esty, “the minute a child shows attention disorder or disruptive behavior in a school, he or she would get neurofeedback therapy.”
My head injuries didn’t stop with my early fall. As an equestrian, I’ve had four significant knocks to the head, one requiring 10 stitches and another rendering me amnesic for a half hour. There have been several others that, at the time, didn’t seem serious enough to seek medical attention. But that’s the insidious thing about head injury. Most people don’t even know they’re injured.
Esty compares the brain to a huge computer. Imagine, she said, if someone took a little hammer and knocked off a few connections here and a few connections there. The programs would run, but some would have a few small errors, slowing down the processing time. The more hits from the hammer, the slower the processing. The destruction of any connection, she said, creates a short circuit that has to be bypassed, and as a result, compensatory programs have to be developed, further slowing down processing time. That’s your brain after each injury.
It doesn’t take much. A 5-mile-an-hour fender bender can send your brain smashing against your skull and ruin your life. By any standards, I’d had enough blows to the head to cause some kind of damage. So I decided to try EEG stimulation.
The only thing I had to lose was my:
1. Extreme forgetfulness. This went way beyond the occasional, “Hon, have you seen my keys?”
2. Extreme fatigue. I thought it was old age setting in.
3. Inertia. It’s very difficult for me to start things.
4. Chronic neck and head aches. I thought everyone in our stressed-out world ached at the point where the head meets
5. Sensitivity to bright light. It also causes ocular migraines for me.
6. Extreme sensitivity to noise and cold.
7. Forgetting words/general fog. I thought it went with the accumulating decades.
8. Money. This therapy is not covered by insurance. The initial consult for the brain map cost $450. Each session is
I’ve now had two brain maps – one by Stokes and the other by Esty. Both were revelatory. I was almost tempted to call my ex-husband and say, “See, I wasn’t losing all those library books on purpose like you thought.”
No wonder I was tired all the time and it took me forever to get things done, assuming they ever got done. My theta, delta, and alpha waves had invaded my waking hours, bullying my beta and SMR waves practically off the map. Delta and theta are supposed to be high during sleep or rest. Beta and SMR are the ones the get things done. Back to the orchestra metaphor: My drums were banging so loud, my violinists packed up and went home. My conductor had thrown up his baton in despair and stomped off years ago.
“You’re going through life underwater,” said Esty. “It’s like the heat’s on in the house, but it’s all escaping through the roof.”
She attached two electrodes to a location she made me swear I would not reveal (this is where the art meets the science) and hit me with the picowatt of power. I felt nothing.
For three days, I felt nothing. Still losing things, still inert, still procrastinating about everything. Then on Sunday, I found myself cleaning my car. I’d been thinking about doing that for about a year. After that, I moved all the houseplants back inside for the winter. I’d been thinking about doing that for more than a month, leaving the poor things to shiver in the cold wind. Then there was my grungy saddle, bridle, boots, chaps, and anything else leather I could find that hadn’t been cleaned in months. I chewed through my entire list of chores that had been rolling around in my head. And come 3
p.m., when I’m usually ready for a nap, I was searching for more things to do.
“Wow,” was all my husband could say. “You got to keep this brain stuff up.”
After my second treatment, I noticed I stopped losing my keys, which is a minor miracle in my house. Then, when I lectured to my journalism class at Georgetown, I found every word I was looking for. Prior to that, I’d be in the middle of a sentence and forget the word for something as rudimentary as “deadline.”
The results after the third session weren’t as dramatic, but as I discussed my progress with Esty, I realized I now had a new norm. That’s why the changes weren’t as obvious. It’s now normal for me not to lose my keys, which saves me anywhere from 20 minutes to an hour each day. As I talked more, I realized a truly dramatic shift had happened. There was a new step in my thought process. I’ll stay with the key example:
Before EEG Stimulation, I’d stop the car, take out the keys and not be aware of what I was doing. I’d walk in the house and, without thinking about it, put the keys down someplace. Then when I went to look for them, I couldn’t remember anything after stopping the car, let alone where I’d put the keys.
Now, after I stop the car, I’m fully aware of what I’m doing with the keys. Fully aware are the operative words. This may sound like a big so-what to anyone who doesn’t have this problem. But it was life changing for me. Because this new step doesn’t stop with the keys. This awareness effects every aspect of my life. Try climbing a ladder every day with a rung missing and see how exhausting that gets. That’s what it was like for me every day.
I still haven’t lost my keys and I’m more productive than I’ve been in years. Will it last? Esty said yes. But if I start to slip, I know where I’m heading. Back to the brain zapper machine.
As for Jeff, things just keep getting better for him. In the past, schoolwork always ignited a hellacious fight. Writing, in particular, was difficult for him. This past semester, he got an A in English for the first time in his life. And he wrote this poem:
The boy you hate is finally gone.
He has gone to experience what life never offered
Comfort, love, pleasure without pain and a stress free environment.
Without a rustle of leaves
Or a flutter of wings
He is gone forever.
He is forgotten in the blink of an eye,
Never to be thought of again,
For he is gone.