What Is Neurotherapy?
Neurotherapy is a drug-free treatment that helps people improve their brain function through technology. Neuro- refers to neurons, the nerve cells of the brain and the nervous system. Neurotherapy uses the premise of brain plasticity, meaning neurons can create new connections and reorganize neural pathways to improve brain functioning. This is fundamental in the treatment of a variety of psychological and neurological conditions.
There are two distinct types of neurotherapy. The first, using neurofeedback, suggests people can learn to control their own brain functioning through the use of real-time displays of brain activity. This is often referred to as "brain training."
The second type is known as neurostimulation, where a person's neural activity can be modified through electrical currents or electromagnetic pulses. This is typically non-invasive and through the scalp; however, some treatments require a surgical procedure to insert electrodes into the brain.
Neurotherapy has become a popular treatment alternative for attention-deficit/hyperactivity disorder (ADHD) and it is becoming more widespread as a treatment for a variety of psychiatric and neurological disorders including depression, anxiety, obsessive-compulsive disorder, migraines, and brain injury. This article will explain the different types of neurotherapy currently available, which technology works best for specific disorders, and what a treatment session looks like.
What Neurotherapy Can Help With
The brain is complex, and each system requires a delicate balance of electrical and chemical activity at the neural level to maintain stability. A variety of psychiatric and neurological symptoms are related to irregular neural activity, giving rise to many potential applications of neurotherapy.
Attention dysregulation:having trouble with attention and concentration, as well as periods ofhyperfocus.
Behavior dysregulation:difficulty controllingactivitylevels,impulses, andcompulsions.
Emotional dysregulation:difficulty controlling emotional responses in a healthy way. Instead, theyexperience intense emotions, often with outbursts, and have difficulty returning to a normal state once they are triggered. A low response is also possible as in the case of anhedonia as a symptom of depression.
Motor system dysregulation:difficulty controlling motor movements, exhibiting symptoms like tremors,tics, and Parkinsonism.
Nervous system dysregulation:often caused by trauma, they experience difficulty relaxing, being in a state of hypervigilance and anxiety, and anover-reactive fight or flight system.
Sensory dysregulation: inability to process sensory input effectively, causing people to feelover-stimulated or under-stimulatedby their environment.
Some of the common conditions treated with neurotherapy include:
- Anxiety disorders
- Attention-deficit/hyperactivity disorder (ADHD)
- Autism spectrum disorders (ASD)
- Bipolar disorder
- Brain injury/stroke
- Neuropathic pain
- Depression
- Emotion regulation
- Learning disorders
- Migraines
- Obsessive-compulsive disorder(OCD)
- Post-traumatic stress disorder (PTSD)
- Schizophrenia
- Sleep disorders
- Substance use disorders
Neurofeedback
Neurofeedback addresses irregular brainwave activity caused by maladaptive neural patterns, which can affect emotions, thoughts, and behaviors in a way that can be distressing or disabling.
Neurofeedback can be empowering to the individual who is suffering. It is a process of brain training where the individual learns self-regulation through audio/visual feedback about their brain activity displayed on a screen. The neural activity is measured by an electroencephalogram (EEG) through the electrodes that are strategically placed on the scalp.
The feedback is usually displayed on a screen in the form of an interactive graphic, video game, movie, or music. Advances in technology in recent years are making this treatment more individualized, and even portable.
What Our Brain Waves Reveal
When neurons are active, the brain produces patterns of electricity which can be picked up by an EEG in the form of brain waves. Electrodes are placed strategically on the scalp to measure the electrical activity being produced. The brain produces fast waves and slow waves (known as frequency) as well as tall waves or short waves (known as amplitude or power). Frequency is measured in waves per second or Hertz (Hz).
The brain exhibits different wave patterns for each state of arousal. As we fall into deeper stages of sleep, the frequency of our brain waves slows down while amplitude increases. Someone who is learning something new or extremely focused will show gamma waves, which have a higher frequency than you see in normal awake activities.
Brain Wave Patterns:
- Learning, extreme focus, REM sleep (gamma; 30-100 Hz)
- Awake and attentive (beta; 13-30 Hz)
- Relaxed (alpha; 8-13 Hz)
- Light sleep, meditation (theta; 4-8 Hz)
- Deep sleep (delta; < 4 Hz)
When the brain is dysregulated, irregular brain wave patterns show up. These irregularities have been understood for a long time in conditions such as epilepsy, sleep disorders, brain injury, and Parkinson's. In more recent decades, neuroscientists have been studying brain wave patterns of people with a variety of neurological and psychological conditions, and have coined the maladaptive patterns as the "electrical fingerprint."
In 2014, the Food and Drug Administration (FDA) approved the use of the EEG as a diagnostic tool in addition to the traditional clinical interview. This means brainwaves have become accepted as a biomarker of clinical conditions beyond epilepsy and sleep disorders and EEGs can be ordered to assist with diagnoses and guide treatment.
Once the pattern is confirmed, treatment can be designed to target the specific electrical fingerprint that shows up on the EEG.
Neurofeedback Treatment: Can It Help Treat ADHD?
For example, neurologists explain how the ratio of theta and beta waves (T/B ratio or TBR) is different in the brain of someone with ADHD. Specifically, the frontal lobe shows less fast wave activity (beta) and more slow waves (theta) while awake. Other research shows differences in slow cortical potentials in people with ADHD.
Other researchers have discovered the malfunctioning neural connection between the frontal cortex and the amygdala in people with PTSD. A new neurofeedback device called Prism was approved for use by the FDA in 2023, to help people control that neural pathway.
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Types of Neurofeedback Therapies
Neurofeedback has been a treatment option since the 1970s and has evolved over time along with an advanced understanding of the brain and technology. Modern neurofeedback provides various forms of treatment options depending on the condition or symptoms being treated:
- Frequency/power neurofeedback: Using two to four electrodes, this technology is used to teach people to change the amplitude (power) or speed (frequency) of specific brain waves in particular brain locations in the treatment of ADHD, anxiety, and insomnia. This technology is the most extensively researched and commonly used in clinical practice.
- Slow cortical potential neurofeedback (SCP-NF): Using EEG feedback, the goal is to train people to modify the direction of slow cortical potentials which is useful in the treatment of ADHD, epilepsy, and migraines.
- Live Z-score neurofeedback: Using EEG recordings, the brain wave activity of the individual is sent to a database for comparison and provides continuous feedback. This is used primarily to treat people with insomnia.
- Low-resolution electromagnetic tomography (LORETA): This technology uses 19 electrodes to provide feedback, and has been instrumental in treating addictions, depression, and obsessive-compulsive disorder.
- Hemoencephalography(HEG) neurofeedback: This technology provides EEG feedback on the neural signal produced by the blood flow to the cortex and is used primarily in the treatment of migraines.
- Functional magnetic resonance imaging (fMRI): This technology is the most recent development, and can provide real-time feedback from the blood oxygenation level-dependent (BOLD) neural response within the cortex and from deeper subcortical structures of the brain including limbic system structures such as the amygdala. It has also been successful in treating depression, ADHD, anxiety, PTSD, substance use disorder, and schizophrenia.
fMRI neurofeedback is being studied in the use of learning "mind control" over machines like computers, robots, and prosthetic limbs through increasing blood flow and neural activity in the somatosensory cortex.
What Does a Neurofeedback Session Look Like?
During a typical neurofeedback session, other than fMRI, you'll sit in a chair with electrodes on your scalp. This is completely painless. It's similar to the doctor using a stethoscope to listen to your heartbeat. And just like your heart, your brain can have an arrhythmia.
Your therapist will guide you through some simple activities while the EEG records the electrical impulses in your brain. Depending on your treatment plan, you may be asked to watch images on a screen, play a video game, or listen to music.
The electrodes provide instant audio and visual feedback about your brain activity. If you're watching images on a screen, for example, the screen will become brighter when your brain produces favorable brainwave patterns. When it produces less desirable brainwave patterns, the screen dims. Similarly, a noisy waiting room full of people standing around is presented on the screen and you learn to engage in brain activity that causes the noise to decrease and everyone to sit down and become orderly.
It is amazing when someone learns they can control what they see on the computer screen through their mind. This instant feedback helps your brain learn what it needs to do to make the image on the screen respond, providing positive and negative feedback directly to you (a learning process known as operant conditioning).
Over time, your brain figures out how to sustain the desired brainwave patterns (and minimize the production of undesired ones).
A neurofeedback session typically lasts between 30 and 60 minutes and usually involves 30 to 40 sessions. The number of sessions a person needs varies, but it's rare for a person to need more than 40 sessions.
The techniques learned during neurofeedback can also be practiced when you're engaged in normal, everyday activities at work, school, or home. This practice helps you train your brain to respond in a healthier way in the environments where you spend most of your time.
Neurostimulation
Neurostimulation is less about the self-regulation of brain activity and is a more passive approach to changing brain activity through electrical and magnetic brain stimulation. Typically a low-voltage electric current or electromagnetic pulse will be administered. More rarely, surgical procedures are involved.
Types Of Neurostimulation Therapies
A few examples of neurostimulation treatment options are listed below:
- Low-energy neurofeedback system (LENS): This technology is designed to deliver a tiny electrical signal to the brain through the scalp causing a slight change in brain wave activity. People relax while this takes place and do not try to control brain wave activity. The "feedback" part of this treatment involves the computer software program that reads current brain activity through the electrodes on the scalp and delivers a precise signal that is similar but slightly different to the person's current brain activity. This slight difference allows a recalibration in electrical and chemical activity in the brain that alleviates symptoms. This type of neurofeedback has been used to treat traumatic brain injury, ADHD, insomnia, fibromyalgia, restless legs syndrome, anxiety, depression, and anger.
- Transcranial electric stimulation (tES): There are three types of tES including direct current (tDCS), alternating current (tACS), and random noise stimulation (tRNS). Similar to LENS, a constant low-voltage signal is transmitted into the brain through electrodes on the scalp to stimulate or inhibit activity in the cortex; however, there is no "feedback." This approach is being studied for use in treating depression, schizophrenia (negative symptoms), neuropathic pain, and an adjunct to speech therapy for people with aphasia. Currently, a portable device is undergoing clinical trials for the treatment of major depression from home.
- Transcranial magnetic stimulation (TMS): This technology involves an instrument containing a coil that generates electricity and produces a magnetic field. It hovers directly above the skull and emits pulses directed into the brain, either targeting the cortex or deeper structures. The FDA has approved TMS for treatment-resistant depression, migraines, and OCD.It is used off-label for a variety of other psychological and neurological conditions. Treatment often involves five 20-40-minute sessions per week for six to seven weeks.
- Deep Brain Stimulation (DBS): This neurotherapy involves surgical implantation of an electrode in the desired brain area, along with a lead connected to a stimulator device implanted in the chest (similar to a pacemaker for the heart, but it is for the brain). DBS has been very effective in the treatment of movement disorders like Parkinson's and is being researched for its potential to alleviate symptoms of depression, OCD, and Tourette's syndrome.
Deep Brain Stimulation Can Help Treat OCD Symptoms, Studies Show
Other Benefits of Neurotherapy
There are several advantages to neurotherapy that set it apart from other treatments, including:
- Provides long-lasting effects.
- Produces minimal side effects.
- Usually non-invasive.
- May reduce the need for medication and shorten therapy time.
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Even outside of the clinical setting, commonly cited benefits include enhanced memory and focus, better mental clarity, and more restful sleep. Neurotherapy has even proved to be beneficial in sports training further enhancing athletic performance.
Is Neurotherapy An Evidence-Based Treatment?
There is a plethora of research on neurotherapy and the results are encouraging, and the neurotechnology is continuing to develop at lightning speed. Below are just a few studies in support of neurotherapy:
- ADHD: Research has shown that neurotherapy induces a state of relaxed attention, and works comparably to ADHD medications. In fact, the American Academy of Pediatrics named neurotherapy a "Level 1 Best Support" intervention for attention and hyperactivity behavioral, on par with medication.
- Addiction: According to a comprehensive review published in 2016, neurofeedback may offer positive results for people who are addicted to cocaine, alcohol, and computer games. It may even decrease food cravings.
- Anxiety and depression: One study revealed that after 30 neurotherapy sessions and heart rate variability training, 57% of people with severe anxiety and 45% of people with severe depression showed normal brain activity.
- Autism: A few scientific reports suggest that neurotherapy can improve ASD-related behaviors such as stimming, emotional outbursts, and ritualistic behaviors.
- Migraines: In a 2010 study, 62% of participants using neurotherapy reported major or total improvement in their migraines.
- PTSD: A controlled study showed that 24 neurotherapy sessions significantly reduced PTSD symptoms. Other studies suggest that neurofeedback improves executive functioning and reduces medication use.
Yet more research is needed to understand some of the conflicting results in the literature. For example, there appears to be a subset of people across studies who are unable to self-regulate their brain activity and therefore do not benefit from neurofeedback. The underlying mechanism driving these individual differences should be explored and possibly identified prior to treatment.
Things to Consider
Neurotherapy can be used on its own, but it can be even more effective when used as an adjunct to traditional therapy approaches (such as cognitive-behavioral therapy).
While neurotherapy may help treat many conditions, there are also a few disadvantages associated with this approach. They include:
- Cost: It can be an expensive treatment option, especially if your insurance doesn't cover it.
- Time: It can be time-consuming with some treatments requiring several visits per week.
- Commitment: It may take months to work, and you may need booster sessions.
Factors such as these can make neurotherapy less appealing than other treatment methods for some people.
How to Get Started
Your doctor may be able to refer you to a local neurotherapist. It is also helpful to check with your health insurance company to see if your policy will cover any or all of the treatment. If so, you may have to use a specific neurotherapy provider.
The International Society for Neuroregulation & Research also offers an online directory that you can search based on your geographical location or the provider's area of specialty. Doing a search for "neurotherapy near me" or "online neurotherapy" may offer additional results.
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