Two years ago, I walked through the door of a Seattle therapist’s office with the goal of resetting my 45-year-old brain. A trauma survivor with a history of depression and anxiety, I was hoping that an alternative mode of therapy I’d heard about called neurofeedback might finally alleviate my more stubborn symptoms.
At the time, the simple act of swerving my car to avoid a pothole or tripping over my dog triggered my body’s fight-or-flight response—vestiges of a childhood spent with a psychotic mother. I had other issues, too: inadequate concentration, difficulty with decision-making, and a strangely selective memory. I never forgot numbers, whether my seventh-grade boyfriend’s birthday or the six-digit codes of items I rang up as a cashier during college, but words proved trickier. Any meaningful vocabulary growth peaked at about age 15. For a writer, this is problematic.
Neurofeedback wasn’t my first attempt at improving my mental health. I’d tried, or still used, psychotherapy, antidepressants, homeopathy, hypnotherapy, diet modifications, exercise, meditation, and acupuncture. Some modalities had a greater impact than others, and all of them helped me to some degree. But even when I was able to keep the worst symptoms in check, other lurking issues detracted from my sense of “being okay.” Having given a fair shot to the more popular treatments, I was driven to seek one less common.
Neurofeedback, also known as EEG biofeedback or brain biofeedback, fit the bill. During a typical treatment, sensors are placed on the head to capture the frequency and power of the brain’s electrical activity, visually represented by the five types of brain waves: delta, theta, alpha, beta, and gamma. Very generally, neurofeedback is a process by which therapists attempt to regulate brain waves. They do this by tracking your brain activity on a computer and then repeatedly send this information back to the brain via computer imagery or an electrical signal. Because there are still a lot of questions about how exactly the treatment works—assuming it does work—the details can vary depending on the therapist, however. As the Washington Post explains:
A patient might watch a movie, for example, while hooked to sensors that send data to a computer. A therapist, following the brain activity on a monitor, programs the computer to stop the movie if an abnormal number of fast or slow brain waves is detected or if the brain waves are erratic, moving rapidly from fast to slow waves.
According to the Washington Post, in addition to depression and anxiety, neurofeedback is currently being used to treat a number of other conditions including attention deficit disorder, attention deficit/hyperactivity disorder, addiction, autism spectrum disorder, chronic fatigue, learning disabilities, obsessive-compulsive disorder, post-traumatic stress disorder, tics and seizures, and traumatic brain injuries. This wide application spectrum is part of the reason I was drawn to the treatment. I wondered if some of my brain’s problematic tendencies might be attributed to conditions beyond depression and anxiety. Could neurofeedback be a complete 60,000-mile service for the price of an oil change?
To be clear, I made a deliberate choice to be hopeful about neurofeedback’s possibilities. I think anyone who has ever suffered from a mental illness knows how important hope is during the often long and frustrating search for solutions. People’s responses to the “tried-and-tested” treatments vary. It’s not unusual for those treatments to fail, or at least, to not fully succeed. Even after 60-plus years of ever-increasing use, antidepressants and their efficacy remain a debated topic. Indeed, researchers continue to attempt to answer the most basic questions, like why people get depression. Brain science remains so fluid that I’m surprised no one has written a book called “Fifty Shades of Grey Matter” yet.
Those who question neurofeedback’s potency point to a lack of conclusive evidence that its effects are permanent, or even long lasting, after treatment has ceased. This is a fair critique and much more research needs to be done in order to figure out what exactly neurofeedback is accomplishing. But my experiences with psychotropic medication have shown similar problems. I started on paroxetine (the Paxil generic) in my 20s. It abruptly stopped working in my 30s—while I was taking it—and I slogged through five other medication trials before I found an effective replacement. Since then, paroxetine has been identified as having anti-cholinergic effects, which can include cognitive impairment and memory loss.
At the same time, the pharmacological revolution has stifled interest in electrophysiology for decades, as Dr. Bessel van der Kolk notes in his 2014 book The Body Keeps The Score. An additional challenge lies in the lack of available grant money for studies. Dr. Mary Lee Esty, who has researched and practiced neurofeedback in Maryland for 25 years, told Quartz that she’s had to self-fund several research projects. As she put it, “How else was it going to get done?”
Today, neurofeedback research is on the upswing. Most studies to date have examined its use in treating ADHD in children. Other studies heralded as promising by neurofeedback advocates have failed to convince skeptics either because they weren’t large enough or because they weren’t a double-blind, randomized controlled trial—the so-called “gold standard” for new treatments. However, outcomes are solid enough that in 2012, the American Academy of Pediatrics approved biofeedback as a Level 1 “best support” treatment option for children with ADHD.
Neurofeedback as treatment for PTSD in military vets is also being studied. Data collected in 2011 by “Homecoming for Veterans,” a no-cost neurofeedback initiative of California’s The EEG Institute, has proved positive. In 2015, Esty and her research partner Dr. David V. Nelson published outcomes of two different studies in the journals Military Medical Research and Military Medicine respectively. Though the sample sizes were quite small, again due to funding constraints, the findings reported a significant reduction in symptoms for all but one study participant.
As neurofeedback graduates from what Esty calls its “late adolescence,” she feels it’s finding a wider audience in the brain-health field. She cites her invitation to present at the Nevada Psychiatric Association’s 22nd National Psychopharmacology Update in February 2017, as an example.
As for my own experience, I continued treatment once a week for three months—with a six-week break in the middle—before tapering to every two weeks for another two months. The therapist shared data with me at intervals, first collecting a baseline of the 21 sites on my brain and then tailoring my treatment based on what we saw.
More than half of the sites lacked any measurable electrical activity. The therapist called this “suppression,” a common pattern for a trauma survivor. If a brain is triggered enough times for protection and survival, and the stress hormone cortisol is released, cell and neuron development are altered, and an excess of myelin, or white matter, develops. Communication slows between the amygdala (responsible for emotional processing) and the prefontal cortex (responsible for memory, learning, decision-making, and the like), while it increases between the amygdala and the hypothalamus, where fight-or-flight begins.
When the therapist focused my treatment on reengaging the suppressed sites, electrical activity returned—score a win for neuroplasticity. I stopped treatment once the improvement in my sense of well-being seemed to plateau. But I felt clearer: instead of stumbling, I could glide through my days.
This shift took up full-time residence somewhere around my eighth session. I had the unfamiliar sense that all the parts of my brain were at the party—and not a frat-house fiesta, either. This translated into a respite from the normal cognitive grind as my decision-making struggles abated and I experienced days of intense (for me) productivity. I felt more certain about my actions in general—the analysis paralysis and second-guessing that had always been a big part of my “technique” quieted.
What didn’t change was my hair-trigger fight-or-flight response, nor did my memory or learning retention improve. That was disheartening, but only for a moment. Rather than attribute the unresponsiveness to a neurofeedback failure, I view it as further confirmation of the brain’s complicated circuitry.
In terms of longevity, my very anecdotal assessment has been that most of the gains I made have stuck around, albeit not as pronounced. I still have occasional days of frustrating fog and lack of clarity. But none of these setbacks have derailed me from my overall quest for mental health solutions. Doing layperson research is part of being my own best mental health advocate, and I’m keeping my ear to the ground.