Can direct neurofeedback help when our minds separate from our bodies?

When we think about human senses, most of us are able to easily identify the five primary senses of sight, hearing, smell, taste and touch.  But did you know that we actually have three more senses that are integral to our fully embodied, lived experience as humans?  These are vestibular senses of body rotation, gravitation and movement, proprioception as the experience of agility, balance and coordination, and interoception as the ability to feel what is going on inside of our bodies.  It is this last one that is more recently coming forward into the light as it is critical in the healing process related to complex trauma.

When our sense of interoception is damaged, we might be challenged to know when we feel hungry or full, cold or hot, and/or thirsty.  It can also make self-regulation difficult.  When we learn it is not safe to attune to this sense or feel betrayed by it, the mind works to separate from the body, learning to ignore any sensations that emanate from the body, for fear those powerful sensations will reveal our inability to attend to them.  This manifested itself in my own experience when I grew up hungry due to food insecurity.  I quickly learned that the personal, physical sensation of discomfort that accompanies hunger was something I could ignore, especially when my next meal was consistently in question.  Then, when food was present, I had difficulty in portion control, often eating so much that I was in physical pain.

The sense of interoception is often adversely impacted when the human body experiences trauma, especially interpersonal trauma in childhood, and can be so badly damaged that it leads to fragmentation, such as dissociative conditions.  And our Western medical model supports this separation of body and mind, where medical students are trained to simply view the body as the focus for treatment and psychotherapists are trained to view the mind – and its thoughts – as the main focus of treatment.  As we start to embrace the inseparable mind-body connection and better understand the impact of complex mental traumatization, we are learning that talking about past traumas in therapy is only part of the healing process.  More is needed!

In fact, before venturing into cognitive trauma work, it is vital to create safety and some level of internal state regulatory capacity, so people recovering from complex post-traumatic stress disorder (C-PTSD) can avoid the overwhelm that leads to dissociation and holds them back from post-traumatic growth.  Research is now showing that neurofeedback therapy (NFT), like direct neurofeedback, can be added to the treatment of C-PTSD as a method of implicit regulation, changing the brain in a way that eases the symptoms of trauma and opening the window wide to deep healing and inner peace.

If you would like to read more, click on the link below:

Can direct neurofeedback help individuals with a diagnosis of schizophrenia?

The effects of the unprecedented coronavirus will be felt by all for a currently unknown period of time.  The fear-driven behavioral responses that this pandemic has been producing is a reflection of how deep and strong our survival response goes.  And, yet, at some point, relief will come in the form of a vaccine.  However, there is another health challenge that stirs fear in the hearts of many, the life-long diagnosis of the severe mental disorder of schizophrenia.

One of my very first clients that I saw as a Marriage and Family Therapist Trainee carried a diagnosis of schizophrenia.  My client challenged me to learn more about this disorder in order to provide the best quality of service I could at that point in my training.  I learned that schizophrenia, although not as common as other mental disorders, affects feelings, thinking, and behaviors and the symptoms can be very disabling.  Symptoms of schizophrenia are categorized using the medical terms of either positive, negative, or cognitive.  Positive symptoms add and negative symptoms take away.

For example, positive symptoms might include hallucinations, delusions, or repetitive movements that are hard to control.  Negative symptoms include reduced feelings of pleasure, reduced speech, apathy, reduced social drive and social interest, and loss of motivation.  The underlying cause or causes of this severe mental disorder are still unknown and available treatments focus on eliminating the symptoms of the disease.  The first line of attack as far as treatment is concerned is antipsychotic medications.  Once a medication is found to work, then psychosocial treatments, such as therapy, is offered to help individuals learn and use coping skills.  Research has shown that participating in such psychosocial treatments reduces relapses and/or hospitalizations; however, the most challenging aspect of treatment is nonadherence to medication.  Therefore, a focus on increasing treatment adherence could have a positive effect on all impacted by this severe mental disorder.

Individuals with schizophrenia struggle to live life independently and improving this situation is a significant mental health priority.  It seems as though the negative symptoms of this disorder are associated with poorer functional status and quality of life than are the positive symptoms and this may be because primary negative symptoms generally do not respond well to the antipsychotic medications currently available.  Research has suggested that up to 60% of patients may have prominent clinically relevant negative symptoms that require treatment.  With this information it then becomes more easily understandable why these individuals may not be compliant with their medications – because those medications don’t work for them.  The question now is what is being done to support these individuals and address this unmet medical need?

Well, there is hope on the horizon.  An article recently published in the Journal of the American Medical Association Psychiatry looked into the use of transcranial direct current stimulation (AKA direct neurofeedback) as an add-on therapy for negative symptoms of schizophrenia.  In this double-blind randomized clinical trial of 100 individuals diagnosed with schizophrenia with predominant negative symptoms, results showed that this non-medication treatment was effective and safe in ameliorating negative symptoms.

If you would like to read more, click on the button below:

Might direct neurofeedback reduce impulsive behaviors?

The symptom of impulsivity can be found listed under several mental/behavioral health diagnoses, including but not limited to intermittent explosive disorder, substance abuse, OCD, PTSD and binge eating disorder.  When the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5™) was published in 2013 and included binge eating disorder, I finally felt validated and, at the same time, gratitude for discovering yoga, which helped to reduce my anxiety and my out-of-control eating, especially in light of the fact that I didn’t want to start taking any prescription medications.

My relationship with food has been a long and winding road.  I have memories when I was 4 or 5 of sitting at my kitchen table by myself, long after everyone else finished eating and was allowed to move on, because I was not allowed to leave the table until I finished everything on my plate, including those horrible green vegetables.  I tried every trick in the book, including slipping some to the dog under the table and putting some in my mouth, wiping my mouth with a napkin and spitting what was in my mouth into the napkin.  I also hear my parents in my mind saying “Eat your food!  There are people starving in Africa” and thinking to myself “Great, send them my food!”.

From there, after my parents got divorced, food became scarce for most of my adolescence.  My parents’ divorce and subsequent relationship was very contentious, pushing me into the land of anxiety.  I began to worry about where my next meal would be coming from and if it would be enough.  The pattern that grew from there involved eating large amounts of food (even if I wasn’t hungry) when food was available and eating very quickly (to ensure I got enough before it disappeared).  I also have memories as a young adult where I would eat my meal very quickly and then eat what was left by others on their plates.

As time passed, my relationship with food changed when my weight began to increase.  At this point, I would not allow myself to eat anything until the end of the day, after I had taken care of everyone else’s needs on my list.  Only then, almost like a reward for completing my “To Do” list for others and my sense of self-restraint or control, would I allow myself the indulgence of fulfilling one of the most basic human needs.  What didn’t change at this point though, was the speed in which I ate and the amount of food I would eat!

I then ventured into the many ‘diets’ being promoted.  My weight began to yo-yo.  My life felt so out-of-control as did I!  It wasn’t until I discovered yoga that I found myself in a space to really confront this unhealthy relationship I had with food, facing the fears lying beneath my journey in the land of anxiety.  And even with the support of my yoga practice (and a boost from some hypnotherapy), it took me many more years to see food as simply a source of energy for my body, like gas or electric for a car.

So how excited was I when I read the recent promising research on using direct neurofeedback (i.e., transcranial direct current stimulation or tDCS) to reduce impulsive behaviors!  Although it is not exactly clear how it does so, a positive effect was found in 74 out of 92 research studies.  It warms my heart to learn that there is an alternative to prescription medications, something that specifically supports the brain’s innate ability to reorganize itself towards health, and does so relatively quickly.

If you would like to read a little more on this research, click on the box below:

Is direct neurofeedback safe and effective for depression when pregnant?

I believe most of us want to do what is best for our health, such as eating well, exercising, getting enough sleep and staying connected with friends and family and I imagine maintaining our health and wellbeing takes another step up on our list of priorities when we think about getting (or are) pregnant.  If we smoke, we might consider stopping.  If we drink alcohol, we again might consider stopping.  However, if we experience a mood imbalance (think anxious and/or depressive symptoms), do we consider stopping any medications we are taking that are currently supporting our experience of more balance in our moods?  And what happens if we begin to experience some of these symptoms for the first time during our pregnancy, do we consider taking medications while pregnant or try to tough it out?

It is not uncommon for physicians to encourage women to stop such mood management medications as the side effects can be premature birth and low birth weight, similar to the impacts of smoking and drinking during pregnancy.  Where does this leave moms-to-be that are either taking such medications or might experience antenatal anxiety and/or depression?  There is research that shows babies have higher levels of the stress hormone cortisol when moms experience untreated depression, which increases the risk of that baby developing anxiety, depression, and other mental and behavioral challenges later in life.  So it is well known that depression in pregnancy negatively affects both mom’s and her baby’s health, so is there any other option?

A recent pilot randomized controlled research trial shows hope for a non-invasive, non-medication brain stimulation treatment option, specifically transcranial direct current stimulation (tDCS), also referred to as direct neurofeedback.  The results of this trial reflect the feasibility and acceptability of such an option along with encouraging preliminary effectiveness and no serious adverse (i.e., side) effects in this under-treated population.  The effects even lasted a month after delivery!  The results of this pilot study supported the next step to a definitive random controlled trial to evaluate tDCS for antenatal depression.

If you might be interested in reading more about this treatment option, either for yourself or someone you know that is struggling with such a decision, please click on the link below to learn more:

Can Stimulating the Prefrontal Cortex Calm the Default Human Survival Flight/Fight Response?

When humans encounter situations that they perceive as threatening, the parts of the brain responsible for our survival (i.e., amygdala, hippocampus) kick in to determine if running away from the threat is possible, to fight if not, and if neither is possible to stand still, hold our breath to be quiet and ultimately faint.  This flight/fight/freeze/faint response is not only the default position of our brains, it can be so activated over time from trauma and stress that it stays turned on even when we are not in harm’s way.

As someone that grew up in a home that would now be described as chaotic, I found myself in a series of situations that I either ran away from or fought, with a few where I found myself frozen in fear.  As a young child we don’t understand how these experiences are effecting our development, we just do what we have to – anything to survive.  As a young adult, I began to sense the amount of pressure I held in my body and used that energy to drive myself forward, sometimes to the point of exhaustion.

Through several years of psychotherapy, I discovered that the survival response in my brain, when activated (which happened to be most of the time), reduced my access to the parts of my brain that helped me to focus and communicate.  I subsequently learned that this is referred to as ‘amygdala hijacking’ and I describe it as the amygdala literally turning off the light switch leaving it in the dark to fend for itself without being able to see that there is access to support, specifically the prefrontal cortex.  And when you can’t access this part of the brain on a consistent basis, it loses its ability to offer a more balanced perspective of life.  Remember that saying “If you don’t use it, you lose it”, well it applies here too.

When I discovered yoga, I found a way to keep these two parts of my brain connected and when I did, it reduced the level of anxiety in the moment and began to strengthen the bridge that allows space to response, instead of react.  One of the most powerful tools that I learned from my time on the yoga mat was deep belly breathing, which was the first tool that I took off of the mat and into my everyday experiences.

Research has shown that practicing such breath techniques has neurophysiological impacts through respiratory vagus nerve stimulation.  The vagus nerve is the main part of our parasympathetic autonomic nervous system that is responsible for rest and digest processes and when stimulated is closely associated with emotional balance, mental flexibility, empathy and attachment.  It does this through decreasing hippocampal activity among other things, reducing the reactivity in the fear center of our brain, making access to the prefrontal cortex easier.  Now, what I have to admit is that I practiced such breath techniques for years until I began to consistently experience the emotional balance I so craved.  So, from personal experience I know it works, yet it can take time.

So how excited was I when I read the recent research in the Journal of the American Medical Association (JAMA) Psychiatry that looked at this bridge from a different perspective – stimulating the prefrontal cortex in order to allow it to stay online and calm the fear center of the brain when experiencing threatening circumstances, reducing anxiety.  This research looked at the effects of transcranial direct current stimulation, such as used in direct neurofeedback, of the prefrontal cortex on amygdala threat activity in people who experience chronic anxiety.  Neuroimaging was used to assess the impact and the results reveal a direct connection between the ability of the prefrontal cortex to regulate the fear response in the amygdala.  These findings offer more support to the neurocognitive mechanism contributing to the positive effects of direct neurofeedback and offer much hope to more directly and quickly reduce anxiety through such a non-pharmaceutical treatment option.

Are you looking for a magic pill for anxiety, but without the pill?

As a yoga teacher, you might expect me to tell you that meditation is the answer.  And, although meditation has absolutely been shown to reduce symptoms of anxiety, many people who suffer from anxiety get anxious just thinking about the idea of meditation.  Instead, non-invasive brain stimulation (i.e., direct neurofeedback) might bring more immediate relief of symptoms, creating space in the mind to contemplate meditation and even begin to practice it!

As someone whose nervous system tends to lean towards anxiety, my yoga practice including but not limited to pranayama, meditation and self-inquiry has brought me much peace over years of practice.  Yet, when chaos would begin to brew as it will and I would begin to feel a sense of overwhelm, I would greet my fear all over again, like a familiar (yet not comfortable) old friend.  I wondered if all of my body-mind-spirit practices would ever be enough to soothe my root chakra to the point of simply accepting fear for what it is – an early warning system meant to guide me to safety.

It wasn’t until I experienced direct neurofeedback that I sensed that shift in my relationship with fear.  I came to understand that trying to train the mind when the brain is caught in a deeply patterned dysfunctional loop can only do so much to soothe my nervous system and create new neural connections.  Operating from the conscious mind, we quickly discover that making the unconscious conscious is really hard heart work!  Awareness brings understanding and understanding creates an opportunity for choice, yet our unconscious mind can throw so many barriers up to prevent such awareness for fear of breaking our hearts.

When we can work with the body directly – specifically the brain – we can address the root source of the problem, circumventing the barriers of the mind while supporting the body’s self-healing abilities.  For anyone that has tried acupuncture, this idea may sound familiar.  By soothing the fear centers in the brain, the mind begins to notice space where there was none before.  Space to consider our experiences (past and present) in a new light with a new perspective.  And when we venture into those places of fear, such as chaos, we have a greater capacity and ability to stand in our own power and not get swept up in that sense of overwhelm.  From this place of power, we being to experience a greater sense of connection, to our authentic self as well as to the larger collective consciousness, realizing we are not alone.

When we truly can accept that ‘we are not alone’ into our belief system and we add ‘interdependence’ and compassion to our value system, the fears of uncertainty and unpredictability that underlie anxiety can be replaced with equanimity.  With the help of direct neurofeedback, I no longer found myself plagued by the belief that independence is the source of happiness, where shame is abundant when asking for help or support, or the thoughts around needing to be perfect in order to be acceptable and loved, which drove me to exhaustion.  Direct neurofeedback appeared to create space in my mind for new beliefs and values much more quickly than psychotherapy and/or yoga alone.

Recent research on non-invasive brain stimulation such as direct neurofeedback in generalized anxiety disorder is beginning to explain such results.  If you are interested in reading more, click on the link below:

The Stigma of Stuttering – Can Direct Neurofeedback Improve Speech Fluency?

If you know – or have ever known – someone that struggles or struggled with stuttering, then you most likely are aware of how physically and mentally exhausting it can be for them to communicate as they attempt to control the disruptions in their speech caused by this neurodevelopmental condition.  And when we realize that this condition typically begins before the age of 6 and impacts about 5% of preschool children, then I’m sure that most of us can imagine how children might develop additional mental and emotional challenges, such as anxiety, embarrassment, shame and low self-esteem, that most likely will have a significant impact on how they experience life as they grow up.

The good news is that many children outgrow this condition as their brains continue to develop.  With the help of speech therapy, many others will be able to learn how to slow down their speech enough to manage the disruptions.  However, some (approximately 1%) will continue to stutter for a lifetime.  Research focused on these adults is beginning to show changes in the actual structures of the brain when compared to adults without this neurodevelopmental condition.  This is great news as it allows for exploration of treatments known to impact those brain structures.

Once such treatment, direct neurostimulation is beginning to gain some traction in the realm of research on stuttering.  There may be variations in the neurostimulation technique; however, the treatment is non-invasive and includes the delivery of direct, low-intensity electrical currents to the scalp.  If the intensity of the electrical current is higher, it will work to change the neurons (stimulating or reducing neural firing), while lower intensity currents will work with the brainwaves, specifically disrupting dysfunctional brainwaves patterns and supporting the brain’s innate ability to organize and regulate itself.  Either way, these treatments that gently work to stimulate the brain directly are bringing hope to those who continue to be challenged by this condition into adulthood.

So, if you, a loved one or someone else you know is part of the 1% of the adult population still dealing with this neurodevelopmental condition, consider reading the recent research by clicking on the link below:

Might direct neurofeedback be worth a try?

I’m a big believer in our innate ability to heal ourselves, the power of the human body and mind to continually work together towards homeostasis and health.  I also have personally experienced the chaos created in both by trauma, challenging my body and mind to maintain that state of equilibrium and well-being.  Through my own healing journey, I have discovered tools along the way that have worked to reinforce that innate ability to heal and feel sense of encouragement when the research supports personal experience.  Direct neurofeedback is one of those tools.

Trauma comes in all shapes and sizes, whether you experienced abuse or neglect as a child, grew up on a home with one or both parents suffering from a mental illness or addiction, or were a witness to domestic violence while living with adults or going through a contentious divorce.  The enduring nature of the trauma from such interpersonally violent upbringings stems from the impact on the developing brain and nervous system.  When we embrace this fact, then we can also embrace the fact that sometimes the mind cannot talk itself out of such experiences when not involving the body in the process.

The brain, along with the spinal cord, forms the body’s main control center of our central nervous system.  This control center is where incoming stimulus is evaluated and decisions about what action to take are made.  It is the neurons in the brain that support the mind’s awareness of sensations, emotions, thoughts and ultimately behaviors when they communicate with each other.  When our neurons communicate, they produce electrical pulses referred to as brain waves.  These brain waves can be compared to the radio waves and the various stations that we tune into to listen to the radio.  AM stations work on a lower bandwidth, while FM stations have a higher bandwidth.  Our brain waves change according to what we are “tuned into”, with our slower brain waves being the AM stations and our faster ones being the FM stations.  Therefore, the brain is the main body part that is driving our beliefs, perceptions and reactions.

Understanding this very complex organ has taken some time as we waited for science to catch up with the personal experience of many.  With the advent of the electroencephalogram (EEG for short), we are able to see the various brain wave activity and now research has been able to identify the brain wave patterns associated with various neurological and emotional conditions, including ADHD, anxiety and depression.  This information created the opportunity to identify and work with tools to change or modify those brain waves, supporting the brains natural tendency towards balance and health.

Therefore, we are now better able to understand that when our brain waves are out of balance we will experience dis-ease in our minds and bodies, creating an unnatural, unhealthy environment that jeopardizes our overall well-being and health.  This understanding allows a more specific focus on tools that change or balance our brain waves to return the brain to its natural healthy state and thus creating an atmosphere for peace of mind and strength of body.  It helps us to appreciate the past experience with psychotherapy (or “talk” therapy), where it has been shown that changing our perceptions changes our experience of the world.  It also better explains the use of drugs (prescription or otherwise) to alter the brain’s ability to function and alleviate symptoms of dis-ease in the mind and body.

A newer approach to what ails many in the Western world is the use of more traditional Eastern practices such as yoga, meditation and deep breathing, which research is now able to show that these practices support the brain’s natural balance by modifying the brain wave patterns that create the imbalance.  In addition to these techniques, which work best when implemented as daily practices over the long haul, direct neurofeedback is showing success in altering brain waves more quickly that underlie the symptoms of a wide range of conditions, offering more immediate relief.

If you would like to read more about the research to determine for yourself if this tool might be worth a try, click on the button below:

Neurofeedback – Promising non-pharmaceutical intervention strategies for anxiety and depression!

Many people that I connect with express a desire to try other approaches to address symptoms of anxiety and depression before turning to medications, especially when it is their children that are suffering from such symptoms, as all prescription medications come with undesired side-effects.  As a psychotherapist and yoga teacher, I share the research with them that shows the effectiveness of integrating these two (yoga and talk therapy) healing arts to support the shift in focus toward health promotion for those who prefer to take a more natural, holistic approach to healing. Now I am excited to share recent research that demonstrates combining neurofeedback with heart rate variability training (e.g., deep slow abdominal yogic breathing) provides another viable non-pharmaceutical approach to address the symptoms of anxiety and depression.  And the research showed a reduction in symptoms for both children and adults!

Neurofeedback is not new and is a form of biofeedback, where instruments are attached to the body to provide information to the individual on the functioning of their body.  Biofeedback, including neurofeedback, as a field of study has been growing since the 1960s.  Neurofeedback (or EEG biofeedback) is the form of biofeedback that enables people to change the brain’s electrical activity.  An EEG (electroencephalography) is the device that captures the real-time brain wave activity so it can be displayed and assessed for any unhealthy patterns that might be contributing to symptoms, such as anxiety and depression.  Being able to offer a way to change unhealthy brain wave patterns through neurofeedback is of special interest to those of us working with clients to relieve such distressing symptoms because the brain is a central contributor to the emotions, physical symptoms, thoughts and behaviors that define many problems for which people reach out for support.

Yoga and it’s slow, controlled deep abdominal breathing is also not new.  What is new is the research that is showing how this yogic breathing impacts heart rate variability (HRV).  HRV has been shown to be linked with an increase in cardiovascular disease, specifically when the variability is low.  (Please refer to last month’s Reflection to learn more about HRV.)  Stress and anxiety increases the activity of the sympathetic nervous system, the system responsible for the flight-fight response in the body, leading to increases in heart rate and a lowering of heart rate variability. On the other hand, activation of the parasympathetic nervous system, the system responsible for the rest-digest response in the body, has been shown to decrease heart rate and increase heart rate variability, specifically through the stimulation of the vagus (Cranial X) nerve that controls the heart, lung and digestion.  It is the controlled breathing found in a regular yoga practice that stimulates the vagus nerve, bringing balance to the activity of the sympathetic nervous system activity.

Even more recent research has brought these two healing modalities together to assess the impact of stimulating both the brain with neurofeedback and the vagus nerve with deep abdominal breathing on symptoms of anxiety and depressing in both children and adults.  The results showed evidence that such training may provide an effective, non-pharmaceutical approach to reducing such symptoms, with some additional benefits such as improving blood pressure!

To read the full research article, click on the link below: