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When emotional dysregulation has us in its grip, might direct neurofeedback help?

When we are born, the parts of our brain that are driving the car are the ones responsible for our emotions.  The prominent logical part of our brain – the prefrontal cortex – doesn’t start to grow until between the ages of 1 and 2 years of age, with the most important years in a child’s development extending to the age of 3.  During these first 3 years of life, it is critical that a child receives warmth, love and responsive care.  Otherwise, the child is at greater risk of experiencing an interpersonal traumatic attachment injury, which impacts the brain’s development, leading to growing fears of abandonment/rejection and emotional dysregulation.  Basically, the emotional brain highjacks the logical brain and remains in the driver’s seat, possibly for life!

If a child does not experience the warmth and care they need from a primary care giver, dysfunctional symptoms begin to emerge as a result of such a traumatic attachment injury.  These symptoms will lead to a diagnosis of Reactive Attachment Disorder (RAD) in childhood, if the child is fortunate enough to have someone in their lives to intervene and secure the support that is needed.  If not, the child will adapt in ways to maintain safety, yet will not outgrow the symptoms.  As an adult, the symptoms now get a different diagnosis – and are labeled as a personality disorder.

One of those labeled personality disorders is borderline personality disorder (BPD).  This diagnosis is characterized by emotional dysregulation and poor executive function, which includes adaptable thinking, self-monitoring, and self-control.  Serious symptoms include impulsive, self-destructive behaviors, including self-injury and suicide attempts.  People suffering the symptoms of BPD find it difficult to establish and maintain stable, trusting relationships because of the fear of abandonment from significant others.  Therefore, it can be difficult to heal through traditional psychotherapy alone, since the therapeutic relationship is one that is based on trust.

This dilemma then begs the question of whether direct neurofeedback might support people who are have been diagnosed with BPD, perhaps facilitating their healing journey.  Well, recent research took a look at if, and how, such an intervention might be helpful.  What this research showed was that increasing the activity of the dorsolateral prefrontal cortex through repeated stimulation via direct neurofeedback significantly improved major executive functioning and cognitive control over negative emotions, bringing hope to many!

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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.

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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.

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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: