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Can direct neurofeedback provide hope to those experiencing post-stroke fatigue?

As a direct neurofeedback provider, I am continually amazed at the positive effects it has on people’s lives.  I am in awe of the human body’s natural ability to heal itself, especially when it is supported naturally.  I feel privileged to work directly in supporting the brain’s neuroplasticity and its innate ability to organize itself towards health.  I feel excited every day to learn how this treatment modality is being utilized to address so many different body-mind symptoms of disease, to improve quality of life and well-being.  A recent exploratory study took a look at a very common symptom post-stroke, fatigue.

According to the CDC, stroke:

  • Is a leading cause of serious long-term disability;
  • Reduces mobility in more than half of stroke survivors age 65 and over;
  • Impacts someone in the US every 40 seconds.

With such statistics, anything that we can do to support the brain-body recovery would be a significant development.  As someone who has a family history of cardiovascular disease, including stroke, I feel excited about the possibilities.

With fatigue being one of the most commonly reported symptoms after a stroke, the study looked at using transcranial direct current stimulation (aka direct neurofeedback) to support the activity of the brain on its road to recovery.  The study only included a single session of direct neurofeedback and the results indicated that such treatment may be a useful tool for managing post-stroke fatigue.  I can only imagine the results if more sessions were offered, but I guess we will have to wait for that study!

In the meantime, if you or someone you love is suffering from post-stroke symptoms, especially fatigue, consider reading this study (click below) and looking for a direct neurofeedback provider in their area.

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!

To read more, click on the link below:

 

Might transcranial direct current stimulation (aka direct neurofeedback) be an additional tool to reduce symptoms of depression as a result of the impact of the pandemic?

If there is one silver lining to this pandemic it is the blossoming realization and acceptance of the fact that people need people!  It is shining a light on the cultural ideal of independence and reflecting the shadow side of such an ideal.  Human beings were designed to be interdependent, using relationships within their tribes and communities to grow and thrive.  If independence was truly the healthy ideal, why aren’t more people thriving during this pandemic?

Use this time to reflect on the lessons being brought forward to us.  If we embrace the fact that we need each other – and that it makes us feel good to help each other – than perhaps we can learn to be at ease with asking for help and support when we need it, knowing it will deepen our connections with others and make others feel good about themselves.  What brings hope during these unexpected – and let’s just own it – scary times is collaboration and comradery.  Knowing we are not alone – in our experiences, thoughts, and emotions – and that if we just have the courage to reach out, we will find relief.

Action is actually an antidote to fear.  So, although the mind says withdraw, let the body lean in and reach out a hand – to call a friend, to pet an animal, to throw and catch a ball with a child and best of all to give and receive a hug with a loved one.  You might even try your hand at writing, perhaps a letter or poem, to someone you care about and are unable to see in person at this time.  Letting them know you are thinking about them and care about them might forever change their world in that immediate moment.

All of these acts of connection soothe the mind’s sense of disconnection.  As neuroscience is demonstrating, our brains are wired for connection and, when we begin to experience disconnection, symptoms like depression start to develop.  And the current pandemic conditions are only exacerbating any pre-existing sense of disconnection.  Therefore, we need more tools that support the brain’s innate ability to reorganize towards health, beyond medications that bring so many unwanted side-effects.  We need tools that reduce the fear signals in the brain so that action becomes more of an option when depressive symptoms loom.

Well, such a tool exists and a recent systematic review and meta-analysis of the research reflects that this tool is effective in the treatment of depression.  Prior to this review, the results were mixed.  However, now enough randomized clinical trials have been conducted and the cumulative data reflect that direct neurofeedback has achieved superior response and remission rates, warranting further large-scale clinical trials!

This information is vital as we continue to move through this pandemic and beyond.  The lasting effects of the physical distancing required for our immediate physical health are still unknown at this time, yet history informs us that the psychological wounds may be deep.  Acknowledging that symptoms of depression may be arising, whether within our own experience or witnessing it in others, helps to anticipate support might be needed along the healing path.  Knowing about the treatment options facilitates choice throughout the journey.

To read more about this research 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:

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.