I had never come across a treatment that could produce such a dramatic change in mental functioning in so brief a period of time. So when Sebern offered to give me a neurofeedback demonstration, I eagerly accepted.
SEEING THE SYMPHONY OF THE BRAIN
At Sebern’s office in Northampton, Massachusetts, she showed me her neurofeedback equipment—two desktop computers and a small amplifier—and some of the data she had collected. She then pasted one electrode on each side of my skull and another on my right ear. Soon the computer in front of me was displaying rows of brain waves like the ones I’d seen on the sleep-lab polygraph three decades earlier. Sebern’s tiny laptop could detect, record, and display the electrical symphony of my brain faster and more precisely than what had probably been a million dollars’ worth of equipment in Hartmann’s lab.
From stick figures to clearly defined human beings. After four months of neurofeedback, a ten-year-old boy’s family drawings show the equivalent of six years of mental development.
As Sebern explained, feedback provides the brain with a mirror of its own function: the oscillations and rhythms that underpin the currents and crosscurrents of the mind. Neurofeedback nudges the brain to make more of some frequencies and less of others, creating new patterns that enhance its natural complexity and its bias toward self-regulation.4 “In effect,” she told me, “we may be freeing up innate but stuck oscillatory properties in the brain and allowing new ones to develop.”
Sebern adjusted some settings, “to set the reward and inhibit frequencies,” as she explained, so that the feedback would reinforce selected brain-wave patterns while discouraging others. Now I was looking at something like a video game featuring three spaceships of different colors. The computer was emitting irregular tones, and the spaceships were moving quite randomly. I discovered that when I blinked my eyes they stopped, and when I calmly stared at the screen they moved in tandem, accompanied by regular beeps. Sebern then encouraged me to make the green spaceship move ahead of the others. I leaned forward to concentrate, but the harder I tried, the more the green spaceship fell behind. She smiled and told me that I’d do much better if I’d just relax and let my brain take in the feedback that the computer was generating. So I sat back, and after a while the tones grew steadier and the green spaceship started pulling ahead of the others. I felt calm and focused—and my spaceship was winning.
In some ways neurofeedback is similar to watching someone’s face during a conversation. If you see smiles or slight nods, you’re rewarded, and you go on telling your story or making your point. But the moment your conversation partner looks bored or shifts her gaze, you’ll start to wrap up or change the topic. In neurofeedback the reward is a tone or movement on the screen instead of a smile, and the inhibition is far more neutral than a frown—it’s simply an undesired pattern.
Next Sebern introduced another feature of neurofeedback: its ability to track circuitry in specific parts of the brain. She moved the electrodes from my temples to my left brow, and I started to feel sharp and focused. She told me she was rewarding beta waves in my frontal cortex, which accounted for my alertness. When she moved the electrodes to the crown of my head, I felt more detached from the computer images and more aware of the sensations in my body. Afterward she showed me a summary graph that recorded how my brain waves had changed as I experienced subtle shifts in my mental state and physical sensations.
How could neurofeedback be used to help to treat trauma? As Sebern explained: “With neurofeedback we hope to intervene in the circuitry that promotes and sustains states of fear and traits of fearfulness, shame, and rage. It is the repetitive firing of these circuits that defines trauma.” Patients need help to change the habitual brain patterns created by trauma and its aftermath. When the fear patterns relax, the brain becomes less susceptible to automatic stress reactions and better able to focus on ordinary events. After all, stress is not an inherent property of events themselves—it is a function of how we label and react to them. Neurofeedback simply stabilizes the brain and increases resiliency, allowing us to develop more choices in how to respond.
THE BIRTH OF NEUROFEEDBACK
Neurofeedback was not a new technology in 2007. As early as the late 1950s University of Chicago psychology professor Joe Kamiya, who was studying the phenomenon of internal perception, had discovered that people could learn through feedback to tell when they were producing alpha waves, which are associated with relaxation. (It took some subjects only four days to reach 100 percent accuracy.) He then demonstrated that they could also enter voluntarily into an alpha state in response to a simple sound cue.
In 1968 an article about Kamiya’s work was published in the popular magazine Psychology Today, and the idea that alpha training could relieve stress and stress-related conditions became widely known.5 The first scientific work showing that neurofeedback could have an effect on pathological conditions was done by Barry Sterman at UCLA. The National Aeronautics and Space Administration had asked Sterman to study the toxicity of a rocket fuel, monomethylhydrazine (MMH), which was known to cause hallucinations, nausea, and seizures. Sterman had previously trained some cats to produce a specific EEG frequency known as the sensorimotor rhythm. (In cats this alert, focused state is associated with waiting to be fed.) He discovered that while his ordinary lab cats developed seizures after exposure to MMH, the cats that had received neurofeedback did not. The training had somehow stabilized their brains.
In 1971 Sterman attached his first human subject, twenty-three-year-old Mary Fairbanks, to a neurofeedback device. She had suffered from epilepsy since the age of eight, with grand mal seizures two or more times a month. She trained for an hour a day twice a week. At the end of three months she was virtually seizure free. Sterman subsequently received a grant from the National Institutes of Health to conduct a more systematic study, and the impressive results were published in the journal Epilepsia in 1978.6
This period of experimentation and huge optimism about the potential of the human mind came to an end in the middle 1970s with newly discovered psychiatric drugs. Psychiatry and brain science adopted a chemical model of mind and brain, and other treatment approaches were relegated to the back burner.
Since then the field of neurofeedback has grown by fits and starts, with much of the scientific groundwork being done in Europe, Russia, and Australia. Even though there are about ten thousand neurofeedback practitioners in the United States, the practice has not been able to garner the research funding necessary to gain widespread acceptance. One reason may be that there are multiple competing neurofeedback systems; another is that the commercial potential is limited. Only a few applications are covered by insurance, which makes neurofeedback expensive for consumers and prevents practitioners from amassing the resources necessary to do large-scale studies.
FROM A HOMELESS SHELTER TO THE NURSING STATION
Sebern had arranged for me to speak with three of her patients. All told remarkable stories, but as I listened to twenty-seven-year-old Lisa, who was studying nursing at a nearby college, I felt myself truly awakening to the stunning potential of this treatment. Lisa possessed the greatest single resilience factor humans can have: She was an appealing person—engaging, curious, and obviously intelligent. She made great eye contact, and she was eager to share what she had learned about herself. Best of all, like so many survivors I’ve known, she had a wry sense of humor and a delicious take on human folly.
Based on what I knew about her background, it was a miracle that she was so calm and self-possessed. She had spent years in group homes and mental hospitals, and she was a familiar presence in the emergency rooms of western Massachusetts—the girl who regularly arrived by ambulance, half dead from prescription drug overdoses or bloody from self-inflicted wounds.
Here is how she began her story: “I used to envy the kids who knew what would happen when their parents got drunk. At least they could predict the havoc. In my home there was
no pattern. Anything could set my mother off—eating dinner, watching TV, coming home from school, getting dressed—and I never knew what she was going to do or how she would hurt me. It was so random.”
Her father had abandoned the family when Lisa was three years old, leaving her at the mercy of her psychotic mother. “Torture” is not too strong a word to describe the abuse she endured. “I lived up in the attic room,” she told me, “and there was another room up there where I would go and piss on the carpet because I was too scared to go downstairs to the bathroom. I would take all the clothes off my dolls and drive pencils into them and put them up in my window.”
When she was twelve years old, Lisa ran away from home and was picked up by the police and returned. After she ran away again, child protective services stepped in, and she spent the next six years in mental hospitals, shelters, group homes, foster families, and on the street. No placement lasted, because Lisa was so dissociated and self-destructive that she terrified her caretakers. She would attack herself or destroy furniture and afterward she would not remember what she had done, which earned her a reputation as a manipulative liar. In retrospect, Lisa told me, she simply lacked the language to communicate what was going on with her.
When she turned eighteen, she “matured out” of child protective services and started an independent life, one without family, education, money, or skills. But shortly after discharge she ran into Sebern, who had just acquired her first neurofeedback equipment and remembered Lisa from the residential treatment center where she had once worked. She’d always had a soft spot for this lost girl, and she invited Lisa to try out her new gizmo.
As Sebern recalled: “When Lisa first came to see me, it was fall. She walked around with a vacant stare, carrying a pumpkin wherever she went. There just wasn’t a there there. I wasn’t ever sure that I had gotten to any organizing self.” Any form of talk therapy was impossible for Lisa. Whenever Sebern asked her about anything stressful, she would shut down or go into a panic. In Lisa’s words: “Every time we tried to talk about what had happened to me growing up, I would have a breakdown. I would wake up with cuts and burns and I wouldn’t be able to eat. I wouldn’t be able to sleep.”
Her sense of terror was omnipresent: “I was afraid all the time. I didn’t like to be touched. I was always jumpy and nervous. I couldn’t close my eyes if another person was around. There was no convincing me that someone wasn’t going to kick me the second I closed my eyes. That makes you feel crazy. You know you’re in a room with someone you trust, you know intellectually that nothing’s going to happen to you, but then there’s the rest of your body and you can’t ever relax. If someone put their arm around me, I would just check out.” She was stuck in a state of inescapable shock.
Lisa recalled dissociating when she was a little girl, but things got worse after puberty: “I started waking up with cuts, and people at school would know me by different names. I couldn’t have a steady boyfriend because I would date other guys when I was dissociated and then not remember. I was blacking out a lot and opening my eyes into some pretty strange situations.” Like many severely traumatized people, Lisa could not recognize herself in a mirror.7 I had never heard anyone describe so articulately what it was like to lack a continuous sense of self.
There was no one to confirm her reality. “When I was seventeen and living in the group home for severely disturbed adolescents, I cut myself up really badly with the lid of a tin can. They took me to the emergency room, but I couldn’t tell the doctor what I had done to cut myself—I didn’t have any memory of it. The ER doctor was convinced that dissociative identity disorder didn’t exist. . . . A lot of people involved in mental health tell you it doesn’t exist. Not that you don’t have it, but that it doesn’t exist.”
The first thing Lisa did after she aged out of her residential treatment program was to go off her medications: “This doesn’t work for everybody,” she acknowledged, “but it turned out to be personally the right choice. I know people who need meds, but that was not the case for me. After going off them and starting neurofeedback, I became much clearer.”
When she invited Lisa to do neurofeedback, Sebern had little idea what to expect, as Lisa would be the first dissociative patient she tried it on. They met twice a week and started by rewarding more coherent brain patterns in the right temporal lobe, the fear center of the brain. After a few weeks Lisa noticed she was wasn’t as uptight around people, and she no longer dreaded the basement laundry room in her building. Then came a bigger breakthrough: She stopped dissociating. ”I’d always had a constant hum of low-level conversations in my head,” she recalled. “I was scared I was schizophrenic. After half a year of neurofeedback I stopped hearing those noises. I integrated, I guess. Everything just came together.”
As Lisa developed a more continuous sense of self, she became able to talk about her experiences: “I now can actually talk about things like my childhood. For the first time I started being able to do therapy. Up till then I didn’t have enough distance and I couldn’t calm down enough. If you’re still in it, it’s hard to talk about it. I wasn’t able to attach in the way that you need to attach and open up in the way that you need to open up in order to have any type of relationship with a therapist.” This was a stunning revelation: So many patients are in and out of treatment, unable to meaningfully connect because they are still “in it.” Of course, when people don’t know who they are, they can’t possibly see the reality of the people around them.
Lisa went on: “There was so much anxiety around attachment. I would go into a room and try to memorize every possible way to get out, every detail about a person. I was trying desperately to keep track of everything that could hurt me. Now I know people in a different way. It’s not based on memorizing them out of fear. When you’re not afraid of being hurt, you can know people differently.”
This articulate young woman had emerged from the depths of despair and confusion with a degree of clarity and focus I had never seen before. It was clear that we had to explore the potential of neurofeedback at the Trauma Center.
GETTING STARTED IN NEUROFEEDBACK
First we had to decide which of five different existing neurofeedback systems to adopt, and then find a long weekend to learn the principles and practice on one another.8 Eight staff members and three trainers volunteered their time to explore the complexities of EEGs, electrodes, and computer-generated feedback. On the second morning of the training, when I was partnered with my colleague Michael, I placed an electrode on the right side of his head, directly over the sensorimotor strip of his brain, and rewarded the frequency of eleven to fourteen hertz. Shortly after the session ended, Michael asked for the attention of the group. He’d just had a remarkable experience, he told us. He had always felt somewhat on edge and unsafe in the presence of other people, even colleagues like us. Although nobody seemed to notice—he was, after all, a well-respected therapist—he lived with a chronic, gnawing sense of danger. That feeling was now gone, and he felt safe, relaxed, and open. Over the next three years Michael emerged from his habitual low profile to challenge the group with his insights and opinions, and he became one of the most valuable contributors to our neurofeedback program.
With the help of the ANS Foundation we started our first study with a group of seventeen patients who had not responded to previous treatments. We targeted the right temporal area of the brain, the location that our early brain-scan studies (described in chapter 3)9 had shown to be excessively activated during traumatic stress, and gave them twenty neurofeedback sessions over ten weeks.
Because most of these patients suffered from alexithymia, it was not easy for them to report their response to the treatments. But their actions spoke for them: They consistently showed up on time for their appointments, even if they had to drive through snowstorms. None of them dropped out, and at the end of the full twenty sessions, we could document significant improvements not only in their PTSD score
s,10 but also in their interpersonal comfort, emotional balance, and self-awareness.11 They were less frantic, they slept better, and they felt calmer and more focused.
In any case, self-reports can be unreliable; objective changes in behavior are much better indicators of how well treatment works. The first patient I treated with neurofeedback was a good example. He was a professional man in his early fifties who defined himself as heterosexual, but he compulsively sought homosexual contact with strangers whenever he felt abandoned and misunderstood. His marriage had broken up around this issue, and he had become HIV positive; he was desperate to gain control over his behavior. During a previous therapy he had talked extensively about his sexual abuse by an uncle at around the age of eight. We assumed that his compulsion was related to that abuse, but making that connection had made no difference in his behavior. After more than a year of regular psychotherapy with a competent therapist, nothing had changed.
A week after I started to train his brain to produce slower waves in his right temporal lobe, he had a distressing argument with a new girlfriend, and instead of going to his habitual cruising spot to find sex he decided to go fishing. I attributed that response to chance. However, over the next ten weeks, in the midst of his tumultuous relationship, he continued to find solace in fishing and began to renovate a lakeside cabin. When we skipped three weeks of neurofeedback because of our vacations schedules, his compulsion suddenly returned, suggesting that his brain had not yet stabilized its new pattern. We trained for six more months, and now, four years later, I see him about every six months for a checkup. He has felt no further impulse to engage in his dangerous sexual activities.
How did his brain come to derive comfort from fishing rather than from compulsive sexual behavior? At this point we simply don’t know. Neurofeedback changes brain connectivity patterns; the mind follows by creating new patterns of engagement.
The Body Keeps the Score Page 40