The Far Shores of Neurofeedback
by Jim Robbins

Excerpted from A Symphony in the Brain: The Evolution of the New Brain Wave Feedback by Jim Robbins, Grove/Atlantic, Inc.. Copyright 2000 by Jim Robbins. Reprinted with permission. For more information, see www.symphonyinthebrain.com. This excerpt first appeared in Cerebrum: The Dana Forum on Brain Science, Vol. 2, No. 3, Summer 2002 (www.dana.org).

Author's Introduction for Cerebrum

When I first heard there was a new kind of biofeedback that allowed people to make their brains stronger, I was taken aback. Wasn't biofeedback something that came and went in the 1960s and '70s? I had never tried it, but I associated it vaguely with the Seventies, the counterculture, and Transcendental Meditation. The field had a pejorative, New Age whiff about it. Add the word "brainwave," and it sounded even wackier. Yet I was hearing interesting things about it, and I have always believed that the mind and brain are the last great frontier. I was also battling a case of chronic fatigue syndrome, and had exhausted the traditional medical route. So I sold an editor on a magazine story and traveled to Santa Fe to test what is known as "neurofeedback."

Brainwave training is a relatively straightforward process, almost more difficult to explain than to do. It is based on a principle from the behavioral school of psychology, dominant in the 1960s and 1970s, called "operant conditioning of autonomic responses." The idea is that, with the right information, physiological functions thought to be "automatic" can be brought under conscious control. This began with teaching lab rats, and later people, to control their heart rate by rewarding them with a softly beeping tone when they achieved their goal. Later, scientists discovered that you could teach people to vary their brainwaves, at will, if they were given a reward--such as a pleasant tone or beeping light. In the computer era, the reward is performing well on a video game.

In brainwave training, a sensor that picks up brainwaves is placed on the subject's scalp. That brainwave signal is amplified and fed into a computer. When a subject is able to expand his normal frequency range--measured in "hertz," a standard electrical unit--he is rewarded with a Pac man that gobbles dots or a space ship that pulls ahead in a race. When he cannot maintain the desired, or "healing," frequency, he loses the video game. Most brains quickly learn to gain the desired control.

After training for a half an hour on an instrument--two computers and an amplifier --my mind was tired, my thoughts muddled. But an hour or so after I finished I experienced what brainwave training aficionados call the Clean Windshield Effect. The world looked sharp and crystalline, and I had a quiet, energetic feeling that lasted a couple of hours. It was the first time I had felt this way in years, and it convinced me to look a little deeper. This new biofeedback was something very different, I was told, a technique that can treat attention deficit disorder and closed head injuries and depression and, according to some, an incredibly long list of other problems.

Still, the claims being made for neurofeedback seemed far too good to be true. If it is such a good thing, why hadn't I heard of it? Why hadn't it swept its way into the health care system? But I have been blessed with a healthy streak of cynicism, and I know, as a journalist, that the systems that surround us--be it science, health care, government, even journalism--function far less perfectly than is generally believed. Things fall through the cracks, get over-looked and ignored. It was no great leap for me to believe that something as far out of the conceptual box as neurofeedback could have been missed. So I persisted, knowing from experience that these oversights are where some of the best stories dwell.

The Cats with Stronger Brains

I found that neurofeedback was born in a research laboratory at the Sepulveda Veteran's Administration Hospital in the 1970s. Dr. M. Barry Sterman, a psychologist at the University of California, Los Angeles, was doing sleep research on cats. He noticed unusual rhythmic activity in their electroencephalogram (EEG), an instrument that records electrical activity of the brain. Specifically, over the cats' sensorimotor cortex, he recorded 12 to 15 hertz rhythms. (The brain's rhythms are divided into four basic categories. Delta, at 1 to 3 Hz, is sleep; theta, at 4 to 7 Hz, is the hypnogagic state, between sleep and deep relaxation; alpha, at 8 to 12 Hz, is a deeply relaxed but aware state; and beta, 13 to around 30 Hz, is the state of being fully aware.) Sterman operantly conditioned some cats to create this alpha frequency, so he could study the way it affected their sleep.

Then, in one of those fortuitous accidents of science, he used those same cats, along with fresh cats from the pound, in a different experiment. He received a grant from the Defense Department to study the toxic effects of rocket fuel. When he injected the cats with the fuel, he found that their response followed a predictable course: They started to pant, vocalize, and then go into seizures-except for the cats from the operant conditioning experiment. They never experienced the seizures. It took years to figure out why, but eventually Sterman discovered that the cats he had taught to control their brainwaves had presumably strengthened their brains and made themselves resistant to seizures, findings that were replicated in other studies.

Sterman went on to do a series of experiments on human subjects who suffered from epilepsy. He found that the technique greatly reduced the number and severity of seizures. The training also seemed to positively affect mood and reduce anxiety. He published his results in several top journals. Joel Lubar, at the University of Tennessee at Knoxville, replicated Sterman's work with epileptics and went on to do more than 20 years of research with attention deficit disorder (ADD) and hyperactivity.

With the promise of pharmaceuticals, funding for behavioral interventions dried up, but several clinicians continued to use the technique--which was boosted when computers came along in the 1980s--with great and predictable success in thousands of cases. Now the use of neurofeedback is growing, with more than 1,500 psychologists, counselors, primary care physicians, neurologists, and psychiatrists using it to treat ADD, depression, head injuries, and anxiety.

Some experts have criticized the "experimental" nature of brainwave training and claimed that the evidence isn't there yet. But to be fair it should be noted that the field of health care is crowded with treatments that clinicians judge to be effective yet have not been thoroughly researched. According to the Journal of the American Medical Association, for example, the use of clonodine, a blood pressure medication, as a treatment for behavioral disorders in children, grew 28-fold from 1991 to 1995 with virtually no studies on efficacy or safety. The difference is that medication is something that doctors are familiar with. While the same cannot be said about neurofeedback, that is changing.

Brainwave training is an extremely young field and full of potential. The instrumentation being used in clinics today was built on a shoestring in basements, and there is a great deal of room for improvement. Virtual reality, faster computers, better sensing technology, and other tools are expected to enhance the efficacy.

It remains to be seen how far neurofeedback can be taken. But if the hypothesis at the center of neurofeedback is true--that people can be taught to operantly condition parts of their brain and by doing so make it more robust--the notion of a designer brain may be something that is accomplished not with drugs but with computers and "self regulation." What the future might hold is the subject of this excerpt.

The Far Shores of Neurofeedback

While neurofeedback is being used primarily as a tool for attention deficit disorder, many in the field believe the technique has a far broader--in fact, an unbelievably broad--application. It is also being applied to treat depression, head injuries, anxiety, sleep disorders, and a host of other neurological problems. And it is also being widely used by athletes, performers, executives, and others who have no problem, per se, but simply seek to enhance their performance: to increase their memory and their cognitive abilities, to sleep sounder and wake more refreshed, to play golf or the cello better, or simply to live a better, more wide-awake life, an aspect of neurotherapy known as mental fitness training or peak performance.

There is a great deal of controversy, as we have seen, within and outside the field, over the kinds of claims being made for neurofeedback in the areas that have little or no research to support them. But there are coherent, predictable models that shed some light on how EEG biofeedback might be working.

A big question is, what is happening to the brain as a result of the training? One hypothesis has to do with the way the cells in the brain connect with each other. Since information travels along the branch-like connections between cells, called dendrites, the denser and greater in number these connections are, the better the transfer of information. As frequency is enhanced during a neurotherapy session and the brain is activated, more blood than usual streams to that area of the brain, the nutrients in the blood may be strengthening or reorganizing existing connections. This is what many scientists think happens during any learning process. (Brain scans show that after people go blind the neurons that govern their Braille-reading finger become much more robust.) Since every aspect of a person is driven by an assembly of neurons, the healthier those neurons are, the healthier are the functions that they govern.

Barry Sterman's studies showed some of those changes, and not just in the brain; there were physiological changes from the top to the bottom of the cats and monkeys he studied. "Very specific, measurable changes," says Sterman. "In the brain cell firing patterns changed and cells in the motor pathway reduced their rate of firing. Circuit patterns changed. And we found changes in the body. Respiration stabilized. Heart rate went down. Muscle tone in anti-gravity muscles decreased. Reflexes diminished."

After Sterman left the field in the early 1980s others took up the task of conceptualizing neurofeedback. There are numerous proposed models; I have chosen the one outlined by neurofeedback pioneers Sue and Siegfried Othmer, the owners of EEG Spectrum, (for which they have borrowed freely from other places) because it is simple, has the greatest scope, is the most unifying, is being used by a large number of people, and is one they admit is constantly being revised according to what they and their affiliates learn. It is not the only approach, nor is it necessarily the best. Their nascent model holds that EEG biofeedback can treat so many disparate problems because they are really just one problem: disregulation of the brain. Since the brain is command central and runs the show, according to their explanation, once connections between neurons are strengthened, and the brain is running at the appropriate speed, and stabilized, it can resist a myriad of problems better than before the training. The Othmers reason that if "self-regulation" of the brain can have dramatic, long-lived effects with epilepsy, one of the most intransigent of all problems to treat, and bring about an end to or reduction in violent seizures that have wracked a human body, it is only logical that the principle of strengthening the brain should apply to a wide range of conditions, some more profound, some less. Why not try it, as long as medicine's first rule--Do no harm--is kept in mind?

Viewed through the prism of neurotherapy, human beings do not suffer an epidemic of depression, chronic pain, immune system dysfunction, addictions, anxiety, or any one of a laundry list of other afflictions. Instead, the epidemic is in hyperactive or worn-out nervous systems--buffeted by birth perhaps, infancy and childhood certainly, by a culture that encourages overwork and has created some of the most stressful places on earth: modern cities. There are only three diagnoses under the Othmer model: One, a person is so chronically over-aroused he or she cannot relax, resulting in, for example, anxiety, agitation, impulsivity, and anger. Two, a person may be chronically under-aroused, resulting in some types of depression, lack of motivation, and spaciness. The third principal diagnosis is brain instability. Using an automobile analogy, the lug nuts on the wheels are loose and the front end is wobbly. The driver can sometimes drive quite well, but suddenly the car veers off in one direction or another, and there is little the driver can do. Bipolar disorder (manic depression), migraines, pre-menstrual syndrome (PMS), panic attacks, motor and vocal tics, vertigo, bruxism (teeth grinding), epilepsy, and many others are all considered stability problems.

Tossing Out the Diagnostic and Statistical Manual

In a sense, the model is a move back to a much simpler pre-molecular time in neuroscience and to a much simpler time in psychology. The Othmers have essentially thrown out most of the hundreds of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, the encyclopedia of all the psychological dysfunctions, and replaced them with just three.

Nearly all health problems, this model holds, flow from over-arousal, under-arousal, or instability in the central nervous system. With any of the three conditions, the stressed-out brain and the rest of the central nervous system are not robust enough to manage the body appropriately and so render people susceptible to any condition to which they may be predisposed: Joint pain flares up. They can't sleep. Or they sleep too much. They get headaches. Panic attacks. Manic depression. Pain. Depression. They are anxious. Nervous. Can't pay attention. Simply treating a person for one of the three conditions can alleviate hundreds of different and seemingly disparate problems. That is why with 20 sessions of neurofeedback in the same two sites, a patient often reports that four or five symptoms diminish or disappear. The hundreds of traditional diagnoses are simply farther downstream from the diagnosis of a stressed-out central nervous system.

This iconoclastic view of mental illness received scientific support recently. In October of 1999, Dr. Rodolfo Llinas, an eminent neuroscientist at New York University, proposed a revolutionary new theory about seemingly unrelated disorders. Speaking at a Society for Neuroscience meeting, Dr. Llinas said that there are six layers of cells in the cortex, divided into specialized regions, that allow movement, planning, speech, and response to emotions. According to a description of his talk in The New York Times, the sixth layer of cells provides connection to the thalamus, which is the part of the brain that takes sensory information and passes it on to the cortex. But the thalamus is more than a relay: It is a generator with special cells that set the pace for the cortical cells. They in turn feed information back to the thalamus. This loop creates the symphony of the brain, coordinating actions, perceptions, movements, and even consciousness.

Dr. Llinas studied patients with brain disorders and found that parts of their thalamus seemed to be abnormally slow, even asleep. The critical parts of the cortex that govern many aspects of a person are misfiring, because there is no thalamic conductor to set their pace. Without proper control by the thalamus, the cells in the cortex become overly excited. Because the thalamus has many highly specialized regions, a whole host of things can go wrong in a very small area. If one small area--perhaps no bigger than a pinhead--of the thalamus is suffering a "brown out," for example, then because it connects to the motor area of the brain it causes the tremor of Parkinson's disease. Another small area which is very close by connects to a different area of the cortex and it causes the cells that govern pain to become excited, and so the patient is in chronic pain. Dr. Llinas also cited some types of depression, tinnitus, and obsessive compulsive disorder as problems that may be caused by a thalamus and cortex that are out of phase.

The Othmers believe Llinas's model sheds light on the mechanism of neurofeedback. They believe that when people train with neuro-feedback they are training one end of that loop between thalamus and the cortex. The changes made on the cortical end project back on the thalamus, which is deep in the brain. "Changing the cortical rhythm changes the rhythm of the thalamus," said Sue. "If the cortex slows down the whole system slows down. The lower parts of the brain get involved because the system is interconnected."

The most critical variable in the Othmers' model of higher-range training is frequency. The general approach is the 12-to-15-hertz, or SMR, training on the right side, which calms and enhances the emotional aspects and relaxes physical tension, while 15-to-18-hertz training on the left side helps improve attention and alertness. In 70 percent of the patients the Othmers and their affiliates see, the approach is the same: The left side needs to be brought up to the 15-to-18-hertz frequency, while the right side needs to be calmed to 12 to 15 hertz. The reason, says Sue Othmer, is that the left hemisphere organizes more localized function, which requires higher frequencies, whereas the right hemisphere organizes function more globally, which happens with lower frequencies.

While this is the general approach, each brain is different, and frequencies are tailored to each individual's response. A recent change in the Othmers' approach is where the electrode is placed on the brain. For years neuro-therapists used only C-3 and C-4 sites, which are midway between the top of the head and the ear on each side, and some still insist that those tried-and-true sites are best. But the Othmers and others have experimented with sites on the temporal lobe, an inch above the ear on each side, for problems of stability, and they have proven to be very effective. And they have combined their training on the central parts of the brain with prefrontal and parietal sites to enhance specific effects related to the function of those parts of the brain. In other words, training right brain might bring up emotional aspects, while adding FP-1 helps coordinate the emotional well-being with thinking and planning, since FP-1 is over the prefrontal cortex, which governs those issues.

Another variable is the hemisphere of the brain that these frequencies are trained on. Management responsibilities are divided between the two spheres of the human brain. If the left side is trained, a person will see his or her analytical skills and sequential learning abilities improve. If the right side is trained, the Othmers believe, it brings up emotions and feelings, and even promotes intuition. The Othmers believe that training the left or right cortex, the top layer, strengthens the subcortical structures as well. For example, an overactive amygdala, which causes fear and panic, and lies deep in the brain, is calmed even by training the cortex. The training doesn't so much influence the local area around the electrode, they say; rather, it influences networks of brain communication.

There are a number of reasons the traditional medical model has so many different diagnoses, according to the Othmers. One of them is that there are usual genetic and environmental differences in people, and disregulation can affect people in different ways. Another is that disregulation happens along a continuum or spectrum. The mildly disregulated brain manifests in ADD or anxiety; the more profoundly disregulated brain may be autistic or suffer fetal alcohol syndrome. "The disregulation model can restore simplicity to what has become a very cumbersome process of diagnosis," says Sue.

"Embarrassingly Broad" Applications

The arousal model, the Othmers say, explains why our society is marinated in brain-altering drugs, licit and illicit. Americans spend about $55 billion a year on legal drugs. Illicit drugs, as well as coffee, nicotine, and alcohol, add billions more. Viewed from the point of view of many of those who practice neurofeedback, most of those drugs are going largely toward one purpose: to moderate the level of arousal. People who are lower on the arousal curve drink coffee to get themselves up, or if they are children, they may poke the kid in the seat next to them to get some stimulating response; while those who are chronically over-aroused move themselves lower with alcohol, for example, or with something more powerful, a prescription drug such as Valium.

The notion that all mental illnesses are the same but occur along a continuum of severity is actually an old idea. What changed that notion was the advent of lithium, a naturally occurring element that worked remarkably well for bipolar or manic depression but nothing else. That view has been rendered an anomaly by a new class of drugs. "Prozac went in the opposite direction," says Sue. "It was embarrassingly broad in its application." It proves, she maintains, that the hairsplitting of the diagnostic model is inadequate. She sees support for her disregulation model and neurofeedback's sweeping approach in the way psychotropics and other drugs are increasingly applied. Prozac, for example, is used to treat not only depression, but also PMS, panic anxiety, eating disorders, obsessive compulsive disorder, ADD, and other problems. Anticonvulsants such as Tegretol, Dilantin, and Neurontin, developed for seizure disorders, are being used for everything from panic attacks to migraines, to chronic pain, to rage and borderline personality disorders.

Many biofeedback practitioners have long advocated--but been widely ignored--that simply prescribing drugs or performing surgeries to treat symptoms is perhaps the greatest shortcoming of modern medicine. If 75 to 90 percent of the visits to primary care physicians are for stress-related problems, allopathic medicine falls terribly short by not treating stress. Giving someone a pill for depression or anxiety, it has been said, and not dealing with the underlying problem, is akin to taking a car that has a red trouble light glowing on the dashboard to a mechanic who simply unhooks the light.

The EEG Spectrum model is a complete and, for a solid-state physicist and a neurobiologist who never completed her Ph.D., seemingly arrogant rewriting of the disease model. And they haven't just rewritten the model, they have said myriad previously untreatable problems are fairly easy to treat. Sue shrugs as if to say, "Can't help it, that's the way it is." "The body has an incredible, innate sense of healing, and neurotherapy exploits that," she says. "Once the brain is shown the way and learns where it functions best, it will stay there. It's all about the nervous system finding its own balance. We're not changing it; we're allowing it to change itself. Acupuncture does the same thing. If you give the brain a chance, it will do what it needs to do and will heal itself. Neurofeedback allows the brain to pause for an instant, and allows it to reset. And doing that is an incredible thing to witness."

Among the people who treat clinically with neurofeedback, the conversations are sometimes startling, almost beyond belief. I attended an EEG Spectrum training seminar on neurofeedback in Seattle. As I listened to Sue Othmer's portion of the talk, I couldn't believe my ears. Every half hour as the lecture subject changed from one health problem to the other, she would say, "Compulsive eating? That's one of the things we do best," for example, or "Anger? That's fairly easy to do," then she would tell which sites to train. During a break, we had lunch in the hotel restaurant, where our waitress greeted us with an extremely high-pitched Betty Boop voice. "SMR would bring that down," Sue said offhandedly. "SMR's effect on relaxing muscles can bring down the tone." It sounds almost preposterous, even to people who understand neurofeedback. I brought that up to Sue. "After a very short time you stop wondering whether this works," she said, "and realize the challenge is how to optimize and manage the powerful effects."

Still, it is tempting to agree with the criticism of the expansive claims. In spite of the research, in spite of the testimonials, I probably would have dismissed all of this and gone on to other things had I not experienced it firsthand in a dramatic way. When I was doing research for a Psychology Today story, I did about 15 sessions of C-3 beta, C-4 SMR. (It is fairly easy to do. Spectrum shipped me a loaner instrument, and with help over the phone, I set the equipment up and was able to start doing sessions in just a few hours.) As I started to near my eleventh half-hour session, I gradually noticed my energy level increasing. My mood was more buoyant. I started sleeping more soundly. I started waking up in the morning right away, without the usual attendant fogginess and the urge for another cup of coffee. I could work much longer without wearing out. The differences were dramatic. Yet I also felt this coldness coming over me, a kind of emotional detachment that I found unpleasant. I mentioned it to Sue. "Oh, too much left-side training," she said, immediately. Sure enough, more right-side training "warmed me up," as they say, as my emotional feelings started to return. I started turning up the frequency on the right to avoid sleepiness--from the window of 12 to 15 hertz, up half a hertz at a time. As I got up in the 14-to-17 range, it amped me up something fierce, especially right after I finished. I remember leaving the house after a session and driving to the grocery store, and my internal monologue was chattering away a mile a minute. Sue laughed when I called. "Too high," she said. "Walk the frequency back down." I did, and it fixed the problem.

Repairing the Criminal Brain

So neurofeedback is off and running, being used for all manner of things. Perhaps the place where neurofeedback will make the most dramatic difference, and where it already shows tantalizing promise, is in the area of treating criminal behavior.

A growing body of evidence, made possible by a new generation of brain imaging, shows that in many cases neurological damage is at least partially responsible for criminal behavior, perhaps far more than we realize. Dr. Dorothy Otnow Lewis is a psychiatrist at Bellevue Hospital in New York and a professor at New York University School of Medicine who has pursued the brain-crime link for years. She and Jonathan Pincus, a neurologist at Georgetown University, have published a series of groundbreaking studies that demonstrate a link between violent behavior and damage to the brain from abuse and accidents. The relationship began in 1976 when Lewis received a grant from the state of Connecticut to examine one hundred juvenile delinquents. She strongly believed that damage to the brain was responsible for delinquency and asked Pincus to help her by giving each of the kids a neurological examination. It was a defining moment for Pincus. At the time, he told The New Yorker magazine in 1997, he thought there was no connection between neurology and behavior. "After seeing the kids for himself," author Malcolm Gladwell wrote, "Pincus, too, became convinced, that the prevailing wisdom about juvenile delinquents--and, by extension, about adult criminals--was wrong and that Lewis was right. 'Almost all the violent ones were damaged,' Pincus recalls, shaking his head."

If neurofeedback can truly heal damaged parts of the brain that control key functions, such as the prefrontal cortex, it would stand to reason that some criminals should benefit from the technique. That was the belief of Douglas A. Quirk, a Ph.D. psychologist at the Ontario Correctional Institute near Toronto, who passed away a few years ago. He started working with biofeedback in 1959, using galvanic skin response, alpha brain wave training, and eventually Sterman's SMR protocol to treat several hundred epileptics. For the last 20 years of his life, he treated inmates at the correctional center. Quirk came to believe that certain types of violent behavior originated in a kind of epileptic burst in a deep part of the brain called the drive center. "If separate parts of this area are stimulated electrically, the animal subject responds as though it was experiencing rage, sexual arousal, hunger, satiety, or pleasure reinforcement," Quirk wrote. "If electrical stimulation of the drive center were to be achieved in ambulatory human subjects, it seems possible that the results might include dangerous or uncontrolled behavior; that is, acts unregulated by the usual organizing effects of conscious cortical processing. Depending on the location stimulated, the actions might include 'blind rages' (assaults, malicious damage?), inappropriate sexual acts (sex offenses?), unexplained over or under eating, or escalating violent or addictive behaviors…Nature and accident have arranged for just such electrical stimulation in some human subjects. These are people who are subject to deep-brain epileptic events."

Seizures are, of course, where neurofeedback was born and where its efficacy has best been demonstrated. Quirk identified 77 convicts who he felt were victims of this kind of pathology, resulting from head injury or abuse. He trained them using a varying number of sessions, from none to 34 or more, using both galvanic skin response and SMR. A year and a half after they got out of prison, Quirk found that those who had received zero to four sessions had a 65 percent rate of re-arrests for violent offenses, while those who received 34 or more sessions had a 20 percent rate of recidivism.

Another approach to treating violent offenders involves a model of emotional development known to professionals as attachment disorder, a pathology that begins as soon as a child is born. For critical normal development of the brain, an infant needs what some professionals call a somatosensory bath and others call love--hugging, talking to, rocking, cooing, holding, and other kinds of personal contact with a parent or other care giver. Such affection apparently builds robust connections between cells in the brain and establishes pathways, especially among those that govern emotions. A deficiency in the appropriate contact can cause emotional and even physical problems later in life. In one study, brain scans of neglected children show that 20 percent of the prefrontal cortex fails to develop properly. In another study of attachment, a researcher brought in well-bonded babies. He separated infant and mother in the same room and asked the mother not to respond to vocalizations or other attempts to recruit the mother, and he filmed the results. "Within thirty or forty seconds that baby is crying or anxious, showing all the classic signs of anxiety," says Sebern Fisher, a therapist who specializes in the treatment of attachment disorder with neurofeedback in Northhampton, Massachusetts. "This is a baby that has reason to believe that he's going to be responded to. Imagine that neglect happens as the routine. What then happens to the baby? The arousal system keeps cranking up, but there's no response. At some point the organism can't stand it anymore. After three or four months it shuts off. The light is gone. The yearning ends."

The child becomes numb physically or emotionally in the interest of his or her own survival, and the extent of this numbness borders on the unbelievable. Children with severe attachment disorder may be so deadened physically they will break a bone and not realize it, or they will eat until they throw up because they cannot tell when they are full, or they will go out into bitter cold without a coat and get frostbite and not know it. The emotional symptoms are even more troubling. They are often sadistic and violent, torturing cats and starting fires and visiting cold-blooded violence on other people. They are aggressive and antisocial and have been dubbed "children without conscience." A high proportion of them will go on to become criminals.

Fisher, who spent 12 years as the clinical director of a residential home for severely disturbed children, believes neurofeedback is a powerful way to intervene in this pathology. "With attachment disorder there is not an adequate amount of right hemisphere development," says Fisher, referring to the emotional, feeling side of the brain. "Postmortem work or MRIs show that antisocials tend to have smaller right hemispheres, while normals have slightly larger right hemispheres. The circuits aren't live. There are fewer synapses that develop, less blood flow. If the emotional apparatus doesn't come on line in that first year [with the somatosensory bath], we don't have a technique--outside this one--that I know of that can bring it on line." Fisher hooks up and trains the right brain to stimulate the reestablishment of the networks that regulate the emotions.

"You can start to get an empathic response if you train on the right side, sometimes right away. If you train too much on the left side, you get a cold, detached person, and their sense of attachment is gone." The number of cases of attachment disorder treated is no more than a handful, but changes seem dramatic. The changes are physical as well as psychological, a profound illustration of the mind-body connection.

A young woman from India, who had been raised in an orphanage, came to see Fisher for such a problem. "I remember she was sitting across from me at the mental hospital," says Fisher. "Sitting is a loose term. She could not bear to be in her skin. She was on lithium and an antianxiety agent. She was physiologically a mess. Every measure for disregulation that EEG Spectrum puts out, she met. Everything. ADD, constipation, incontinence, sleep. Every single measure. Physically and emotionally. She was skating along on the top of nothingness, a basket case in every way."

Within 30 sessions profound changes were happening. "She started to warm up. Started making eye contact, having some internal awareness. She started to have normal bowel movements. She had been constipated for years. Her lithium dose dropped. She stopped drinking alcohol, very fast." After more than 100 sessions of SMR training, Fisher says, "everything dropped away. Her bipolar illness, her ADHD, her PTSD, her alcoholism.

Seeking Peak Brain Performance

EEG biofeedback is even more controversial when the subject of autism, fetal alcohol syndrome (FAS), and other similar types of brain damage comes up. At most several dozen cases of autism have been treated with neurofeedback, and many of them have turned around dramatically. Steve Rothman, a psychologist in Bellevue, Washington, who leases neurofeedback machines to people for home use, has treated six cases of autism and sixteen cases of FAS. Eighty percent of his FAS patients have made substantial gains, he says, and five of the six autism cases he treated also showed dramatic, and apparently long-lasting, gains.

Rothman expects skepticism about such claims. But he says that results he obtained are fully what he expected to happen. The things that parents report "are extremely consistent with what we would expect to happen with this technology," he says. "Better sleep. More vocalization. Less shyness. You can predict outcomes with this model, and for me that's a compelling argument for its efficacy."

While neurofeedback serves as a treatment for any number of problems, it is also widely used by people who have no problem per se but simply want to enhance normal function. A cross section of sports and other high-performance professions are beginning to use the technique.

Rae Tattenbaum has an advanced peak performance program that utilizes brain wave training in her office in West Hartford, Connecticut. A clinical social worker, Tattenbaum worked for 10 years as a specialist in the use of technology in education and health care for Northern Telecom. She got so interested in neurofeedback that she quit her job a few years ago to devote full time to it, combining it with her other interest: singing.

Tattenbaum will treat anyone to optimize what he or she does, but she specializes in training opera singers to enhance their performance, and she is on the faculty of the Voice and Theater Department at the Hartt School in West Hartford, Connecticut. Tattenbaum borrows from several practitioners to create a treatment tapestry that clients say works very well. She starts out with 20 sessions of SMR 12-to-15-hertz training on the right side, which centers and relaxes a person and, she says, strengthens the ability to be in the present, which keeps performance anxiety down. Training 12 to 15 hertz keeps them more firmly planted in that frequency and less likely to drift accidentally into theta. "The theta range [the subconscious] is where the fear of performance lies," Tattenbaum says. "That's where childhood fears are. I don't let them go there. I keep the inhibit tight, to keep them from drifting into theta. And because of that, they can focus better on what they are doing." Because working on the right brain causes a rise in emotional feelings, she says, the SMR brings up feelings of empathy. "We're opening them up to be able to get in touch with the passion of the song," she says.

One singer who benefited from the training is Robin Blauers, who also teaches at Hartt. Thirty-five years old, she has been singing since she was eight years old. "I noticed that I couldn't be present as a performer," she says. "I used to feel that I was outside myself, watching and judging. I could never fully be present. It's like driving a car. You arrive at your destination but on automatic pilot, and you don't remember driving there." A year of training, she says, changed that. "I did a recital last July, and it was the first time I really enjoyed myself because I was present in the moment. The training gave me an overall sense of well-being that I didn't have before, whether I am singing or at work. I can step back, take a deep breath, and focus on things much better." She still does the training, she says, and she loves it. "After an hour of training, I feel like I just slept for twelve hours."

Professional golfer Ed Galvan says that neurofeedback dramatically changed his golf game. The 40-year-old Galvan, of Alhambra, California, is a self-confessed golf addict who started competitive play in 1987 and plays regularly in tournaments in Asia, Australia, and southern California. The training has taken three strokes off his game, he says, and was the reason that he was ranked in the top 20 in the southern California section of the PGA of America. It hasn't changed his income from golf, he says, which was $26,000 in 1998. But that doesn't matter. "It's eliminated the head trips and taken my game to the next level," he says. "I'm definitely much more relaxed. When you play golf, too many thoughts come into your head--doubts about your skills or where the troubles lies, a lake or out of bounds. What EEG [training] does is develop the brain to maintain a thought for a longer period of time. I can focus on the target line, where I want to hit the ball. It's turning everything else off and being in that one line. It's a whole new level of concentration. People say they are concentrating, but I don't think most people know what concentration really is."

There are also a few of the old-time alpha guys--Jim Hardt and Adam Crane among them--who insist that the early claims that alpha training is a shortcut to the goal of transcendence and enlightenment are very real.

"It's interesting that brain wave training--alpha in particular--can get people off of drugs and alcohol, can replace depression with sadness and joy, can open people's hearts with love," says Hardt. "But the single reason I have tenaciously pursued this for over thirty years is that it leads to transcendent experiences. In the early years, the rate of profound spiritual experiences was somewhere between one in ten or twenty. Occasionally, someone who was really ready would have a profound experience. While that was exciting, it was also frustrating because my mission was to bring this to everyone. As I've improved the equipment and the protocols, now we have three out of five having experiences like that."

Gift of the "Lost Tribe"

There are a host of low-tech things that can be integrated into neurofeedback treatment. In April of 1999, for example, the results of a well-designed study conducted at Harvard on 44 bipolar patients were released. In addition to their regular medication they were given omega-3 fatty acids-oil derived from fish. Omega-3 fatty acids are vital to proper functioning of cell membranes. According to an article in the Washington Post, the experimental group did so much better than the control group that after four months the experiment was stopped mid-way and all of the patients were given fish oil. It is the latest of several very positive studies of the effects of specific types of fat on the brain. Some clients who do neurofeedback training for bipolar or other problems of stability, therefore, also take Omega-3, which is obtainable at any health food store.

New diagnostics have already begun to hone the way neurofeedback is applied. Now QEEG research shows that there are at least three or four different subtypes of ADHD, for example, that have origins in different parts of the brain. "That means we won't be treating all ADHD the same," says Sterman. "The training will become much more specific rather than training everyone the same." Joel Lubar, meanwhile, is experimenting with something called LORETA, low resolution electro-magnetic tomography, which, with the use of very fast computers, will allow QEEGs to read the brain's deep cortical and subcortical regions, and may allow the client to train those areas directly, rather than indirectly through the cortex, which should make the protocol much more powerful.

Is it possible? Has a forgotten, somewhat eccentric lost tribe of biofeedback devotees been laboring away, beneath our noses, to develop a powerful way to heal humankind of some of its most intractable social, personal, and economic problems? Have we begun to harness the incredible power of the human mind? Is the brain far, far more plastic than science has proven? Can we use our will to change our biology, to get a personality makeover? Is it this easy, this mechanical, to change the human brain, to erase anxiety and fear and stress as if they were words written on a chalkboard? Has brain wave training returned from a near-death state to spark a true revolution of the mind and brain that will change the whole game: our assumption about who we are, what we have to live with, and who we have to be?

I don't know. I know that in my case brain wave training gave me back a part of my life that chronic fatigue syndrome had taken away and traditional medicine could not treat. Others tell similar stories. But the true scope of brain wave training is a big question that remains to be answered. "Research will tell us for whom it works and under what conditions," says Chris Carroll.

Many in the business, however, believe neurofeedback will dramatically change the landscape of health care. Moreover, the imprisoned right brain could well throw off the shackles of the left, according to Siegfried Othmer. "The last one hundred years has been the century of the left hemisphere," he says, referring to its analytical, rational nature. "It's put science in charge and the rest of us in awe of it, and it defined for us the 'pinnacle of intellectual experience.'" And it diminished the rest of human experience [feelings and emotion] by comparison. It did it at the expense of the right brain. Neurofeedback will help bring about the rise of the right hemisphere to effect a rebalancing.

Biofeedback has been down the road of fantastic, miracle claims once before, of course, in the 1970s. The difference this time is that there are many more people practicing it, using much more sophisticated equipment, getting replicable results and predictable changes. At the very least, these results strongly suggest that the academic bias against behavioral medicine in general and biofeedback in particular be dropped. The sullied reputation that biofeedback got in the 1970s needs to be buried once and for all and the technique honestly evaluated. The research is admittedly thin, but the clinical outcome studies are overwhelming, and those, combined with the predictability of the model, anecdotal information, and the reputations of many of those involved, are extremely compelling. There is precious little else to effectively treat the wide spectrum of problems that neurofeedback purports to treat. Biofeedback needs a second look. Research desperately needs to be funded.

One of the most exciting things of all is that the field is in its infancy. Each of the neurofeedback pioneers has taught the brain, in his or her own way, to play a piece of music. But no one has brought all of the instruments and players and music together. That grand and complicated and beautiful piece of music has yet to be played.