qeeg & neurofeedback brain training - noap€¦ · neurofeedback defined like other forms of...

qEEG & Neurofeedback Brain Training

qEEG & Neurofeedback Brain Training

Karen Dodge, PhD, MSPH, MSW

Course Outline

Handouts!

� Definition of NFB

� Introduction to qEEG guided Neurofeedback

� Explanation of qEEG evaluation/Measures

� Explanation of the Neurofeedback Intervention or Brain Training TX

� The business end of qEEG NFB

Neurofeedback Defined

� Like other forms of biofeedback, NFT uses monitoring devices to provide moment-to-moment information to an individual on the state of their physiological functioning

� The characteristic that distinguishes NFT from other biofeedback is a focus on the Central Nervous System

� NFT has its foundations in basic and applied neuroscience as well as data-based clinical practice.

� It takes into account behavioral, cognitive and subjective aspects as well as brain activity (ISNR, 2014)

� It works on Operant Conditioning

D.Corydon Hammond, “What is Neurofeedback” Journal of Neurotherapy, Investigations in Neuromodulation, Neurofeedback and applied Neuroscience” 10.4 (2007) : 25-36. DOI 1300/J184v10n04_04

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Neurofeedback is considered an integrative approach and works well with other modalities; it provides more complete TX

� Group therapy� Individual Therapy� Family Reconstruction� Psychiatry/Medication� Psychology/testing and roll out of talk therapy� Hypnosis� EMDR� Exposure� Breath/Body work/DBT� 12-Step

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Coburn et al., “The Value of Quantitative Electroencephalography in Clinical Psychiatry: A Report by the Committee on Research of the American Neuropsychiatric Association” The Journal of Neuropsychiatry and Clinical Neurosciences 18 (2006):460-500

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A step-wise explanation of qEEG-guided neurofeedback

� Orientation/SCL� Acquire EEG, convert into qEEG; set up SCL� Set up file Structure; add Excel capacity� Brain Mapping Surface Z scores; LORETA & 3-D� Develop Protocols (guided by symptoms and metrics for a custom TX. in a hybrid format)

� Report Creation sent to therapists to mull over� Select issues to be addressed working w/ primary DX., first

� First 10 sessions of NFB Brain Training� Brain Mapping again to indicate progress and changes� Second 10 sessions of NFB Brain Training for another symptom using custom protocol

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John N. Demos, Getting Started with Neurofeedback , New York: W.W. Norton & Company Inc (2005)

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Current Problems or Symptoms SEVERITY (1 to 10)

Age Started If severity >3

Optional CommentUse back if necessary

Denial of a problem

Attention Deficits- Easily distractible, etc

Auditory sequencing (listening & putting things in correct order)

Balance Problems

Blurred Vision

Chronic Pain

Compulsive behaviors and/or thoughts

Decreased tactile (touch) or skin sensitivity

Delusional (distorted or fixed idea(s))

Depression (sad or blue)

Difficulty understanding social cues

Difficulty calculating e.g., math

Dyslexia- letter reversal

Executive Function problems (judgment, decision making, self monitoring, organizing, etc.)

Face Recognition Problems

Failure to initiate action

Generalized Anxiety

Hyperactive and/or agitation

Impulsive Behaviors

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What is a qEEG?

� A qEEG (quantitative Electroencephalography) is a computer generated analysis of EEG data, providing information about cortical timing.

� The analysis provided identifies variations from the norm/average as compared to a normative database.

Robert W. Thatcher Ph.D, “LORETA Z Score Biofeedback” Neuroconnections (2010)4

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John R. Hughes,MD, Ph.D and E. Roy John, Ph.D, “Conventional and Quantitative Electroencephalography in Psychiatry” The Journal of Neuropsychiatry and Clinical Neurosciences 11 (1999):190-208

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Fig. 1 – Example of conventional digital EEG (left) and qEEG (right) on the same screen at the same time.The conventional EEG includes examination and marking of EEG traces and events. The qEEG (right)includes the Fast Fourier Transform (Top right) and normative database Z scores (Bottom right).

qEEG Measures 6

Thatcher Ph.D et al, “Z-Score EEG Biofeedback: Technical Foundations”www.appliedneuroscience.com6

Brain Mapping Measures Used7


Robert W. Thatcher Ph.D, “LORETA Z Score Biofeedback” Neuroconnections (2010)

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Structure and FunctionBrodmann Areas

Location Functions Right Hemisphere

Left Hemisphere

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Supramarginal Gyrus/ Somatosensory

Economic decisions, (bilateral) goals, pain, conscious awareness of visual spatial events (bilateral), activation at rest- default mode network (bilateral)

Personal space, estimate, meta-emotions, mental rotation, stereopsis, Line bisection judgments, Visuospatial attentionRetrieval of words

Recall episodes, tool use, handwriting, spelling, shift attention, language, literalness, imageability

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Robert W. Thatcher, Ph.D and E.Roy John. Foundations of Cognitive Processes. New Jersey: Lawrence Erlbaum Associates, Inc. Publishers: 1997, 1-5.9

NFB Treatment

� Operant Conditioning

� The Mechanism of rewards lies within each individual and is different for everyone

Biological Correlates of Operant conditioning: The highlight neurochemicals

� Acetylcholine

� Norepinephrine

� Dopamine

� Serotonin

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How does it work, again?

� Looney Tunes

Simply put, Neurofeedback,

Exercises your brain!And addresses

resistance

How long is a typical session?11


Reward Network

Makris et al., “Decreased Volume of the Brain Reward System in Alcoholism” Biological Psychiatry 64.3 (2008) 192-202, doi10.1016/j.biopsych.2008.01.018

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Robert W. Thatcher, Ph.D and E.Roy John. Foundations of Cognitive Processes. 26-30.13

Decision making14

Kenji Doya, “Modulators of Decision Making” Nature Neuroscience 11 (2008) 410-416. doi 10.1038/nn207714

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Eric J. Nestler and Robert C. Malenka. “The Addicted Brain” Scientific American 290 (2004) 78-85, doi 10.1038/scientificamerican0304-7815

Neuroplasticity

� Refers to the brain’s ability to change

� The brain’s plasticity is strongest during childhood

� Neuroplasticity impacts our ability to learn and change behaviors

� qEEG-guided NFB changes neuroplasticity

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Jordan Grafman, “Conceptualizing Functional Neuroplasticity” Journal of Communication Disorder 33.4 (2004)345-356, doi 10.1016/s0021-9924(00)00030-7

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Neurons and Axons17

Robert W. Thatcher, Ph.D and E.Roy John. Foundations of Cognitive Processes. 1-10.17

NeurotransmitterDistribution in the Central

Nervous SystemFunctions Affected

Drugs That

Affect It

Dopamine Midbrain, Ventral tegmental

area (VTA), Cerebral cortex,

Hypothalamus

Pleasure and reward

Movement, Attention, Memory

Cocaine, Methamphetamine,

Amphetamine. In addition,

virtually all drugs of abuse

directly or indirectly augment

dopamine in the reward

pathway

Serotonin Midbrain, VTA, Cerebral cortex,

Hypothalamus

Mood, Sleep, Sexual desire,

Appetite

MDMA (ecstasy), LSD, Cocaine

Norepinephrine Midbrain, VTA, Cerebral cortex,

Hypothalamus

Sensory processing,

Movement, Sleep, Mood,

Memory, Anxiety

Cocaine, Methamphetamine,

Amphetamine

Endogenous opioids (endorphin and enkephalin)

Widely distributed in brain but

regions vary in type of

receptors, Spinal cord

Analgesia, Sedation, Rate of

bodily functions, Mood

Heroin, Morphine, Prescription

painkillers (Oxycodone)

Acetylcholine Hippocampus, Cerebral cortex,

Thalamus, Basal ganglia,

Cerebellum

Memory, Arousal, Attention,

Mood

Nicotine

Endogenous cannabinoids (anandamide)

Cerebral cortex, Hippocampus,

Thalamus, Basal ganglia

Movement, Cognition and

memory

Marijuana

Glutamate Widely distributed in brain Neuron activity (increased

rate), Learning, Cognition,

Memory

Ketamine, Phencyclidine,

Alcohol

Gamma-aminobutyric

acid (GABA)

Widely distributed in brain Neuron activity (slowed rate),

Anxiety, Memory, Anesthesia

Sedatives, Tranquilizers,

Alcohol22

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Efficacy of qEEG NFB for SUDs

18 Robert W. Thatcher, Ph.D and E.Roy John. Foundations of Cognitive Processes. 26-30.

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Scott et al., “Effects of an EEG Biofeedback Protocol on a Mixed Substance Abusing Population” The American Journal of Drug and Alcohol Abuse 31.3 (2005): 455-469

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How Important is combining qEEG with neurofeedback?

� A qEEG report provides information that can help a professional target neurofeedback training.

� Combining the qEEG and analyzing the EEG can display information about a person’s brain problem and can speed the efficacy of neurofeedback training.

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Robert W. Thatcher, Ph.D. “Neuropsychiatry and Quantitative Electroencephalography (qEEG) in the 21St Centruy” Neuropsychiatry (2011)20

Can a clinician use a qEEG without specific training or experience?

� There is a big learning curve when learning to apply information from a qEEG.

� Some decide to learn the qEEG and neurofeedback at once or to rely on experts who can provide an analysis of the qEEG and how to combine it with neurofeedback.

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Do I need to buy special qEEG equipment?

� Yes- one can buy special equipment or one can send a client to a location that can record the EEG for you, although not all equipment is compatible with neurofeedback-oriented qEEG’s. �CR has the equipment in-house. �It is called a NeuroField amplifier and we use NeuroGuide as our statistical program. Both are FDA registered!

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Can a clinician attempt to learn neurofeedback training and qEEG at the same time?

� One can do this, but the learning curve for both concepts is very steep, so it is recommended that a clinician learn the basics of neurofeedback first, followed by learning the qEEG.

Thatcher Ph.D et al, “Z-Score EEG Biofeedback: Technical Foundations”www.appliedneuroscience.com

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Is there insurance reimbursement?

� There are two main billing codes: 95816 for the EEG and 95957 for the analysis of the EEG. Professional interpretations are billed with the same codes but with the trailer “-26.”

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“New Guidelines for Third Party Reimbursement for Biofeedback”, Applied Psychophysiology and Biofeedback, accessed September 2014 http://www.aapb.org/i4a/pages/index.cfm?pageid=3387

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Do qEEG’s improve client compliance?

� According to several clinicians, the qEEG adds credibility and has improved client motivation to stick with the neurofeedback program. �Neurofeedback training enhances patient’s longevity in most intervention modalities particularly with our pt. population as was documented in a RCT performed in 2005 at UCLA with a primary SUD sample of approx. 200 pts (Scott, 2005)

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E. Roy John Ph.D and Leslie S. Prichep, “The Relevance of qEEG to the Evaluation of Behavioral Disorders and Pharmacological Interventions” Clinical EEG Neuroscience 37.2 (2006) 135-143 doi10.1177/155005940603700210

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Who should qEEG NFB be recommended to?

This should be based on judgment, but some recommendations of situations to be considered are:

� SUDs�TBI/Stroke/Head injury�Rage disorders�Depression�Anxiety� Seizures� Long, difficult psychiatric/medical history with little response to many medications� Suicidal depression� Existing neurofeedback client who is making little or no progress within 8-15 sessions

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John R. Hughes,MD, Ph.D and E. Roy John, Ph.D, “Conventional and Quantitative Electroencephalography in Psychiatry” The Journal of Neuropsychiatry and Clinical Neurosciences 11 (1999):190-208

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References

� Apkarian, A. V. Functional magnetic resonance imaging of pain consciousness: cortical

� networks of pain critically depend on what is implied by “pain”. Curr. Rev. Pain 3, 308–

� 315 (1999).� Buzsaki, G. (2006). Rhythms of the Brain, Oxford Univ. Press, New York.� Cannon, R., Lubar, J., Thornton, K., Wilson, S., & Congedo, M. (2005) Limbic beta� activation and LORETA: Can hippocampal and related limbic activity be recorded

and� changes visualized using LORETA in an affective memory condition? Journal of� Neurotherapy, 8 (4), 5-24.� Cannon, R., & Lubar, J. (2007). EEG spectral power and coherence: Differentiating� effects of Spatial–Specific Neuro–Operant Learning (SSNOL) utilizing LORETA� Neurofeedback training in the anterior cingulate and bilateral dorsolateral

prefrontal� cortices. Journal of Neurotherapy, 11(3): 25-44.� Cannon, R., Lubar, J., Sokhadze, E. and Baldwin, D.

References

� John, E. R., Prichep, L. S. & Easton, P. (1987). Normative data banks and neurometrics:

� Basic concepts, methods and results of norm construction. In A. Remond (Ed.),� Handbook of electroencephalography and clinical neurophysiology: Vol. III. Computer� analysis of the EEG and other neurophysiological signals (pp. 449-495). Amsterdam:� Elsevier.� Lubar, J., Congedo, M. and Askew, J.H. (2003). Low-resolution electromagnetic

� tomography (LORETA) of cerebral activity in chronic depressive disorder. Int J� Psychophysiol. 49(3):175-185.� Luria, A. The Working Brain. Penguin Press, London ISBN 0 14 080654 7� Thatcher, R.W., North, D., and Biver, C. Evaluation and Validity of a LORETA� normative EEG database. Clin. EEG and Neuroscience, 2005b, 36(2): 116-122.

� Thatcher, R.W. and Collura, T. Z Score Biofeedback and New Technology.� International Society of Neuronal Regulation Annual Meeting, Atlanta, GA, September� 16-21, 2006.� Thatcher, R.W., North, D., and Biver, C. Self organized criticality and the development

� of EEG phase reset. Human Brain Mapp., Jan 24, 2008a.� Thatcher, R.W., North, D., and Biver, C. Intelligence and EEG phase reset: A twocompartmental� model of phase shift and lock, NeuroImage, 42(4): 1639-1653, 2008b.� Thatcher, R.W. and Lubar, J.F. History of the scientific standards of QEEG normative� databases. In: Introduction to QEEG and Neurofeedback: Advanced Theory and

� Applications, T. Budzinsky, H. Budzinsky, J. Evans and A. Abarbanel (eds)., Academic� Press, San Diego, CA, 2008.� Thatcher, R.W., North, D., Neurbrander, J., Biver, C.J., Cutler, S. and DeFina, P. Autism� and EEG phase reset: Deficient GABA mediated inhibition in thalamo-cortical circuits.� Dev. Neuropsych. (In press, 2009).

References

� D.Corydon Hammond, “What is Neurofeedback” Journal of Neurotherapy, Investigations in Neuromodulation, Neurofeedback and Applied Neuroscience 10.4 (2007)25-36 doi.10.1300/J184v10n04_04

� Kerry L.Coburn Ph.D, Edward C.Lauterbach MD, Nash N. Boutros MD, Kevin J. Black MD, David B. Arciniegos MD and C. Edward Coffey MD, “The Value of Quantitative Electroencephalography in Clinical Psychiatry: A Report by the Committee on Research of the American Neuropsychiatric Association” The Journal of Neuropsychiatry and Clinical Neurosciences 18 (2006):460-500

� John N. Demos, Getting Started with Neurofeedback , New York: W.W. Norton & Company Inc (2005)

� Robert W. Thatcher Ph.D, “LORETA Z Score Biofeedback” Neuroconnections (2010)

� John R. Hughes,MD, Ph.D and E. Roy John, Ph.D, “Conventional and Quantitative Electroencephalography in Psychiatry” The Journal of Neuropsychiatry and Clinical Neurosciences 11 (1999):190-208

� Robert W. Thatcher Ph.D, Carl J. Biven Ph.D and Duane M. North, MA, “Z-Score EEG Biofeedback: Technical Foundations”www.appliedneuroscience.com

� Robert W. Thatcher, Ph.D and E.Roy John. Foundations of Cognitive Processes. New Jersey: Lawrence Erlbaum Associates, Inc. Publishers: 1997.

� Nikos Makris, Marlene Oscar- Berman, Sharon Kim Jaffin, Steven M. Hodge, David N. Kennedy, Verne S. Caviness, Ksenija Marinkovic, Hans C. Breiter, Gregory P. Gasic and Gordon J. Harris, “Decreased Volume of the Brain Reward System in Alcoholism” Biological Psychiatry 64.3 (2008) 192-202, doi10.1016/j.biopsych.2008.01.018

� Eric J. Nestler and Robert C. Malenka. “The Addicted Brain” Scientific American 290 (2004) 78-85, doi 10.1038/scientificamerican0304-78

� Jordan Grafman, “Conceptualizing Functional Neuroplasticity” Journal of Communication Disorder 33.4 (2004)345-356, doi 10.1016/s0021-9924(00)00030-7

� Robert W. Thatcher, Ph.D. “Neuropsychiatry and Quantitative Electroencephalography (qEEG) in the 21St Centruy” Neuropsychiatry (2011)

� “New Guidelines for Third Party Reimbursement for Biofeedback”, Applied Psychophysiology and Biofeedback, accessed September 2014 http://www.aapb.org/i4a/pages/index.cfm?pageid=3387

� E. Roy John Ph.D and Leslie S. Prichep, “The Relevance of qEEG to the Evaluation of Behavioral Disorders and Pharmacological Interventions”Clinical EEG Neuroscience 37.2 (2006) 135-143 doi10.1177/155005940603700210

� Kenji Doya, “Modulators of Decision Making” Nature Neuroscience 11 (2008) 410-416. doi 10.1038/nn2077

� William c. Scott, David Kaiser, Siegfried Othmer and Stephen I. Sideroff. “Effects on an EEG Biofeedback Protocol on a Mixed Substance Abusing Population” The American Journal of Drug and Alcohol Abuse 31.3 (2005):455-469

qeeg & neurofeedback brain training - noap€¦ · neurofeedback defined like other forms of...

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