Neurofeedback — Retraining the Brain
Neurofeedback, a type of biofeedback also known as “brain biofeedback” or “EEG (electroencephalogram) biofeedback,” is an alternative therapy that began in the 1920s but gained popularity in the late 1960s and early 1970s. It offers another option for treatment of OCD.
Neurofeedback is a painless method whereby, after an evaluation by a trained clinician, one or two sensors (electrodes) are attached to the scalp (usually by a special paste) and the patient is seated in front of a computer. These electrodes are connected to an amplifier, which relays the patient's brainwave activity to the monitor. On the screen is a program that resembles a video game. The brainwave activity alone drives the game.
There are many kinds of games from which to choose; sometimes the patient selects which one he would like to use. Typical images include scenes that resemble driving down a placid highway or watching the scenery on a tranquil tropical island. However, the game is played solely with one's brain! The patient is not expected to do anything other than calmly focus on the screen, and is not connected to the computer except by the sensors on the head.
Does neurofeedback hurt?
No. The electrodes or sensors only measure brainwave activity; they do not apply any electrical impulse. And they certainly don't read thoughts, as some anxious patients have wondered.
The computer measures the patient's brainwave activity, and some kind of reward — a pleasing image, game points, or a sound — usually accompanies any increase in calm, focused brainwaves. As the session progresses, the clinician observes the patient's brainwave activity and adjusts the reinforcement as necessary. Practitioners say this process reduces the repetitive, obsessional quality of thought known as “brain lock.”
Over time — perhaps twenty to thirty half-hour sessions, sometimes more — the patient's brainwave activity should show a significant reduction in anxiety. (Repetition is necessary, as this form of “brain exercise” needs consistent reinforcement, just like physical exercise at the gym.) Gradually, the patient should be able to attain that state of calm on his own whenever needed.
Neurofeedback has not been definitively proven to reduce anxiety and OCD symptoms, but has so far shown promise, and there is anecdotal and case report evidence to support its use. Many therapists are enthusiastic about this option, which is also used to treat attention deficit hyperactivity disorder (ADHD), epilepsy, and other neurological and behavioral conditions. At least one recent study showed benefits retained at 10 years post-treatment for ADHD, and many other patients have seen lasting gains.
Essential
In rare cases, neurosurgery might be considered for OCD. This option is almost always reserved for severe cases that do not respond to medication, CBT, or anything else. New techniques have made it possible to reduce the incidence of infection and other post-surgical complications, and are said to be painless. However, surgery can carry a risk of undesirable side effects.
As of this writing, most health plans do not cover neurofeedback alone, as the process is considered experimental. However, many will agree to cover it under the general procedure code for biofeedback. Some will pay for the treatment when it is done in conjunction with more traditional psychotherapy.
This option may be a good one for people who are phobic about medications or unable to take them because of medical or physical conditions, including pregnancy or breastfeeding. Neurofeedback has no known lasting side effects, although some patients may feel a little “spacey” or experience other mild symptoms, such as fatigue, for perhaps an hour after the session.
