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Combining Neurofeedback with Psychotherapy to
Optimize Success

By Leo Leiderman, Psy.D.,ABPP,CGP

The psychotherapy and neuroscience fields provide a great window into the powers of human nature when we understand the interconnectedness between the mind and body. Many problems such as chronic anxiety, panic, verbal tics, anger disorders, insomnia and headaches originate in the brain when the fight/flight/freeze stress reaction is stuck in gear. Our brains are highly influenced by neuroelectrical activity in terms of communication between different parts of the brain. The brain depends on the effectiveness of neuroelectrical activity and connections like a telephone and computer depend on electricity to function. When our brains are functioning optimally we can easily access or “shift gears," like the transmission of a car, from different brain wave frequencies and from one part of the brain to another.

Problems with neuroelectrical activity are evidenced at times by too much or too little neuroelectrical activity in the brain. We overtly experience physical distress reactions, emotional terror and/or despair when this occurs. Overwhelming physiological, cognitive and behavioral symptoms may take over and dominate one’s ability to be in the moment. Often individuals are trapped in a fight/flight reaction that is activated by the brain at times when no present danger exists to that individual. Being in such a heighted state of alert, individuals are without the resources to internalize the help they desperately need.  

The roots of  neurofeedback date back to the 1960’s when Sterman, a psychologist, was working on a program for NASA to help control seizures in astronauts. Neuropsychologists have observed that many seizure disorder patients had simultaneous hyperactivity conditions and became calmer with neurofeedback treatment. That led to other psychologists developing protocols to alleviate hyperactivity and other attention deficit disorders. Seizure disorder conditions have special relevance and responsiveness to neurofeedback because they affect the brainwaves that neurofeedback measures.

Neurofeedback is a therapeutic intervention that:

  • is highly effective in addressing the most intractable mental health and physiological conditions.
  • provides more flexibility in brain structures and networks.
  • enhances the activation of the calming part of our nervous system responsible for relaxation, sleep and digestion.
  • allows access to parts of the nervous system which were not accessible previously; thereby activating brain functions that provide greater self-control, emotional awareness and expression.
  • when used in conjunction with psychotherapy, reduces overwhelming physiological symptoms and helps patients attain greater emotional stability thus enabling them to benefit more from therapy.

What is Neurofeedback?
Neurofeedback is a type of biofeedback. It utilizes software that provides visual and auditory feedback, to teach the brain how to regulate itself. What we have learned, is that when the brain is given access to itself and information about itself, incredible changes can occur. These changes become relatively permanent by the subsequent neurochemical and physiological changes and “rewiring of the brain” produced by neurofeedback. In neurofeedback there is a famous expression: “Neurons that fire together, wire together.”

Neurofeedback begins with administering a Quantitative Electroencephalography or QEEG brain mapping a procedure very similar to the electrocardiogram (EKG procedure). Both brain and heart functioning can be quantitatively measured in electrical activity. QEEG brain mapping assesses overall brain functioning by comparing a subject’s brain waves to an age and gender controlled normative database. These highly reliable maps are then used to produce neurofeedback treatment plans geared to training an individual’s irregular brain wave patterns towards normalcy. In all neurofeedback interventions, sensors are attached to an individual’s scalp adjacent to specific areas of the brain that have been found to be deviant as measured by the QEEG brain maps.

Conditions Treated by Neurofeedback
Neurofeedback has been found to be successful  in treating attention deficit and learning disorders. Research has also shown that neurofeedback benefits conditions affected by the central nervous system such as anxiety disorders, depression, chronic fatigue, insomnia, fibromyalgia, explosive or anger disorders, obsessive-compulsive disorders, post-traumatic stress disorders, autistic spectrum disorders and migraine and tension headaches.

Neurofeedback is one of the few interventions used today with traumatic brain injury (TBI) resulting from car accidents, sports injuries, falls, etc. It is believed to promote neural cell repair, better brain network connections and reestablish functioning in areas of the brain that were impacted by injury. With recent injuries, neurofeedback interventions focus on returning function to the same injured brain hemisphere. With older injuries, we use interventions that include both right and left brain hemispheres.   

Conventional medical treatments have had minimal success in treating Aspergers and Autism. In contrast, neurofeedback has been successful in producing dramatic changes in the functioning of patients with Aspergers and Autism. With Autistic spectrum disorders, neurofeedback is focused in the right hemisphere to reduce over-activity of the brain as well as increasing functioning in those areas of the brain that enhance the individual’s sensitivity and awareness to self  and others. Even in extreme cases of autism, results are possible. Behavioral changes such as speech, eye contact as well as reductions in aggressiveness have been obtained.

Sometimes patients with Post-traumatic Stress Disorder (PTSD) are unable to benefit from psychotherapy because their cognitive and physiological symptoms are too overwhelming. Some PTSD patients are chronically in a fog while others appear over-stimulated and are unable to stop ruminations and intrusive thoughts. Today there is great interest, research and understanding on how trauma impacts the brain, body and psyche. Neurofeedback as an intervention, regulates brain wave frequencies, making it ideal at addressing trauma symptoms. For example, experts today believe that early childhood and adolescent trauma memories are encoded in brain wave frequencies. The shattering effects of trauma alter brain wave frequencies causing cognitive disorganization and physiological symptoms like flashbacks and chronic fear.

Neurofeedback has long been used as a highly effective intervention  for the treatment of PTSD. For over 25 years, it has been used to enhance brain functioning in veterans (Vietnam to present day) with combat-related PTSD.  These individuals are excellent candidates for combined neurofeedback and psychotherapy. Through the combined treatment,  patients experience a greater ability to access their feelings, past traumas and dreams. They exhibit increased abilities to express their feelings, perceptions and insights with others and to shift out of emotional overload and be able to control hair trigger reactions and impulsivity.

Future Directions
Another unique and exciting aspect of this field is the applicability of using QEEG brain mapping to understand what is happening to the brain before, during and after a psychotherapy intervention. QEEG brain mapping like other neurofeedback interventions, is safe and non-invasive. It has very high reliability and validity when compared to the other neuroimaging techniques like the MRI, but it is cost effective and its practicality makes it ideal for research purposes. For example, the writer of this article is currently engaged in research on understanding the brain regions and networks that are impacted as a result of intense group psychotherapy interventions.

1. Demos, J. (2005). Getting started with neurofeedback (1st Ed.). NY: W.W. Norton & Company, Inc.
2. Swingle, P. (2008). Biofeedback and the brain. How neurotherapy effectively treats depression, ADHD, autism and more (1st Ed.). Piscataway, NJ: Rutgers University Press.

Dr. Leo Leiderman is a American Board Certified and NYS licensed Clinical Psychologist. He is in private practice in Purchase and South Salem, NY. He provides individual, couple’s, group, family psychotherapies as well as state of the art QEEG brain mapping and neurofeedback services for all ages in his private practice. He also supervises licensed mental health clinicians. In addition, he facilitates yearly day and two day long marathon groups in his private practice and is a frequent presenter locally and nationally on mental health and neurofeedback topics. He is a nationally Certified Group Psychotherapist and is the current president of the Westchester Group Psychotherapy Society.

Leo Leiderman’s website: http://westchester-nps.com/  
Email: lleiderman@westchester-nps.com
To view Dr. Leiderman's referral listing, click here.

Disclaimer: Although Dr. Leiderman is a member of the Westchester County Psychological Association (WCPA), the views in this article are his and not the views of WCPA.

Statements contained in the authored articles on the Westchester County Psychological Association (WCPA) website are the personal views of the authors and do not constitute WCPA policy unless so indicated. The information in the articles on the WCPA website is for educational purposes only. The information contained in the articles is not intended for diagnosis, psychological advice or medical advice.  It is not intended to be treatment and is not a replacement for psychotherapy. If you are in need of psychological treatment, you can utilize our clinician database which can be accessed by clicking on the link, "Find a Psychologist." WCPA and its directors and employees are not liable for any damages resulting from the utilization of information contained in articles posted on the WCPA website.


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