A growing number of psychiatrists and psychologists in B.C. say they’re successfully treating patients by harnessing the power of patients’ own brain waves.

Neurofeedback treatment has been studied for several decades but remains controversial among scholars.

“This debate has been going on for a long time,” said Simon Fraser University neuroscientist Randy McIntosh.

“There is a long history of using things like neurofeedback to help somebody re-orient their brain.”

McIntosh — a professor in SFU’s department of biomedical physiology and kinesiology, and B.C. Leadership Chair in Neuroscience and Technology Transfer Across the Lifespan — said there’s evidence neurofeedback works for patients with certain disorders, even if there is disagreement over exactly how or why.

As with any mental health treatment however, “There’s not a single therapy that’s going to work for everybody,” he said.

“But it might work for some.”

‘Brain training’

“Neurofeedback is brain training with the goal of increasing cognitive flexibility,” said Victoria psychologist Susan Brock.

Brock, former chair of the Canadian Psychological Association’s quantitative electrophysiology section, said healthy brains need to “be able to shift flexibly between states” of mind at appropriate times.

But conditions such as post-traumatic stress disorder (PTSD), one of her specializations, can keep people “in a constant state of over-arousal even when there is no need to be.”

That causes a loss of cognitive functioning for such patients, many of whom are emergency first responders and veterans.

Electroencephalogram-guided neurofeedback involves technicians placing electrodes around a patient’s head, as seen in this photo, to scan the electrical activity in their brains. Here, the patient is seen watching a display monitor. (Craig Chivers/CBC)

Electroencephalography-guided neurofeedback is offered by a number of private psychiatrists and psychologists across B.C.

The treatment, in simple terms, involves technicians placing electrodes around a patient’s head to scan the electrical activity in their brains, known as an electroencephalogram (EEG).

The EEG creates a sort of computer brain map, which can then be used by mental health professionals to help encourage healthier states of mind.

Clinicians use several methods to do this, but often patients watch a video while fitted with the EEG electrodes.

If their brain shows unhealthy or undesirable electrical activity, the video becomes darker and quieter. But when their brainwaves more closely match a “map” of a healthy brain, the video gradually gets brighter and more audible, as their EEG starts to mirror a healthier or calmer brain.

In effect, being able to enjoy a clearer video acts as a type of reward or incentive to calm the mind and, the theory goes, to slowly build healthy patterns.

The unorthodox approach is used more and more among people with a range of mental health conditions from attention deficit hyperactivity disorder (ADHD) to anxiety and post-traumatic stress disorder (PTSD), according to clinicians.

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Brock said she’s “seen a good response” in her decades of experience using the treatment. She said her patients often report troubling areas of their lives that “haven’t really changed” for the better, despite having tried a variety of mental health therapies before.

Many still struggled with the ability to shift their mind states when needed — for instance, to be able to calm themselves when distressed.

“It’s not that they don’t want to change,” Brock said. “They don’t know how.

“And for most, it is not for lack of trying; part of the beauty of neurofeedback training is it happens on a subconscious level.”

More data needed

While frontline psychologists and psychiatrists say they see clear clinical improvements in many of their patients, researchers are divided on neurofeedback’s efficacy. 

Several peer-reviewed studies suggest better data is needed to prove it works for the wide range of disorders practitioners claim to treat. Evidence appears strongest for ADHD, anxiety disorders, and traumatic brain injuries.

A Basic and Clinical Neuroscience journal article in 2016 found it “is a safe and non-invasive procedure that showed improvement in the treatment of many problems and disorders” including ADHD, anxiety, depression, and autism.

But, the authors cautioned, “its validity has been questioned in terms of conclusive scientific evidence of its effectiveness.”

Another study, in the journal Psychiatric Clinics of North America, compared multiple neurofeedback trials, finding they produced “significant benefits” for ADHD and anxiety and were “probably efficacious” for traumatic brain injuries and substance use.

But the researchers said “despite findings of positive outcomes” for depression and PTSD, evidence remains “insufficient” without more rigorous or larger scientific studies.

Best combined with other treatments

For frontline clinicians, the results are in front of their eyes — and in their patients’ experiences.

Four years ago, psychiatrist Dr. Kourosh Edalati founded Elumind Centres For Brain Excellence, which has private clinics in North Vancouver, Langley and Kelowna. He offers neurofeedback, alongside more conventional psychotherapy and medications.

“As an integrated model, we’ve seen very, very good responses,” he said. “The principle behind neurofeedback is really operant conditioning … which means positive and negative reinforcement.

“The brain learns that connecting to the right pathway is rewarding. Through all the repetition, the brain starts to switch to the right pathways.”

A skullcap covered in sensor nodes and wires is placed on a person's head.
Test person Niklas Thiel poses with an electroencephalography (EEG) cap which measures brain activity, at the Technische Universitaet Muenchen (TUM) in Garching near Munich in September 2014. (Reuters)

By taking a multi-pronged approach to treatment, said SFU’s McIntosh, neurofeedback is likely best combined with other methods.

“We have to be very cautious to not think, ‘I’m just going to get brain stimulation that’ll make me better,'” he said. “Some people need additional support.”

“It does seem to work for some people … allowing people to get unstuck.”

But he said precisely how neurofeedback achieves that in the brain remains unproven.

“Why are these things working?” he said. “The ‘how’ of it is a bit of a mystery.

“The evidence is pretty good — but not conclusive.”

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