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Promising Anxiety Treatment Awaiting Acceptance

By David Kaplan<http://www.houstonchronicle.com/author/david-kaplan/>

June 25, 2016


At his private clinic near Greenway Plaza, Steve Cochran practices one of the most promising therapies you've likely never heard of. He specializes in neurofeedback, a technique designed to make a person calmer and more focused. Clients, who fly in from as far as California, come to the Neurotherapy Center of Houston with anxiety, depression, attention disorders and more.

Cochran and other practitioners in Houston and around the world report dramatic benefits from the decades-old treatment, but neurofeedback has remained under the radar. It hasn't achieved wider acceptance for a variety of reasons. Insurers typically don't cover it, and the medical community generally ignores the field or is skeptical. Another challenge is that it is hard to explain how neurofeedback works. It may sound weird when first described - as a way to treat a malady by non-consciously guiding your brain in a desired direction using electrodes and computer software.

In the first session, a client receives an EEG "brain map," or electroencephalogram, which identifies the location of errant brainwave activity. In subsequent sessions, electrodes are placed on the person's scalp near the part of the brain that needs regulating. The client then watches a video on computer software that can read brainwave activity. The video stops and starts. By non-consciously regulating his or her brain activity in the desired direction, the client is rewarded by being able to watch the movie with no interruption, Cochran said. "When you are getting feedback from the brain, you can modify it, even if you don't have conscious awareness" of what is taking place, said Cincinnati psychologist Kirk Little, president of the International Society for Neurofeedback and Research in McLean, Va.

Not everyone benefits from neurofeedback, Cochran said, and people who want to get better are the ones more likely to improve. Cochran's client, Katy resident Caroline Howell, said neurofeedback "did wonders," enabling her to overcome severe depression, but when she tells her friends about it, they say, "If it's so great, why haven't I heard of it?" Along with a number of psychological conditions, neurofeedback can treat drug and alcohol addiction, brain trauma, impairments from stroke, migraines and epilepsy. It's also used by artists and athletes to enhance performance. Other therapists in Houston offer neurofeedback, but Cochran's 8-year-old clinic is among the few focused almost exclusively on it.

Neurofeedback is typically not a person's first choice, Cochran said. In many cases "their doctor first prescribed medications that didn't work." Clients may come in skeptical, he said. "They find it hard to believe you can train parts of the brain just as you can strengthen a muscle." Neurofeedback is "a word of mouth thing," said Kurt Othmer, president of EEG Info, a neurofeedback clinic in Woodland Hills, Calif. "Someone you trust tried it and got good results." But it also has numerous advocates in the medical community. In his book on neurofeedback, "A Symphony in the Brain," science writer Jim Robbins writes that neurofeedback "has vast untapped potential for millions of people," and is "safer than most prescription medicines," but in need of more research to be better understood.

Neurofeedback operates on the principle that the brain can be trained to modify its own settings.

During a neurofeedback session, clients focus on a particular brainwave bandwidth, each of which has a separate function. The lowest brainwave bandwidth, delta, is dominant during deep sleep; the theta range is active during the fuzzy state between sleeping and waking. Alpha waves are dominant in a state of well-being and calm, which can be achieved through meditation or neurofeedback, said Bob Dickson, the former executive director of the Southwest Health Technology Foundation. The beta range is dominant when a person is alert, executing a task and in a thinking mode, Cochran said. High beta, however, signals an anxious state in which neurofeedback can be useful, he said. The goal of neurofeedback in the high beta state is to reduce brain wave activity. The principle is nothing new. One of the earliest milestones in neurofeedback research came in 1958, when University of Chicago psychologist Joe Kamiya trained graduate students to enter the alpha state with electrodes and verbal prompts, as Robbins wrote.

In the 1970s, people used neurofeedback - also called biofeedback - to reach blissful alpha states, and the field suffered from the reputation that it was something to do to get high, Cochran said.

It still isn't widely endorsed by the medical community. Among the skeptics is Russell Barkley, clinical professor of psychiatry and pediatrics at the Medical University of South Carolina, who has treated ADHD for 40 years and published hundreds of articles on the subject. .

"Claims about biofeedback have far outstripped the supporting evidence," he said. Positive results from neurofeedback can be attributed to the placebo effect, he maintained, and it doesn't hold up when subjected to the most rigorous testing - a double-blind or control group study in which a person doesn't know if he is doing an actual or sham neurofeedback session. Neurofeedback doesn't need double-blind studies to demonstrate its effectiveness - other less-expensive types of studies are valid, Little argues.

Just in the past three years, more than 500 peer-reviewed neurofeedback research studies have been published, he said. And the clients who've seen benefits from neurofeedback don't doubt that the technique really works.

Patient feedback

Cochran has a quiet presence and a calm, gentle voice. The son of Houston psychiatrists, the clinical social worker received neurofeeback training from psychologist Eugenia Bodenhamer-Davis at the University of North Texas. He first began practicing neurofeedback in 2007. Natalie Delgadillo first came to Cochran's clinic reluctantly, thinking, "This is some stupid hippie mumbo-jumbo." Her mother made her go.

She was 18, and her attention disorder was causing severe anxiety. She chain-smoked, rarely slept and was "kind of all over the place." A drug she took for ADHD made her "like a caged animal," her mother, Elizabeth Soto, recalled. Cochran weaned her off the drug, and after five or six sessions of neurofeedback, "I could see a calmness come over her," her mother said.

Neurofeedback at Cochran's clinic generally requires 30 to 40 visits; he charges $100 per visit.

Delgadillo, who first went to the clinic four years ago, is now a 23-year-old University of Houston student and off all medication. After stopping neurofeedback in 2013, she remained a much calmer person, she said, but recent issues in her personal life caused anxiety to return, and she is doing neurofeeback again and feels more relaxed.

Another of Cochran's clients, Chris Jolly, who graduated from Texas A&M University a year ago, once thought he had an inherent problem retaining information. He was actually impaired by multiple oncussions suffered while playing sports, he said. After finishing neurofeedback training at the Neurotherapy Center of Houston about two years ago, his grades shot up. He could better understand, focus on, and retain what he studied, he said. Other clinicians, including Dr. Nancy White, a psychologist and one of Houston's first neurofeedback practitioners, celebrate similar success stories. When she started, 27 years ago, "people thought I was weird … far out," she said. Her practice was initially focused on marriage and family counseling, and she still offers that, but her Galleria-area clinic, Unique Mindcare, now has a strong emphasis on brain-related treatments including neurofeedback and Nexalin, a non-invasive brain stimulation which, she says, works to balance brain chemistry when treating depression, anxiety and sleeplessness. (The neurofeedback society does not promote specific products, including Nexalin.)

One of her clients, a 16-year-old boy, had been diagnosed with a neurological autoimmune illness at age 10. Medicine improved his condition, but he had been left with residual symptoms, including ADD, OCD, anxiety and "brain fog" which, he said, made it hard to think clearly. After a year's worth intensive neurofeedback and Nexalin, his ADD, anxiety and brain fog were eliminated by about 99 percent, he said.

"It's made a remarkable difference in my life," said the teen, who asked to remain anonymous. He currently goes in for treatment when needed, about once every six months.

Tipping point

Little is optimistic that neurofeedback is on the verge of gaining wide acceptance; he believes it's reached its "tipping point," partly because funding for neurofeedback research has increased significantly in recent years and computer technology has become more affordable for practitioners. In October, Little's group, the International Society for Neurofeedback and Research, and the American Academy of Child and Adolescent Psychiatry will team up to make a presentation to the American Medical Association, requesting that neurofeedback be formally recognized as a legitimate and valid procedure. If that happens, he said, insurers will be more likely to cover the treatment.