How is brain imaging and cognitive neuroscience impacting neurofeedback?

In many respects, the field of neurofeedback has changed a great deal over the last five to ten years. By learning from advances in both cognitive neuroscience and brain imaging about the brain, neurofeedback has learned to better target different areas of the brain.

Much more information exists and will continue to help training strategies in the future. Some recent promising research from imaging studies suggests advances in applying neurofeedback for Learning Disabilities and chronic pain, as an example.

Note that just identifying areas of the brain does not directly correlate to putting an electrode over the cortex of a particular area. Many of these structures or mechanisms are deep in the brain, and may not have direct connections to the cortex above the structure. Also, Since the brain is a richly integrated network that is a complex system, simply targeting one specific area may not in fact have a specific effect. Much more work must be done to identify the best way to use neurofeedback for training, even if a new area is identified.

Example: Depression
Many imaging studies have linked depression to lack of perfusion or activation in the left frontal lobe. These patterns may correlate to other symptoms, not just depression.

As a result of the research, many clinicians over the last few years have targeted the left frontal lobe for depression more directly. Others have trained the differential between left and right frontal hemispheres (asymmetry). (Click here for the Baher study as one example.) Psychologists, psychiatrists and other therapists have reported training the left frontal lobe often helps depression faster than previous neurofeedback methods. It also to help deal with more resistant types of depression. Several different training approaches have been reported.

More outcome studies are certainly need. But practicing clinicians frankly see the results clinically with the most difficult depressed clients - often who are not well managed on meds.

Example: OCD/Rumination
OCD - and in particular rumination, have been shown with many imaging studies occurring around the anterior cingulate. Again, as a result, several training strategies, targeting sites with the richest pathways and proximity to the anterior cingulate, have been created with neurofeedback. This strategy has significantly improved clinical outcomes.

(For a wonderful book on OCD that talks in some depth about the research, click here. Schwartz, an MD associated with UCLA, lays an elegant argument for neurofeedback - without mentioning neurofeedback.)

Example: PTSD
An example: James LeDeoux is a well known researcher who wrote a book called "The Emotional Brain." It made the amygdala somewhat popular. The amygdala is the part of the brain that plays a major role in trauma or extreme fear.

Since therapists deal often with PTSD, there's been great interest in using neurofeedback to influence or quiet the amygdala. Since it's sub-cortical, well underneath the cortex, there's no direct way to train it. But there are pathways in the cortex that have loops influencing structures all the way down to the brainstem. Was their a pathway to the amygdala?

Sebern Fisher, a psychotherapist in Massachusetts has a practice that dealt with a lot of traumatized patients and PTSD. She identified a spot now called FPo2. It's just under the right eyebrow in the corner of the eye, close to the bridge of the nose. There was some reason to think it may be closer to the amygdala, or there may be pathways between that area of the brain - pre-frontal orbital cortex and the amygdala. Additional brain research has tended to support that thesis. By training at that spot, she started reporting starting in 2001 seeing a profound change in her traumatized clients. She started teaching her specific training model to many other therapists. Many reported similar improvements to what Sebern described.