Article: Neurofeedback: A Treatment for Reactive Attachment Disorder

Conclusion:

Neurofeedback training offers a remedy not previously available for reactive attachment disorder. It appears to address the core symptoms of sense of self and other, of emotional bonding, and of empathy,setting the stage for meaningful psychotherapy and reparenting. Reactive attachment disorder is, at its foundation, a disorder of brain regulation. Neurofeedback challenges the brain to regulate itself more competently in the emotional realm.

J.S. Grotstein, a psychoanalyst speaking from a psychodynamic perspective, was the first to propose a disregulation model for psychopathology. (Grotstein, 1986). His speculations raised the question about how the brain organizes itself in the domain of affect, a question that Davidson further elaborated (Davidson, 2000). Rodolfo Llinas found evidence for the disregulation model of certain neuropsychiatric syndromes with magnetoencephalography (Llinas, 1999). And McCormick proposed that certain neuropsychological disorders may be traceable to disregulations in thalamic rhythms (McCormick, 1999). Finally, Othmer and Kaiser describe how EEG neurofeedback can effectively normalize thalamic rhythmic activity and in doing so remediate certain psychopathologies, including autism, Asperger's, and RAD (Othmer, 1999). Jointly, these studies lay the theoretical basis for the results presented in this paper.

Neurofeedback is a technique of operant conditioning which directly changes brain function, in particular the timing of specific regulatory networks in the brain. It most dramatically affects arousal regulation. In so doing, this 'brain training' can normalize the propensity to high arousal seen as the hallmark of Reactive Attachment Disorder. More specifically, it can exercise the cortical-subcortical circuitry involved in emotional regulation and fear response. Theories that the brain organizes itself through regulation of timing supports clinical experience that neurofeedback addresses even the stark baseline fear which is the affective underpinning of RAD, as well as its multiple manifestations or co-morbidities: sleep disorder, hyperactivity, learning disabilities, explosive disorder, oppositional defiant disorder and conduct disorder. Clinical experience with neurofeedback further suggests that despite Schore's observation of a specific time window for the learning of emotional regulation, we are not dealing with a "critical period" in which such learning has to occur or it remains forever unlearned. The "wiring" for attachment (the drive) is in place before or at birth, and under the right set of conditions it can be activated. Neurofeedback has proven itself one of these conditions.

In RAD, the most devastating reality is the absence of the other, the internal experience of no other. In every case I have seen to date in which neurofeedback has been used, the person with RAD begins to recognize the existence of an other. Their internal landscapes develop horizons, and they find three-dimensional people there. As their arousal set point comes down, and they begin to recognize the existence of the other, they begin to experience a new organization of self in relation to the other. As I have suggested above, this is not without its hazards, but it makes treatment of these hazards possible through more traditional interpersonal psychotherapies. My experience and that of many others suggests that the introduction of neurofeedback makes Reactive Attachment Disorder a condition that can be, finally, successfully treated.

References

Davidson, Richard J.; Putnam, Katherine M.; Larson, Christine L., Dysfunction in the Neural Circuitry of Emotion Regulation---A Possible Prelude to Violence. Science, 289, pp591-594, 28 July, 2000

Grotstein, J.S. (1986). The psychology of powerlessness. Disorders of self-regulation and interactional regulation as a new paradigm for psychopathology. Psychoanalytic Inquiry, 6, 93-118.

Llinas, Rodolfo R., Ribari, Urs; Jeanmonod, Daniel; Kronberg, Eugene; Mitra, Martha P. Proceedings of the National Academy of Sciences, 96, #26, pp. 15222-15227, December 21, 1999.

McCormick, David A. Are thalamocortical rhythms the rosetta stone of a subset of neurological disorders? Nature Medicine, 5, #12, pp1349-1351, December 1999.

Othmer, Siegfried; Othmer, Susan; Kaiser, David A. EEG Biofeedback: An Emerging Model for its Global Efficacy. In Introduction to Quantitative EEG and Neurofeedback, Evans and Abarbanel, editors, Academic Press, 1999, pp. 243-309.

Schore, Allan N., Affect Regulation and the Origin of Self, Lawrence Erlbaum Associates, Publishers, 1994.

Sebern F. Fisher
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