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Staring intently at the video game on the screen in front of him, a 17-year-old boy steered his airplane through a narrow crevasse. His hands lay motionless in his lap, though, while his mind alone controlled the game.
A tight blue EEG cap studded with white electrodes monitored the electrical rhythms produced by his brain, and a mass of rainbow wires transmitted the signals to the monitor displaying the airplane. When he entered a calm, focused state, the sensors connected to his head detected the resulting minute changes in electrical activity, and his plane flew quickly and smoothly, deftly maneuvering around rocky cliffs.
His parents brought their son to Sylvania psychologist Jake Elliott's office once a week for an entire year to play neurofeedback video games like this one in hopes that symptoms of his autism would improve -- maybe even forever.
Nationwide, businessmen use neurofeedback to promote calm, clear thinking, opera singers to improve their stage presence, and Olympic athletes to enhance athletic performance. Proponents argue that anyone at all can benefit from the therapy, and those with mental disorders stand to gain the most.
But some doctors cite concerns about neurofeedback's lack of grounding in firm scientific evidence.
Still, many Ohioans are turning to neurofeedback for psychological illnesses, including anxiety, attention deficit hyperactivity disorder, depression, and autism. Many practitioners think neurofeedback may eventually become a first response rather than a last resort to treat these mental disorders.
Neurofeedback trains people to avoid producing deviant brainwave patterns. Generating much of one kind of brain wave causes a person to enter a different mental state. When we are awake but drowsy or daydreaming, for example, slow waves called theta waves dominate the brain.
When we are focused and attentive, neurons fire at a quicker rate, and fast waves called beta waves take over. Normally, people have no idea when one kind of brain wave gives way to another, though it causes them to shift psychological states. While hooked to a neurofeedback device, however, they become aware of these changes and, supposedly over time, able to control them.
Dr. Joseph Kamiya at the University of Chicago successfully used neurofeedback for the first time in 1958, teaching one of his graduate students to increase his alpha brainwaves when he rang a bell.
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"Neurofeedback is not something we do to the person, it's something they do to themselves," said Dr. Elliott. He has been using neurofeedback in his practice for more than 20 years and has served as an editor for the Journal of Neurotherapy for the last decade. He treats an estimated 40 to 45 patients each week using the therapy.
"The brain is always reforming and reconditioning itself. It's pruning off unused connections and manufacturing new ones. It's almost like a root system that's continuing to grow, and when we're doing neurofeedback, we're actually causing some growth," said Dr. Elliott.
On a recent afternoon, the 17-year-old former patient returned to Dr. Elliott's office with his father to play his favorite games one more time and discuss how the therapy has impacted his life.
"When we first started, I was thinking how can that work when you're just staring at a screen with your brain wired up," his father said. "But by golly it works."
He and his wife noticed small changes in their son after only a month. "He was staying on task a little bit more, and he was dealing better with things that used to upset him," he said. His son finished the therapy seven months ago, and his father claims the changes have persisted.
Dr. Elliott claims the boy's obsessive behaviors have decreased. He used to spend hours reciting the dialogue from his favorite movies. "Since I've been doing this, I can control it. I don't do it so frequently," he said.
The doctor expects his improvements will last the rest of his life. He says people usually experience a major change in brain function after only eight sessions, but cementing these changes typically takes at least 20 more.
Patients can keep themselves entertained during those dozens of sessions by choosing from around 40 different games, such as neurofeedback-rigged Pac-Man or movies that dim and go black when the brain is not producing the desired frequencies. The 17-year-old patient usually chose a game where different colored cheetahs race across a verdant backdrop.
Most neurofeedback videogames were born from NASA research in the 1990s examining which mix of brainwaves kept pilots most on task. Researchers realized they could modify the equipment used in their experiments into a video-game-like training setup available for the general public. Today many manufacturers, Brainmaster Technologies Inc. and Thought Technology Ltd., for example, produce neurofeedback video game equipment.
To become certified, would-be practitioners must complete required coursework and mentoring programs before passing an examination. "By the time you go through that, you know what you're doing," he said.
The problem is, not everyone who practices neurofeedback does go through that rigorous training.
"I'd like to see certification become mandatory," said Judy Crawford, the director of certification at the Biofeedback Certification International Alliance. "The public doesn't even know what questions to ask."
The number of BCIA certified neurofeedback practitioners has reached nine in the state of Ohio and has been climbing steadily nationwide in recent years, but no way exists to know how many people are practicing without a license. "The FDA has not regulated the use of neurotherapy, but I think it's only a matter of time before they do," Dr. Elliott said.
Costs of therapy
Eugene Arnold, professor emeritus of psychiatry at The Ohio State University, thinks the hours the patient spent with a beloved therapist could be more significant than the hours of neurofeedback therapy he underwent. "It appears that there is some benefit from neurofeedback, but what we don't know is whether this is actually a specific effect of neurofeedback or whether it's just a nonspecific benefit of a youngster spending 20 plus hours with an encouraging adult," he said.
Uncertain whether the therapy itself works, he says he would avoid directing patients to receive neurofeedback.
"Neurofeedback is pretty safe, and it's kind of sensible based on the theory behind it, but it's not easy, and it's not cheap," he said. The therapy typically requires 20 to 30 sessions that usually cost between $50 and $150 each, according to the BCIA.
"If you happen to be rich and have a lot of time then it makes sense," Dr. Arnold said.