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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.




How 20 sessions of ‘brain training’ helped 

Lucas Giolito get back on track this season

By PAUL SULLIVAN

CHICAGO TRIBUNE |

JUL 15, 2019 | 7:00 AM


When Dylan Cease was called up to the White Sox two weeks ago, Lucas Giolito welcomed another “cerebral” starter to the rotation.   Both like to meditate and think outside the box, which is why Giolito underwent 20 sessions of what he called “brain training” last off season to try to get his sagging career back on the right path.The White Sox’s brain trust approved of Giolito’s plan, and now the brain training seems to be paying dividends for the pitcher and the rebuild.

In a few short months he made the unlikely journey from worst starter — statistically-speaking — in the majors to becoming an American League All-Star pitcher. But Giolito believes the best is yet to come, starting Monday night in Kansas City when he faces the Royals in the resumption of the so-called “Forever Beef” rivalry.  Being a deep thinker and closet intellectual — he scored 30 on the ACT — Giolito wants to use that brainpower to his advantage. But it doesn’t always work out that way, and, like the Cubs’ Yu Darvish, Giolito has often been accused of overthinking on the mound.   “I think it can help you and hinder you,” he told me. “Baseball is obviously a game of failure. It’s very easy to get into your own head. You saw that last year. I was in that spot a lot.

“At the same time, you can use intelligence, smarts, whatever you want to call it, to refine your game and make it even better. Over the last six months I’ve kind of transitioned into that area more, where I’m utilizing my brain more and then turning it off when I need to.”Giolito pitched a hitless inning for the AL in the All-Star Game, recovering from self-described “jitters” that began with a four-pitch walk to Freddie Freeman, the first batter he faced. He quickly realized his delivery was “out of sync” and righted himself while pitching out of the stretch, getting a called third strike past Cody Bellinger before retiring Nolan Arenado and Josh Bell on groundouts.  It was as good as he always dreamed it would be.


“Going out there further cements to me that this is where I belong,” he said afterward. “Obviously I’ll continue to build some confidence from there and keep riding it out. Maybe apply some things that I’ve been learning from all these guys (on the AL staff) and keep it rolling.”

Giolito has an 11-3 record and a 3.15 ERA, dominating the opposition for the most part, with the glaring exception of two recent starts against the Cubs, in which he allowed 12 earned runs over 8 1/3 innings in a pair of losses. But to truly consider this a “comeback," he has to keep it going the rest of the way. Otherwise, it will just be a nice first-half story that faded away. In other words, Giolito knows he still has work to do.  Giolito could’ve returned to action Sunday on regular rest, but the Sox opted to hold him out of the rotation until Monday, with Cease making his second major-league start Tuesday. It made a bit of sense since Giolito carried a no-hitter into the seventh inning against the Royals in his opening start of the season in Kansas City in March, and the Sox are trying to limit Cease’s innings so they won’t have to shut him down in September.

But the obvious drawback was starting the struggling Ivan Nova and fresh-off-the-injured-list Dylan Covey in the first two games in Oakland, killing any chance of immediately building on the momentum the Sox had built at the end of the first half.


Giolito and Cease can be a 1-2 punch that prevents the Sox from sliding backward in the final 2½ months, but they could use some help in the rotation so it all doesn’t fall on their shoulders. Cease should be greatly aided by watching Giolito, who admitted his confidence wavered last year, which forced him to look for different solutions to his problems.

The neurofeedback sessions are one big factor in the turnaround. If there was any question the confidence was back, he answered it by shrugging off the wildness that started his All-Star appearance.  “If you want to compete at this level and stay here a long time, you have to have the confidence you’re better than everybody else every time you’re pitching,” he said. “That’s what I take into my games, whether it’s a start against whoever during the regular season or the All-Star Game for one inning.   “For me, that’s what it’s all about.”