Biofeedback assists with anxiety-based problems

Biofeedback assists with anxiety-based problems

Biofeedback, a process that records brain activity and other bodily functions, while not new, is recognized more today as people look for alternatives to prescription medications.

The treatment technique prompts the patient to control or monitor his or her physiological or mental state in order to enhance learning, concentration, and relaxation, or to modify physiological responses that may accompany anxiety-related problems.

Bassis and Carter, a Sudbury-based psychotherapy and consultation service, has been using biofeedback as part of its assessment and treatment programs since the mid-’90s and has found it to be a useful tool.

Dr. Edward Bassis uses it for a variety of anxiety-related problems like depression, brain-injury and retraining, obsessive-compulsive disorders (OCD), phobias, as well as performance enhancement for competitive sports, and to treat attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD).

Biofeedback covers a range of modalities. Physiologically, it can measure heart rate, breathing, skin conduction, temperature and muscle tension. Neurologically, a process known as EEG (electroencephalographic) biofeedback, also called neurofeedback, measures brain waves, allowing patients to look at how their brains function.

“Initially, we do an assessment,” Bassis said. “We may do a combination of breathing and neurofeedback, particularly with someone who has an anxiety-based problem. That way, you know what the body is doing on a physiological level as well as what the brain is doing.”

The use of biofeedback has increased over the years because more people know about it and the centre’s familiarity with it has grown, encouraging its use in a greater variety of ways.

A person with a hand tremor can be treated by locating and hooking up the Electromyograph (EMG) to the spasming muscle or muscles. The person would then be trained to learn how to relax those muscles with continual feedback from the computer. Then, he or she would learn how to carry out simple tasks without the hand tremor and, eventually, evolve to more challenging movements.

Competitive athletes can be trained to improve attention, concentration and focus, and reduce negative emotions that get in the way of performance.

Treating ADD/ADHD

Children who have been diagnosed with ADD or ADHD by a pediatrician also come to the centre. ADD and ADHD have been described as a collection of temperamental traits and styles of thinking associated with short attention span, distractibility, difficulties organizing and completing assignments and impulsiveness, according to the ADD Centre’s website. These often lead to academic underachievement.

“We would do a variety of assessments (both on and off medication) because there are so many other things that would look like ADD or ADHD that are not,” Bassis said.

To determine if a child has ADD or ADHD, other problems that look like it have to be ruled out. This means evaluating learning abilities, including cognitive strengths and weaknesses, personality, behaviour and feelings. Neurofeedback would also be part of that assessment process.

Traditionally, behavioural rating scales for identifying ADD and ADHD are given to a parent and the child’s teacher and then returned to the pediatrician, who in turn, decides from an observational visit and the rating scales whether or not the child has ADD or ADHD. If a parent pursues this route, the child will be put on some type of stimulant drug such as Ritalin to control his or her behaviour.

Bassis disagrees with this assessment process. “If you give the same rating scale to both parents independently, we often get very different profiles. If you give the scale to three different teachers, you now have five different profiles for one child.”

Often, a child will come to the centre already diagnosed with ADD and not have it.
However, if Bassis and Carter have diagnosed a child with ADD, neurofeedback can be used to display increased brain wave activity associated with attention, concentration and focus (beta waves), and decreased brainwave activity associated with distractability (alpha or theta waves).

“The key word is ‘associated’,” Bassis points out. “You can’t say the brainwave activity we are working on is the cause of ADD; it is only correlated with it. There may be very different underlying structures responsible that we can’t see or look at.”

He added that there is no pure form of ADD because there are always other influences like school and home life that cannot be separated. However, the notable improvements in behaviour may cross over those domains.

Other strategies are also employed with the neurofeedback process. “We are always looking at what kind of behavioural interventions are required within home and school settings,” Bassis said.

Bassis said the success rate for the treatment is approximately 75 to 80 per cent, and most of the children who are on medication come off it. Unlike medications, which can cause reduced appetite, ticks or OCD behaviours, neurofeedback has no negative side effects.
Stephanie Lazure, one of two clincians who administer biofeedback, said the training allows the child to have more control.

“They can chose to concentrate or they can chose not to concentrate, whereas if they are on medication, they may be sitting quietly in their chair, but they are not necessarily concentrating the whole time.”

Bassis questions long-term retention of information acquired under stimulant medication.

“Short-term attention, memory and retention of information acquired under stimulant medication improve, but not consolidation of that memory into long-term.”

Although Bassis recommends this method over medications when treating ADD or ADHD, he stressed the importance of the experience and skill of the clinician operating the equipment because there are no real norms or standards in neurofeedback.

“The norms that are out there are very specific to the different kinds of neurofeedback equipment,” Bassis said. “So, if you’re administering neurofeedback in your office and the equipment is different from the equipment I’m using, I’m not even sure we’re measuring the same thing.”


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