Richard Soutar, Ph.D.
Neurofeedback is generally a gradual process, and it is common for clients to misattribute subjective changes in symptoms to neurofeedback. It is also common for clients to assign negative symptoms to neurofeedback and positive improvements to other interventions they themselves have initiated. I had one client who even attributed improvements of his symptoms to a new breakfast cereal he was trying rather than to the ten sessions of neurofeedback he had done.
Placebo effects are common with all psychological and medical interventions. It has a powerful effect and has been documented to even cause remission in cancer cases. This is why investigators work so hard to maintain a double-blind status during drug trials and other experiments. A simple sugar pill can become the vehicle for relief of pain or the cause of pain, depending on what you as a clinician tell the client about its purpose. This is true for medications as well as supplements and it applies equally to neurofeedback.
Everyday people have a variety of symptoms, some mild and some severe. The list is endless. They often come and go mysteriously. Someone may have a headache and attribute it to allergies when the true source may be pollution or stress. The causes of headaches are legion. Stress is ultimately the source of over 70 percent of doctor visits. According to the ACE study, toxic stress (affective trauma) is also the source of 60% of adult medical ills.
Stress has been called a silent killer. Most people are not aware of the effects of stress when it occurs unless they reach a physiological limit and experience a symptom. More than likely they will attribute their symptoms to something they believe is a common cause that is tangible such as bad food or a supplement deficiency, etc. NewMind clinics have available to them a symptom tracker for clients to rate their symptoms before each session which makes it possible to monitor their waxing and waning intensity. This allows for a more comprehensive method of analysis of their symptom patterns and what may be causing them. It also allows for a better assessment of the most recent neurofeedback protocol effectiveness.
Toxic Stress is extreme psychological stress that over time contributes to the degradation of physical organ symptoms. Psychological trauma can set off a series of physiological cascades that can be destructive or even deadly over time. This type of trauma can be such a part of daily life from an early age that most individuals adapt to it as if it were normal. The only hint of it is the endless variety of symptoms they suffer from that no doctor or psychiatrist seems to be able to help them resolve. The theories of causes for suffering change from professional to professional and from year to year. The client’s symptoms often intensify and change as they get worse,
The people who come to neurofeedback offices are often these people. They suffer from Toxic Stress and have no idea. They have lived with it all their lives and had endless symptoms that start out mild and gradually end up severe as they change progressively into more challenging conditions. They have no concept of Toxic Stress and how it has silently worked its devastating magic. No one has been able to help them. That is what motivates them to try innovative treatments such as neurofeedback. They are desperate. They have no idea of the psychological and physiological details of this process. They have constructed elaborate stories stitched together from all their experiences and what they have heard from friends and other professionals. The idea that all this suffering could come from half-forgotten memories of psychologically challenging events that triggered perpetual repetitive and destructive physiological cascades seems unbelievable.
Neurofeedback trains the brain in a way that slowly returns it to a more balanced function from a state of dysfunction easily seen in a qEEG brain map. As it does, this pathways open up and people begin to integrate past trauma as part of the allostatic movement toward a neo-homeostasis. The brain reorganizes in order to adapt. Statistically we know what a normal brain looks like and how far an individual’s brain has wandered from that optimal point of function. It reveals it in stark images. Most people are immensely relieved to see the truth that they feel has been denied them for so long laid out in clear images. The qEEG report is usually validating and reassuring as it is a map for recovery as well. For once they have evidence that there is something that can validate their narrative of suffering and measure the change resulting from planned intervention.
When they begin neurofeedback to guide their brain and CNS back to towards normal functioning they look forward to feeling better as the days go by. They expect to feel better each day. But that is not how healing occurs with brain and CNS. The brain has to go through many iterations of trial and error in a step-by-step process in a search for superior balance. At first, for many, relief comes right away. Then it slips away. Some days are better and some days are worse. That is how healing takes place. What is even more challenging is that additionally difficult and intense emotions surface as well as the associated physical pains that accompany them. Sometimes it feels like you are going backwards in your healing, or even worse, nowhere at all. This is the difficult dimension of integrating affective trauma and Toxic Stress. It is a challenge for both clinicians and clients. It typically occurs during Alpha Theta training but often occurs to a lesser extent in initial fast wave training (standard eyes open protocols).
In rare cases, people doing standard fast wave training are completely overwhelmed by the process and experience intense temporary symptoms they have never felt before. They may have vivid nightmares or panic attacks as well as physiological responses. They can easily lose faith and believe you are making them worse. If they quit the training, they may remain stuck at that point for some time. They may accuse the therapist of malpractice. This is where a symptom tracker comes into play. Clients often make more progress than they are aware of, and the tracker displays that improvement. The immediate challenge before them eclipses the progress that actually has occurred. The reassurance the tracker supplies provides the confidence to continue training and derive the full benefit of the neurofeedback sessions.
Part of the job of a neurotherapist is to help the client manage this process. To properly prepare them for what is to come and successfully navigate it providing the proper support. This takes extensive training and mentoring. That’s why we have training and certifications in addition to ongoing mentoring. That is why NewMind has weekly grand rounds in the form of Lunch and Learns. That is why we have assessment tools and bio-psycho-social tracking tools. We provide easily accessible individual support through internet meetings and videos.
When neurofeedback is not done right, those rare individuals who fail to survive the process often concoct stories based on misinformation and commiserate with others on the internet. Those who discredit neurofeedback often maintain that its results are due to placebo effects and that there is insufficient evidence to show it has efficacy. Yet there are also detractors who make claims of severe side effects as if neurofeedback was a drug. The research shows it is somewhere in between. There is a death of adjudicated proof of neurofeedback doing harm. The FDA does not recognize any cases of harm that fits their definition. Still, these few people claim that neurofeedback has caused them extreme symptoms without any scientific evidence that demonstrates how that could occur. Again, their experience is most commonly a consequence of unresolved emotional trauma that has been improperly dealt with.
As previously mentioned, many professionals and most people don’t realize the effects that severe anxiety and trauma can have on an individual and often don’t believe it is possible. Yet these effects have been well documented by science for decades. When trauma integrates it can sometimes temporarily produce strong physical and psychological symptoms that usually pass. With layers of trauma the symptoms come in waves. Clients can perceive this as a process of getting worse but ironically it is the process of getting better and a necessary phase of integration. Often clients in this category display a psychological profile that is dominated by distrust, lack of emotional inhibitory control, panic, rage episodes, black and white thinking, personalization, and catastrophic thinking, to mention a few. They feel powerless and gravitate toward narratives that portray themselves as a victim. These are common features of complex trauma. They experience increased impulsivity, hypertrophy of the orbital frontal region, hypersensitivity to stress, etc. This makes them very difficult to manage and develop a therapeutic relationship with them. Many have personality disorders.
The physical symptoms these individuals experience are often related to somatoform or conversion disorders. They frequently change in nature and location and when one resolves another takes its place. They over-focus on their physical symptoms and often obsessively research potential illnesses related to them. When encountering neurofeedback and while starting to integrate trauma, their symptoms often increase and shift in emphasis, and they may develop new ones. Typically, they interpret this as a deterioration in their condition and as acquiring a new condition they did not previously have. If therapists are not aware of somatoform and conversion disorders they may not know how to deal with the client and the relationship can spin out of control with the client leaving the practice in a vulnerable and unmanageable state. The clients become suspicious and at times obsessive with regard to their clinical experience. They may develop delusions regarding their condition. They may post their complaints obsessively on the internet and look for confirmation from others. This activity sheds a negative shadow on neurofeedback. This is why practitioners need to be trained to recognize these clients and assist them in the proper fashion.
The NewMind system has an assessment called The Interactive Self Inventory which can be used to identify clients with severe trauma, so it does not get confounded with medical problems they have. Utilizing this or alternative psychological assessments can aid in parsing out for the client which symptoms belong to the medical condition, and which symptoms are a consequence of trauma. Informing clients of the effects on trauma that neurofeedback can have and its potential to cause trauma to surface and initiate an integration episode is essential in these cases. Identifying and informing clients who are likely candidates for intense episodes of trauma integration is an important step towards misunderstandings and premature departure of clients with trauma. Referring these clients to other practitioners who extensive experience with trauma is advisable and may be necessary if you have no training in treating complex trauma. This ensures the best outcome for all involved and for the field of neurofeedback in general.