By Ralph Yeung
Within the past few years, Queen’s has been made keenly aware of the importance of mental health. So much so, in fact, that Principal Woolf spearheaded the formation of a committee, which earlier this year outlined strategies the school will take to promote mental health.
These initiatives are not without their hurdles. I once had a conversation with a psychiatrist who described relapse of mental illness as one of the more frustrating, but expected, aspects of her work. Patients often slip into negative thought patterns, and then keep using such patterns to process new information. This leads to patients continuously perceiving situations in a negative light.
Psychotherapy aims to disrupt this habit, often by helping an individual recognize these patterns and consciously interrupting such thoughts when they happen.
This technique works because the brain is plastic, as many neuroscientists call it. The brain changes and adapts based on demand for usage. It strengthens neural (brain) circuits that are used often, and leaves unused neurons malleable enough to form new circuits. It’s this concept that some believe are key to both the problem and the solution: the brain keeps reinforcing a circuit that processes information negatively, but it can be weakened by interrupting the circuit, in hopes that a less negative thought process can develop over time.
Recognizing and interrupting negative thought processes isn’t always easy, and patients can relapse into negative thought patterns during or after psychotherapy. That being said, what if technology can facilitate this pattern breaking?
What if a machine can detect when we use neural circuits which process negatively, and interrupt signalling with another stimulus to weaken this circuit and break this habit?
It sounds like something out of science fiction, but it is, in fact, the very basis of a fairly unheard of treatment called neurofeedback.
“It’s like the rumble strips on the highway,” says Dr. Janet McCulloch, one of two physicians at the Kingston Institute of Psychotherapy and Neurofeedback (KIPN). “When you hit them, it triggers your self-orienting response. It’s the same here.”
The concept behind neurofeedback is fairly simple: representative brain activity is measured using an easily attachable electroencephalogram (EEG) with five electrodes. A computer program monitors brain activity for specific patterns correlated with negative thought processes. The patient listens to relaxing music during an approximately 30 minute session, during which static noise interrupts the music briefly whenever a threshold amount of these patterns are detected.
“The computer is [monitoring] electrical patterns. When it sees a person go into a turbulent state, it gives them instant feedback, triggering a cascade. First thing it does is trigger the orienting reflex. From there, [the brain] does self-scanning and self-correcting,” McCulloch said.
Like rumble strips, the static sound interrupts the otherwise smooth flow of music. This shift in sound causes a person to interrupt their current processing in order to process the new stimulus (the static noise). This interrupts signalling through the circuits being used at the time, and over time, gradually weakens the circuit, as it is no longer used. By playing static noise when negative processes are used, the computer may target those specific circuits for degradation.
Yan Yu, a second-year medical student who observed at KIPN earlier this year, summed up the process. “[Patients’] own established mental habits of thinking, most of which are subconscious, leads them to thinking in a depressive or anxious way. That pattern of thinking is so engrained, it’s subconscious, so we subconsciously get the brain to correct itself with neurofeedback,” Yu said.
This is particularly useful for individuals who are overly anxious or depressed, as it may help them break out of skewed patterns of perception and help them relax. “Relaxation training is part of it, but it’s not just about relaxation. It’s about training stability, flexibility and resilience. It’s also about training the right and left hemispheres to cooperate,” McCulloch said.
As explained by the KIPN website, an ideal brain should be capable of switching between brain states based on how much attention and focus is required at the time (flexibility). When we don’t need to focus, it should be able to relax. When demand is high, it should be able to focus, and remain stably focused (resilience). Neurofeedback can help increase brain flexibility and the ability to remain stably focused. Essentially, it’s about training your brain to self-regulate properly by helping create more efficient thought processes and their neural circuitry.
There are many benefits of using neurofeedback as a potential treatment for various mental health issues. McCulloch describes how it is personally valuable to her. “For me, in psychiatry, we rarely have a tool to look at something objectively. [Evaluations] are so subjective, whereas this is an objective, quantitative result,” she said. These quantitative results can also be tracked over time and over sessions, giving numerical data to support whether an individual is responding to neurofeedback.
Given the benefits, it may come as a surprise as to why neurofeedback hasn’t become a more standard treatment for various mental illnesses. The technological barrier is no longer an issue: besides the EEG electrodes, patients simply need to install software that is compatible with most personal computers. But, it’s the pricing of hardware and software packages that is hindering neurofeedback’s diffusion. Professional systems sell for $9500 and personal ones, which are designed for home use, sell for $5000 (according to one provider’s website). Nonetheless, McCulloch says that costs are going down and that some patients end up purchasing their own systems to be used at home.
McCulloch mentions the lack of neurofeedback efficacy studies as a problem for larger institutions that want to collect more information about its effects before implementing it into treatment protocols. “Medicine is very conservative, to set up a large scale study will take years and no pharmaceutical company is going to fund research in neurofeedback,” McCulloch said.
This is not to say research studies involving neurofeedback aren’t happening. Here at Queen’s University, starting in 2013, Dr. James Reynolds will be working with Dr. McCulloch, to test the efficacy of neurofeedback treatment for individuals with fetal alcohol syndrome (FASD).
“We hypothesize that children with FASD will demonstrate significant improvements in multiple domains of brain function after [neurofeedback] treatment, and that measures of stress or depression will be improved in parents/caregivers [of these children],” Reynolds said.
It would not be difficult to imagine other research groups adopting the technology, as the equipment is fairly easy to use.
“It probably only takes someone half an hour to learn how to use one of these,” Alex Legnini, who manages KIPN, mentioned as he hooked up the electrodes to my head. Dr. McCulloch suggested a demonstration as the best way to understand how neurofeedback works.
Alex took three minutes to attach the electrodes and measure a 30 second baseline of my brain activity. The next 15 minutes (the demo is half a session length) were a blur. I could hear the occasional static interrupting the soothing music, and at a certain point, I felt my mind slip into a different place.
“Like switching gears in a car,” McCulloch reflects on her own neurofeedback sessions.
Does it really work? Medical student Yu, believes it does, even after just one session. “Right afterwards I found myself full of energy, so full of energy that I did my first ever 10 kilometer run. That night I had trouble falling asleep and when I did, dreamed vividly. As I continued to do neurofeedback I found myself being more conscious of my feelings.”
I didn’t go for a ten kilometer run after my session.
I slept soundly for the first time in a week though.