Hey, I'm Kurt Othmer From EEGInfo
Opened my iPhone last night, and saw a little google alert
that some researchers have looked at the "available research" on neurofeedback
and decided that all the effects they're seeing, are placebo.
Let's talk about neurofeedback and the placebo effect
so one of the really common questions we get is
"hey, do you think this might be placebo?"
and, that's actually a really cool question
because the placebo is this very powerful thing
it reflects to a large extent the power of our minds
to conjure up health
just by believing that we might be more healthy
so if I tell you "hey this magical pill is going to make you feel better"
Low and behold, you actually feel better
and that's all in the power of the mind
and this is a huge problem for medicine in general
because some stuff that really looks like medicine, really has no active ingredient at all
and now we take something like neurofeedback
that has these powerful clinical results
but it looks awfully funny
we're putting electrodes on the scalp
and we're watching the EEG
and watching video games
it looks kinda too good to be true
so how do we know that this isn't placebo
First, is animal research
cats do not have a placebo response
Let's go back to the early days of Barry Sterman in the 1970s
he looked at the EEG of cats
and this was right about the time my mom was looking at the EEG of cats over in Cornell
and Barry Sterman was at UCLA and he was looking at the EEG of cats
and he says, "these cats are making this little burst of activity when they're focused and concentrating
can we give them a little food reward and make them make more of that little burst?"
and low and behold they did
they gave them a little food
and they made more of those bursts
flash forward, now this is the 1970s and
Astronauts are going to the moon and
they're seeing things out the window that they shouldn't be seeing
so there's aliens flying by
and Huston is saying "Hey guys, you're not actually seeing aliens" and
"Hey I can see somebody walking around on the ground"
"No, you can't"
So, they start testing the rocket fuel
because, their idea is there's probably rocket fuel leaking into the cabin
and that's what's giving them these hallucinations
so, UCLA and Barry Sterman was asked
to test this rocket fuel on kitty cats
I'm really sorry, that's not research that would be allowed to be done today
but, you have kitty cats in the 1970s getting injected with Monomethylhydrazine
again I'm sorry
and this, what you're seeing here, is a cat having a seizure after being exposed to Monomethylhydrazine
and they had a problem in this research
in this research some of the cats went into these seizures
some of the cats did not
who were these cats that didn't go into seizure
those were the cats that had trained those bursts
in the neurofeedback research
they had trained to make more of that activity
that sort of weight lifting for those little kitty brains
that exercise of making those bursts for that food reward
had lead them to be seizure resistant
so they had strengthened their brains enough
to be seizure resistant
but here's the deal
cats don't have a placebo response
they didn't go "I believe in you great researcher, I believe in your healing capabilities"
"I'm going to not have seizures anymore"
no, cats don't care
we know that, you've been on the internet
cats don't care
when you look at the placebo
the effects are in the same direction as expectations
so, if you ask somebody
if you tell somebody "hey this sugar pill
this fake pill
is going to make you feel better
it's going to make you feel happy"
If the placebo is working for that person
they're gonna feel happy as a result
what we don't have is the opposite
I can't say here's the same sugar pill
and it's going to make you feel happy
and then they feel sad as a result
what's true of neurofeedback is
our results can change based on our protocol alone
so, when we train in one direction we can have positive clinical results
we can have a migraine go away
and for that same person with a slightly different protocol
we can inadvertently make that migraine worse
we can make that headache worse
we can make somebody uncomfortable in a session
now, don't get me wrong, we don't leave anybody worse off
we can always get somebody back out of a negative symptom
but like a psychiatrist finding the right drug for you
the right medication
they try different doses to find what's exactly right
we do the same thing with neurofeedback
and we find that right protocol
and we do that largely by listening to "how is that headache right now
is it adjusting? Is it changing? is it getting worse? is it betting better?"
we can make that headache worse and better
in that session, in that moment
you can't do that with a placebo
you can't take the same sugar pill
and give it to the same person
and without telling them that it's any different
suddenly have their headache get worse or better, worse or better
right there in the same session back and forth, and back and forth
those are the results that we're seeing today
are that quick, they change that fast
to be worse and better, worse and better, right there in the session
and we're just listening to symptoms
we're just adjusting based on symptoms
The next, and this is my hero Ben Goldacre
who says "look I'm really not interested if your medical intervention is better than placebo
is better than magic"
"I am interested in
Is your medical intervention better then the best possible therapy I currently have"
and you should listen to his talks on TED.com he's excellent
so let's ask that question
is neurofeedback better than the best available therapy we currently have
Let's talk about comparison studies
Let's take the best available drug addiction therapy that we know of right now
which is the 12-step program
there's some interesting research going on right now with drugs
but the main thing you get when you go to rehab
is the 12-step program
so let's compare the 12-step program, to the 12-step program with neurofeedback
how do we compare?
well we did a study in the 90s
with 121 subjects split into two groups
these are the drug profiles of the various drugs they were taking
when they came to rehab
we had 121 subjects split into two groups
63 in the 12-step group
58 in the experimental group that received 12-step and neurofeedback
now, initially, and we're going to talk about this in a minute
initially there were a whole bunch of folks who dropped out
so they don't end up in the final analysis here
but in the final analysis, abstinence after one year
12 out of the initial 27, so 44% were still sober in that 12-step group
That's actually really good for a 12-step program
In the neurofeedback group, now this is neurofeedback plus the 12-step program
36 out of 47 were still sober one year later
that's 77%
that is unheard of
and it warrants some attention
The fourth case I would make for how we know that this is not placebo
is that for some of these things there just is not a placebo explanation for how we are seeing these results
there is some amazing FMRI research
And just a moment on FMRI
You can actually do FMRI neurofeedback
and the beautiful thing is, this is being done at top universities by top researchers
and they get to have these tiny little populations
a research study of one subject
they basically say, change this part of your brain
and we're going to see it in the FMRI
we're going to show that back to you in the FMRI
and, you see that part of your brain?
I want you to change it
I want you to make that change
and they do, and they go "published" and "done"
and FMRI feedback works and it's awesome
So FMRI feedback and then also looking at FMRI for neurofeedback
a quick moment, FMRI, what is it?
Functional Magnetic Resonance Imaging
you've heard of an MRI for your knee?
sees what's going on with the joint in your knee
this is Functional Magnetic Resonance Imaging so it's looking at the functional changes of your brain
so we can actually do neurofeedback using FMRI
and we can do imaging with the FMRI
to see changes on the EEG Neurofeedback
this is really profound, and is great evidence for the work we're doing
there's connectivity changes looking at the EEG
this is just some symptom changes from a vet we worked with
massive reduction in symptoms in the first three sessions
this is what we're getting done in the first three sessions
this warrants attention
and these are all his symptoms taken together
you can look at his on our www.HomeComing4Veterans.org website
you can look at his results
This is a SPECT scan
Pre / Post SPECT
you notice here this diamond pattern
that Dr. Daniel Amen who donated these SPECT scans to our non-profit
he points to this as the classic model for PTSD
this sort of diamond pattern
and you see that highlighted here
and then after the neurofeedback
and that pre / post shows this dramatic change
after the neurofeedback
Let's talk about a 1991 study
23 point gain in Wechsler IQ score
So we changed IQ doing neurofeedback
and that was already a replication of previous data
this is really recent, this is just a couple months old
this is a publication looking at 5,740 subjects
now people want to criticize and say "hey there's nothing here"
but, this is big!
numbers this large, they blow out of the water drug studies
This is big! 5,740 subjects
and we are moving ...
you see these red numbers that are over to the right
that's after the neurofeedback
look at how far that is from normal
that black line there is normal
that's that Gaussian distribution
that red line, look at how far that red line is from that average
that's after the neurofeedback
look at how much they've improved in impulsivity
this is huge
and that's across the board
that is major change
for most of the folks coming through neurofeedback
that's really big
and that cannot be ignored
so in the grand scheme of things
this needs to be paid attention to
so when we have researchers out there
who say "oh we don't even need to look at it"
well, there's not even enough research yet
to say that there's not enough research yet
in other words, these researchers come along and say "oh, we're not going to research it because there's not enough research"
well isn't that convenient
but I want to leave you with one very simple message
that, this needs to be attended to
even if you dismiss everything I said
even if you say "hey, this is silly, this is probably still placebo, yeah, he did a nice talk, but, this is probably still placebo"
even if you dismiss all of that
you need to pay attention to one fact
and that is here in this graph
here at the top, that flat line
is where people stayed in the study
that's the first 20 sessions
and they stayed in their treatment program
that's the folks doing the 12-step and the neurofeedback
and the ones getting both 12-step and neurofeedback
stayed in the program
and anybody who does 12-step work,
anybody who does drug addiction work will tell you
if all you do is keep people in the program
if you keep people coming back
that's enough
but going forward the implications are big
we're getting people sleeping better
we're improving headaches
we're keeping people sober for long periods of time
we are in four homeless shelters here in the Los Angeles area
doing work with veterans and shelter residents
and doing a tremendous amount of good
but clearly the flight is just now showing up as the researchers are starting to say
"I don't want to look at this"
"I want to get rid of this"
and so the fight begins
so I invite you to come to our non-profit
Home Coming for Veterans www.HomeComing4Veterans.org
and make a donation
help us support vets
help us increase the research
and the message
and get this information out there
and for those professionals out there
please come to a training course and learn how to do this
we need more volunteers at the shelter
and we need more good clinicians who are doing this
and those of you who are already doing this work
and haven't been to a course in five, ten, twenty years
it's time to come back
because the work we're doing today is stronger and faster and more effective
check out the links in the show notes
and thank you so much for your time
I'm Kurt Othmer from EEG Info