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February 11, 2005

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Publication Date: Friday, February 11, 2005

Training the brain Training the brain (February 11, 2005)

Neurofeedback as therapy for mental health

By Diana Reynolds Roome

Playing computer games may not seem like an obvious road to health, but Dr. Kathy Kermit has been helping patients control a range of problems from depression, insomnia and chronic pain to attention deficit disorder and post-traumatic stress disorder by controlling green space ships or blue waves on a screen.

Kermit is a Mountain View-based psychologist who uses neurofeedback to help patients learn how to control their own troublesome symptoms or behaviors. People come to her when other methods, such as drugs or psychotherapy, seem ineffective or counterproductive.
Trauma recovery

When Cynthia Robbins-Roth, a San Mateo biotech consultant and author, was seriously injured in a small-plane crash, all the bones between her eyebrows and upper jaw were smashed.

"It was a very arduous physical recovery," said Robbins-Roth, who had large areas of her face reconstructed. But the psychological recovery was far more elusive and just as troublesome.

"I had a difficult time being a passenger in a car. I would be overcome by panic that we'd go off the side of the road," she recalled. "With PTSD (post-traumatic stress disorder), you know rationally you're not about to crash, but the brain chemistry is doing what it did when you were about to crash. I had an overwhelming sense of disaster."

Despite regular therapy sessions with Kermit, who was recommended by a family doctor, some symptoms persisted.

"Our talk sessions were great, but talking did not seem to be getting at the post traumatic stress," said Robbins-Roth. "PTSD does not cure itself."

When Kermit suggested trying neurofeedback, Robbins-Roth was skeptical at first. But Robbins-Roth started reading about it, particularly in "Symphony in the Brain," a book by Jim Robbins (no relation) which explores the development of neurofeedback from biofeedback.

As a biologist, Robbins-Roth knew more than most people about the cellular structure of the brain, but she was also aware that much is still not understood, especially about how neural connections are made. In her case, nerve connections had been literally sheared apart by the impact of the crash. For the first six months afterwards, she was having problems with short-term memory.

But the trauma had caused another kind of disconnection, too, explained Robbins-Roth.

"When a scary event happens, like a crash, you have a fight-or-flight response and everything else not connected with that gets shut off. Some of those parts don't get rebooted -- it's like a computer -- so the experience doesn't get processed and put into past experience where it belongs," she said.

In post-traumatic stress disorder, this causes constant replaying of the experience, or the physical reactions to the experience.

"If you think an anxious thought, it's going to result in a reaction somewhere in the body," said Kermit. "The mind and body are not balanced against each other but are part of the same organism."

Robbins-Roth started neurofeedback by playing a game where she listened to sounds of water while watching her brainwaves move across a screen. By amplifying certain brainwaves, she could produce the sounds she liked best: ocean waves breaking on a shore.

"I was able to generate the ocean sounds I liked more and more. ... I was training my brain to take itself into a calming, meditative state,"said Robbins-Roth.
Getting the hang of it

"The more you practice, the more natural it becomes to change your own brainwave pattern," said Kermit, who sat at a computer beside another patient, monitoring an on-screen display of brainwaves that allows her to detect overproduction or underproduction of certain frequencies.

Kermit looks for signs of over-arousal and under-arousal as well as instability in the central nervous system. Excessive muscle tension may manifest in high beta waves, for example, or a tendency to high theta waves often leads to spaciness or patchy focus, which could indicate ADD. When she finds these, she adjusts games so that patients will strive to produce brainwaves they need to correct their condition.

Symptoms of over-arousal can include anxiety and panic, headaches, obsessions and compulsions, post-traumatic stress disorder, difficulty falling asleep and stress-related medical problems. An under-aroused central nervous system can lead to attention problems, chronic pain, depression, difficulty staying asleep and excessive fatigue. Unstable brainwave activity is more likely to manifest in behavioral problems and hyperactivity as well as bipolar disorders and seizures.

The diagnosis is sometimes less important than relieving the symptoms that are troubling a person and helping them to function better, Kermit said.

Though there is still little research on neurofeedback to document this, effects can be quite fast and are often lasting. This may be because it resembles learning processes such as swimming or riding a bicycle, in which "getting the hang of it" is the goal.

If benefits of neurofeedback have not been fully documented, there are no risks or side-effects either, aside from the possibility of a short-term over-adjustment, which the therapist is able to remedy quickly. It can also be a valuable alternative to drug therapy. For example, a pregnant woman suffering from depression wanted to avoid taking psychotropic drugs.
"Gaming" for kids

Neurofeedback therapy can be applied to children too, particularly those with ADD, behavioral or mood disorders whose parents are reluctant to put them on mind-altering drugs.

"Parents don't feel overjoyed that their child needs to be on meds every day," said Kermit. "They want to start out with a minimally invasive treatment."

Neurofeedback requires only a willingness to sit in front of a computer screen, with a few sensors on the scalp, and play a game or puzzle. This can be an advantage for a teenager who is anxious or depressed but doesn't want to go into details about why or children who do not feel put on the spot by unfamiliar procedures and questions.

"She doesn't have to talk," said Kermit. "And it's fast. Often she's feeling better within a week or two."

For obvious reasons, neurofeedback is often successful with children. The only real difference from a computer game is that instead of using a joystick, they use their mind. If they produce the type of brainwave that Kermit wants to encourage, they will be "rewarded" with a bird flying through the sky, a star spinning faster, or a Pac-Man figure gobbling up more black dots.

Children and teenagers quickly learn to produce the brainwaves that get results, and the process is so attractive that they enjoy coming back for more. What they may not always realize is that getting into the habit of feeling this way may help increase their focus, reduce headaches or incontinence, and alleviate mood swings or a habit of self-injury.

Robbins-Roth knows. "I'm much better, not a 100 percent yet, but I feel my energy level back up to baseline. And I'm a little more skilled at taking a deep breath."


Dr. Kathy Kermit 201 San Antonio Circle, Suite 212, Mountain View, 949-1102, For more information, visit

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