Informed Consent for Biofeedback Therapy

EEG BIOFEEDBACK: INFORMED CONSENT TO THERAPY

What is Biofeedback?

 

Biofeedback is like eavesdropping on your body's internal conversations and using this information to change negative patterns that are contributing to poor physical and mental health.  Our bodies are a sea of information and communication, every organ talking to every other organ.  As a general rule, we don't pay attention to these inside-the-skin conversations.  With very sophisticated computerized listening devices, we can collect this information and feed it back to our brains through our eyes and ears (biofeedback).  With practice, we can begin to change inside-the-skin events to make us healthier.  You already use biofeedback and those inside-the-skin subjective messages.  If you run up the steps noticing your heart rate and respiration increase and you are a little tired, then you slow down for a while.  Now, technology and medical science are able to help us listen to the quieter messages that otherwise go unnoticed and may lead to medical and emotional problems.

What is EEG biofeedback?

EEG (electroencephalogram) biofeedback is a learning strategy that would enable you to alter your states of consciousness:  your thinking, feeling, and perceptual state.  The brain is composed of billions of neurons (or nerve cells).  During any given moment in time, these neurons are involved in numerous chemical and electrical reactions as the brain processes incoming information and outgoing information is sent to all body systems.  The electrical component of these reactions is measured in cycles per second or Hz.  One Hz. would be one cycle per second; two Hz. would be two cycles per second... and so on.  These Hz. cycles are commonly called brain waves.  The predominance of certain brain wave states over others influences how we think and feel.  When information about your own brainwaves is made available to you via computer, you can learn to change them.  By changing them you can alter the way you behaviorally respond to the world around you, thus changing your states of consciousness.  In essence, you will be changing how you think, feel, imagine, and focus.

Why does this training procedure work?

EEG biofeedback training is a painless, non-invasive procedure.  Using some conductive paste, one or two electrodes are attached to your scalp, and one might be attached to your ear.  The brain waves are monitored by means of an amplifier and a computer based instrument that processes the signal and provides the proper feedback.  This is displayed to you by means of a computer video display.  Audio feedback in the form of changing tones is provided.  During the course of training it will be explained to you how your various thoughts can manipulate this video display or audio feedback.  As you experiment with various thoughts that produce a desirable frequency band, the frequency of positive rewards in the form of sound or of advancing counter number increases.  As activity in adverse frequency bands increases, positive rewards are withheld or inhibited.  Gradually, the brain responds to the positive rewards cues that it is given, and a "learning" of a new brain wave pattern takes place.  As you "learn" this brainwave pattern you will begin to grasp what a particular brainwave state "feels" like.  Then, more training sessions are needed to perfect the skills.  Learning to modify a brainwave state is a "discovery" process, a process of gaining more and more control over your thoughts, feelings, and behaviors.

In summary, as one works toward identifying and changing physiology (brain WAVES), the individual becomes more aware of subjective STATES of consciousness associated with those physiological changes.  With more familiarity and practice, the person learns and develops self-regulatory SKILLS based upon physiological and psychological experience.  With guidance and support from a trained neurotherapist, this experience can lead to changes, made by the individual, in STYLES of thinking, feeling, and behaving.  Thus EEG biofeedback can be an empowering clinical tool to promote meaningful change in people in critical areas of their physiological and psychological functioning.

WHAT KINDS OF EVALUATION DOES THIS FORM OF THERAPY REQUIRE?

If you decide that you are interested in this form of treatment, an initial EEG (electroencephalogram) will be completed which takes anywhere from sixty to seventy-five minutes.  In addition, you will be interviewed to document your description of current presenting problems that you and your clinician believe need to be a focus of treatment.  You may be asked to complete a number of clinically indicated psychological tests and a clinical interview which may involve further questions and a review of personal and family history to assess the likelihood of effective training.  The purpose of these evaluation procedures is to develop a customized EEG biofeedback treatment program to address your specific needs.  The primary objective of this evaluation is to maximize possible benefits.  In summary, the data collected during these evaluations is useful in developing a treatment design, identifying treatment objectives, measuring attainment of these objectives, and modifying or identifying new objectives on an as needed basis.

Certain concerns could arise in the process of the evaluation procedures.  These concerns will be minimized by the fact that that you have the opportunity to discuss any such issues at any point during your treatment with your assigned therapist.

What Kinds of General Results May Be Obtained In Treatment?

Training sessions typically last about thirty to forty-five minutes, three to four times a week.  This is of course dependent on your assessed need.  Some improvement is generally seen in five to ten sessions.  Once learning is consolidated, which usually takes around thirty sessions; the benefits appear to be permanent based on follow-up research.  Present research has determined that for a number of conditions, the effects of EEG biofeedback training are relatively stable for a number of years.  It is necessary to remember that your recovery is dependent upon active participation in your treatment.

EEG biofeedback training teaches a person what specific brainwave states feel like and how to turn those states on at will.  The trainee can "move" to different physiological states depending on what the immediate situation requires.  The healthy brain has the ability to vary states of arousal and attention as demanded by specific situations.  The disordered brain has diminished ability to respond to these specific demands.  The immature, injured, or disordered brain seems to lack the normal elasticity of a healthy brain.

There appears to be discontinuities in brain processes or breakdowns in within-the-brain communications.  The disordered brain seems to get "stuck" and exhibits inappropriate brain waves for the immediate situation.  For example:

In the case of Attention Deficit Disorder, a person tends to exhibit more daydreaming-type brainwaves (theta) with less than normal focused attention type brainwaves (beta).  The symptoms of impulsivity, distractibility, and hyperactivity may respond to the biofeedback training.  This may lead too much more successful group therapy, improved ability to learn in educational settings, as well as more positive interactions with others.  Cognitive performance may improve as well.

In the case of closed-head injury resulting from concussion, whiplash or stroke, it has been observed that person may exhibit more daydreaming-type slow brainwaves (theta) with less than normal focused attention (beta brainwaves) or have a mix of excessive slow theta brainwaves and faster beta waves which leads to anxiety, mood swings, and confusion.  EEG biofeedback can reduce symptoms of confusion, irritability, sleep disturbance, depression, anxiety, pain, fatigue, and poor memory.

The alcoholic tends to exhibit more hypervigilant tension-type brainwaves (beta) and less than normal relaxation and deep quieting-type brainwaves (alpha and theta).

One possible consequence that the client should be aware of concerns the observation from research that clients who complete treatment by the methods used in this type of therapy may, for reasons still not clear, subsequently be unable to tolerate alcohol intake without becoming acutely ill with flu-like symptoms.  It is possible that you may experience images of an unpleasant or somewhat negative nature emerging during training, and that your therapist will be available to discuss these images.  Also you may recognize characteristics of your personality that you have never experienced or have not experienced for many years.  Some clients can find this as either a positive or negative experience.  In the event you believe you are having a negative experience, you need to discuss these concerns with your therapist.

In addition, some clients may note a change in the effects of their medications during this form of therapy.  If you notice a change, you are to notify both your physician and your therapist.  If your physician is considering prescribing a new medication or has changed the amounts of your current medications, you need to inform your therapist.  The purpose of this therapy is not to eliminate your need for medications.  However, some clients who have received this form of therapy have experienced a need for reduction or elimination of certain medications.  Again, this is a matter you need to discuss with both your physician and your therapist.

As a client interested in this form of therapy you will be asked to give the following consent to treatment:

  • I understand that just like any other therapy, I may or may not benefit from EEG biofeedback.
  • I understand that all information I will give as a part of this treatment will remain confidential. Therefore, the information capable of identifying me as an individual will not be shown to anyone except treatment staff members.
  • I understand that an outside consultant may be contacted on a periodic basis for the EEG biofeedback program during my treatment. All identifying information will be removed from psychological reports or data files before a consultant reviews them.

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