Historical Notes A Early Beginnings

Until about 40 years ago, it was generally believed that brain electrophysiology was not under conscious control and could not be modified through learning. In fact, even today despite much evidence that EEG can be modified rather easily, there are some who assert that this occurs only through mediation by voluntary control of a skeletal muscle response, e.g., deep breathing. The birth of the field of neurofeedback (NF) commonly is reported to have occurred with a serendipitous discovery in the early 1960s. A University of Chicago physiological psychologist, Joe Kamiya, noted that some persons could consciously control bursts of a frequency EEG if asked to do so by simply observing their ongoing EEG tracings. This was quite a revolutionary idea at the time and led to a large amount of research and clinical work on EEG biofeedback through the 1970s.

Researchers and clinicians in both medicine and psychology claimed to have demonstrated that most persons not only can learn to self-regulate aspects of their EEG but that certain modifications (especially a-frequency amplitude and duration at certain scalp sites) are associated with major changes in consciousness, including perceived decreases in anxiety. For example, Tom Budzynski and Johan Stoyva published results of successful use of biofeedback to increase a levels in conjunction with systematic desensitization therapy for a phobic type condition. Barry Sterman reported decreases in epileptic seizure activity, and Joel Lubar and M. N. Shouse published evidence of positive behavioral changes in a "hyperkinetic" child, with both of these being associated with training of the sensorimotor rhythm (SMR) and inhibiting 0 activity at central scalp sites.

Under the leadership of Barbara Brown, a biofeedback research society was formed in 1969, and several books on biofeedback were published soon thereafter. However, during the 1970s there was increasing criticism of EEG biofeedback. For many it became associated with "consciousness raising" and other "New Age'' movements of the time, and the claims of its advocates often were strongly attacked by researchers publishing in a few prestigious journals. For example, one especially influential article reported that biofeedback did not enable persons to increase a frequency amplitudes beyond those normally occurring when simply sitting in a dark room with eyes closed.

By the late 1970s the earlier promise of EEG biofeedback had faded. Although the larger field of biofeedback (e.g., temperature, heart rate, muscle tension feedback) continued to prosper to some degree, proponents and practitioners of EEG biofeedback were few. Joel and Judith Lubar at the University of Tennessee and Southeastern Biofeedback Institute pursued research and treatment with children having learning and attentional disorders, Lester Fehmi continued to use multi-EEG channel synchrony training to develop flexible attention, and Margaret Ayres reported major success using EEG biofeedback equipment of her own design with victims of head injury and stroke. Dale Walters and Alyce and Elmer Green continued to use and teach these procedures at the Menninger Institute in Kansas. During the early 1980s, Charles Stroebel and Adam Crane continued to perfect equipment for providing feedback of complex patterns of EEG activity.

B. Revival

A major turning point for NF came in the late 1980s largely due to several nearly simultaneous events: publications by Joel and Judith Lubar detailing successful treatment of attention deficit disorder with EEG biofeedback, a research publication by Eugene Peniston and Paul Kulkosky, and the development of high-quality, relatively low priced equipment for both QEEG evaluation and EEG biofeedback by companies such as Lexicor Medical Technology of Boulder,

CO. The 1989 Peniston and Kulkosky research combined conventional treatment and relaxation and temperature biofeedback with NF in treating 10 male alcoholics and compared the results to those of a conventional treatment only control group. The finding of much better and more enduring results with the experimental group aroused strong interest in the potential of NF for treating this notoriously treatment-resistant group. During the 1990s, there was what some describe as an explosion of interest in NF that continues today. A few highlights will be mentioned briefly in the next few paragraphs.

Perhaps to shed an earlier negative image, the terms neurofeedback and neurotherapy largely replaced the term EEG biofeedback by the early 1990s, with the latter now referring primarily to research rather than clinical applications. Whereas scientific research activity in this area is growing but remains modest in extent, the clinical use of NF is spreading very rapidly, both nationally and internationally. It is estimated that approximately 1500 clinics and practitioners now use it as one of their treatment modalities. Some of the pioneers continue to expand their NF practices (e.g., Joel and Judith Lubar at Southeastern Biofeedback Institute and Margaret Ayers at Neuropathways), and there are many relative newcomers with large practices. Notable among the latter are Seigfried and Susan Othmer, who have trained many of today's practitioners and help new trainees establish practices throughout the country.

An early professional group, the Biofeedback Society of America, and its descendant and largest biofeedback association, the Association for Applied Psychophysiology and Biofeedback (AAPB), have always had members with interests in EEG biofeedback. However, until about the mid-1990s, many of these members apparently felt treated as "second class citizens,'' perhaps related to the negative image EEG biofeedback had acquired during the 1970-1990 period and mainstream biofeedback's desire to avoid it. Partially as a result, a separate group was formed in 1992 and presently is known as the Society for Neuronal Regulation (SNR). Consisting of 450 members in 2001, it sponsors annual national conferences at which NF research and related developments are presented. At approximately the same time, AAPB changed its structure to allow for specialty interests, and in 1993 an EEG interest group was formed. This EEG Biofeedback Division within AAPB also has grown rapidly and now is well-accepted, as evidenced by the election of the NF pioneer Joel Lubar as the president of AAPB in 1996. In 1995 a journal devoted entirely to NF-related topics, the Journal of Neuro-therapy, was first published. It now has a circulation of 450 and is abstracted through the American Psychological Association's "Psychlit" service. The first text in the field, Introduction to Quantitative EEG and Neurofeedback, edited by this author and Andrew Abarbanel, was published by Academic Press in 1999. Several NF websites are operative, including that of SNR: www.snr-jnt.org. Although proper training and credentials continue to be controversial topics, more states are including biofeedback (and thus neurofeedback) as practice activities in licensing laws for professionals such as psychologists and counselors. Several groups provide intensive training seminars, and NF certification is available through the Biofeedback Certification Institute of America (BCIA).

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