Biofeedback practitioners have avoided EEG
biofeedback (or neurofeedback) because they perceive the field as complex
and somewhat intimidating. We may remember the high school science teacher
being more than a little apprehensive when she had to cover neuroanatomy.
The truth is that the brain is complex - and we should be grateful for the
complexity! As someone once said, if the brain were simpler in its
complexity we would be that much less able to comprehend it. Overall, the
neurofeedback field is fresh and extremely inviting. One might consider
approaching neurofeedback as an adventure or an exploration into the
unknown. Since beginning my study of the field and the central nervous
system, I have been encouraged that no one seems to know very much about
how the brain works. Somehow the community formed by these inquisitive
types is fascinating and engaging.
It is interesting to note that rather small changes in central nervous
system (CNS) functioning can produce extreme "downstream" effects. This
can be readily seen in the sudden mood shifts prevalent in a bipolar
patient due to, as yet, unmeasurable changes in certain neurotransmitters.
These changes can shift a patientís mood from suicidal depression to
grandiose self-confidence within minutes. As we ponder the powerful
effects of small CNS changes, we realize that, with neurofeedback, the
possibilities for enhancing the human condition are profound. To demystify
this area is one of my purposes in writing this article. We need more
researchers and clinicians working together and communicating the results
they see in their laboratories, clinical settings, and through careful
observation of life. This article will present the opportunities and
challenges facing this new application neurofeedback to immune enhancement
and consider certain theoretical models which may be applicable. In
addition, the limited yet provocative literature in this area will be
NEUROFEEDBACK AS A TOOL FOR CHANGE
To gain an
understanding of how neurofeedback might be an effective tool, let us look
at some things we know. Instability of the central nervous system is seen
in seizure disorder, attention deficit disorder, closed head injury, and
other central nervous system disorders currently being successfully
treated with neurofeedback. Disregulation of brain function is thought to
be the basis of certain psychological disorders (depression, mania,
obsessive-compulsive disorder, anxiety, etc.) which likewise respond to
neurofeedback treatment. Given what we know to be true, the following
working hypothesis may be generated: IF seizure thresholds can be raised,
attention and concentration skills can be refined, and neurons can be
reeducated and/or recruited to produce more normal full-spectrum
functioning in closed head injury; THEN a disregulated, down-regulated, or
unstable immune system be stabilized and/or modulated utilizing
Correlation of EEG patterns with behavior, cognition, and emotion are now
being intensely studied and defined. Equipped with newer and better
instrumentation, the data indicate that subjects may learn to control
previously uncontrollable physiology (self-regulation). Furthermore,
individuals who utilize neurofeedback state that they perceive reality
with greater clarity, have improved mental acuity, as well as acquire
greater control over fluctuations in mood and behavior. As stated above,
we know that small changes in brain activity produced by drugs, trauma,
neurotransmitter shifts, or mood can yield profound effects.
Neurofeedback, which reorganizes and reorients brain electrical activity,
can, in all probability, be utilized to positively modulate the immune
response. We must remember however, that although this is a logical
extension of currently accepted knowledge and protocols it has yet to be
subjected to the rigors of scientific inquiry.
TWO NEUROPHYSIOLOGICAL MODELS FOR CHANGE
theory we learn that feedback corrects incremental deviations from a
desired course and creates stability via the integration of new knowledge.
When a disregulated or unstable CNS is given neurofeedback it can yield
greater regulation and stability. Often that is desirable. Given what we
know of the plasticity of the human brain (Diamond, 1988), it is certainly
reasonable to assert the hypothesis that EEG biofeedback can alter immune
function within an individual. This paper will discuss two well documented
models for this assertion. The first is based upon what we know about the
effect of stress on immunity (a field of study known as psycho-neuro-immunology),
and the second is based upon what we are learning about the intricate
feedback mechanisms "hard wired" within the CNS, the immune system, and
the endocrine system. This is an exciting and growing body of literature
which is more clearly defining the bi-directional feedback circuits
existing within these three systems.
I . STRESS AND IMMUNITY
The human exists
in a state of dynamic equilibrium called homeostasis. The body reacts when
homeostasis is challenged by intrinsic or extrinsic forces (stress).
Research demonstrates that exposure to pathogens, toxic odors, marital
conflict, depression and grief suppress immune function. Conversely,
vitamin C, sleep, stimulating positive experiences, physical fitness,
exposure to humor, even light boosts immune function. To date, more than
20 hormones and neurotransmitters have known immunological modulation
potential (Khansari, 1990). Likewise, many neurotransmitters either
increase or decrease in response to stress or to drugs that help us cope
with the effects of stress.
Few experts dispute the role of stress in determining, or at least
modulating, how healthy an individual is at any point in time. With
increased stress or perceived threat, the hypothalamus releases
corticotropin-releasing factor (CRF) a hormone which triggers release of
adrenocorticotropin (ACTH) by the pituitary gland which, in turn,
stimulates the release of corticosterone by the adrenal glands.
Corticosterone is a known suppresser of immune function and its role is
much more complex in modulating immunity than has been previously
understood. Both the hypothalamus and its neighbor the pituitary gland are
part of, and therefore regulated by, the CNS. This is why relaxation
training is thought to have beneficial effects and explains why people who
meditate experience significantly less physical symptomatology.
The sympathetic nervous system, which is innervated under the "fight or
flight" condition and often accompanies acute stress, has undergone
extensive study as it relates to immune system modulation. It is thought
that sympathetic nervous system changes that accompany anxiety and
depression (common sequelae during bereavement) play a role in immune
suppression or "down-regulation." Other studies indicate that T-cell
mediated natural killer cell activity is significantly decreased as
observed in college students who are not coping with the demands of school
(Rogers, 1979). Epinephrine and norepinephrine, the primary stress
response hormones, consistently decrease immune response making the body
more vulnerable to disease (for a more complete discussion of this please
see my article "Self-Regulation of the Immune System" in Megabrain Report,
Volume 3, Number 1, pages 30-39, 1996).
I I . CNS -
ENDOCRINE FEEDBACK AND IMMUNITY
elucidated extensive mediating mechanisms with a dense communication
network that interfaces the central nervous system (CNS) with both the
endocrine and immune systems. The brain communicates with the immune
system through two known pathways, the autonomic nervous system and the
hypothalamic pituitary adrenal axis - HPA (Angeli, 1994). Recent
discoveries yield consistent evidence that the immune process provides
protection against infection and that its impairment seems to be involved
in the development of autoimmune disorders, malignancies and rapid
advancement of the AIDS virus.
Karen Bulloch (1990) demonstrated that autonomic servous system fibers are
directly connected to the thymus where T-cells mature. More recently,
Felten and Felten (1991) have demonstrated that primary lymphoid organs
are heavily innervated by fibers from the sympathetic nervous system. A
relatively new field called "immunoendocrinology" is uncovering numerous
bilateral interactions between the immune system and neuroendocrine
circuits. Researchers' Derijk and Berkenbosch (1991) discuss evidence
indicating that an immunoendocrine feedback loop, which they term "immune-hypothalamo-pituitary-adrenal
system" is an important factor in immune system modulation. Maladaptive
neuroendocrine responses, i.e., disregulation of the stress system, often
lead to disturbances in growth and development, and cause psychiatric,
endocrine/metabolic, and/or autoimmune diseases or vulnerability to such
disease (Stratakis, 1995).
The dedicated work of many scientists in their search for neuromodulatory
mechanisms has led us to conclude that the immune system, endocrine
system, and central nervous system contain a web of "hard-wired" feedback
loops. The exact mechanism of action of these immune modulating feedback
loops await further research, however they will become more and more
important in describing how neurofeedback can enhance the immune systemís
ability to either maintain health and ward off disease or become impaired
thus creating sickness. At the present time, our ability to describe an
exact mechanism is limited by our elementary understanding of how the
immune system communicates with the brain at the electrical and
THE HISTORY OF SELF-REGULATION AND IMMUNITY
inherent in the application of biofeedback and neurofeedback to immune
disorders becomes obvious as one scans relevant literature in this area.
The few studies that do exist are generally flawed by poor immune system
assays or lack of control groups. Additionally, decreases in physical
symptomalogy, a relatively poor second order immune system marker, is
generally used. The ability to properly assay the immune system is rather
expensive and therefore limits clinicians and/or researchers. The
heterogeneity of the diseased individual (psychologically, socially, and
physically), the variability of assays, and the clinical relevance of
observed changes further complicate the interpretation of research.
BIOFEEDBACK AND IMMUNITY
summarize the relevant biofeedback literature let us begin with Peavy, et
al (1985). He administered EMG and thermal biofeedback with relaxation
training to a group of subjects and found significant increases in
phagocyte (a cell that engulfs and absorbs unwanted microorganisms)
activity comparing pre and post treatment blood work. In 1993, Farber
utilized biofeedback with meditation to successfully treat psoriasis,
often thought to be a stress-related disease.
Gruber, et al (1988) conducted two studies involving metastatic breast
cancer. The first, a pilot study, involved 10 subjects given biofeedback
and guided imagery over a one year period. Blood samples taken monthly
indicated significant increases in multiple immune system markers. In
1993, the same author reported on an 18 month study showing positive
shifts in immune system markers (natural killer cells and lymphocytes) and
psychological changes with stage one breast cancer when subjects were
given biofeedback, guided imagery, and relaxation training (Gruber, et al,
1993). McGrady, et al (1992) reported increased lymphocyte growth as well
as positive shifts in white blood cell count in fourteen subjects trained
with EMG and thermal biofeedback-assisted relaxation for four weeks. The
author also reported that the subjects with lower initial anxiety scores
and forehead muscle tension levels showed larger increases in lymphocyte
growth and larger decreases in neutrophils (white blood cells known for
their excellent ability to destroy unwanted microorganisms) than subjects
with higher initial anxiety and muscle tension levels.
Auerbach, et al (1992) conducted a study on 26 HIV+ males who were
assigned to either a treatment group, consisting of thermal biofeedback,
guided imagery and hypnosis or a wait list control for eight weeks.
Although no significant changes were found in T-4 level in the treatment
condition, significant decreases were noted in HIV related symptoms as
well as increases in energy. For a further understanding of relaxation,
imagery and biofeedback-assisted strategies as well as the use of humor,
emotional factors, hypnosis and conditioning paradigms, the reader may
reference an article titled, "Self-regulation of the immune system through
biobehavioral strategies" in Biofeedback and Self-Regulation (March,
NEUROFEEDBACK AND IMMUNITY
so new that there are currently very few studies. Michael Tansey (1994)
published the first peer reviewed article as to the curative effect of 14
Hz. EEG neurofeedback on multiple cases of Chronic Fatigue Syndrome (CFS).
Fran Lowe (1994) likewise reported positive effects on five subjects with
CFS utilizing 13-14 Hz. beta training. Both Tansey and Lowe measured
improvement on psychometric measures rather than direct measurement of
immune system factors (i.e., Ebstein-Barr virus).
Subjects with HIV make excellent candidates for study since the progress
of the disease was fairly consistent especially in the days prior to the
advent of protease inhibitors and combination drug treatments. Since the
disease was continuous and progressive, increases in T-4, especially in
group data, would have been highly unlikely and would most likely be due
to a treatment that strengthens the immune system. A single case study was
presented at the Society for the Study of Neuronal Regulation conference
in 1994 by Ellen Saxby. In this study she recruited one HIV+ subject and
utilized 14 Hz. enhancement of C1-C2 utilizing EEG-driven
photo-stimulation for five sessions. The subject increased T-4 absolute
count from 110 to 264, a 140% increase. Saxby's results are suggestive but
the single case design is scientifically inconclusive and limits
A neurofeedback pilot study that is "in press" was completed by me along
with co-investigators: M. Crane, L. Wong, and C. Aguirre. The study is
titled "The effect of alpha and theta neurofeedback and alpha-stim
treatment on immune function, physical symptoms, and subjective stress
within a group of HIV+ subjects, a controlled study". Due to the current
publication status of the study, I can only summarize the results here.
The goal of the study was to document previously observed changes and to
justify the utility of further investigation. Forty subjects were assigned
to one of three treatment conditions and a control group. Of the 20
subjects given alpha neurofeedback training over four months at O-z, one
group of 10 subjects averaged a 31% increase in T-4 count, the other group
of ten increased 25%. The alpha-stim only and control group showed no
change. In addition, all the subjects given neurofeedback reported a
significant decrease in physical symptoms and subjective stress within the
first month of the study. These results have been extremely compelling in
favor of the possibility of positive immune modulation with neurofeedback.
At the present time we are attempting to raise funds for further research
to replicate and refine these results. Likewise, we intend on expanding
the scope of our research to other immune problems. Future studies will
have better measures of immune function and examine electrode placement
issues for maximum benefit.
WHERE DO WE GO FROM HERE?
complexity involved in the interaction between the central nervous,
immune, and the endocrine systems become better understood many questions
will be resolved. Certainly the immune system has a level of
sophistication and organization that we are just beginning to comprehend.
Neurofeedback as a science is still in its infancy because so little is
known about how changes in cortical EEG effect deeper brain structures
(the thalamus, hypothalamus, etc.). The interface between these deeper
brain structures appear to be modulated by the cerebral cortex. Hopefully,
changes in cortical EEG can positively modulate the immune and endocrine
systems. Surface electrode placement must be further investigated. A
logical extension of work done by M.B. Sterman, J. Lubar, S. Othmer, P.
Rosenfeld, M. Diamond and others indicate that higher cortical regions
better regulate and perhaps stimulate lower, primary input areas (Schummer,
1989). Extending this further, Kang, et al (1991) showed significant
differences in natural killer cell activity inversely correlated with
right frontal activation. This finding supports the hypothesis that there
is a specific association between frontal brain asymmetry and certain
immune responses. Dr. Marian Diamond (1996) stated that as early as 1980
the French reported significant increases in immune system function were
observed with removal of the left cerebral cortex. She found in her own
lab that removal of the adrenals significantly decreased cortical activity
and that placing thymus and pituitary cells into mice that do not have
these cells increased the number of T-4 and T-8 (or CD4 and CD8) cells.
These factors would indicate that an electrode placement over the central
or left frontal cortex would probably yield even more significant results
than the occipital placement referenced in our research. Further study is
necessary to confirm these hypotheses.
At this point in time there are many more questions than answers. However,
as more knowledge presents itself regarding neural pathways for the
propagation of positive modulation of the immune system we can correlate
these changes with cortical EEG patterns utilizing sophisticated EEG brain
mapping technology. Once correlation is quantified between the EEG and
immune function, research can be designed to change cortical EEG utilizing
the operant conditioning paradigm inherent in biofeedback. Advances in
computer technology, more sophisticated methods of recording brain
activity, possible utilization of photic stimulation and such techniques
as guided imagery will likely yield better and quicker learning curves to
reorganize and reorient brain electrical activity to match desired
frequency-amplitude patterns. Cerebral blood flow may also come under
scrutiny since new provocative research indicates that increased blood
flow enhances cortical growth and may more efficiently regulate or
stabilize the brain. Methods to measure and feedback cerebral blood flow
are currently under development.
As researchers, it is important to adhere to the discipline inherent in
the scientific method so that the results we see will be real and stand up
to replication. Neurofeedback is perhaps one of technology's greatest
gifts to humankind. Some have said that we can look forward to freedom
from autonomic control and thereby maximize human potential as it relates
to physiology. The new frontier of neurofeedback will allow for immune
enhancement as well as broadening the applications to the various
disorders of the central nervous system already under investigation.
Ultimately neurofeedback can, and undoubtedly will, facilitate the growth
and development of human potential, communication, and consciousness. As
Dr. James Hardt stated, "Neurofeedback will eventually allow humanity to
transcend our present limited consciousness as we experience true
liberation from automatic stress responses, addiction, chronic pain,
anxiety, depression, and a variety of other cognitive, emotional, and
physical limitations" (1994).
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