What Is Neurotherapy & How Can It Help Improve Focus, Mood & Brain Performance?
Neurotherapy is an approach to therapy for issues like anxiety, depression, brain fog and fatigue that targets changing brain states. The term includes neurofeedback and biofeedback, which aim to retrain the brain, either developing new skills or increasing brain fitness and performance through exercise. But neurotherapy also covers the use of brain stimulation techniques such as trans-cranial direct current stimulation (tDCS), audio-visual entrainment (AVE or AVS), and cranial electro-stimulation (CES).
Neurotherapy is based on the idea that how we think, feel and act is reflected in our physiological functioning, particularly in the brain and nervous system. Problems like depression and anxiety result when the brain gets stuck in maladaptive states and patterns. Often these unhelpful patterns are in some sense learned - for example you've become conditioned to get anxious and panicy when you have to get on a crowded train or bus. Neurotherapy opens up the opportunity for new learning, creating new brain pathways that serve us better.
Because neurotherapy is linked to learning, the changes it induces are enduring (beyond the period of therapy), and neurotherapy is generally safe and only minimally invasive.
Applications & Benefits of Neurotherapy
But simply, neurotherapy aims to improve brain performance. Common applications include:
- stress relief, and anxiety management (also panic)
- improving mood and building emotional resilience
- improving attention, concentration, focus and other aspects of executive function
- improving cognitive performance and learning
- boosting motivation and energy, and learning to manage cravings, habit problems and addictions.
Important disclaimer: I'm not personally qualified as a medical practitioner and do not claim to offer treatment for issues classed as medical disorders (for example, depression and ADHD).
How Does Neurotherapy Work?
The strategy of neurotherapy is to stimulate neuroplastic change, that is change in structure and / or function of brain cells. Typically neuroplastic change means in some way "rewiring" neurons. This change can be either internally or externally driven (i.e. the driver or trigger can be within the brain itself or can come from some stimulus outside the brain).
Psychiatrist and researcher Norman Doidge is a recognized authority on neuroplasticity, and in his recent book "The Brain's Way of Healing" he lists five elements of neuroplastic healing (not all of them need to be present in every case):
1. General Cellular Healing
In cases of (for example) traumatic brain injury or toxic insult (e.g. heavy metal toxicity) the first thing that needs to happen is recovery of general cellular function in both neurons and glia (which are support cells in the brain).
Dr Doidge thinks there needs to be some stimulus to revive brain circuits which have become dormant. He gives several examples in his book, including low intentsity lazer light (soft lazer or cold lazer) and intentional thinking and behaviours (i.e. internally-driven neuroplastic change). I list a few more later in this article.
The brain can modulate its own functioning - balancing exhitation and inhibition. Dr Doidge describes this as quitening a noisy brain, and as improving the brain's "signal-to-noise ratio".
Catching up on sleep is important for brain healing - in deep sleep it's known that the brain undergoes a sort of cellular clean-up process.
5. Neuro-differentiation and learning
The recovered brain is now in a position to start re-learning lost functions. Any learning process involves neuroplastic change, as Dr Doidge demonstrated in his first book, "The Brain That Changes Itself".
Types of Neurotherapy
To repeat a point I made earlier, neuroplasticity can be either internally-or externally-driven. This means broadly there are two types of neurotherapy:
- Neurotherapy based on learning, conditioning and training (i.e. involving internally-driven neuroplastic change). Biofeedback and neurofeedback are prominent examples (more on these below). These methods may involve skills development, or increasing "brain fitness" through exercise (like a kind of weight-training for the brain) or some combination of the two. In terms of Dr Doidge's five elements of neuroplastic healing, this type of neurotherapy is probably predominantly a matter of stage 5, neuro-differentiation and learning, but with contributions from neuro-modulation and neuro-relaxation.
- Neurotherapy based on brain stimulation (i.e. externally driven neuroplasticity). Clearly in Dr Doidge's scheme neuro-stimulation is the dominant element - but that doesn't mean other elements aren't involved too.
My thinking is that brain stimulation pulls (or pushes) the brain out of its habitual pattern or state (which may be a "stuck" state or a maladaptive pattern) and then the brain's natural propensity for self-regulation, or self-balancing, or even self-healing, kicks in. In other words the stimulation is a kind of stressor from which the brain naturally "recovers", as best it can.
The process may parallel other forms of change - for example if you go to the gym and lift weights, you stress your muscles causing minor damage. In the hours and days following, the muscles heal themselves, perhaps growing back stronger than before (especially if you repeat the exercise).
If this is indeed the mechanism, it would help explain why so many different forms of stimulation seem to have similar benefits. Take one example, tDCS, which I explain more fully below. In this technique you typically apply a voltage from left hemisphere to right. But what if you get your electrodes the "wrong" way round? Can you do harm? I asked this question of a knowledgeable person and apparently it still has a beneficial effect, but it's slower than the "right" way round.
Examples of Neurotherapy
1. Neurofeedback & Biofeedback
Biofeedback is a training tool that measures some form of physiological activty in the body, and feeds back the changing signal in real-time, creating the opportunity for developing greater self-awareness and also for learning to influence your physiology in a desirable direction.
Neurofeedback is a form of biofeedback that's based on a direct measure of brain activity, such as EEG. (I describe EEG neurofeedback more fully in this article.)
Clearly biofeedback and neurofeedback are forms of internally-driven neurotherapy, though it may be that the training session itself is a kind of stimulation that in some sense stresses the brain and provokes a "recovery".
A leading neurofeedback practitioner, Dr Paul Swingle, has developed a technique he calls "brain driving" that links brain stimulation to feedback (in other words the stimulation is conditional upon the particular brain state).
2. Brain Stimulation
Brain stimulation based neurotherapy can take several forms.
tDCS - Trans-cranial Direct Current Stimulation
tDCS involves applying a DC (constant) voltage to the scalp, so as to activate (or increase neuronal excitability) or inhibit the brain at the points of contact. You need two electrodes, between which electrical current flows. One or both can be on the head (the second could be nearby, e.g. on the shoulder). The small current (around 1 milliamp) can be felt as a light tingling.
The practitioner can choose where to place the electrodes (and thus which part of the brain to stimulate) and can reverse the polarity, so either activating or inhibiting the brain.
The technology is remarkably simple and low cost - indeed several consumer devices are now on the market (probably the best known is Focus tDCS.) Typically something like ten sessions may be done over a period of a few weeks.
Preliminary research for tDCS suggests considerable promise - though it must still be regarded as an experimental therapy. For example, studies have shown that it helps depression. Although there is (to my knowledge) no evidence that it is unsafe, long term effects are not really known.
Audio-visual Entrainment (AVE)
Audio Visual Entrainment (AVE) uses pulsed light and sound to effect changes in
brain function. Also known as Audio Visual Stimulation (AVS), this technology elicits
the brain's natural frequency-following response, meaning that brainwaves (EEG)
follow (or entrain to) the rhythm of the stimulation - for example pulsing light and sound at 10Hz (ten times a second) stimulates alpha EEG activity (since 10Hz is in the alpha range).
Evidence indicates AVE may produce changes in neurotransmitters (e.g. serotonin,
endorphins) and also in cerebral blood flow (often found to be altered in brain
AVS can be a useful adjunct to biofeedback and neurofeedback.
CES - Cranial Electrostimulation
Cranial Electro Stimulation (CES) - also known as cranial electrotherapy or cranial electrotherapy stimulation - is like tDCS in that it applies an electrical stimulus to the brain. But rather than using a constant voltage, an alternating or pulsed current is used. The electrodes are typically attached to the ear lobes.
First developed in the late 1940's, CES is now quite well established as an evidence-based therapy. One of the best-known and best-researched CES products available is Alpha-Stim. This device uses a unique, complex, patented wave-form. (The name Alpha-Stim derives from the finding that it increases alpha EEG activity.) More than a hundred independent research studies (including double-blind trials - see graphics below) support the efficacy of Alpha-Stim for anxiety, stress, depression, headache and migraine, and insomnia. In the US Alpha-Stim has FDA approval as a medical device for certain conditions. Research suggests Alpha-Stim significantly raises levels of brain chemicals, notably serotonin (as measured in cerebrospinal fluid) - also beta endorphins (which are linked to pleasure).
How You Can Access Neurotherapy
All the forms of neurotherapy I've mentioned can be tried at home using consumer devices, at reasonable cost. That is to say, they're generally considered to be safe and (relatively) non-invasive. Personally I believe some caution should be exercised. Anything that can have a positive effect on brain function, may potentially also have a harmful effect if used in the wrong way or at the wrong time. The effect that neurotherapy has on your brain must depend to some extent on what state your brain is in. If the brain is in a delicate, fragile or overly-sensitive state, then any given neurotherapy may have negative consequences. That said, I think it's very unlikely to cause lasting harm.
How I Can Help
My own professional practice is based on biofeedback (and especially forms of biofeedback related to breathing) plus some neurofeedback. I don't run brain stimulation sessions in my office, basically because (i) my professional insurance doesn't cover it and (ii) it's so cheap to buy a device to try out for yourself. However I do have a very small number of devices available for rent.
For clients who want to try out forms of neurotherapy and brain stimulation at home, I can offer some guidance on which protocol may work best, based on a simple EEG assessment. (For more information on EEG assessment see this article.) By protocol, I mean the specific choice of how to apply the neurotherapy - with most forms of neurotherapy the practitioner has some decisions to make. For example, with tDCS, where should you place the electrodes on the scalp? Or with AVE, what frequency of stimulation should you give? With EEG neurofeedback, which particular aspect of EEG should you train, and in which part of the head? These decisions are not straight-forward.
Though I can offer some guidance (based on assessment), the decision to try out a neurotherapy device for yourself in the end is yours. My advice is to learn as much as you can first, and at least make an informed choice.