A growing number of psychiatrists and psychologists in B.C. say they’re successfully treating patients by harnessing the power of patients’ own brain waves.
Neurofeedback treatment has been studied for several decades but remains controversial among scholars.
“This debate has been going on for a long time,” said Simon Fraser University neuroscientist Randy McIntosh.
“There is a long history of using things like neurofeedback to help somebody re-orient their brain.”
McIntosh — a professor in SFU’s department of biomedical physiology and kinesiology, and B.C. Leadership Chair in Neuroscience and Technology Transfer Across the Lifespan — said there’s evidence neurofeedback works for patients with certain disorders, even if there is disagreement over exactly how or why.
As with any mental health treatment however, “There’s not a single therapy that’s going to work for everybody,” he said.
“But it might work for some.”
‘Brain training’
“Neurofeedback is brain training with the goal of increasing cognitive flexibility,” said Victoria psychologist Susan Brock.
Brock, former chair of the Canadian Psychological Association’s quantitative electrophysiology section, said healthy brains need to “be able to shift flexibly between states” of mind at appropriate times.
But conditions such as post-traumatic stress disorder (PTSD), one of her specializations, can keep people “in a constant state of over-arousal even when there is no need to be.”
That causes a loss of cognitive functioning for such patients, many of whom are emergency first responders and veterans.
Electroencephalogram-guided neurofeedback involves technicians placing electrodes around a patient’s head, as seen in this photo, to scan the electrical activity in their brains. Here, the patient is seen watching a display monitor. (Craig Chivers/CBC)
Electroencephalography-guided neurofeedback is offered by a number of private psychiatrists and psychologists across B.C.
The treatment, in simple terms, involves technicians placing electrodes around a patient’s head to scan the electrical activity in their brains, known as an electroencephalogram (EEG).
The EEG creates a sort of computer brain map, which can then be used by mental health professionals to help encourage healthier states of mind.
Clinicians use several methods to do this, but often patients watch a video while fitted with the EEG electrodes.
If their brain shows unhealthy or undesirable electrical activity, the video becomes darker and quieter. But when their brainwaves more closely match a “map” of a healthy brain, the video gradually gets brighter and more audible, as their EEG starts to mirror a healthier or calmer brain.
In effect, being able to enjoy a clearer video acts as a type of reward or incentive to calm the mind and, the theory goes, to slowly build healthy patterns.
The unorthodox approach is used more and more among people with a range of mental health conditions from attention deficit hyperactivity disorder (ADHD) to anxiety and post-traumatic stress disorder (PTSD), according to clinicians.
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Brock said she’s “seen a good response” in her decades of experience using the treatment. She said her patients often report troubling areas of their lives that “haven’t really changed” for the better, despite having tried a variety of mental health therapies before.
Many still struggled with the ability to shift their mind states when needed — for instance, to be able to calm themselves when distressed.
“It’s not that they don’t want to change,” Brock said. “They don’t know how.
“And for most, it is not for lack of trying; part of the beauty of neurofeedback training is it happens on a subconscious level.”
More data needed
While frontline psychologists and psychiatrists say they see clear clinical improvements in many of their patients, researchers are divided on neurofeedback’s efficacy.
Several peer-reviewed studies suggest better data is needed to prove it works for the wide range of disorders practitioners claim to treat. Evidence appears strongest for ADHD, anxiety disorders, and traumatic brain injuries.
A Basic and Clinical Neuroscience journal article in 2016 found it “is a safe and non-invasive procedure that showed improvement in the treatment of many problems and disorders” including ADHD, anxiety, depression, and autism.
But, the authors cautioned, “its validity has been questioned in terms of conclusive scientific evidence of its effectiveness.”
Another study, in the journal Psychiatric Clinics of North America, compared multiple neurofeedback trials, finding they produced “significant benefits” for ADHD and anxiety and were “probably efficacious” for traumatic brain injuries and substance use.
But the researchers said “despite findings of positive outcomes” for depression and PTSD, evidence remains “insufficient” without more rigorous or larger scientific studies.
Best combined with other treatments
For frontline clinicians, the results are in front of their eyes — and in their patients’ experiences.
Four years ago, psychiatrist Dr. Kourosh Edalati founded Elumind Centres For Brain Excellence, which has private clinics in North Vancouver, Langley and Kelowna. He offers neurofeedback, alongside more conventional psychotherapy and medications.
“As an integrated model, we’ve seen very, very good responses,” he said. “The principle behind neurofeedback is really operant conditioning … which means positive and negative reinforcement.
“The brain learns that connecting to the right pathway is rewarding. Through all the repetition, the brain starts to switch to the right pathways.”
Test person Niklas Thiel poses with an electroencephalography (EEG) cap which measures brain activity, at the Technische Universitaet Muenchen (TUM) in Garching near Munich in September 2014. (Reuters)
By taking a multi-pronged approach to treatment, said SFU’s McIntosh, neurofeedback is likely best combined with other methods.
“We have to be very cautious to not think, ‘I’m just going to get brain stimulation that’ll make me better,'” he said. “Some people need additional support.”
“It does seem to work for some people … allowing people to get unstuck.”
But he said precisely how neurofeedback achieves that in the brain remains unproven.
“Why are these things working?” he said. “The ‘how’ of it is a bit of a mystery.
“The evidence is pretty good — but not conclusive.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
