NEUROFEEDBACK TO IMPROVE ACADEMIC PERFORMANCE

As a student, you may have heard of various techniques to improve your academic performance, such as studying regularly, getting enough sleep, and eating a healthy diet. However, have you ever considered neurofeedback as a way to enhance your cognitive abilities?

Neurofeedback is a non-invasive brain training technique that uses real-time feedback to help individuals learn how to regulate their brainwaves. It involves placing sensors on the scalp to measure brain activity and displaying the information on a computer screen. The individual then receives feedback in the form of visual or auditory cues, which they can use to modify their brain activity.

So, how can neurofeedback benefit students? Here are some potential advantages:

1. Improved focus and attention: Neurofeedback can help students improve their ability to concentrate and stay focused on tasks. By training the brain to produce more of the brainwaves associated with attention, such as beta waves, and inhibit brainwave patterns associated with tuning out and daydreaming, students may find it easier to stay on task and avoid distractions.

2. Reduced anxiety and stress: Many students experience anxiety and stress related to academic performance, exams, and deadlines. Neurofeedback can help reduce these feelings by training the brain to produce more of the brainwaves associated with relaxation, such as alpha and sensorimotor rhythm. Learning to reduce hibeta brainwave activity helps with reducing rumination and worry. 

3. Better sleep: Adequate sleep is crucial for academic success, but many students struggle with sleep issues such as insomnia or poor sleep quality. Neurofeedback can help improve sleep by training the brain to produce less hibeta activity (brainwaves associated with anxiety that prevent falling asleep) and increase sensorimotor rhythm, which helps with feeling calm and improves sleep quality. 

While neurofeedback is a promising technique, it's important to note that it's not a magic solution. It requires consistent practice (similar to going to the gym for your brain) and may not work for everyone. After enough brain exercise (usually 40 sessions) the changes are lasting. Additionally, it's important to seek out a qualified practitioner who can guide you through the process.

In conclusion, neurofeedback is a potential tool for students looking to enhance their cognitive abilities and academic performance. By training the brain to produce specific brainwaves, students may experience improved focus, reduced anxiety, enhanced memory and learning, and better sleep. If you're interested in trying neurofeedback, feel free to contact the ADD CENTRE to explore our customized training programs based on EEG Assessment. email: addcentre@gmail.com

 

 

 

 

Breathing to Improve Heart Rate Variability (HRV) training.

At the ADD Centre / Biofeedback Institute of Toronto clients do HRV training because it is an important component of self-regulation skills, especially self-regulation of emotions. You can quickly calm yourself with the right breathing technique. Your heart is not a metronome with the same time between heart beats. Variations in heart rate – called the beat-to-beat interval - are healthy; in fact, the larger the variations, the better. Athletes and younger people have higher heart rate variability (HRV) than less fit and older people.   

 

a.     The easiest way to increase your HRV and have higher, healthy variations in heart rate, is by pacing your breathing to match your changes in heart rate. Heart rate increases as you inhale and decreases as you exhale. For most folks, higher HRV is achieved by doing diaphragmatic breathing at approximately 6 breaths per minute. Each person has their own resonant frequency (the breathing rate that achieves the highest variability in heart rate) and that is the breathing rate they should use when practicing to increase HRV. Your resonant frequency will be explored in your early sessions at the ADD Centre.

 

                                              i.     Women and/or shorter people (including children) usually have a higher resonant frequency, and thus a slightly faster breathing rate, which could be as high as 8 breaths per minute. Tall people and/or large men will typically breathe at a lower rate, sometimes as low as 4.5 breaths per minute.

                                            ii.     Most people find that around 6 (5.5 to 6.5) breaths per minute gives them synchrony between breathing rate and heart rate changes.

                                          iii.     You will find the best rate to achieve synchrony between your breathing and your heart rate changes while practicing with HRV feedback and your trainer’s coaching during sessions at the centre. You can watch the screen and get the red mountains (heart rate increases and then decreases) in sync with the blue mountains (inhalation and exhalation).

                                           iv.     You can practice at home, with longer periods of time (10 or even 20 minutes) or practice for short times frequently during the day. Just breathe diaphragmatically at a steady rate with a longer expiration than inspiration. Counting to 4 while letting the air in and then counting 5 to 10 while exhaling works well: 4 in and 6 out is a good ratio for calming. Inhalation is associated with activation (sympathetic nervous system) and exhalation is associated with calming (parasympathetic nervous system).  Attach this breathing practice to routines so that it is done frequently, such as when you first awaken and before you get out of bed, finishing a meal, driving (a red light lasts 30 seconds, so you can do 3 breaths), and so on. This is an example of the attach-a-habit-to-a-habit strategy you will learn in training. You are attaching the new habit of effortless diaphragmatic breathing to an existing habit/regular routine.

                                             v.     Completely relax your neck and shoulders and put your hand over your diaphragm (just above your waist) and feel it moving in and out. With your shoulders completely relaxed breathe in and feel your diaphragm moving out (belly rising) while you count 1, 2, 3, pause as you say 4, then let your air out slowly while you count 5, 6, 7, 8, and with all your air out pause while you count 9, 10. Repeat this breathing and counting.

                                           vi.     At home you can lie on your back and put a book or pillow on your tummy to follow your own inhale and exhale.

 

 

b.    If you want to practice with a pacer, download a free trial of E-Z-Air from the Biofeedback Federation of Europe (www.bfe.org)

 

c.     If you wish you can watch how the changes in your breathing affect your heart rate with an ‘app’ on your iPhone that monitors your pulse. Some examples are:

                                              i.     ISync beat and Camera HRV– these apps are available for iphone and they allow you to track your SDNN. SDNN (standard deviation of the beat-to-beat interval) is a measure of heart rate change or heart rate variability. A higher number (>50 msec.) is better. Athletes may have an SDNN >100 but after a concussion it might drop as low as the 30 – 50 msec. range.   

                                            ii.     HRV4

                                          iii.     My calm beat (breathing pacer)

                                           iv.     Breathe 2 Relax (pacer with music)

                                             v.     and many, many more if you google search for HRV apps.

 

More exact measures can be obtained with Em-wave (from Heart Math) or Thought Technology’s eVu TPs Package that measures not just HRV but also skin conductance (for arousal level) and finger temperature (for relaxation).

 

More information about the power of HRV training is available in Dr. Leah Lagos best-selling book, Heart Breath Mind, or watch a You Tube video featuring Dr. Lagos, a Psychologist and HRV specialist who practices in New York. 

 

 

©ADD CENTRES LTD 2022

Brain Training at the ADD Centre

 

Completing the ADD Centre Brain Training Program results in:

Sharper Focus

Improved Attention

Improved Stress Management

Reduced Anxiety

Increased Calm

Better Self-Regulation Skills

 

Brain Training, also called Neurofeedback or EEG biofeedback, uses your brain’s ability to learn and adapt to improve brain function. This exercise for the brain uses a computer to give immediate feedback of your mental state and it results in positive changes due to neuroplasticity, the brain’s ability to change with new learning. 

To achieve improved brain performance small sensors are placed on the top of the head and on each ear.  These electrodes measure brainwave activity and relay the information back through a computer.  The client knows instantly if they are “in the zone”, showing a healthy brainwave pattern associated with calm focus. A trainer sits with them as a coach, providing strategies that promote staying in the zone. Eventually they learn to produce that mental state of calm focus in everyday life and become more effective at school or work, in social interactions and in sports.   

When the brainwave patterns shift into a CALM, FOCUSED, RELAXED state, then the computer feedback facilitates maintaining that state, and the brain begins to learn.

Here is a sample feedback screen, the BOWLING SCREEN:

When the client feels calm, focused and mentally relaxed the bowling ball moves down the alley and gets a strike! 

Here is another example: SAILBOAT RACE SCREEN:

The AIM is to get the Green Boat to win! This is done without using a keyboard or mouse – only your brain!

 

The Green boat will move ahead only when the client is calm, focused and mentally relaxed.  The Green boat is competing against Inattention/Daydreaming (yellow boat) and anxiety and worry (pink boat).  The client can use their breathing and heart rate at the bottom to help them win the race.  Learning to achieve greater heart rate variability (breathing and heart rate in sync) improves stress management and helps increase calm, alert brainwave patterns.

Self-regulation skills are better predictors of success in life than intelligence. Neurofeedback is a well-researched method that improves self-regulation of attention and emotions. Better self-regulation skills lead to improved performance in athletics, studying and employment.  

 

ADD Centre Concussion Intervention

 

ADD Centre Concussion Intervention

Medical specialists diagnose concussion but often have little to offer in the way of interventions to the approximately 30% of people who do not make a full recovery. Medical imaging using MRI and CT scans are helpful for detecting structural problems, like a brain bleed or skull fracture, that require medical intervention. They do not detect concussion, so a normal scan does not rule out a concussion. Concussions cause functional problems due to disrupted communication between different areas of the brain, referred to as diffuse axonal injury (DAI). DAI involves  the stretching and twisting of the axonal connections. It causes disruption of communication of electrical signals from one neuron to another. Gradual return to work and play after concussion meets the conservative criteria of “do no harm” but does not offer guidance when symptoms involving memory, attention, headaches, light and sound sensitivities and mood swings/irritability cause daily frustration months after the traumatic brain injury.

 At the ADD Centre there is hope for functional recovery for those with postconcussion syndrome because we offer active intervention – brain exercise and heart rate variability training – based on a comprehensive assessment. Assessment measures include the following:

19 Channel QEEG and Evoked Potentials (ERP). This type of assessment can reveal the effects of damage elicited by stretching and twisting of axons, called diffuse axonal injury (DAI). The evoked potentials are particularly important for reflecting brain speed. Mild traumatic brain injury (mTBI/concussion) will often have a negative impact on the right and/or left insula which, in turn, relates to changes in heart rate variability. At the ADD Centre we use Evoke Neuroscience and Neuroguide to analyze brainwave patterns (EEG). Then we know how to train for healthier patterns.

Heart rate variability (HRV) is a measure of the changes in heart rate. The higher the variability, the healthier the cardiac pumping system. After a concussion, HRV is often reduced.  Training to increase heart rate variability is helpful for stress management and, additionally, to improve cognitive function.

Continuous Performance Tests measure attention, impulse control, variability of response time (drifting attention), and response time (speed of response). Doing these tests as a baseline and then again after a series of training sessions provides an objective measure of improvement. 

Neurocognitive Testing – CNS Vital Signs Neurocognitive Testing is used at the ADD Centre. It is done on-line and includes tests of visual and verbal memory, simple and complex attention, executive function, social acuity, processing speed and reaction time.

 Balance Testing – Meditech Balance Board and accompanying software, a system developed in Germany, is used at the ADD Centre to assess balance and risk of tumbling before and after training.

Clinical Interview – A clinical interview that includes an explanation of the findings and discussion of a treatment plan is completed with a professional registered with the College of Psychologists of Ontario. 

 Following Assessment, a individualized training program is created. Components may include any of the following modalities: single channel neurofeedback training, heart rate variability training, LORETA neurofeedback training, balance training. 

 Comprehensive testing is completed before and after training to gauge progress.  Here is an example Before and After brain maps showing decreased over-activation (red and orange areas) following an ADD Centre training program for Concussion. Note that every concussion is different: some people will show area of under activation.  

Before Training:                                                                 After Training:

 

 

 

ADHD: HUNTERS in a Farmer’s World Michael Thompson & Lynda Thompson

 

ADHD: HUNTERS in a Farmer’s World

Michael Thompson & Lynda Thompson

(Based on writings of Thom Hartmann)

Unlike farmers, who carry out boring, daily chores, hunters show a

Dichotomy of-Focus. Attention is either Intense OR Superficial

Trait as it appears in ADHD	Hunter’s View
Attention span seems short, but they can become intensely focused for long periods of time when interested in something.	Constantly monitoring their surroundings, scanning for something to go after, or for danger. Intense concentration when   after something.
Disorganized and impulsive - make snap decisions.	Spontaneous and go after opportunities. Able to throw themselves into the chase on a moment’s notice. Fast decisions.
Distorted sense of time. Unaware of how long it will take to do something.	Flexible, able and ready to change strategy quickly. Time is less important than achieving your goal.
Impatient	Tireless, capable of sustained drive, but only when hot on the trail of some important goal.
Does not convert words into concepts adeptly and vice versa - may dislike reading and, especially, writing because it takes too long. Hate to revise what they write. Write the minimum.	Visually oriented. Concrete thinker – clearly seeing tangible goal even if there are no words for it.
Has difficulty following directions	Independent.
Daydreamer	Bored by mundane tasks and talk – drifts off BUT enjoys the hunt. Seeks  excitement and often calm in a crisis.
Lacking social graces	No time for social ‘niceties’. Says what he thinks.
Acts without considering the consequences	Willing and able to take risks and face the danger.

 

 

REMOTE TRAINING OUTCOMES

As we approach the end of 2020, we felt it was prudent to objectively evaluate results of our remote, single channel neurofeedback training. As with in-person training, the neurofeedback is combined with biofeedback and metacognitive strategies. Our remote program uses Procomp2 equipment from Thought Technology. (See image below.)

This unit, along with accompanying sensors for single channel neurofeedback (brainwave training), plus heart rate (BVP) and respiration sensors, has allowed us to work remotely with clients using a virtual meeting software program that meets all privacy standards. We are excited to announce that the preliminary results are showing excellent gains on neurocognitive testing, measured using the CNS Vital Signs test battery.  

   RESULTS SHOW:

Clients who have completed 20 to 40 sessions of REMOTE ONLY training have demonstrated an average gain of 18 percentile points on  their over-all test scores on a battery of standardized neurocognitive tests (CNS Vital Signs).

(A percentile indicates the per cent of same age people who obtain a particular score; thus, if you score at the 50^th percentile rank, you are mid-average – as good, or better, than 50% of people. So a gain of 18 percentile points, if you started at the 50^th, would bring you up to the 68^th percentile rank. In other words, your score went from being better than 1/2 of the population to being better than 2/3 of the population. )

This Neurocognitive test battery includes measures of short term memory, attention, executive function, social acuity, cognitive flexibility, processing speed and reaction time.

 

         ADD Centre clients are very happy with their improvements and we are delighted that remote training is achieving the same kind of great results observed for over 25 years with in-person neurofeedback plus biofeedback interventions. We look forward to continuing to offer remote training as a part of our ADD Centre Programmes. Our clinical research, which involves tracking many measures before and after training, will continue to be updated as more clients complete their remote training and do progress testing.

         Helping people of all ages improve self-regulation of attention and emotions in order to bring out their potential continues to be the mission of the ADD Centre, whether we are seeing people in-person or working with them remotely.  

Testing Neurofeedback as a Treatment for Tourette’s

SMR training over the sensorimotor strip - has been used at the ADD Centre as a treatment for clients with symptoms of Tourette's for over 20 years with good and lasting results. 

- Dr. Lynda Thompson

- Testing Neurofeedback as a Treatment for Tourette's - Article Link

Q&A with Michelle Hampson, Ph.D.

Michelle Hampson, Ph.D.Associate Professor of Radiology and Biomedical Imaging
Director of Real-Time fMRI
Yale School of Medicine
Dana Grantee: 2009-2011

Tourette’s Syndrome is a neurodevelopmental disorder, diagnosed in children and adolescents, characterized by uncontrollable, repetitive movements or sounds, called tics. These movements might include frequent, irrepressible eye blinks, shoulder shrugs, throat clearing, grunts, or verbal outbursts. Such tics are not only socially disruptive but can be physically harmful to those diagnosed with this disorder. Unfortunately, traditional treatments for Tourette’s disorder, which include cognitive-behavioral therapy and certain antipsychotic medications, are not always effective – and can result in unpleasant, or even intolerable, side effects. The need for alternative therapies and interventions for a disorder that is more common than most realize is quite acute.

Michelle Hampson, Ph.D., an associate professor of radiology and biomedical imaging and the director of real-time functional Magnetic resonance imaging (fMRI) at the Yale School of Medicine, is interested in exploring the possibility that using neurofeedback from a brain region called the supplementary motor area (SMA), which previous studies have shown activates prior to a tic, may offer some relief, helping people diagnosed with Tourette’s Syndrome to better control their tics and reduce their frequency. Here, Hampson discusses why neurofeedback may be a good alternative treatment for this disorder and the challenges of developing the right training paradigms.

What first interested you in trying to use real-time fMRI feedback as an intervention for Tourette’s syndrome?

When I came to Yale, I discovered there was an active Tourette’s group at the Child Study Center. This condition seemed tractable from a research perspective in that it has a very clear symptom, the tic, and you know exactly when the symptom is occurring. In that sense, it’s easy to study with neuroimaging because you have a clear event-related marker to associate with brain activity. Being able to identify a symptom-related brain pattern is the first step in developing a neurofeedback intervention, so Tourette’s is a promising disorder in that respect. Also, compared to disorders like schizophrenia, for example, where people may have very different types of symptoms, there is a lot less heterogeneity. People have different types of tics, of course, but it seemed to me to be a much more solid diagnostic category and more likely that the brain circuitry involved is consistent across patients.

That said, it’s also been a challenge to study using neuroimaging. Many types of tics involve head movements, which can add a lot of noise to the imaging data.

I’d add that we also know that some people with Tourette’s are aware of a tic coming on before it occurs. It’s kind of like when you feel a cough coming on, but you are in a large auditorium and you don’t want to draw attention to yourself. So, you can suppress that cough, right? A subgroup of people with Tourette’s can do that. Not everyone, some people are completely unaware that a tic is coming on and feel like it is completely involuntary. But this subgroup is aware of a tic coming on. And these individuals feel the urge to make the movement and they report they have some ability to suppress or control the movement, at least in the short term. Like with that cough, you can prevent yourself from coughing for a certain amount of time but eventually that cough is going to happen. You are going to leave the auditorium to do it or disrupt whatever’s going on, but the cough will eventually come. It’s the same with the tics. However, the fact that some individuals do feel they can control the tics to some extent suggests that there are existing brain circuits that enable that control and that could be potentially strengthened via neurofeedback.

Why do you think it is worthwhile to develop a biofeedback intervention for this condition?

New treatments are needed – not everyone responds to the treatments that are available now. And even those that do often have troublesome residual symptoms or unbearable side effects. Our hope is that neurofeedback could help fill that gap.

This technique allows us to monitor a certain aspect of brain function using fMRI and give direct, real-time feedback back to patients, showing them how that aspect of brain function is changing. We cue them at certain times to try to increase or decrease that aspect of brain function. They get to practice controlling that aspect of brain function using the feedback we give them as a training signal. You can do this with any aspect of brain function as long as you know what aspect of brain function or activity is associated with the symptoms you are trying to control.

For example, in Tourette’s, we know that the supplementary motor area (SMA) is involved with tic behaviors. If you stimulate this area you can cause tic-like symptoms. And previous fMRI work shows that this area gets really active just before a tic movement occurs, too. That led to the idea that if we provide feedback about the SMA’s activity, we could train patients to control it, and it might result in an improvement in symptoms.

In a recent experiment, you trained study participants to both increase and decrease activity in the SMA. Why?

While it may seem to make the most sense to train them to decrease activity in the SMA, which seems like the most clinically useful direction, there’s also very interesting literature showing that when patients are very focused on a particular task, their tics will completely go away. You may know the story that Oliver Sacks told about the surgeon with Tourette’s syndrome who had tics but was able to do surgery because when he was focused on that task, the tics went away. The problem with that focus is that you can’t keep people hyper-focused all the time. They need to be able to relax and go to sleep. And being able to relax and sleep is something, like navigating social situations, that can be very difficult for people with Tourette’s. If they are a little bit stressed, they just can’t stop tic-ing and it is exhausting.

It’s sort of an odd situation. There is evidence to suggest that tics decrease when someone is very relaxed, happy, and well rested and seem to increase when people are stressed out. But the tics also decrease when they are very cognitively focused, and interestingly, cognitive focus often involves elevated SMA activity. So, in our most recent study, published in Biological Psychiatry, we tried to train the study participants to both increase and decrease activity in the SMA to see how it would affect their symptoms. We hoped, with training, there was some circuitry in the brain that we could strengthen that would allow them to better control activity in the SMA and reduce their tic urges.

What are some of the biggest challenges to designing a neurofeedback paradigm for this population?

There are many unknowns regarding how to optimize training to maximize the chances of getting clinical benefits. As you noted before, one choice we made was to train individuals to both upregulate and down regulate activity. If you upregulate by thinking of things that stress you out and make you want to tic a lot, like people making fun of you, that’s not likely to be therapeutic. So we talked with the participants about strategies that would be more helpful, like thinking about the sports they love and, if their tics tend to go away when they play those sports, imagining the movements they make and using that motor imagery to co-opt the brain circuitry involved with the tics. So, these are approaches to upregulating the SMA that we thought might have a potentially therapeutic aspect. The downregulating strategies were related to relaxing and also potentially therapeutic. In this way, we tried to maximize the therapeutic benefit of training in both the up and down directions.

I think, at the cellular level, there are probably different patterns of cells in the SMA that are active when you upregulate activity with these different strategies compared to the cells active prior to tics, but the hope was that engaging the SMA for these other purposes can suppress tics. So, it may be possible that certain types of hyperactivity in the SMA might reduce some of the tics. Unfortunately, it’s not possible see cellular level differences using fMRI – but this was our reasoning.

What did the patients think of the training?

Understanding the feedback is easy. You don’t have to understand what’s happening in the brain very deeply. We use a line graph for the feedback so, at certain points, they are trying to make the line go up and, at other times, they are trying to make the line go down. They don’t have to understand anything more complex than that. Just make the line go up or down – and they get direct feedback on whether or not they are succeeding.

That said, trying to control that line was very challenging for them. We knew that it would be before we began the study and told them they shouldn’t be discouraged – you are making changes even if you think you aren’t controlling all that well. Your brain may be picking up something even if you don’t feel like you’ve mastered control of this area.

I should add that our main measure for control, in the Biological Psychiatry paper, didn’t provide evidence that participants were actually learning effective control. It was sort of remarkable that we got the symptom change effects that we did given how noisy the learning patterns in the brain were.

How do you explain the fact that you saw sustained symptom changes?

We can’t rule out a possible placebo effect, or a learning effect that is not specific to the circuitry trained. The sham control was quite compelling, and the participants generally believed they were getting real neural feedback. But, on the other hand, an argument could be made that, at some level, during neurofeedback their brains saw a relationship between the feedback they were getting and what was happening in the brain. It’s possible that when there is a statistical relationship between the feedback and brain activity, your brain starts to rewire and build new synapses to adjust and learn. Maybe the sheer act of changing synapses in response to those statistical relationships is therapeutic. Because you don’t see the same statistical regularities in the sham treatment, that could explain why neurofeedback was associated with more symptom improvement than the sham condition.

It’s also possible that the neurofeedback did strengthen the circuitry allowing them to control their SMA, and that our measures of control over the region were just too noisy to capture that. The symptom changes are assessed across longer time frames and in a sense that provides a form of averaging that reduces noise. So, this could be a power issue, where we had better power to detect clinical changes than changes in control over the SMA. We discuss these different possibilities in detail in the Biological Psychiatry paper.

What is also interesting is that symptom changes seemed to persist and grow two weeks to a month after the neurofeedback was over. We first noticed this in another study where OCD participants who got real neurofeedback improved much more over time after the intervention, not just during the intervention. That was really surprising to us, and a similar pattern seemed to hold in the Tourette’s study. We published that finding in NeuroImage; it has some practical implications for neurofeedback studies that are discussed in that paper.

How do you plan to follow this work?

There are a lot of other conditions we are interested in studying but, in terms of Tourette’s Ssyndrome, we still have quite a bit of data to mine. We have resting state data, and we want to see which connections in the brain might have changed in response to the training. If we can identify certain functional connections that were strengthened in participants during the neurofeedback, and that are related to symptom changes, we can better understand why the participants showed the symptom improvements they did. This may help us identify other neural pathways that we should be targeting with our feedback.

That’s one of the nice things about neurofeedback: it’s kind of a closed loop in terms of basic science and clinical findings. It has an experimental medicine approach that allows us to constantly look at what’s happening in the brain and refine our targets as we learn more about what biomarkers are changing and how those changes relate to symptoms.

fMRI is, of course, quite expensive. And you’ve mentioned that there is a subset of patients, like those with tics that involve big head movements, who could not get feedback in the scanner. How do you see this type of therapy evolving?

There is a lot of interest in the neurofeedback world in eventually translating fMRI neurofeedback protocols to other modalities. There’s amazing work going on in Talma Hendler’s group in Israel which is identifying the electroencephalogram (EEG) fingerprints of fMRI activity patterns so they can train using only EEG. That’s the kind of long-term goal that the field is very interested in achieving.

Another option, in addition to the use of EEG, is functional near-infrared spectroscopy (fNIRS), which can measure blood flow activation on the outer surface of the brain. This is another promising option for measuring activity in the SMA. Developing the training paradigm using fMRI, which has good spatial resolution where you can target exactly where you want in the brain, is a good place to start. Then once you’ve found the right targets to train people to control, that result in symptom improvement, you can work on ways to translate those biomarkers to a different modality.

References

Time course of clinical change following neurofeedback. Rance M, Walsh C, Sukhodolsky DG, Pittman B, Qiu M, Kichuk SA, Wasylink S, Koller WN, Bloch M, Gruner P, Scheinost D, Pittenger C, Hampson M. Time course of clinical change following neurofeedback. NeuroImage 2018, 181:807-813. doi: /10.1016/j.neuroimage.2018.05.001

Orbitofrontal cortex neurofeedback produces lasting changes in contamination anxiety and resting-state connectivity. Scheinost D, Stoica T, Saksa J, Papademetris X, Constable RT, Pittenger C, Hampson M. Orbitofrontal cortex neurofeedback produces lasting changes in contamination anxiety and resting-state connectivity. Translational Psychiatry 2013, 3:e250. doi: 10.1038/tp.2013.24