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The Promise of EEG biofeedback for Managed Care Providers,
Indemnity Insurers, and Disability Insurers

By Siegfried Othmer, Ph.D.
Copyright EEG Spectrum International, Inc.
January 2000

The most rapidly growing new modality for addressing the most challenging mental health conditions is neurofeedback, or EEG biofeedback. Grounded in animal and human subject research going back thirty years, EEG biofeedback was discovered to be effective in raising the seizure threshold in man. Subsequently, it was found effective in controlling hyperactivity in children. Now usually called neurofeedback to distinguish it from the conventional peripheral biofeedback, it is being used mostly with ADHD, but clinical work has shown efficacy for a variety of other conditions of interest to the cost-conscious managed care or other insurance company professional.

Neurofeedback can be helpful in stabilizing brain function over the long term. It is a training tool. As such, it can be used in any circumstance where anticonvulsants may be used, but where results of medical treatment often fall short: seizure disorders, migraines, mania, bipolar disorder, and severe rage disorders and other behavioral disorders in children. EEG biofeedback has been successful in avoiding the need for brain surgery for medically intractable seizures, and it should be considered routinely before surgery is authorized. Controlled studies in the medical literature over the past twenty years testify to the robustness of this technique for seizure reduction. Migraine syndromes are profoundly responsive to neurofeedback, and the training can be used to reduce chronic medication requirements (e.g., Imitrex) to zero. Neurofeedback can be used to stabilize a person in both the depressive and manic phases of bipolar disorder, and has been shown capable of aborting rapid cycling behavior completely with extended training. In all of these cases, medical management was found to be incapable of normalizing function. Finally, the training can be effective in remediating the severe behavior disorders of children, which may often be traceable to subclinical ictal (seizure-like) phenomena.

EEG biofeedback has also been shown to be effective (in clinical work, much of it unpublished) in a variety of clinically intractable syndromes: suicidality, fibromyalgia, chronic fatigue syndrome, dissociative identity disorder (DID), and borderline personality disorder. For example, one community mental health service reports that over a period of months every person who came to the service asking to be admitted to the hospital for suicidality was able to return home after a single session of EEG biofeedback training, a session which took less than an hour. In the case of fibromyalgia, neurofeedback has been able to achieve full remediation of pain in conjunction with normal medical management of the condition. In the case of DID, one clinician reports that out of 37 consecutive subjects treated with neurofeedback, there was not a single hospitalization after such treatment was begun.

EEG biofeedback has also been shown to be very effective in addictions treatment. When combined with Minnesota Model treatment, neurofeedback has demonstrated higher retention in program, improved cognitive function, and much improved relapse prevention. In the case of severe, relapse-prone alcoholism, studies with as much as ten year follow-up have demonstrated relapse prevention rates of 70% in Viet Nam Veterans. More recent studies with other drugs have achieved relapse prevention rates in excess of 50% in two-year follow-up for poly-drug users, and for cocaine, methamphetamine, and heroin abuse. These results were presented at the annual meeting of the American Association for the Advancement of Science, and are currently being submitted for publication. Much of the research work with addictions in general, and with alcoholism in particular, was in fact concerned with subjects who met criteria for Post-Traumatic Stress Disorder (PTSD). The results of long-term follow-up to the training indicates that the PTSD was effectively remediated in most of these individuals, who no longer met diagnostic criteria for the condition. Neurofeedback should therefore be considered a primary treatment for PTSD.

Neurofeedback has been shown effective in remediating severe PMS syndromes. With very high success rate symptom ratings can be reduced to levels which are no longer of concern. EEG biofeedback has also been shown to be effective in anger management.

Of potentially significant interest to the insurance industry, EEG biofeedback has been shown very effective in remediation of the symptoms of post-concussion syndrome, whiplash, and minor closed head injury. Sleep is improved, irritability and pain reduced, and cognitive function may be restored.

Dramatic results have recently also been achieved in children with severe developmental disorders, such as Autism, severe developmental delay, and Reactive Attachment Disorder. In these instances, we are confronted with conditions for which no satisfactory remedy currently exists.

Finally, EEG biofeedback has emerged as a significant resource in the management of chronic pain. As part of an intensive multi-modality treatment program, even long-term chronic pain syndromes have been shown responsive to this intervention. In fact, increasingly neurofeedback training is emerging as the linchpin of the treatment program. This alone gives hope that significant numbers of people currently totally disabled with chronic pain may be restored to functionality.

The largest potential monetary impact on insurance company disbursements may in fact lie in the area of recovery from total disability, particularly in cases where that disability is attributable to seizures, bipolar disorder, borderline personality or DID, traumatic brain injury or stroke, fibromyalgia or chronic fatigue, addictions, obsessive-compulsive disorder, chronic pain, or PTSD.

In summary, EEG biofeedback training offers new promise for a number of relatively intractable conditions that are currently a significant drain on insurance company resources. It is a training paradigm, one that is best seen by analogy to physical rehabilitation, except that in this case the rehabilitation is directed toward brain function. The training may therefore be long-term, and labor-intensive. Continuation of the training on a long-term basis would of course always be contingent on progress being made along the way. Hence, costs are self-limiting in the individual case.