Biofeedback Group Project #1
The Use of EEG and EMG Biofeedback in Treating
Psychological Disorders
By: Christine Alquisira, Katya Amina, Karissa Rasdal,
Krista Seiwert
The use of biofeedback in treating psychological disorders
is relatively new to the world of psychology. Since the
1960's, scientists, researchers, and therapists have
readily explored alternative forms of treatment in order to
move away from the conventional use of medication and
psychotherapy. In this paper, we will be discussing the
use of EEG in treating epilepsy and drug addiction as well
as EMG feedback in treating insomnia and depression using
case studies, research, and providing descriptions of the
two forms of biofeedback.
Christine Alquisira
The Use of EMG in Treating Insomnia
Introduction
Though not new to the world, the use of biofeedback to
treat disorders is still an up and coming therapy. It has
been used to treat a variety of disorders ranging from
migraine headaches and depression to epilepsy and drug
addiction. Over the years biofeedback has proven to be an
effective method of treatment and used as an alternative
form of medicine. Biofeedback training involves bringing
about change and control of the body's vital functions
through the use of simple electronic devices. Biofeedback
teaches one to reduce stress, eliminate headaches, control
asthmatic attacks, recondition injured muscles, and relieve
pain. The idea that a person can learn to regulate his or
her own vital functions finds widespread acceptance today.
But before the 1960s, autonomic functions such as heart
rate and pulse, digestion, blood pressure, brain waves, and
muscle behavior, were believed to be beyond control.
Recently, biofeedback, along with other methods of self
regulation, such as guided imagery, progressive relaxation,
and meditation, are practiced at the behest of physicians
and psychologists alike. Biofeedback training teaches a
person how he or she can consciously regulate normally
unconscious bodily functions (such as breathing, heart
rate, and blood pressure). One of the disorders that holds
prevalence in our society and that can be effectively
treated using biofeedback is insomnia.
Insomnia and EMG Therapy
Insomnia is a sleep disorder that effects thousands of
people all over the world. It is characterized by
prolonged sleeplessness or inability to sleep usually as a
result of pain, medication, or psychological distress.
Most treatments for insomnia focus on the use of prescribed
drugs such as CNS depressants and muscle relaxants (Coursey
et al., 1980). Unfortunately, the use of these drugs can
produce uncomfortable side effects, decreasing
effectiveness over time, disturbance of sleep stage
relationships, and withdrawal effects. Because of this,
researchers have been stimulated to seek effective,
nonpharmacologic therapies to treat insomnia. The use of
EMG biofeedback has been gaining popularity among
therapists and has shown to provide effective results in
treating insomnia.
Biofeedback is used in cases where insomnia stems from
over-activation of the autonomic nervous system.
Biofeedback of muscle tension and skin dampness in
conjunction with general relaxation techniques is used. EEG
biofeedback has proved to be useful when insomnia is due to
a mental or emotional problem, not a physical problem. Such
cases are found in people who have a pattern of thinking
obsessively during bedtime. Their bodies relax very nicely,
but they just can't get their minds off of whatever it is
that their minds get obsessed with.
Studies
Cognitive intrusions and pre sleep hyperarousal have been
advanced as major causal factors in the origin and
maintenance of sleep onset insomnia. Clinical observations
indicate that insomniacs often worry excessively about
falling asleep and have difficulty with sleep retarding
intrusive thoughts while in bed (Sanavio 1987).
In a study conducted by Coursey, Frankel, Gaarder, and
Mott, researchers compared two nondrug approaches to
electrosleep techniques in testing to see whether chronic
insomniacs could be treated. Electromyograph (EMG) and
autogenic training were the approaches used to produce
relaxation in the subjects and they emphasized
physiological and psychological components. The EMG
recorder monitors the electrical activity of a muscle
group, most frequently the frontalis muscle of the
forehead. This activity is transformed into a tone (or
clicks) whose frequency varies directly with the amount of
muscle tension. This auditory signal is fed back to the
subject, who is instructed to decrease the frequency of the
sound and thereby learn to decrease muscle tension.
The autogenic training procedure is a form of
autosuggestion in which the subject thinks repetitiously of
simple, standard phrases focusing mainly on heaviness and
warmth in the extremities. The subject learns to achieve a
state of "passive concentration" attending passively to the
particular phrase (e.g., "my right arm is heavy") and to
the sensations in the part of the body to which the phrase
refers. Results of the study showed that the group who
used EMG and autogenic phrases as treatment for their
insomnia had a significantly more number of patients who
improved than the electrosleep technique. 50% of EMG only
patients showed a significant improvement in sleep.
In a different study done by Ezio Sanavio from the
Department of General Psychology in Padova, Italy, he
wanted to compare cognitively focused programs versus EMG
biofeedback training (psychophysiological) in sleep onset
insomnia. Results did not show a significant difference
between the two programs but based on results, both
treatment methods were successful in reducing perceived
pre-sleep arousal. Also, in the EMG biofeedback program,
patients gained better knowledge of somatic arousal and the
capacity to control and cope with feelings of muscle
tension.
Montgomery and Besner (1975) used EMG feedback to treat
seven insomniacs for a duration of 16 weeks. They found
that there was a significant reduction of frontalis EMG
activity, of reported difficulty in falling asleep, and of
number of night awakenings, and a significant increase in
total sleep time.
Freedman and Papsdorf (1976) did a similar research study
comparing the effectiveness of EMG feedback, progressive
relaxation, and a placebo to treat chronic insomnia. Both
treatment groups had a significant reduction in frontalis
and masseter EMG, heart rate, and forearm extensor EMG.
There was improvement in sleep onset in both treatment
groups, a greater percentage of REM sleep, and less time
awake. They found that EMG was no more effective than
progressive relaxation in treating insomnia patients.
Conclusion
These studies are only a handful of what has been done with
EMG and the treatment of insomnia. Yet, they overall
evaluate and show that the use of biofeedback is effective
treatment in and of itself. The field of biofeedback has a
long way to go before reaching complete success so it may
be best to combine biofeedback and psychotherapy to fully
treat disorders such as insomnia. But at least people know
now (unlike in the 1960's) that things such as autonomic
functions are within our control. Biofeedback Therapy has
put the power of healing back into the arms of its patients
and because of this, it will continue to be successful.
References:
Sanavio, Ezio (1987). Pre sleep Cognitive Intrusions and
Treatment of Onset Insomnia. Journal of Behavior Research
and Therapy, Vol. 26 (6) pgs 451-459.
Coursey, Robert D., Frankel, Bernard L., Gaarder, Kenneth
R., and Mott, David E. (1980). A Comparison of Relaxation
Techniques with Electrosleep Therapy for Chronic, Sleep
Onset Insomnia. Journal of Biofeedback and Self
Regulation, Vol. 5 (1) pgs. 57-74.
Lashley, Joyce K., and Elder, S. Thomas (1976). Selected
Case Studies in Clinical Biofeedback. Journal of Clinical
Psychology, Vol. 38 (3) pg. 535.
Rickles, William H., Onoda, Larry, and Dyle, Collin C.
(1975). Biofeedback as an adjunct to Psychotherapy.
Journal of Biofeedback and Self Regulation, Vol. 7 pgs. 1-
33.
Depression and EMG Biofeedback Therapy
By Katya Amina
"Depression has been with [humankind] man since the
beginning of record history. In the Bible, King David, as
well as Job, suffered from this affliction…Depression has
been portrayed in literature and the arts for hundreds of
years…Freud linked the development (pathogenesis) of
depression to guilt and conflict…" (Medical Author: Peter
J. Panzarino, Jr., M.D., F.A.PA & medical Editor: Leslie
J. Schoenfield, M.D., Ph.D.)
Definition of Depression
What is Depression? Sleeping too much or too little,
inability to function at home or school, headaches,
digestive disorder, nausea, excessive crying, feelings of
sadness, hopelessness feeling of inappropriate guilt or
worthlessness, frequent wakening in the middle of the
night, thought of death or suicide. According to the
American Psychiatric Association, more than nine million
individuals (6%) of all U.S. adults are affected by this
emotional illness. One in every five Americans will
experience a major depressive episode during their
lifetime. With women, they are twice as likely to develop
depression as men. (Psychiatric Institution of Washington
P.I.W ). Depression: an illness that involves the body,
mood [cognitive] and thoughts, that affects a person eats
and sleep. The way one feels about one self, and the way
one thinks about things. The signs and symptoms of
depressive include loss of interest in activities that was
once interesting or enjoyable. The principal types of
depression are major depression, dysthymia, and bipolar
also called manic-depressive disease. (Medicine Net)
Personal Experience
During the cease of my Christmas vacation, I had to
terminate my vacation length to a shorter period of time,
so that I would have made it back to school for winter
session at our local Junior College and returning back to
wet Humboldt County from sunshine Southern California was a
personal issue and emotional rollercoaster that I was
confronted with. I returned back to Humboldt county with a
set notion that I was leaving my accepting environment Los
Angeles, family & friends and of course the social scene
which doesn't consist of gigantic Redwood trees and
beautiful bodies of water. Don't get me wrong I am very
much so appreciative of all the beautiful natural view that
I am exposed to each day. But does the quote "Too much of
anything is bad for you" On the contrary, Humboldt County
does offer a social setting and scene, which I reside in,
and feel the most comfortable and happiest at.
I personally never experience a mere devastating, shocking
experience of depression as I experienced during my trip
back. My schedule circulated from waking up at five thirty
in the morning so that I can make it to the bus stop on
time and attending an intense course from nine o'clock in
the morning to five in the evenings. I 'd faced the
majority of the stressor mentioned above such as frequently
wakening up in the morning, excessive crying, Persistent
feeling of sadness anxiety, hopelessness and I definitely
felt restlessness, agitation and irritable. Other
obstacles/factor, which also played key roles that possibly
aid in contributing or triggering my depression such
emotions during that particular time in my adolescence. My
mental state was very unbalanced. Factors that caused my
unbalanced for example, being a broke college student as I
realize that most college students are (broke), my roommate
and I were in the process of being evicted from our off
campus housing and to add the cherry on top, we had no
money which is an incredible stressor. The year of 2003
literally took me through an experience of a state of
depression! I'm thankful that I was able to experience,
overcome and grow from that mental illness called
depression.
History
"In the 1950's and 60's Depression was alienated into two
types: Endogenous and neurotic. Endogenous meaning that the
depression comes from within the body, perhaps of genetic
origin, or comes out of nowhere. Neurotic or reactive
depression has a clear environmental precipitating factor,
such as the death of a spouse, or other significant loss,
such as the loss of a job." (Medicine net) alongside the
two different types of depression, There could a
correlation possibility between Depression; Neurotic and
endogenous and the most pull and tug battle between nature
vs. nurture. Keeping in mind that correlation doesn't
always equal causation.
Roth ad Mountjoy (1997) argue that there is a spectrum of
depressive states that extends from bipolar states at one end,
to neurotic depression at the other end, and that nonendogenous
disorder should be distinguished in etiology, but because of
difference in the course of the illness and the prognosis. They
argue that the neurotic depressions have a different clinical
profile; they are characterized by "episodes attacks which are
separated by relatively clear intermission broken by no more
than mild occasional symptoms. They frequently evolve after
some traumatic event, such as loss, demotion, or failure, and
lack a history of trauma in childhood or adolescence, whereas
dysthymia often occurs without a clear reason for onset, as
well as sometimes being triggered by adverse life events."
(Norris, Currieri p 185-86)
Treatments with EMG
What treatments could EMG approach in biofeedback for treating
depression? "The most prominent use of Neurobiofeedback(sm)
[EMG electroencephalograph the brain and neurofeedback] in the
United States is for anxiety disorder and stress management.
For these conditions, relaxation training and peripheral EMG
biofeedback modalities are very helpful when someone is
depressed; they have a dominance of slower moving brainwaves.
This medical model may prescribe anti depressants or
stimulants. This will speed the brainwave up temporary until
the medication is metabolized in the body and the old brainwave
pattern dominates once again." (Bio med)
Conclusion
True depression, may cause inconveniences in an individual life
from not being able to enjoy daily activity, but I believe that
once an individual is temporary stuck in an unbalance state of
mind and emotional illness, anti-depressant will not find a
solution to their resolutions. I believe that with any
situational or disposition experiences, that has lead any
person (s) to form an unbalance in their state of affairs. We
need to reconstruct their tribulations in event that we could
possibly find multiple aspect/factors that might/could cause
depression and therefore we can properly construct an
individual unbalance state of mind.
References:
Michigan Institute for Neurobiofeedback. Neurobiofeedback Training for Depression. Bio-
medical.com-NEWS http://www.bio-medical.com/news_diplay.cfm?newsid43. Retrieved
April 06, 2003
Norris, Currieri (1999) Introduction to Quantitative EEG and neurofeedback. III the
Classification of Depressive Disorder
The Australian Psychological Society LTD (2002) Disability Online, Depression-Coping
ad Recovering.
http://www.disability.vic.gov.au/dsonline/dsarticle.nsf/pages/Depression_Coping_and
Recovering?OpenDocument Retrieved April 06, 2003
MedicineNet (2003, February 06). Focus on Depression.
http://www.psychinstitute.com/mental_illness/depression.html
EEG Treatment in Psychological Disorders
Introduction
In Biofeedback one of the types of feedback given is the
electrical activity that a person has in there brain. This
is obtained by using the electroencephalograph, EEG. Slower
frequency waves that are at 1/2-4 Hz per cycle are called
delta. Theses are the slowest waves and have the longest
amplitude. Another group of slower frequency waves are the
theta waves at 4-8 Hz if you are awake at this time then
you are likely to be disoriented, normally this occurs
while you are sleeping. The next frequency is the alpha
waves and these go at 8-13 Hz per cycle, when you are here
you are in introspection, if you are thinking of something
that brings you happiness then it is likely that you are
using Alpha waves. Then you have beta waves that run at
about 13 Hz and up, the beta waves are going when you are
more awake and alert to the world.
When using the EEG, there are different types of placements
depending on the mode that you use. First there is a
method that uses only three. In this system you have two
electrodes that are active and a third electrode that is in
the center that grounds the activity. Then there are other
methods that use about 20-30 different electrodes placed
around the head at different locations to give you a better
picture of the type of activity going on all over your
brain (Schwartz, 1995).
Drug Addiction and EEG
By Karissa Rasdal
For the past year I have been trying to quit smoking cigarettes, I
started to notice the aversive effects that this drug was having on my
body. I woke up and coughed every morning and when I would walk even
short distances I noticed that I would be out of breath really easily.
But at the same time I kept up the habit and would sometimes do this at
times when I couldn't even handle it at all, like when I was sick and I
would practically make myself throw up just so I could have a couple of
drags off a cigarette. I would find myself walking in the pouring rain
to get a pack even though I knew that the money I had in the bank
needed to be used for paying bills, because I needed to have a
cigarette. Just so that I could read my chapter for the test next
week, and don't forget the pre-test cigarette and the after test
cigarette, and when I seen a friend smoking they needed company so I of
course would smoke a cigarette with them.
According to Oakley Ray and Charles Ksir this would be an addiction as
defined as giving yourself up to the habit, I Taking this a bit further
they said that this habit would take up a large portion of the
individuals thoughts, and time to obtain the needed drug or items that
are linked to using it. When I finally realized that I had an
addiction it was clear I needed to change. I tried to quit on the
Great American Smoke Out where people who smoke try to quit for 24 hrs.
After this day I quit for a week and then started smoking again,
something stressed me and I couldn't do without a nice refreshing
Newport any longer. I tried to quit repeatedly and friends said could
you please make your mind up either quit or smoke. Then it occurred to
me that maybe I had a substance dependence as stated in the DSM IV TR
as including Withdrawal from the substance and needing to take a
similar substance to relieve the symptoms, unsuccessful attempts to cut
down or control the habit, and continued use of the substance even
though it isn't the healthiest thing to use (Ray et al., 2002). It is
said that when a person losses control of the habit and cant self
regulate then you have a disorder. This causes a problem with drug use
because your physiology could be altered and this is what leads to your
dependence on the drug (The Institute). It is further suggested that
after you have a dependence your body may need the substance to
maintain Homeostasis, the concept that your body maintain itself, by
having some sort of balance (Schwartz, 1995).
Then one day I decided to take a Biofeedback class and I found that you
could use the EEG to help with drug addiction. There was one problem
there was very little research focus on cigarette cessation. So I
looked into other substances and found quite a few resources on
alcoholism and alpha-theta neurotherapy. The addicted brain seems to
have less alpha brain wave activity than someone who isn't addicted.
When a non-addicted person closes their eyes there is an increase in
the amount of alpha, while the addicted persons alpha is flat, this
person is on edge and just cant seem to relax. It seems that the
addictive person is always in the flight or fight response of the
sympathetic nervous system and thus the person is constantly aroused
and thus is stuck in a situation that normally helps us to escape when
there is danger (Neurofeedback Center of America).
Since there was a distinguishable pattern for the brains of addicts it
left a possible opening for research into trying to get an increase in
the addicted brain. One particular person who has studied this is Dr.
Peniston. The Peniston Protocol originally involved 15, 30-minute
sessions 5 days a week, now though it is more common to have 30
sessions including a scene of a rejection of the desired behavior in
the beginning of each session. They place electrodes on a 01
monopolar reference linking the ears and a ground on the forehead.
Here they are just looking for a baseline activity level for this
subject. Then the person is taught to warm their hands, it is believed
that when you are in the flight or fight part of the nervous system
there is increased blood flow and so relaxation is used to decrease
this blood flow. The person is taught autogenic relaxation techniques
and diaphragmatic breathing to help increase relaxation. They get
feedback on the alpha theta frequencies in their brain while they
construct a scene where they do the desired behavior that they are
trying to decrease, with the final outcome being completely free of the
substance in your visualization process (Norris, 1999).
In studies people have found that the Peniston protocol had one of the
highest rates of effectiveness for alcoholics with 80% abstinence rates
compared to a twelve step program with rates around 30-40%. One source
suggests that the protocol helps the person increase in abstract
thinking, stability, conscientiousness, boldness, imagination and self
control (Patterson). While another source suggest that this training
helps decrease depression, anxiety, positive personality changes, and
Beta-endorphin levels (Walters, 1998).
There were many limitations to the study that call to question if the
effects were really due to the biofeedback machine or something else.
The first was the fact that the control and treatment groups differed
on their IQ's. This could have been the real reason for the different
outcomes of the two groups. Another limitation is that the authors
never tell you where they placed the active electrode and said that
they placed the other electrodes one the forehead and the right ear
this is confusing and needs to be discussed further. They also
question how independent the sample is, and exactly what is the
procedure that Peniston actually used. It is questionable that other
researchers can replicate these results without more research. This
statement was made because it is said that the biofeedback machine is
what caused the change. If it is the machine that caused the change
then it is said that the therapist doesn't even need to be in the room.
It seems more likely that the desensitization training and flooding
could have more to do with the changes and thus the need for the
therapist. If the patient starts to become agitated then the therapist
could guide them back, but these things aren't mentioned in the
article. With these limitations it is questionable whether the effects
can be replicated (Graap, 1998).
Even with these limitations it appears that the positive effects of
using this type of addiction cessation program seems to have the most
effective results. This could be caused to an increased level of blood
to the brain, giving it more glucose and oxygen.
When you are ready to begin it is important to note that you need to
have the person in darkness because this is where the alpha is produced
in higher quantities and it is important that there eyes are closed
this is something that deals with Block's Law which states that alpha
blocking stimulus is proportional to the product of it's luminescence
and the visual solid angle it subtends. Few designers of machines have
thought of this and so machines have swinging devices on them. The
best results come through auditory stimulus. Another thing to consider
is the consistency that the filters have, thus not filtering out the
many different types of brain wave activity and thus giving you a false
thought of how good you are doing. Another thing to consider is the
area you are in, if there is a lot of sound then this could cause
problems to the training.
It is also said that if you want the person to learn this better it
should be done on consecutive days instead of spread out because
learning this doesn't take as long. Doing things this way you could
have the person out in 7 days with about 12-20 hours of training, with
nicotine withdrawal taking about 7 more days to completely learn the
process (Hardt, 1994).
Thus having the client learn to control there alpha-theta frequencies
can help the person to control their emotions when they are withdrawing
from their substance. It appears that this is one of the better ways
of controlling the problem of addiction because the person is able to
relax the flight and fight system. I know that this time quitting
smoking I have had fewer emotional outburst and don't seem to have as
many withdrawal symptoms making it easier for me to forget about my
addiction and move on to a more healthy way of living.
References
Graap, K, and Freides, D, Regarding the Database for the Peniston
Alpha-Theta EEG Biofeedback Protocol. Applied Psychophysiology and
Biofeedback. 1998; 23:265-272.
Hardt, J., A Tale of Self Discovery. Megabrain Reports. 1994,
http://biocybernaut.com/publication/hardts-work.html.
The Institute, Therapeutic Uses of Neurofeedback. Michigan Institute
for Neurofeedback. http://www.expertsinmind.com/uses/cond.php?cond=2.
Neurofeedback Centers of America, Remedial Neurofeedback training,
Alcohol and Drug Addiction...A New Solution to an old problem.
http://www.greatbrain.com/addiction.htm.
Norris, C., Quantitative EEG and Neurofeedback. San Diego, CA: Academic
Press; 1999.
Patterson, D., EEG Neurotherapy For the Treatment of Alcoholism and
Addictions, Brief Overview. Biofeedback and Alternative Medicine
Centers; http://www.biofeedback.net/altmedicine/daleeeg.htm\.
Ray, O., and Ksir, C. Drugs, Society and Human Behavior 9th addition.
New York, NY: Mc Graw Hill; 2002.
Schwartz, M., and Associates. Biofeedback A Practitioners Guide Second
Edition. New York, NY: The Guilford Press; 1995.
Walters, D., EEG Neurofeedback Treatment for Alcoholism. Biofeedback.
1998;26:18-21&33. Centers;
http://www.biofeedback.net/altmedicine/daleeeg.htm.
Epilepsy and EEG Biofeedback
By Krista Seiwart
Epilepsy is a perplexing disorder that can be very challenging
to find a cure or remedy for. Many patients resort to taking
long term, anticonvulsant medications that can have disrupting
side effects and only work for 50% of the patients.
Neuropathy, liver damage, decreased blood count, bone marrow
depression, decreased platelet count, or depression, are all
possibilities when taking anticonvulsant drugs. Less
significant side effects include shaky hands, bodily hair
growth or loss, mental confusion, memory loss, weight gain or
loss, imbalance, double vision, fatigue, and gum overgrowth.
It is no wonder why one would seek to find alternatives to
these risky medications. Fortunately, seizure control using
EEG biofeedback has a promising future.
According to Dr.John Basmajian, the founder of biofeedback, it
is "the technique of using equipment (usually electronic) to
reveal to human beings some of their internal physiologic
events, normal and abnormal, in the form of visual and
auditory signals in order to teach them to manipulate these
otherwise involuntary or unfelt events by manipulating the
displayed signals. This technique inserts a person's volition
into the gap of an open feedback loop, hence the artificial
name biofeedback, here necessarily a human being must want to
voluntarily change the signals because they meet some goals."
And goals regarding fewer seizures are proven possible. In the
epileptic's case, biofeedback trains the patient to generate
certain brainwaves to prevent certain seizures. There are many
different types of seizures, and everyone's brain chemistry
varies. Consequently, different types of brain waves are
advantageous to different types of seizures. The main
challenge is to find which brainwaves are beneficial for which
people.
Joel Reiter, M.D. and Donna Andrews developed a biofeedback
program for complex partial seizure patients. The first step
in the program is to locate where the slow or abnormal brain
wave activity occurs using the electroencephalograph. Next,
the patient is trained deep breathing exercises, progressive
relaxation, and imagery skills. These exercises increase alpha
rhythm activity and decrease theta rhythm activity in the
abnormal part of the brain. Once the patient can activate
alpha waves and deactivate theta waves at more than 50
microvolts, the amount and frequency of seizures theoretically
go dramatically down.
Most research on EEG biofeedback with epileptics has been to
increase the alpha rhythm activity while decreasing the theta
wave activity. There have been other successful studies
increasing other brain wave activity, but all studies have
worked to decrease theta wave activity. The success rate of
studies using this method has been astonishing. Most studies
have a 60% to 83% success in the considerable decline of
seizure type or seizure frequency. Comparing this to the
success rate of anticonvulsant medication, which has a 50%
success rate, it should be the remedy of choice.
Although biofeedback seems like the optimal answer to an
epileptic's predicament, there is little known about epilepsy
and the effects of biofeedback on epilepsy. Every epileptic
has different seizures, and different brain waves can be
advantageous to different people. Nevertheless, biofeedback
has been very beneficial to the studied participants, and has
potential to help many more epileptics.
REFERENCES
Andrews D.J., Cobb T.E., Kasti A., Lambert R.D., Reiter J.M.
"Complex Partial Epilepsy: A Therapeutic Model of Behavioral
Management and EEG Biofeedback." Andrews-Reiter Epilepsy Research
Program, Inc., 1981.
Holder G.S., Krulikowski D.I., Lobar J.F., Natelson S.E.,
Pamplin W.E., Shabsin H.S., Whitsett S.F. "EEG Operant Conditioning
in Intractable Epileptics." Self Control vol. 1, No. 2, 1990.
Reiter, Joel M.D. "Epilepsy: A New Approach" Prentice Hall
Press, 1995.
Schwartz, Mark S. and Associates. "Biofeedback A
Practitioner's Guide" The Guildford Press, 1995.
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