Regular Features:
Edition 3: Feb 09



Sanja Stefanovic

> Mirjana Askovic is a psychologist and neurofeedback therapist
at STARTTS.

 

Background

Dalia, a 5 year old Iraqi girl, was referred to STARTTS by her mother. Dalia presented with severe sleeping disturbances. She had difficulty falling asleep and would wake up after only 2 to 3 hours in fear, reporting nightmares. Her mother was unable to soothe Dalia, and would need to spend the rest of the night holding and comforting her.  In turn, the school reported that Dalia was withdrawn and a fearful child. 

Dalia arrived in Australia with her mother and older brother in a boat when she was 2 years old. The journey to Australia was traumatic:  the boat was lost at sea for several days, the family didn’t have enough food, and Dalia was difficult to soothe. After arrival, the family spent 5 months in a detention centre without appropriate medical care. On assessment, it emerged that Dalia’s mother was depressed and not coping well parenting her children without her husband, who remained in Jordan. The mother also reported that, as a baby, Dalia was sensitive, not easily settled, and had feeding difficulties.

Intervention
The initial phase of therapy involved work with Dalia and her mother to strengthen their bond and attachment. This was done through psychoeducation, modelling, and teaching on safe touch using massage and essential oils. A key objective was to demonstrate soothing techniques and to encourage mum to be more physically nurturing with Dalia.  Mum’s parenting skills were strengthened and she was encouraged to pursue her own therapy.

With this preliminary work underway, the next phase of therapy involved strategies to decrease Dalia’s hyperarousal and to specifically deal with her nightmares. To counteract Dalia’s nightmare fears, she was given a few strategies to use at home to make herself feel safer. For example, the counsellor and her made a drawing of a dream fairy who would look after her during the night and protect her against bad dream. Also, she was given ‘gold magic dust’ to disperse around her bed, again as a protective ritual against nightmares. In addition, Dalia underwent neurofeedback therapy to reduce her high levels of arousal and to better regulate her sleep. Sensors were attached to Dalia’s skull to measure her brainwave activity.

Through a computer game that provided feedback, brainwaves that were related to her anxiety and hyperarousal were decreased and brainwaves that promote a calmer, more relaxed state were increased. Following her 5 week program of twice weekly sessions, there was a significant decrease in Dalia’s arousal levels: mum reported she was falling asleep more easily, not waking up during the night, and that the nightmares had ceased. The school also noticed that Dalia was more attentive in class, looked generally happier and was more socially engaged.

About Neurofeedback
Neurofeedback is a therapy technique that presents the user (client) with real-time feedback on brainwave activity, as measured by sensors on the scalp, typically in the form of a video display, sound or vibration. The aim is to provide real-time information to the Central Nervous System (CNS) as to its current activity. It can help to think of neurofeedback as exercise for the brain: when brain activity
Brainwave training
changes in the direction desired by the trainer (therapist), a positive ‘reward’ feedback is given to the individual.  And if the change is in the opposite direction to what was intended, then either different feedback is given or the provision of otherwise attained ‘positive’ feedback is inhibited (or blocked).  Rewards/reinforcements can be as simple as a change in pitch of a tone or as complex as a certain type of movement of a character in a video game.  The process helps the brain to more effectively regulate various functions (sleep, emotions, thinking, behaviour, etc).  It could be called operant conditioning for internal states. 

3 key learnings

The STARTTS counsellor learned the following through this case:

  • Trauma often disrupts secure attachment between parents and their children – therefore, intervention must address the parent/child relationship.
  • Difficulty regulating hyperarousal is a common consequence of trauma.  Neurofeedback counteracts this by helping the brain to regulate itself more effectively and thus restore optimal functioning.
  • Because of the complexity of clients’ issues, it pays to be flexible and to use an eclectic mix of strategies that can address different aspects of trauma.  These strategies often involve parenting skill-building, repairing attachment, relaxation and stress reduction, cognitive restructuring, play therapy, etc).  

> Mirjana Askovic
Mirjana is a psychologist and neurofeedback therapist at STARTTS. She has 20 years experience working with children and adolescents. Her current role involves developing STARTTS neurofeedback clinic and promoting neurofeedback in work with traumatised clients internationally.

 

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© 2009 STARTTS  Contact: hintsforhealing@startts.org.au