> Sejla Tukelija is a neurofeedback counsellor at STARTTS.

Angie, a 10 year old Liberian refugee, is having problems regulating her attention and focus at school , as well as her emotions (she often fluctuates from feeling very sad to feeling very angry). She was referred to STARTTS neurofeedback (NF) clinic. A combination of counselling and neurofeedback therapy (NFT) was thought to be the best approach, since all the assessment pointed at chronic issues with attention and focus as well as emotional dysregulation.   For that reason the sessions involved some time in each mode.

During NFT, Angie received moment-to-moment information about the rhythmic electrical activity in her brain. In NFT, electrical brain activity is recorded by placing a sensor on different locations on the head and then transmitting the brain's signals via electrodes to a computer screen. Angie was able to receive direct feedback about her brain activity with auditory and visual cues on the computer screen. The brainwaves considered desirable   vary from person to person, and has both objective (e.g. EEG) and subjective elements (e.g. reporting what makes you feel more alert, focused, relaxed, secure, etc.). As the brain is rewarded for making specific brainwaves, it can gradually learn to reregulate its own functioning.

The mechanism of action is similar to other forms of learning: the more the brain is rewarded while being trained in a desirable frequency, the more it will function in that frequency after training. With Angie, the treatment protocol was to challenge her brain to respond more flexibly and with greater capacity in those areas responsible for regulation of emotion and attention.   This information is not processed consciously but the brain becomes aware of the impacts of particular electrical firing with visible results in the game. With this feedback and learning, Angie was soon able to induce the changes in her brainwave patterns that would enable positive outcomes to her games and gradually seeing the relationships between sensations, thoughts and behaviours. She felt more in control of her responses – and this in turn gave her a sense of grounding and confidence.

The counselling component of Angie's sessions involved both play and conversation. Initially Angie was very quiet, and only mildly responsive to my questions or comments. As time progressed, she began to talk and engage more. Gradually, we spent more play time and interacting in each session together with the use of NFT.   Angie and I would often make origami boats and flowers. As with NFT, she enjoyed the structure and predictability of these games as well as having a concrete outcome – seeing the effects of her activities. She was creating new things and she enjoyed being successful in this play.

Throughout my work with Angie I ensured that I was getting a regular feedback from her teachers and her mother. This crucial perspective is essential in planning and carrying out good NF and therapy.

Little by little, the feedback from her teachers indicated that Angie was gaining more focus and seemed less angry and irritable. Re-test with the same methods as were initially used showed that she was much less anxious and worried and her oppositional behaviour reduced dramatically.   She was less impulsive and generally more cooperative. These were important outcomes for the school and social interaction with other children.   These changes occurred in spite of Angie's home situation not improving, with a continued absence of adequate supervision and emotional support and guidance.  

3 MAJOR LEARNINGS

• NFT exercises the brain. There is no direct contact with the brain but through observation of its activity children learn flexibility and stability at a neurological level. This then translates into behavioural change
• The use of NFT can help regulate basic functions like sleep, attention and emotion quickly and efficiently.
• Being a learning process, NFT training needs to be conducted at least twice a week and initial training goals may be met by twenty sessions,   at which time the initial re-tests are usually performed.

At STARTTS we combine NFT with psychotherapy and other therapies.

For more information about STARTTS NF Clinic you can visit STARTST web site: www.startts.org

> Sejla Tukelija
Sejla is a neurofeedback counsellor at STARTTS. She has been with the service for over 12 years, working in various capacities, and has presented on neurofeedback therapy at national and international conferences.

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