BIOFEEDBACK AND BRAIN ACTIVITY

Josef Faber∗

Abstract: Biofeedback is a treatment technique in which people are trained to im-

prove their physiological functions by using different signals from their own bodies,
e.g. from skin, heart (ECG), muscles (EMG), brain (EEG) etc. Psychothera-
peutists use it to decrease intrapsychic tension in anxious and depressive patients
and epileptics or learn to relax boys who suffered from attention deficit and hyperac-
tivity disorders. The main system for consciousness (thalamocortical reverberation
circuit) generates whole brain electromagnetic frequencies permanently (1-30 Hz =
EEG activity). But we choose a specific frequency band, e.g. SMR (Sensory Motor
Rhythm = 13-18 Hz) and these SMR episodes are rewarded by success in a simul-
taneously watched TV game. SMR is then repeated still more often and brings into
electrogenesis and into psyche tendency its own property, which is motor inhibition
and increasing attention. This is the aim of the therapeutical learning process.

Key words: Biofeedback principles and treatment, electroencephalography

Received: January 11, 2010
Revised and accepted: March 4, 2010

1. Introduction
The idea of biofeedback is old. Everybody controls his/her own behavior con-
sciously and subconsciously. Also our look into mirror is feedback. But, seen from
the new point of view, the notion of feedback is slightly different. Thanks to new
electronic devices we can see our body and mind better than by our naked sensory
organs.
Biofeedback (BF) is a new electronic treatment technique in which people are
trained to improve their physiological functions by using different signals from their
own bodies. Neurologists use biofeedback to put down the epileptic attacks [27] or
to help stroke patients regain movement in paralyzed muscles.
Psychotherapeutists and psychiatrists use it to decrease intrapsychic tension
in anxious and depressive clients [20, 22], schizophrenic patients [11] and learn to
relax boys who suffered from ADHD (Attention Deficit Hyperactivity Disorders)
syndrome [15, 17, 21]. PET (Positron Emission Tomography) shows metabolic
reduction in some brain structures, e.g. superior prefrontal and premotoric areas;
fMRI shows hypocativity in the gyrus occipitotemporalis and both amygdalae [13]
(Fig. 1).
∗ Josef Faber

Czech Technical University in Prague, Faculty of Transportation Sciences, Department of Control

and Telematics, Konviktská 20, 110 00 Prague 1, Czech Republic

c
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Fig. 1 Longitudinal section of the brain. AA – area adolfactoria or septal nu-

clei, rhythmic generator for the hippocampus (HI). AM – the amygdala, part of
the limbic system. HI and AM are structures where epileptic foci (EF) are very
frequently localized. ARAS – ascendant reticular activation system, center for vig-
ilance maintenance. BO – bulbus olfactorius, odors perception. CO – neocortex,
95% of all cortex, logical, rational, cognitive, speech centers etc. GC – gyrus cin-
guli, attention and perception of pain. HI – the hippocampus, old cortex, emotional
and memory functions. HT – the hypothalamus, the highest neurovegetative cen-
ter HY – hypophysis, a gland with the highest neurohumoral endocrine functions.
LBF – lobulus parietalis, part of the neocortex for touch, pain and attention. LC
– locus caeruleus, nucleus for paradoxical sleep regulation. MES - mesencephalon,
midbrain, superior part of the brainstem. NR – nucleus ruber, motor center. M.
oblong. – the medulla oblongata, inferior part of the brainstem. NRA – nuclei
raphe, centers for synchronous sleep regulation. PF – prefrontal cortex, rational
function, operating memory, attention, psychic Ego. PM – premotor cortex, area
for movement preparation. Pons Varoli – middle part of the brainstem.

Other specialists in different fields use this technique to help their patients
better regulate their heart rhythm and decrease stress [18] or improve vasculariza-
tion in dihidrotic eczema [19] or suppress tremor in parkinsonism and damp down
frequency of epileptic attacks [1, 30, 26, 27, 25, 28, 29].
R. Christopher deCharms et al. [2] found that by using real-time functional
magnetic resonance imaging (rtfMRI) to guide BF training, subject (healthy vol-

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unteers and chronic pain patients) were able to learn to control over activation in
the rostral gyrus cinguli in the cortex, a region putatively involved in pain percep-
tion and regulation.
J. Lévesque et al. [15] used FB in 20 children who suffered from ADHD, ex-
periments were controlled by functional MRI (fMRI) and by psychological Stroop
task. The results suggest that BF has the capacity to normalize the functioning of
the brain structure (the left superior parietal lobule) but mainly the right anterior
part of the gyrus cinguli, the key neural substrate of selective attention. There
is suitable use of the BF technique for increasing attention and eliminating som-
nolence in drivers, pilots etc. [8]. Faber and Vladyka [3] published evidence that
motor, sensoric and psychic stimulations are able to inhibit both EEG and SEEG
(from implanted electrodes to the amygdala and the hippocampus) normal and ab-
normal (epileptic) activity. In our opinion, thinking is the product of the sensory
and motor process but without muscle and locomotion activity (Fig. 2).

2. Electroencephalography (EEG) and EEG –

Biofeedback (EBF)
EBF is a special kind of learning, i.e. operating conditioning. Learning and memory
are two sides of one coin. From the static point of view, the learning process is
distinguished into two main categories:

1. declarative – explicit memory (semantic and episodic) with anatomical sub-

strate in the hippocampus (old part of the brain – archicortex),

2. nondeclarative – implicit memory (skill, word completing, nonassociative

(sensitization and habituation) and associative learning, i.e. Pavlovian con-
ditioning where both stimulations are from the outside (e.g. light and food)
and operating conditioning, i.e. EBF, where the first stimulus is from the
inside (electrical brain activity, e.g. sensorimotor rhythm, SMR) and second
stimulus is from the outside, i.e. reward. This type of learning – operating
conditioning – is also reversal conditioning. Anatomical substrate of non-
declarative learning is mainly localized in the cerebellum and the striatum.

Another point of view of the learning process is a dynamic one: immediate

memory (changes in neuronal impulse frequency and pattern), short – term mem-
ory (increasing activity S-100 protein or FOS protein etc.) and finally long –
term memory (activation of calcium, memory proteins or transcription factors, e.g.
CREB, synapse-strengthening proteins, [9] etc. The last stage of this process oc-
curs during night NONREM-REM sleep. There is interesting aspect, namely that
after antiepileptic successful EBF training increases amount of spindle-burst sleep
(sigma) activity during NONREM 2 sleep [28].
Functional and structural point of view of learning is distinguished into internal
and external, physiological and pathological ones. The internal physiological mech-
anisms of learning occur during REM sleep. The external physiological learning
processes are represented by upbringing, erudition and entire culturogenesis. Inter-
nal pathological learning has a substrate in epileptic focus, which is often hidden in

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Fig. 2 Pharmacoresistant epileptic patients with implanted electrodes to the amyg-

dala and the hippocampus (SEEG) on the right (DEX) and left (SIN) sides. EEG-
superficial scalp electrodes. The arrow shows inhibition (desynchronization, right
part of the picture) massive epileptic activity in EEG and SEEG (left part of the
picture) with enhancement attention by talking with patient.

the deep limbic structures from where behavior disturbances and epileptic attacks
sometimes develop.
Children who suffered from ADHD usually (90% in the population) have very
abnormal EEG curves [4, 5, 6] and also have 41 damaged genes [12]. External
pathological learning is represented by maladaptation, anxious resistant and anx-
ious avoidance attachments, posttraumatic anxious-phobic syndromes and depri-
vation e.g. “wolf-children from the jungle or from long TV watching” [14].

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3. Psychic and Brain Events During EBF

We speculate about this sequence of events during EBF: thalamo-cortical reverber-
ation circuits generate whole EEG spectrum almost permanently in the subdelta,
delta, theta, beta and gamma frequency bands. The entire span ranges from 0.2
Hz up to 80 Hz, but it is possible to record frequency over 30 Hz, so called gamma,
only directly from the cortex. SMR (11-13 Hz or 14-18 Hz) comes randomly like
other frequencies. But every selected SMR episode is rewarded, e.g. by success
during simultaneously watched TV game. This situation represents a pleasure. At
the beginning, the proband is not able to evolve the SMR on purpose but after
EBF training he does it, at least subconsciously (Fig. 3).

Fig. 3 Arrangement scheme of biofeedback training. Wires from scalp electrodes

are connected with EEG amplifier and the first PC, where is EEG signal filtered to
the delta, theta, alpha and beta frequency bands. We select a specific band, here a
slow beta (SMR) activity, to move with the objects on the second PC screen, which
is watched by a learning proband. Psychotherapeutist controls the proband and both
screens.

The reward must come not too late and not too promptly. Ideal latency is circa
250-300 milliseconds. Cognitive potentials P300 also has a similar latency. Thanks
to reward, the proband wants to repeat this situation once again. Pleasant reward
provokes longing to repeat it again.
Thanks to motivation (prefrontal cortex and limbic system) the previous situ-
ations are realized in thalamo-cortical circuits again. In this way, longing is sub-
consciously implemented or will into braielectrogenetic structures, it is a kind of
“miraculous” transformation.

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SMR frequency is subsequently repeated more often. SMR time index increases
and this SMR activity brings its own property into electrogenesis and into psychic
tendency. This property of the SMR regime is motor inhibition and psychic atten-
tion. And it is the aim of this treatment learning process (Figs. 4, 5).

Fig. 4 EEG brain mapping. From left to right, the color ovals are brain scheme for
the delta, theta, alpha and SMR frequency bands. Upper row illustrates beginning of
the session, the bottom row is end of the session. Each session lasting approximately
40-50 minutes is composed of 10-15 rounds. Each round lasts 2-3 minutes. Red
color represents higher, blue color lower amount of frequency band (power). The
last row shows maximum SMR power over the central brain region, where motor
and somatosensory cortical areas are located.

Clinical studies of SMR in patients or during neurophysiological experiments

in animals showed intriguing data [25, 26, 27, 28, 23]. Rapid alpha (11-13 Hz)
and SMR (13-18 Hz) are usually formed to spindles. Behaviorally, these spindles
are accompanied by good attention in lucid vigilance without movement and also
without somnolence, sometimes increasing during mental activity in the central
scalp electrodes, e.g. during Raven task [6]. From the functional point of view,
these rhythms are similar to Gastaut’s rolandic, i.e. arcadic (mu), rhythm [10].
During SMR spindles are blocked, the neuronal impulse firing in nucleus ruber
(important motoric center in the midbrain, which projects its neuronal axon to
motor unit neurons in the spinal chord) and, on the contrary, this impulsing is en-
hanced in the ventrobasal nuclear thalamic complex. It means that motor activity
decreases and sensoric activity increases (Fig. 6).
During “vigilitas passiva” is present, decreasing general attention but increasing
focal attention, synchronized EEG (higher and slower waves), interrupted (group-
ing) firing patterns in neural networks of cortical and subcortical structures and
decreasing muscle activity. State with focused attention is similar to EBF training.
However, we have not enough information about thalamocortical circuits and
their frequency changes because this system is too complex. We need more data
for psychical-EEG relations, e.g. the alpha-attention and short-term memory ratio
during thalamocortical reverberation and “iteration” process is not clear [24, 7].

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Fig. 5 Upper right is EEG curve with increasing amount of SMR spindles. Brain
scheme shows information way from eye to optical cortical area and further to the
frontal (seat of attention and short-term memory) and hippocampal regions (seat
of emotion, motivation, long-term memory).

4. Our Experiences and Results

We observed approximately 2,000 children with diagnosis ADHD, epilepsy,Gille de
la Touirette syndrome and oligophrenia. But special attention was given to 30
children who suffered from ADHD syndrome. The treatment by EBF lasted for 4
months and contained 20 to 30 treatment sessions.
There were 24 boys and 6 girls, aged 7 to 13 years, with ADHD syndrome
(minimal cerebral palsy). The EEE-biofeedback (EBF) trainingas performed on 1-
or 19-channel apparatus with a scope for spectral analysis. The active electrodes
for EBF were C3 or C4 (the central brain region left or right). EEG analysis,
neurological and psychological testing were performed before and after complete
EBF.
Neurological findings remained unaltered by the training, there were usually
spasmophile neuropathy and startle reflexes. The Prague Children’s Wechsler Test
improved in 18 children, in verbal and performances parts from 4 to 12 points, 5 on
average. The Number Square Test also improved by 2 stems in 12 children. The
Way Test, which is suitable for attention, improved in part B in 7 children.

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Fig. 6 Neurophysiological scheme shows during “vigilitas activa” increasing sensory

perception and motor reactivity, desynchronized EEG curve (low and rapid waves),
continuous irregular impulsing in neural networks of cortical and subcortical (tha-
lamic nuclei, nucleus ruber) structures and decreasing reflective and spontaneous
muscle activity.

There were no changes in 23 cases in the optical reading EEG curves, improve-
ment in 7 cases. But spectral analysis showed improvement in 18 children who
improved also mentally. There was a decrease in the delta and acceleration of the
alpha band in 10 children, and a decrease in the massive alpha in 8 children. How-
ever, during training there was an increase in the delta, sometimes also in the theta

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band. It seems contradictory to elicit a decrease in delta and theta during training,
because these frequency bands usually increase during psychotests accompanying
the mentation process. [4, 5, 6]. (Figs. 7, 8)
We present two interesting results: a/ 18 children show improvement in line
with the EEG spectrum and psychological test, b/ sensory–motor rhythm (SMR)
and rapid alpha (11-13 Hz) and mainly “mental” delta activities increased through
proper EBF. But the final result after all the therapeutic sessions is a decrease of
the delta band because this abnormal “biological” delta corresponds with the state
of biological retardation.
Total alpha (8-13 Hz) was without significant changes in the final results (with
the exception over Cz, Pz, T4, T6 electrodes) in comparison with pretraining EEG
testing and with normal control group (60 matched children). We speculate that
the EBF accelerates in some children biological and mental maturation [4, 5, 6].

Fig. 7 Abscisse represents the amount of power in delta rhythm. On the ordinate
are names of electrodes : Fp – prefrontal, F – frontal, T – temporal, C – central
(zero, i.e. in the middle of skull), P – parietal, O – occipital. The odd numbers
designate left, the even numbers right head side. The upper curve shows the amount
of delta activity during eyes closed (black squares, EC ANT) before EBF training
belonging to ADHD children. The middle curve is the delta amount after EBF
training in the same patients (empty squares, EC POST). The bottom curve is
delta activity in 60 healthy control persons (black rhombs, EC CONT). After EBF
training delta activity decreased significantly.

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Fig. 8 Scheme shows alterations of alpha activity in ADHD and in control healthy
children. The legend is the same as in Fig. 7. From frontal up to C3 electrodes
there are no principal changes between these three curves, but over the Cz, Pz, P4,
T6 regions rapid alpha activity significantly increases after EBF training (empty
squares, EC POST) because it is frequently similar to slow SMR.

5. Conclusions
Psychotherapeutists use the recent treatment technique called biofeedback (BF).
Many specialists in different fields use this technique to help their patients in regu-
lating better their dihidrotic eczema, suppress tremor in parkinsonism, damp down
frequency of epileptic attacks, decrease fast heart rhythm, calm attention deficit
and hyperactivity disorders in young boys, etc.
Anatomical and functional substrate of consciousness is thalamocortical rever-
beration circuit, which permanently generates electromagnetic waves during the
day and night in frequencies ranging between 1–30 Hz. Every narrow band from
this whole spectrum has its own property. SMR activity (13–18 Hz) accompanying
motor inhibition and better attention is used as training for calming and quietness.
SMR, like other activities, comes randomly at the beginning. But every SMR
episode is rewarded by success during a simulaneously watched TV game. This
situations represents a pleasure. Thanks to motivation the previous situations are
implemented in the thalamocortical circuit and in memory again. SMR time index

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increases and SMR activity brings into electrogenesis and into psychic tendency
its own property; patients are under the influence of SMR regime. The aim is
accomplished. Therefore, anxiety, hyperactivity, epileptic attacks decrease and
attention rises.

Acknowledgement
This work has been supported by the Grant Agency of the Academy of Science of
the Czech Republic within the IAA201240701 project.

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