Neurofeedback and Schizophrenia

Famous people with schizophrenia include Lionel Aldridge, Syd Barrett, Joey Ramone, Vivian Maier, Gene Tierney, Bettie Page, John Nash

What is Schizophrenia?

– Schizophrenia can develop when there is an impaired Default Mode Network, the neural basis for a ‘self’.  It is a personality disorder.

– The mind’s reward circuitry substitutes gratification gained from external social interaction with an addiction to internally generated content   

 –  Conscious awareness becomes infiltrated by internally generated content, sourced from the same brain areas that control our thoughts and social brain

 – Disordered thoughts and hallucinations are not perceived as such, with 60% of sufferers in denial

– The conscious mind becomes distracted, losing functionality as sleep, focus and emotional stability are compromised – comorbidities such as ADD, OCD, bipolar depression, insomnia ensue.   

– A negative feedback loop ensues, giving rise to episodic breakdowns

– Internal content can take on critical, negative and even third-person dynamics, especially when the person is exhausted or vulnerable. 

 – One third of Auditory Verbal Hallucinations are resistant to conventional treatment.  Neurofeedback training has been shown to result in significant improvements

– Neurofeedback can stabilise mood, restore Default Mode Network functionality, and address comorbid disorders such as anxiety, depression / bipolarity, trauma/(C-)PTSD, ADD/ADHD, OCD and insomnia.

– Genetic and environmental factors contribute to the development of Schizophrenia, such as social exclusion and/or drug use  

– Most vulnerable to Schizophrenia are adolescents and menopausal women

Daniel Webster has extensive experience in working with Schizophrenia.  Phone +44 (0)7966 699430 or daniel@neurofeedback.io for more information on Neurofeedback for Schizophrenia

Neurofeedback London-Brighton does not provide diagnosis nor medical interventions nor medical advice and is not medically trained.  By engaging in neurotherapy, you confirm that you have sought medical advice and are keeping your relevant medical professional informed of therapy progress.

Schizophrenia is a developmental disorder that affects an estimated one percent of the population.  Men are particularly prone to developing symptoms of schizophrenia in their late teens, while women are in their mid- to late twenties, and again susceptible during menopause. 

Schizophrenia Age and Sex Distribution

Early symptoms involve increased social withdrawal, which is accompanied by the person’s substitution of external realities with an internal storyline of their own.  While in the extreme this can manifest in a complete detachment from the environment (‘florid’ states, or catatonia), it is most often a form of ‘augmented reality’ the person is experiencing.  Still interacting with others as much as necessary, the person’s perception is overlayered with internal content. 

This projected imagination enlists emotions and sensory perceptions in a very ‘real’ way, and thus exceeds mere thought processes or ‘mental chatter’.  The person becomes addicted to their own internal mental content as their reward circuitry embraces this simpler path, compared to ‘earning’ such rewards in their external interactions with their environment.  

The internal imaginations become a habit to the extent that they are woven into the perceived reality – over 60% of sufferers are unaware of their condition or in active denial.  Neurologically, the brain area where thoughts and hallucinations are believed to originate recruits the same neuronal network as that used to process external auditory stimuli (reality).  Mirror neurons remain active when in a self-referential state, which can be observed with a brain map, and are an indication that the person is influenced by perspectives other than their own.  The person becomes unable to distinguish fantasy from reality.  

Voices and Hallucinations

The internal content becomes no longer controllable with conscious awareness, especially when the person is in a physically exhausted or vulnerable state.  In this case, the content can take on a negative, critical, even third-person dynamic.  ‘Hearing Voices’ or  ‘sparring with Dad’ (imagined authority) are frequent manifestations of when the internal dialogue becomes hostile. Besides the effort of trying to disguise these internal processes to the outside world, the person is engaged in battling these voices, further fatiguing mind and self-esteem.  Sleep and focus deteriorate and a negative feedback cycle ensues with Insomnia and ADHD/ADD frequently becoming ancillary diagnoses.  All the while, the person is having to balance their internal turmoil with external interactions necessary to ensure their physical survival.  Persistent paranoia and attribution of agency to illusions and hallucinations suffered can result in a delusion of being under constant observation and even persecution.

Externally, the development of schizophrenia leads to further social exclusion or a reduction in genuine emotional relationships, with both family and friends or partners.  The social brain is not engaged in a healthy way at an important stage of cortical development.  This manifests in comorbidities such as anxiety and mood disorders, and PTSD-like withdrawal.  Frustration at the growing gulf between imagined actions and the unfolding reality cause impulsive aggression, and often this is projected at immediate family members, though self-harm is a risk too.  Delinquency and ensuing incarceration further fuel symptoms and increase the likelihood of longer institutionalisation.  Environmental influences and the safety net of friends and family, as well as support from the social system, can have massive effects on the trajectory of the disorder’s development.     

Internally, the formation of a neural basis for a ‘self’, the Default Mode Network, is impaired, as is its ability to anti-correlate with the Central Executive Network.  Key nodes of these networks are often dysrhythmic, impacting the ability to self-sooth and self-nurture.  Vulnerability to substance abuse or dependence follows.     

One in three Schizophrenia sufferers experience pharmacology-resistant auditory verbal hallucinations (AVH);  in 30% of cases antipsychotic medication has little or no effect.  Neurofeedback training has been shown to produce significant results in this population, reducing auditory verbal hallucinations

Schizophrenia is a Spectrum Disorder

Schizophrenia is a spectrum disorder, meaning that severity, onset and manifestation of symptoms can vary substantially.  It’s more modest expressions can still produce symptoms such as borderline personality disorder (BPD) and/or Dissociative Identity Disorder (DID).  High performing schizophrenics can effectively mask their symptoms to maintain a functional appearance at work or around family.  The lack of maturation or development of a true ‘self’ however undermines efforts to gain true emotional satisfaction and fulfilment.  This has a disintegrative effect that tends to become more pronounced with age.  It is not unusual to see the construct of an outward appearance to fall apart with middle age.  This form of non-florid schizophrenia, which would probably struggle to fit into the DSM-5 definition below, partly because the person would likely not classify their internal content as ‘hallucinations’.   Some such sufferers are able to turn their internal activity into a creative expression in the form of literature, art or science.

A genetic predisposition to schizophrenia can be set off by exclusion from the external environment.  Migration, that is, higher exposure to social adversity, has been found to substantially increase the risk of developing schizophrenia.  Cannabis use in adolescents has been linked to schizophrenia since the 1980s, and it’s ability to stimulate internal content generation could be one reason for the high rate of use among persons on the schizophrenia spectrum.   

Schizophrenia and its comorbidities can be debilitating and leading a fulfilling and productive life a challenge.  Life expectancy and quality are reduced by this spectrum condition.  Negative symptoms of social withdrawal and anhedonia emerge usually during mid-life.  Yet many creative minds have shared this struggle.  

Famous People with Schizophrenia

Famous people associated with Schizophrenia Spectrum Disorder include: 

 Maths & Science:   

 – John Nash Jr. – Mathematician, Nobel Laureate, subject of the movie “A Beautiful Mind” 

 – Albert Einstein, Bertrand Russell – both had schizophrenic sons

 Art, Music & Literature: 

 – James Joyce – had a schizophrenic daughter

 – Zelda Fitzgerald, F. Scott Fitzgerald’s wife 

 – Jack Kerouac 

 – [J.D. Salinger’s Holden Caulfield in “The Catcher in the Rye”]

 – Syd Barrett of Pink Floyd; drummer Jim Gordon; Peter Green of Fleetwood Mac; jazz musicians Buddy Bolden and Tom Harrell; Skip Spence of Jefferson Airplane; Joey Ramone from The Ramones

 – Actresses Veronica Lake, Gene Tierney, Bettie Page

 – Darrell Hammond of Saturday Night Live 

 – Photographer Vivian Maier, subject of the documentary Finding Vivian Maier 

Sports:

 – Lionel Aldridge, NFL player; became homeless before diagnosis and turned to mental health advocacy in later years

 – Bobby Fischer, World Champion Chess player

DSM-5 Definition of Schizophrenia

Schizophrenia is characterised by the DSM-5 as follows:

– Two or more of the following Characteristic Symptoms, present for a significant portion of time during a one-month period:

+ Delusions;

   + Hallucinations;

   + Disorganised Speech (e.g. frequent derailment or incoherence);

   + Grossly disorganised or catatonic behaviour;

   + Negative Symptoms (i.e. diminished emotional expression or avolition)

– Social / Occupational Dysfunction, i.e. level of functioning in one or more major areas (work, interpersonal relations, self-care) markedly below the level achieved before onset, or failure to achieve expected levels of interpersonal, academic or occupational functioning for a given age-group

– Duration of disturbance lasting for at least six months, of which the above symptoms persist for at least one month

Schizophrenia is often accompanied by depressive or bipolar disorder, and can apply to people on the autism spectrum.  Other comorbidities include PTSD, Obsessive-Compulsive Disorder (OCD), and General Anxiety Disorder.

The above definition excludes cases where the disturbance is attributable to substance abuse.  Sufferers of the condition often turn to ‘self-medication’, which can intensify episodes.  Schizophrenia is a developmental disorder, and as such doesn’t just remediate itself upon cessation of drink / drug / medication abuse. 

Note that more than half of all diagnosed SSD sufferers do not acknowledge their condition, and as such it appears that many diagnoses make the external, subjective assertion of the existence of hallucinations or incoherence.  On the other hand, distinguishing ‘normal’ internal dialogue / mental chatter from excessive internal content generation can be difficult for less interoceptive individuals, who might not even be aware of their difference.  

The first signs of this development are often missed, as they occur in a naturally transformational period such as puberty, or menopause.  The mind starts becoming addicted to its own content, thus diverting resources from the social interactions that are necessary during nascent personality building.

Cannabis / Marijuana use is often linked to the development of Schizophrenia Spectrum Disorder.  Its frequent concurrent use has prompted publication of over 1,500 studies, with divergent findings regarding causality and exacerbation of symptoms.  Cannabis use doubles the risk of developing psychosis in vulnerable people, particularly during adolescence, where it can impair growth.

The incidence of schizophrenia is higher in urban settings, having doubled in south-east London over the past three decades.

The Neurology of Schizophrenia

Looking into the brain by means of an fMRI scan, the following differences in activation have been found compared to healthy controls.  As this is an observation of patients in a task-neutral, resting state, the differences in activation reflect the strength of the Default Mode Network (DMN)

The DMN is a network of neural hubs that are active when we are in a self-referential state – when there are no external demands on the brain.  Interestingly, the brain consumes about one-fifth (20%) of all energy used by our entire organism, and during resting state, the brain uses only 5% less energy than when ‘active’ in a task-positive way.  (The notion that we only use a fraction of our brain is a myth borne out of the observation that birds only loose their ability to fly when 90% of their brain is removed.)

The research on the DMN during the last two decades further demonstrates that we very much rely on our brain functioning during resting state:  we don’t go into ‘shut-down’ during sleep and relaxation, but are virtually as active when doing nothing as when we are actively thinking.


Schizophrenia fMRI Brain shows diminished Default Mode Network Difference
Diminished Default Mode Network functionality in Schizophrenia per fMRI

In Schizophrenia, the Default Mode Network is substantially weakened.   The maternal neural hub is dysrhythmic, while the paternal hub’s activity is hardly identifiable in the illustration above.  Attention switching ability is impaired, as is the hub responsible for attributing agency to observations, thus resulting in delusions.  Sources of anxiety and mood disorder are also identifiable as is the susceptibility to substance abuse and addictive behaviour.   With one in three sufferers of Auditory Verbal Hallucinations (AVH) resistant to conventional interventions (medication), research into alternative approaches has increased in recent years.  Neurofeedback training of the arcuate fasciculus has been shown to provide significant improvement in AVH and reduced symptoms.  

Hearing ‘Voices’ and other sensory delusions are a function of excess neural activity, giving rise to the existence of another internal perspective other than one’s own.  This overexcitement resembles hyper-vigilance as the nervous system is over-primed to external stimuli.  The secondary auditory processing region in the brain – most often associated with schizophrenia and auditory hallucinations (BA21L) –  accommodates both the internal acoustic information and external sounds.   This could be one of the reasons sufferers of the disorder are frequently unaware or in denial of their illness.  

‘Hearing Voices’, or auditory hallucinations, can take many forms.  Some sufferers experience a mainly benign ‘soundtrack’ or musical accompaniment in their head.  Others hear a realistic, internal, critical commentary, heightening their sense of feeling watched and struggling with an imagined authority whose ferocity increases as the person tires physically and mentally.  The strain on self-esteem is both direct, due to its critical nature, and secondary in that the constant experience diverts the person from the moment and other self-reflective, self-soothing thoughts.  A search for both confidence and numbing often finds a self-destructive drug-cycle that exacerbates the issue of lacking social engagement.  

Differences between the brains of Schizophrenia Spectrum Disorder sufferers and Healthy Controls have been documented in numerous studies.  These include lower Gray and White Matter Volume (GMV / WMV) in left temporal and frontal lobes; excess GMV in the basal ganglia (correlating with positive symptom severity); reduced density of key fasciculae (long distance white matter tracts); loss of GMV, particularly in males past age 35 and prefrontal glial cell loss.  A recent study also found that switching treatment-resistant patients onto clozapine  found subsequent reduction in thalamic and hippocampal volume, enlargement of lateral ventricles (temporal lobe size decline) yet improved symptoms.  Cortical thinning following 6-9 months of Clozapine treatment was also found despite symptom improvement, and causality between medication and anatomical change observations has yet to be established.  

Finding neuromarkers specific to Schizophrenia is a challenge created by the relatively broad definition of the disorder (which serves as the criterium for participant selection in studies), and the commonality of comorbidities such as anxiety, depression and other mood and personality disorders.  The benefit of qEEG-brain map based Default Network Training is that we can form a personalised brain training plan that recognises the individuality of each brain.

Neurofeedback and Schizophrenia

While there are certain commonalities between sufferers of schizophrenia, no two brains are the same.  On the basis of a brain map we can identify particular vulnerabilities and work on these specifically. 

Neurofeedback training can help restore the integrity of the Default Mode Network, the neural basis for ‘self’, as well as switching between self-referential states and active modes (the Central Executive and the Salience Networks). 

Emotional self-regulation can be improved and anxiety, depression, sleep and focus issues alleviated.  

Neurofeedback can calm the brain and help manage the ‘Voices’, as well as other regions prone to over-priming external agency.  Significant reduction in Auditory Verbal Hallucinations (AVH) has been achieved with neurofeedback training. 

Daniel Webster of Neurofeedback London-Brighton has extensive experience working with Schizophrenia patients.  Research and experience have shown effectiveness of neurofeedback training for Schizophrenia. 

Neurofeedback Training can help address specific schizophrenia symptoms and comorbidities including:

– Default Mode Network functionality and psychosis

‘Voices’, auditory, visual and kynaesthetic delusions

– Paranoia and Anxiety

– Thought disorder

– Sleep disorders

– Mood disorders and emotional self-regulation, including depression / bipolar disorder

– Attention switching and focus

– Sense of self

– Self / Other distinction

– Shared authority and societal rules / conventions

Borderline Personality Disorder

– Obsessive Compulsive Disorder (OCD)

– Addiction and vulnerability to substance misuse

– Aggression and social invasiveness

– Suicidal ideation / self-harm

 

Neurofeedback is a form of complementary therapy and should not be seen as a replacement for conventional medicine.  qEEG brain map-based neurofeedback training takes a more holistic approach to brain functioning, rather than just focusing on medical symptoms.  It is not intended as a form of diagnosis nor medical intervention nor medical advice per the disclaimer.

Brain Maps and Personalised Brain Training

Personalised Brain Training is a neurofeedback training method devised by founders of the field, Barry Sterman and David Kaiser.  

 

Every Brain is individual and different, therefore Personalised Brain Training neurofeedback

We take a holistic approach to healthy brain self-regulation, rather than categorisation or diagnosis.  In our view, and experience, symptoms resolve when our system is balanced.

Neurofeedback Training calms the mind and restores functionality

A brain map is an analysis of brain wave behaviour as measured by a qEEG recording.  We record 20 minutes of the brain activities with a 19-sensor qEEG recorder.  There is no stimulation, and contact between the sensors and the head is via an easily removable gel applied to specific points.  From this recording, we can generate a brain map using Kaiser Neuromap software.  

qEEG recording of brain waves is analysed to generate a brain map in form of a Kaiser Neuromap

The functional connectivity between various brain areas allows us to see vulnerabilities to character traits or behaviour patterns.  

Kaiser Neuromap brain maps show character traits for neurofeedback

Neurofeedback training is a process where we give the brain feedback about its own activity at a particular cortical site in real time, via visual, auditory or tactile means.  There is no direct stimulus to the brain and the sensors attached are for measurement of cortical EEG, or tiny electrical currents detectable on the surface of our head.  This signal is then amplified and analysed by software in real-time, and this information is used to provide feedback to our brain.  

Neurofeedback process illustrated by electrode measurement analysed and transformed into feedback via a movie in visual and auditory form for the preconscious mind to process and adapt its behaviour to in a learning process.

 We use a movie of choice as the feedback mechanism – our conscious mind engages with the film, and feedback is delivered by small changes in volume or picture size.  Our pre-conscious mind adapts its behaviour to preserve the more comfortable volume and picture size, and learning occurs.

Neurofeedback helps restore functional connectivity in key neural networks

Neurofeedback training is safe, effective and non-invasive. 

Neurofeedback training is safe and non-invasive shown in a picture using Othmer Method

Neurofeedback is evidence-based. 

Neurofeedback is evidence based therapy with a wealth of over 3,500 peer-reviewed research reports per PubMed neurofeedback

 

Guided by a Kaiser Neuromap, our neurofeedback training targets specific brain areas, neural hubs and networksThis improves integration of the  brain area we are training, as well as its network and sub-cortical connections.

Developed by a founder of the field of neurofeedback, and with a wealth of over 3,000 brain maps and thirty years’ of experience, Personalised Brain Training uses advanced neurofeedback protocols.

qEEG-brainmap takes under an hour to obtain and is a non-invasive process.  A nineteen-sensor cap is comfortably fitted and we record about twenty minutes of brain activity.  Using specialised software, we obtain a visual analysis which we will communicate verbally.  This also forms the basis of our training plan.  Note that we do not provide diagnosis.

qEEG brain map for personalised brain training in neurofeedback

This brain map approach is unique in that it analyses the connectivity of a functional brain area, rather than simply geographic areas of the brain.  

Connectivity is a measure of regional integration of specific brain areas with other areas and key networks.  This is a relative measure – to be meaningful, it has to be referenced to a baseline.  Rather than use an average as a reference, we compare results to a set of hand-picked individuals who are both high-performing professionals and well-balanced individuals.  Our ability to engage with others, form friends and alliances, and make consensual decisions is deemed as important for success as professional specialisation and technical performance.

functional brain area, as first delineated by Korbinian Brodmann in 1909, was first defined by variations in the number of layers in its grey matter.  This difference in physical property still holds as a valid way to separate brain regions, and each has its own function while being connected to other areas of the cortex via white matter, as well as to the brainstem, in particular, the thalamus.  With a brain map, we gain insights into both cortical integration (how well the area connects with its surrounding areas), as well as its thalamo-cortical integration. 

Neurofeedback training relies on real-time EEG measurement, analysis and translation into feedback

Neurofeedback Training Sessions

Personalised Brain Training aims to optimise the cortical connectivity, as well as promoting improved thalamo-cortical connection.  Neuroplasticity, the ability of neural networks in the brain to make new connections, is an essential and continuous process that underpins our ability to learn.  With brain training, we can promote this process.  

Protocols are generally around 30-45 minutes per brain area that we train; as such, training sessions are ideally around 90-120 minutes.  This corresponds to the average length of a movie.  This is also the length of our ultradian rhythms – attention cycles that govern our day, letting us perform at more than 100% at peak, and less than this at trough – think of the lull we experience around lunchtime.  By training the brain throughout a complete cycle, we are more likely to provide the brain with a challenge at different points in its attention cycle for a more comprehensive training. 

The primary feedback mechanism in Personalised Brain Training is auditory, that is, a subtle change in volume.  The brain recognises this, preconsciously, while our conscious mind is focused on the movie, and corrects its behaviour to preserve the continuity of the watching (or listening) experience.  A secondary, visual feedback mechanism can be activated, whereby the picture size changes too, though this is optional in cases of high visual sensitivity (e.g. migraines).   

We can track progress by remapping the brain at intervals, usually after every 20 hours of training.  Ten sessions will give a good indication of responsiveness, which besides subjective feedback we can ascertain with a further remap.  With neurofeedback training, we are showing the brain a more efficient state during a session.  Upon repetition, the brain learns to adopt this new state.  The person has to then implement this new learning in their life.  Internal changes have to be externalised.  Training success depends on this ability thus results can vary.  

Neurofeedback training begins with two to three sessions per week and the frequency of training can then be adjusted to need and symptom improvements.  Intensive courses involving two or more sessions per day can also be accommodated.

Contact Daniel on +44 (0)7966 699430 or daniel@neurofeedback.io to arrange sessions.

The Process

Brain Map

We record qEEG brain activity for about 15-20 minutes.  This process takes about 30-45 minutes overall and we discuss results a few days later via call or in person.  This provides the basis for the Personalised Brain Training Plan. 

Neurofeedback Sessions

 Comfortably watching a movie of choice, we train specific brain areas per our Personalised Brain Training Plan.  Sessions are two hours (shorter if necessary), and ideally we aim to do two or three per week.  Alternatively, intensive courses can accommodate two sessions per day.  Generally, we would look to do 40 hours or 20 sessions.

Contact Daniel on +44 (0)7966 699430 or daniel@neurofeedback.io to arrange sessions.