Neurofeedback may be effective for addressing ‘chemo brain’
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“Chemo brain” — a collection of cognitive symptoms related to memory, concentration and organization — is a potentially upsetting and debilitating adverse effect of cancer treatment.
The exact cause of this phenomenon, which also can be characterized by difficulty sleeping and emotional difficulties, remains unknown.
“There are a few things potentially driving this,” Stephen Sideroff, PhD, an associate professor in the department of psychiatry and behavioral sciences at University of California, Los Angeles, said in an interview with Healio. “However, there are some indications that the cancer itself can also contribute to cognitive impairment. Very little has been done about it until recently. It’s been accepted as a result of cancer and chemotherapy treatment.”
In a study published in Journal of Complementary and Integrative Medicine, Sideroff and colleagues evaluated the use of neurofeedback, also known as electroencephalogram (EEG) biofeedback, in relieving chemo brain among a group of breast cancer survivors. Sideroff spoke with Healio about the concept of neurofeedback and discussed the results and implications of the study.
Healio: What is neurofeedback and what inspired you to study it for reducing chemo brain?
Sideroff: The idea for this study came out of ongoing conversations with my colleague and friend David Wellisch, PhD. David has spent much of his career looking at the psychological consequences of a cancer diagnosis. We have collaborated on a lot of research in the area of cancer and cancer treatment. My focus has largely been on stress and resilience, and one of the approaches I have used is neurofeedback. It is a subset of biofeedback, which is the monitoring of some aspect of a person’s physiology that is then used to retrain the person to voluntarily control that function.
A simple example would be putting an electrode on a muscle of a person with muscle tension. A computer interface will display the level of muscle tension, which is a function of how much nerve electrical activity is going to that muscle. The more nerve activity, the more tension. So, the patient will see on the screen that their muscle tension is 10 microvolts. The therapist would then formulate certain strategies that the patient would carry out to reduce muscle tension. When they are successful, they will see an immediate change in the signal on the screen. So, it’s immediate positive feedback. Conversely, if they start to think about something that makes them tense, they may see the signal go up.
A key concept around this is the notion of self-regulation. With all these physiological symptoms, the biofeedback is being used because the patient has lost their ability to self-regulate. One of the beautiful things about biofeedback is that it teaches the patient how to do their own self-regulating to bring their nervous system back into balance.
Neurofeedback is a subset of biofeedback, and it monitors brainwave patterns. Many conditions correlate with too much or too little of certain brainwave frequencies within the spectrum of frequencies. With neurofeedback, you can display these brainwave patterns, and when a person moves into a more optimal brainwave state, they get positive feedback. As a result, the brain literally learns to shift more readily into these more effective and normalized brainwave patterns.
In a previous research study, we used neurofeedback in a drug treatment center and had great results. We had increased abstinence rates. In the process, we noticed we were able to improve certain aspects of cognitive functioning. Neurofeedback is used a lot with attention deficit disorder, and it’s used with brain injuries. So, the literature pointed to the possibility that if we used it in this population of breast cancer survivors with chemo brain, we might have some similarly positive results.
Healio: How did you conduct your study of this population?
Sideroff: We started by doing a quantitative EEG, recording patterns all over the brain. This has never been done with chemo brain, so we wanted to see what deficits or abnormalities we could find in these patients.
We found significant abnormalities. One of the most significant was an excessive amount of slow brainwave activity. The main window of brainwave frequencies runs from about one to 40 cycle per second. When we’re asleep, we produce a lot of delta wave frequencies, ranging from one to four cycles per second. We found severely excessive amounts of these very, very slow brainwaves in these individuals. It was as though they were walking asleep, so to speak.
These subjects reported difficulties with memory — for example, one woman said she was unable to read a novel because she couldn’t remember the characters in the novel. So, the first thing we did was validate that these subjects had abnormal EEGs. Then we designed a treatment — a training protocol.
Healio: What did the treatment consist of?
Sideroff: The goal was to monitor their brainwave activity and feed information back to them about their brainwaves, such that we would train their brains to function in a more normal pattern.
We used a protocol I’ve used successfully in my work before that essentially consisted of 18 sessions, three times a week for 6 weeks. This was a pilot study, so we had only nine subjects.
We found that our neurofeedback protocol improved cognitive functioning in a number of ways. It also improved other symptoms that went along with chemo brain, like anxiety and difficulty falling asleep. The subjects were able to be more present and more attentive. There were certain tasks — tests of cognitive functioning — where the subjects demonstrated improvement from pre- to post-neurofeedback.
One of the interesting things we found was a significant reduction in one of the scales of obsessive compulsive disorder. We aren’t sure why, but our interpretation is that sometimes our brains can fall into a rut; this would be particularly true with an impaired brain. So, the neurofeedback seems to have lifted the needle out of the groove and allowed the brain to be more flexible.
Healio: Do you think this has potential to be used widely for helping patients with chemo brain?
Sideroff: Yes. We think the results of this study are strong enough to warrant further research into this intervention and similar forms of EEG biofeedback in alleviating chemo brain. We were excited to publish these findings and make clinicians aware of the potential of this approach. We believe these findings could have implications for clinical practice.
For more information:
Stephen Sideroff, PhD, can be reached at Santa Monica Internal Medicine, 1245 16th St. #210, Santa Monica, CA 90404; email: sideroff@ucla.edu.
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