A serious problem with the measurement of any biological signal is that artifact is a particular problem with EEG recording. The EEG is affected by movement: movement of the client’s body, movement of the facial and neck muscles, movement of the mouth and tongue, and, in particular, movement of the eyes. Some brain locations are more forgiving of some forms of movement; for example, eye movement is less likely to cause problems in the back of the head, whereas it is a huge problem with frontal recordings. Having the client keep their eyes closed can help, but even under eyes closed conditions, eye flutter is common and causes major corruption of the EEG recordings. For diagnostic purposes, one can shorten the measurement epoch and analyze only those epochs that seem relatively artifact-free. For treatment, most EEG feedback systems have an artifact rejection option, whereby if the recordings are outside some acceptable range, feedback is interrupted. The best option is an EEG feedback system that has a real-time EMG (electromyograph) which records muscle activity. The EMG signal is between 70 and 100 Hz, but usually one limits the artifact rejection to a narrower bandwidth. When the muscle activity is above threshold, the neurofeedback is interrupted (everything stops) until the EMG settles down, so one is not feeding back the muscle activity instead of EEG. Children can learn to move facial muscles to get rewards (movement of the game icons) instead of learning to modify brain wave activity. The real-time EMG is particularly useful when dealing with hyperactive children. Initially, the feedback game is set to train EMG, not EEG, so that the video game is responding to the muscle activity. The game proceeds (a child is rewarded) when he or she is still and not moving. Once the child quiets down, then the contingencies are shifted to EEG so that the game proceeds as a function of the child’s EEG. This transition takes place without the child being aware of the change. The situation starts with quieting the child by making the contingency for reward a quieting of the body. Then, once the EMG levels decline, the contingency is changed by the neurotherapist “on the fly” to EEG with no interruption in the flow of the treatment session.

Some EEG feedback systems do not have real-time EMGs and rely on the total amplitude of all the EEG bandwidths as the artifact rejection system. Thus, when a client moves, the amplitude of all of the wave bands will increase. One sets the threshold for the total amplitude to say 100 μV, and when that threshold is passed, the neurofeedback is interrupted. This system is quite common in EEG systems, but in my opinion, it is not as good and certainly not as useful as real-time EMG artifact rejection.

The second source of artifact is an electromagnetically polluted environment. The source of the problem can be the 60 Hz of the electrical wiring. Many systems have a “notch” filter to exclude this source of artifact. Office machinery can also be a source of the EMF contamination, as well as any device that has an electrical motor. The latter sources can be particularly troublesome for the clinician because the problem tends to be intermittent in that it is only observable when the machinery is in use. Given that the machinery may be in some other office in the building, one cannot isolate the source of the problem. Cell phones have also been shown to cause problems with medical equipment (van Lieshout et al. 2007), and so I do not allow cell phones to be on in my office (they are annoying for other reasons as well).

The third source of corrupted data is static electricity. Not only can this be problematic in terms of the data, but static electricity can seriously damage the EEG equipment. Grounding is the best solution for static electricity. I make a habit of grounding myself before I touch the client and/or the equipment by touching a metal surface. In my clinic we also ground the client by putting a lead on the client’s wrist and attaching it to the building ground (the casing of the 120 outlet is a building ground so attaching the lead to the screw holding the face plate on the outlet will work). Antistatic floor coverings and desk coverings that are likewise grounded to the building ground are also very helpful in reducing artifact. Having good electrode connections with low impedance is also very important in reducing artifact from EMF fields.

The fourth major source of corrupted data is the neurotherapist. The therapist is in the client’s electrical field when working with the EEG. There are various levels to this. First, the location of the therapist can influence the EEG recordings. In a study of artifact problems associated with the movement and position of the therapist during neurofeedback (Swingle 1997), I found that there was a difference in the EEG amplitude of the various brain wave ranges, depending on where the clinician was standing during the recording. Recordings of the EEG at location Cz were obtained under two conditions: with the therapist directly behind the client and secondly with the therapist one meter to the client’s left side. The differences in amplitudes were 2.3 % for Theta (ns), 13.1 % for Alpha (t = 2.95, df = 6, p < 0.05), 7.3 % for SMR (t = 3.82, df = 8, p < 0.01), 2.0 % for Beta (ns), 4.8 % for HiBeta (ns), and 14.1 % for EMG (70–90 Hz) (t = 2.42, df = 8, p < 0.05).

Similarly, recordings were obtained for clients when they had their feet on an antistatic floor mat versus when they had at least one foot off the mat. Significant differences in amplitude were obtained for Theta, Alpha, and Beta at locations Cz and O1 (t values between 5.36 and 13.46, all p values <0.01). Thus, it is obvious that limiting the movement of the therapist, as well as the movement of the client, is important in obtaining clean EEG recordings and for a reliable feedback to occur. The general rule is “Whatever you do, ALWAYS do the same thing, and STAND STILL.”

Some clients come directly from heaven. Such is the case when one has a client with common ADD (CADD) as the only problem. Further, if this client is a female child of 8 years of age, or so, and comes from a loving, intact family whose love for this little girl is ABSOLUTELY independent of anything she does, then the neurotherapist can “bet the farm” that this child will be finished in 15–20 sessions and often considerably fewer. CADD (Swingle 2001) is the “non-attentive” form of ADD and is characterized by excessive Theta amplitude over the sensory motor cortex (Cz). The normative range for the Theta/Beta ratio in this region is below about 2.20, a bit higher for younger children. If the ratio is very high, such as above 3 or so, then we start seeing the hyperactivity component of the ADHD. At the higher ratios, the child becomes more in need of stimulation and the hyperactivity is self-stimulation. It is difficult at times to appreciate that it is actually “painful” for a child with this condition to sit still.

The basic treatment for CADD is simply Theta suppress, Beta enhance at location Cz. Because of the simplicity of this condition, I rarely resort to braindriving procedures but rely almost exclusively on neurofeedback. I also prescribe the OMNI harmonic for home use provided that in the initial assessment, the harmonic reliably suppresses Theta amplitude. As an example, consider the case of Jenny: a wonderful little 8-year-old girl from a loving, intact family of responsible and sensible parents. This case is of particular interest because it took 20 sessions, where normally with a simple case of this nature I would have predicted less than 15 sessions. The data were shown in the last chapter in Fig. 3.​15, and the reader will recall that the Theta/Beta ratio got worse for the first 15 sessions and then Jenny “got it” and the Theta/Beta ratio dropped and stayed under the clinical cutoff.

It is critical for the therapist to keep parents from being so focused on the numbers that they abort treatment or discourage the child. Fortunately, this family stayed the course and Jenny made marvelous progress with correlated improvements in her schoolwork. Her self-esteem also was markedly boosted, a common effect of correcting ADD.

If on the assessment the client shows a Theta/Beta ratio within the normative range but a large Theta/Beta ratio when cognitively challenged (e.g., reading, counting backward), then braindriving may be a more appropriate treatment methodology. With braindriving using visual stimulation, the client can be engaged in a cognitive task while Theta is being suppressed. This is a very effective treatment for this form of ADD, in which the client is within normative limits on average and only shows the excess Theta amplitude under cognitive challenge. After a few sessions of braindriving, the client may then benefit from straightforward Theta/Beta training at location Cz. Neurotherapy continues until the challenged EEG shows a Theta/Beta ratio within normative limits.

If the brain assessment shows a deficient Alpha response (less than 30 % increase in Alpha from eyes open to eyes closed), then one should do Alpha amplitude enhancement, with eyes open and eyes closed. Generally, one focuses more on the eyes closed condition so the neurotherapy session is split about 75 % eyes closed and 25 % eyes open. Because Alpha blunting can be related to emotional trauma, the therapist should be vigilant regarding any emotional reactions of the client. The increase in Alpha can release memories and marked emotional reactions. This is a major therapeutic opportunity to help the client deal with the trauma, and I usually suspend the neurotherapy at this point and proceed to helping the client with the processing of the traumatic content. I also prepare the client for the possibility of increased dream activity associated with the trauma and that they are likely to be more mindful of the emotional aspects of the trauma for a few days. I also tell them that the neurotherapy has precipitated the most powerful psychotherapy on the planet, for we have engaged the natural psychotherapeutic processes of dreaming and mindfulness. Clients will often relate that they have “finally” processed the emotional trauma. For example, one female client had been burdened with severe guilt feelings associated with sexual molestation by her stepfather when she was in her early teens. She had experienced orgasm during these episodes and thus felt that she had been in some way responsible for this “shameful” behavior. After the release of the Alpha (both at Cz and also at O1), she emotionally accepted the fact that she had been “raped” and subsequently experienced pronounced emotional relief.