Know thyself with neurofeedback

“To know thyself is the beginning of wisdom.”, said the philosopher Descartes
A national French radio station met with Olivier Pallanca, co-founder of Afeepab, a psychiatrist and neurophysiologist who is trying to implement this technique to treat sleep disorders at the highly regarded Pitié-Salpêtrière Hospital in Paris. Here is the report of this meeting.

"Neurofeedback"... what is that? It is a technique to treat yourself, by emitting brain waves in a controlled way, from the area of your brain involved in the pathology you suffer from. That's all it takes! At the Pitié-Salpêtrière Hospital, it is being tested to treat insomnia...

"Nijmegen, Netherlands. In an office, on the first floor of a red brick house, a young girl is sitting, two electrodes glued to the top of her skull connected by wires to a computer. In front of her, on the screen, the pieces of a puzzle are assembling themselves. It is her brain that guides the game: the more certain brain waves (represented by vertical bars on the screen) increase, the more the pieces of the puzzle fall into place. Is this a new thought-driven video game? No. This patient is treating herself! Welcome to Brainclinics, which offers neurofeedback sessions." Intriguing, this beginning of an article published in October in the magazine Sciences et Avenir, and signed Elena Sender. While the French Association for the teaching and study of applied psychophysiology and biofeedback (Afeepab) has just presented this therapeutic process that is neurofeedback at the French Congress of Psychiatry, in Nice, we wanted to know what it was exactly about. We met Olivier Pallanca, co-founder of Afeepab, psychiatrist and neurophysiologist who is trying to implement this technique to treat sleep disorders at the Pitié-Salpêtrière Hospital in Paris.This hospital is very advanced in the use of new methods of care such as neurofeedback but also aromatherapy.

Know thyself with neurofeedback
Knowing oneself with neurofeedback.

How does it work?

"Neurofeedback". The word says a lot about the reality it refers to. A patient suffering from neuropsychological disorders sits in front of a computer, one or two electrodes placed on the top of the skull... Its objective? To emit brain waves in a controlled manner, from the area of his brain involved in the pathology. The patient becomes aware of his own brain activity and tries, if necessary, to modify it. The idea of focusing on brain waves to act on certain disorders is not so new, since it was born in the 1970s in the United States. Olivier Pallanca is a psychiatrist and neurophysiologist at the Pitié-Salpêtrière Hospital in the 13th arrondissement of Paris. He imported the neurofeedback technique in the "sleep" unit of the hospital, of which he has been director since 2011: The aim is to obtain a signal, visible on the computer screen, which reflects the electrical activity of the patient's brain. To do this, it is necessary to have previously established a map, at least summary, of this same brain:

Finally, the process seems simple. The electrodes are almost like stethoscopes placed on the scalp, and are responsible for reporting what is happening in certain parts of the brain. But they are not able to measure the activity of subcortical areas (the cerebral cortex is the peripheral layer of the brain): "They are too deep and they are often nuclei. As a result, the activity is cancelled out, the fields are cancelled out. "Olivier Pallanca explains.
Most of the neurofeedback that has been done so far is done with one electrode, at most two, placed in the middle of the head. Using an electrode to deduce the overall activity of the brain is like observing a cell with a smoked glass: you will see things moving, but you will not be able to identify them. Olivier Pallanca

What is the real impact, and for which pathologies?

Since certain parts of the brain cannot be reached, neurofeedback cannot be applied to pathologies in which these areas are involved, such as those related to language for example. The technique is therefore exclusively focused on "robust", easily identifiable pathologies such as insomnia, or attention deficit hyperactivity disorder (ADHD). "In the department next door, they are testing it in the context of work on autism, but it is not simple," says Olivier Pallanca:

The big issue in neurofeedback is to know if the signal that is going to be returned corresponds to the area that we want to rehabilitate. And even if it does, is the area really being rehabilitated with neurofeedback? Olivier Pallanca In concrete terms, what are the benefits of this technique today? They are real, according to Olivier Pallanca, who reminds us that it is a process used by fighter pilots, in particular.

Finally, the therapist does not doubt the effectiveness of neurofeedback ("if we guide the person and let him regulate himself"), but deplores the fact that it is so complicated to demonstrate its benefits: "For the moment, we do not really have imaging coupled with electrophysiological recording, to be sure to reach the right area. We are still very much in theory, and many people are using different techniques. The effectiveness of the treatment is all the more difficult to determine, as there are as many cerebral signatures as there are patients.

The results are most convincing in people who have become aware of something. From then on, they will initiate a change in their lives. It's a little bit like if we had suddenly turned on the light and you had seen what was in the room, whereas before you kept bumping into it. Olivier Pallanca

Today, neurofeedback in France is still in the experimental phase. What about tomorrow?

Neurofeedback is based on the monitoring of rather complex and uncertain parameters. However, the feedback technique, which consists of giving the patient feedback on the activity of his or her body, is used successfully at the Pitié-Salpêtrière Hospital: cardiac coherence biofeedback allows the patient to regulate his or her breathing and heart rate. The signals of such activity are, for good reason, easier to record and characterize.

Olivier Pallanca decided, by recording in parallel the patient's electroencephalogram (notably insomniacs and epileptics), to couple these same signals to those sent by the brain, in order to better identify the concrete repercussions of cerebral activity on the body's mechanisms: "We chose not to start directly with techniques for which we still don't know why they are effective. We chose not to start directly with techniques for which we still don't know why they work. We preferred to start with something that works, like biofeedback, in order to try to understand what could be used for neurofeedback. With biofeedback, we have more solid things because the signals are easier to record. Stress markers in particular, whether it's heart rate, breathing..."

Olivier, who suffers from insomnia, is one of Dr. Pallanca's patients. The biofeedback technique, still quite new in France, seduced him. He decided to try it three months ago, after a series of tests to ensure that he was receptive to this therapy. Olivier followed three sessions which were profitable for him ("On me it was extremely effective"):

But despite the initial trial and error, Dr. Pallanca believes that neurofeedback has a bright future ahead of it.

Neurofeedback and ethics

Does this therapeutic technique raise ethical questions? After all, by improving the attention span of patients, we are affecting the brain's connections and therefore... brain plasticity?

Dr. Olivier Pallanca assures us that this is a non-invasive technique, and that the first people to be interested in the question were psychologists. He explains that neurofeedback is more like relaxation: The theoretical basis behind it is the theories of reinforcement, of conditioning. If there is an interest, it is to decondition people. Afterwards, to know if this conditioning is really neural... I don't know. The impact, in the worst case, will be a placebo effect.

There is no question of changing the personality of the patients: "We are really dealing with things that affect physiological states such as vigilance, concentration, and not at all with the type of personality register, of thought...". Olivier Pallanca also refuses to treat depressive patients with neurofeedback, believing that the technique has not been sufficiently proven: "I confine myself strictly to the anxiety component."

Today, a few patients receive effective treatment at the Pitié-Salpêtrière Hospital. Dr. Pallanca would like to continue the experiments by calling upon some two hundred healthy volunteers, but the process has been temporarily blocked for financial reasons.

Know Thyself

From series about life's big questions by the BBC Radio. Who are you? The words ‘know thyself' - ‘gnothi seauton’ - were inscribed in stone above the Ancient Greek Temple of Apollo at Delphi. Philosophers have mused on self-knowledge and its uses ever since. But is it possible to ever 'Know Thyself'? Psychologists, such as Bruce Hood, have even suggested that the self is an illusion and there may not be a self to know. Narrated by Stephen Fry. Scripted by Nigel Warburton.