Neurofeedback may help people with OCD change their brain patterns

Photo Cred: Annie Spratt/Unsplash

By Kat Black

Michael Cohen, QEEG-D, a clinical social worker and expert in the neurofeedback field, began treating a patient for obsessive-compulsive disorder (OCD). The patient worked a high-pressure job and found himself anxiously double-checking even simple tasks throughout the day, sometimes working well into the evening revisiting work he already completed.

Cohen introduced this patient to neurofeedback therapy. Within six sessions, he said he noticed improvements in his obsessive thinking, and after five sessions he was more successfully able to move on after completing a task.

OCD is a chronic neurological condition characterized by a time-consuming, distressing cycle of intrusive, recurring thoughts and repeated behaviors. According to International OCD Foundation, it affects approximately 2 to3 million adults in the United States.

Exposure and response prevention (ERP) therapy, a form of cognitive behavioral therapy that involves purposely exposing yourself to triggering stimuli and resisting the urge to perform compulsions, is widely cited as a first-line treatment for OCD. Given the anxiety-inducing nature of ERP, however, some OCD patients may pursue complementary therapies like neurofeedback to facilitate treatment.

“It’s really hard to teach [a person with OCD] to not get triggered,” said Cohen. “[ERP] is extremely arduous. It takes a very long time and is a very uncomfortable process. One of the problems with ERP is you’re simply treating the symptoms. With neurofeedback you’re dealing with some of the underlying mechanisms of brain dysfunction.”

Neurofeedback is a non-invasive therapeutic procedure that provides participants real-time information about their neural activity through brain imaging techniques, which include electroencephalography (EEG) and functional magnetic resonance imaging (fMRI). fMRI neurofeedback measures changes in the brain’s blood flow and EEG biofeedback records brainwave activity via electrodes placed on the scalp.

“Neurofeedback is a form of biofeedback, which means that you’re recording a biological signal and returning that to your client, who gains mastery of it,” said Mark Smith, LCSW, BCN, QEEG-D, founder of Neurofeedback Services of New York. “It’s as simple as teaching people how to breathe.”

The process teaches participants to self-regulate their brain function, and ultimately change their behaviors, through operant conditioning. It has been used to treat several conditions, including anxiety, insomnia, substance use disorder, post-traumatic stress disorder (PTSD), migraines, epilepsy, and depression.

“What happens in OCD is that people are defending themselves completely with intellectual activity,” said Smith. “They get stuck in that ruminative, brain-based cycle and completely cut off that somatic response. When someone gets impacted by trauma or OCD, they can’t take in new data.”

Through brain training, Smith said, patients can learn to disrupt this feedback loop and process new data by stabilizing their sympathetic and parasympathetic responses. He said he recommends his patients with OCD receive neurofeedback therapy two to three times a week, with rest in between sessions. 

Some research supports the efficacy of using neurofeedback to treat OCD, including a 2011 study published in Clinical EEG and Neuroscience, that documented improvement in the symptoms of 33 out of 36 OCD patients who received neurofeedback, as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).

Research conducted by the Yale School of Medicine concluded that half a week after receiving fMRI neurofeedback, participants demonstrated both a decrease in anxiety and an enhanced ability to regulate their orbitofrontal cortex. Hyperactivity in the orbitofrontal cortex is linked to severe OCD symptoms, including contamination anxiety.

According to Cohen, OCD patients can achieve improvement in their symptoms by targeting certain areas of the brain through neurofeedback, specifically the temporal lobes and the cingulate region. A 2017 study published in the Journal of Neurosurgery confirmed that hyperactivity in the dorsal anterior cingulate cortex (dACC) can lead to a deficit in OCD patients’ cognitive control. “The cingulate area [is] well-known to play a role in switching gears, flexibility, and transitioning,” said Cohen.

Cohen said targeting the temporal lobes can improve emotional resilience in people with OCD. He likened neurofeedback to strength training.

“Emotional reactivity exacerbates obsession and worry [in OCD patients],” he said. “With neurofeedback, instead of exercising and strengthening your muscles, [you’re] really strengthening the neuronal circuits that play a role in both anxiety and obsessive thinking.”