Phantoms in the Brain: Probing the Mysteries of the Human Mind
by V. S. Ramachandran, Sandra Blakeslee
A Monthly Summary of News and Events
Vol. 2 No. 5 - May 1999
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Copyright (C) 1999 by EEG Spectrum International, Inc. All rights reserved.
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Working with the 'Unreachable' Child--
A Physiological Perspective, and a Proposed Approach
Siegfried Othmer, Ph.D.
April, 1999
Preamble
With the experience of Littleton fresh in our memories, there is an urgency to confront the issue of the Unreachable Child. Much as one would wish to simply identify and quarantine the potentially violent child, we must instead comprehensively address the neglected mental health needs of our children. In the following, the focus will be on the more intractable end of the spectrum of mental disorders of children.
Recent developments in the neurosciences have led to therapeutically useful models of how the brain organizes its own function on every relevant timescale. Insights are being gained into how the brain encodes information, and how communication between different brain regions is orchestrated. A central organizing principle appears to be that simultaneity of neuronal firing is a criterion of belonging to the representation of a particular 'percept,' or mental construct. A second is that the brain organizes continuity out of transient events by arranging for repetition. Such repetition is periodic, i.e. rhythmic. In this manner, the brain can organize persistent states of the system'i.e. states of attention, arousal, wakefulness, vigilance, affect'through rhythmic 'pacemaker' circuits. A breakdown of the organization of these rhythmic pacemaker circuits can lead to disruption of function. This is probably what happens in traumatic brain injury, where often there is no evidence at all of a structural injury.
It has been proposed that a variety of such pacemaker circuits govern cortical and subcortical function generally, and that specific learning disabilities, affective disorders, and more severe disturbances of mental function can be traced to the disregulation of such circuits. For example, the incident in Japan (November 1997), with children who went into seizure following a mere 5-second exposure to a rhythmic optical signal on television, demonstrates how utterly dependent we are on the integrity of our brain's rhythmic activities. In the case of severe emotional trauma, disregulation of emotional circuitry can result, with lasting impact. Through considerations such as this, we (and others) have proposed a disregulation model of psychopathology'the proposition that the core issue consists of disregulation in regulatory networks, largely irrespective of whether the condition has a genetic, developmental, or environmental, or even purely psychological cause.
Over the last thirty years, it has been learned that operant conditioning on brain rhythms has an impact on physiological functioning. This is variously called EEG biofeedback, neurofeedback, or brainwave training. The trainee is given information about the brain's EEG activity at that moment, and tries to modify that activity in particular ways. The trainee is rewarded for success in achieving that objective. By carefully adjusting reward contingencies on the EEG training, it has been found that attentional disorders can be remediated with this training. More recently, it has been found that affective disorders respond to this training even more readily. Thirdly, disorders of arousal (sleep disorders, migraines) respond to the training as well. From the perspective of this fundamental training of brain rhythms, it is clear that these functions are highly interdependent. Attention and arousal are coupled systems; affect and arousal are interrelated; and finally attention and the affective realm influence each other. In fact, the affective realm may be the more fundamental issue in attention: we attend to what we value, and if the value-setting part of the brain is not functioning well, distractibility and inattention may ensue.
More fundamentally, we assert that the underlying issue in all of these disorders is that of brain self-regulation of states. The brain must be able to maintain stable states. And it must be able to maintain homeostasis (that is, dynamic equilibrium at the appropriate level of arousal). The more severe the condition being addressed, the more we are confronted with instability in brain function. The EEG training appears to support the maintenance of stability of states. Such stability is also a pre-condition for behavioral flexibility. The EEG training simply challenges the brain to function better as an organ of control and self-regulation.
These same concepts have implications not only for children in deficit but for the normal or even exceptional range of function. Continuity of state, for example, may also be the underpinning of working memory. The ability to hold and elaborate a thought is dependent on the integrity and continuity of brain states. An increase in working memory is indicated by some of the academic skills measures subsequent to EEG training. In the following, we discuss briefly the applicability of EEG neurofeedback to specific conditions.
ADHD is the most commonly diagnosed mental disorder of childhood. Whereas stimulant medication is the most common remedy, it may not always be the appropriate one; it only rarely deals with the issues comprehensively; and it is often voluntarily abandoned, despite the fact that the condition usually persists. EEG feedback training can remediate all of the characteristic symptoms of ADHD: impulsivity, distractibility, hyperactivity, and inattention. That is, behavioral control can be learned to the point at which the child (or adolescent or adult) no longer meets diagnostic criteria in the general case.
75% of inmates referred for mental health services in the California correctional system had been identified as ADHD in their school years, and 75% of these had been on Ritalin at some time in their lives. Follow-up of ADHD children into their adult years finds no difference in measures of social pathology (antisocial behavior, criminality, suicide, addiction, divorce) between those who had been on Ritalin and those who hadn't. Clearly what has been proposed as the answer to ADHD is not the whole answer. Brainwave training, on the other hand, addresses the underlying issue of brain disregulation; it does so comprehensively; and the benefits of training appear to last, barring renewed insult to the nervous system. More data exist on the use of EEG feedback for ADHD than for any other condition.
It has been proposed that specific learning disabilities are important factors in much of youth criminality because of the linkage to school failure and self-esteem issues. Learning disabilities are much more common even than ADHD. There is no medical remedy, and the educational remedies adopted to date are clearly inadequate. Evidence has accumulated that EEG training can be helpful in specific learning disabilities such as visual retention, articulation, and dyslexia. Since dyslexia is not a unitary concept, no single approach is appropriate for all cases. To date, therefore, success with dyslexia is still hit- and-miss. The training can influence one's capacity for spatial organization, and it can extend the auditory and visual digit span. WISC math subtest scores may be significantly improved, suggesting greater working memory capacity. This kind of improvement tends to support the proposition that specific learning disabilities are largely functional in character, and traceable to deficits in brain organization that appear to be largely remediable.
In the context of work with ADHD, it was found that the EEG training was equally successful in remediating oppositional behavior and conduct disorder, temper tantrums and episodic rages. This takes such behavior out of the realm of moral failing'although it may be that also'and places it squarely in the domain of neurophysiologically based dysfunctions. One virtue of the training is that the conduct issue never has to be confronted per se with the trainee. The disagreeable behaviors simply fall away over time. The child simply has to be willing to train his or her brain. As attentional mechanisms are trained, the linkages to affect regulation are trained as well. As a result, the brain functions more stably, out of a calmer place, and with improved modulation of emotional control.
As many as 20% of ADHD children may expect to experience bipolar disorder in their lifetime. Moreover, the age of onset appears to be declining significantly over recent decades. An even higher percentage of ADHD children will experience a major anxiety or depressive disorder in their lifetime. Whereas medications can be helpful with the milder forms of anxiety and depression, they are not all that helpful with the more severe manifestations. Depression is currently among the top four factors in terms of the world-wide burden of disease, and ranks as first among mental health issues. Over thirty percent of the U.S. population may expect to experience an episode of major depression in their lifetime. The possibility of avoiding or remediating this level of pathology with neurofeedback training has profound implications for mental health in this country. Further, a depressive component accompanies much of behavioral deviance and other conditions herein discussed.
One of the most intractable disorders in the realm of mental health is RAD. Here the basis does not exist for the formation of a therapeutic alliance with the patient. Fortunately, and fortuitously, it has been found that EEG training can reestablish the internal linkages within the brain which allow the person to reconnect with the ground of their emotionality'and ultimately to recover both the power and the willingness to establish emotional bonds with others. This has been possible even in cases of the most abject early childhood trauma. Remarkably, the pathways of connectivity to the emotional self remain entirely intact'though disrupted in organization until subjected to the reorganizing challenge of EEG training.
In the case of autism, we also have a disruption of the capacity for attachment, but in this case for either genetic, metabolic, or developmental reasons. Despite the existence of manifest organic deficits, the recovery potential for attachment and for affect regulation of the autistic child may be considerable. This is a very recent finding.
One of the tragedies of our human condition is that those who are severely traumatized as children often replicate this abusive behavior in their own adult lives. It is difficult to be sympathetic, even though one may be aware of the causal chain of events. One way of understanding this is in terms of a fundamental disregulation of our subcortical circuitry by which emotions are regulated. These mechanisms are not under sufficient cortical control. Fortunately, such cortical control can be strengthened with EEG training, and PTSD can be resolved essentially non-traumatically, first by the uses of higher frequency training to stabilize cortical functioning, and secondly with low frequency training to resolve the trauma issues under circumstances in which retraumatization is unlikely to occur.
One of the most intractable problems encountered in health care is that of traumatic brain injury. This can lead to the exacerbation of symptoms and vulnerabilities that the child already harbors: disregulation of mood, behavior, sleep, attention, arousal, cognitive function, and motor control. Often the condition will not improve beyond a certain point by itself, and there are no conventional treatments. EEG biofeedback has been found very effective for recovery from traumatic brain injury with respect to the above symptoms.
The problem of violence in children is currently acute. Child-on-child violence in this country is at a level of one Littleton every day. The etiology of violent behavior is multi- faceted. In broad brush, we can see violent behavior coming out of abuse histories, histories of profound neglect, and various conditions that disregulate behavior in the emotional realm--- the epilepsies, Tourette Syndrome, traumatic brain injury (including birth injury), and the anxiety-depression-bipolar spectrum. Thus etiology can be environmental, developmental, or genetic, or more typically an incendiary combination of all these factors.
One of the most profound observations of recent times is that neglect can be as damaging as abuse, in terms of disturbing the natural development of emotional self-regulation. And neglect sufficient to have lingering negative impact is probably commonplace in the modern life of American children. Adding to all of this is the constant rehearsal of violent and destructive behaviors in the entertainment media. It is okay with our society for children to experience every emotion around thrill- seeking, violence and senseless death, and to do so in a context which obscures the traditional clarity of moral choices. Ultimately the only way to trump the manufactured tension of movies and video games is to replicate the experience in life itself, i.e. to be the director in one's own play. The emotionally disregulated self may evolve a concept of self around those issues that clearly separate him or her from others. Satanism and Nazism may furnish the scaffolding for such a construction.
One of the more sinister implications of the calculus of violence is that persons are unlikely to value others more highly than themselves. A diminished self-appraisal is therefore contributory to the escalation of violence. Likewise, if there is a sense of limited prospects to make a positive difference in the world, the temptation looms large to leave one's impact destructively. There is then a reversal of the usual scale of values. To a Ted Kaczynski, for example, a plea of guilty to avoid the death penalty actually meant death'i.e. his removal from the focus of our attention, whereas an actual death sentence would have meant a kind of immortality.
Another aspect of violence, as with other thrills and risk- taking behavior, is that it allows children to feel alive. (Thom Hartmann has proposed this model to explain the apparent violation of Maslow's hierarchy of needs.) In this regard, some violent behavior can be seen as another manifestation of the Reward Deficiency Syndrome that has been used to model addictive behavior. The EEG training can normalize the reward circuitry of the brain, presumably by re-establishing normal communication linkages between different brain regions.
The essence of our humanity is our social nature. We must have connectedness to others in order to be fully human. Once the sinews of connectivity are broken'whether by genetic flaw, developmental insult, abuse, physical injury, psychological trauma, or neglect'they are unlikely to be reestablished by purely psychodynamic interventions, or even by currently available medical techniques. The child's physiology is fundamentally altered, and a physiologically based approach may therefore become a priority, thus opening the door to more fruitful psychodynamic interventions. Fortunately, the physiological manifestations of disorder are largely in the functional realm'that is, they are subject to redress and retraining. The evidence for such disorder and disregulation is to be found in the EEG. And EEG biofeedback training has been shown to be helpful in achieving renormalization of brain behavior. Recent findings indicate that it may be profoundly helpful, even among the most unreachable of children.
Phantoms in the Brain: Probing the Mysteries of the Human Mind
by V. S. Ramachandran, Sandra Blakeslee
Mind and Brain Sciences in the 21st Century
by Robert L. Solso
ADHD Handbook for Families: A Guide to Communicating With Professionals
by Paul L. Weingartner
Brain Policy: How the New Neuroscience Will Change Our Lives and Our Politics
by Robert H. Blank
Childhood conduct problems as predictors of adult criminal activity.
--Hyperactivity, impulsivity and early conduct problems predict an adult arrest record for males, but not for females. Inattention symptoms do not contribute to the risk for future criminal involvement.
Treatment of Drug Offenders Saves Money
--A report shows that Arizona's new policy of treating nonviolent drug offenders rather than putting them in prison has already saved $2.5 million in taxpayers' money in its first fiscal year of operation. The savings represent the difference in cost between placing a prisoner in jail and putting the prisoner on probation and in treatment.
Gender-Specific Differences Found In Human Brain
--Men and women's brains are distinctly different. Men have more neurons in the cerebral cortex whereas women have more neuropil, which contains the processes allowing cell communication. Presented at the American Academy of Neurology 51st Annual Meeting
Life-long history of injuries related to seizures.
--The characteristics and risk factors for injuries caused during epileptic seizures in adults has rarely been studied. A survey of approx. 300 patients found one seizure-related injury every 21 patient-years, and a serious injury once every 64 patient-years. The most common site of injury was the head. Patients with seizure-related trauma had significantly earlier onset age of epilepsy.
Sibling accounts of attention deficit hyperactivity disorder.
--Siblings feel victimized by ADHD siblings and that their experience of victimization was often minimized or overlooked in the family. A need for increased social and mental health services for all members of the family over the course of the disorder are indicated, and that the effects on siblings in particular may be potentially quite deleterious to their health and well-being.
Repeated Exposure To Cocaine Alters Brain Structure
--Cocaine can produce long-lasting changes in the structure of nerve cells in certain areas of the brain, according to new data presented at the Fifth Annual Wisconsin Symposium on Emotion. "Repeated exposure to cocaine results in persisting brain changes that we believe contribute to addiction and the risk of relapse." Drug-induced changes (abnormally elongated and densely packed dendrites) were localized in the nucleus accumbens and the prefrontal cortex, regions of the brain associated with reward, learning and memory,
Differences In Brain Size Found In Hyperactive Children
--Hyperactive children appear to have less grey matter in the right frontal lobe as well as less white matter -- the neuronal connections between cells in both the right and left frontal lobes.
Neuropsychological performance of ADHD adults: measures of frontal lobe functioning.
--Abnormal scores on a series of frontal lobe-executive functioning tests were good predictors of ADHD. However, normal scores poorly predicted the absence of ADHD except when the overall battery was combined into a single index. This findings was consistent with conceptualizations of ADHD depicting mild neurologic dysfunction in frontal lobes.
Effects of 20-min audio-visual stimulation on the cortical EEG.
--20 min alpha stimulation sessions increased delta 1, delta 2, theta, beta 1 and beta 2 activity, with significant effects remaining 30 min later in beta 1.
Photo of John Anderson not available
| Encino, California | June 10-14, 1999 |
|---|---|
| Minneapolis, Minnesota | August 5-9, 1999 |
| DAY 1 Thursday |
AM | Siegfried Othmer | Introduction & mechanisms of brain regulation |
|---|---|---|---|
| PM | Siegfried Othmer | Disregulation model of ADD/ADHD | |
| EVE | Group | Professional issues |
| DAY 2 Friday |
AM | Sue Othmer | 3-Axis model of brain function |
|---|---|---|---|
| PM | Sue Othmer | Demonstration of biofeedback process | |
| EVE | Siegfried Othmer | Research results |
| DAY 3 Saturday |
AM | John Anderson | Protocols |
|---|---|---|---|
| PM | John Anderson & Matt Fleischman | Practicum 1 |
| DAY 4 Sunday |
AM | Matt Fleischman | Assessment |
|---|---|---|---|
| PM | Matt Fleischman | Case management & case histories | |
| EVE | John Anderson & Matt Fleischman | Practicum 2 |
| DAY 5 Monday |
AM | John Anderson | EEG biofeedback in a school setting |
|---|---|---|---|
| PM | John Anderson | Integration with complementary modalities
Case histories |
Conferences for Neurofeedback Clinicians & Researchers | ||
|---|---|---|
| CONFERENCE | LOCATION | DATES |
| SNR 1999 | Myrtle Beach, SC | Sep 30-Oct 3, 1999 |
New Offices online
New Case Histories online
Elizabeth Kim, Ph.D. Brain Fitness Center 2727 W Olympic Blvd Ste 208 Los Angeles CA 90006-2640 (213) 384-8700 Email: elizabjkim@aol.com (new office) Audrey Thompson, Ed.D., LCPC Leslie Murphy, LCPC 1121 Adobe Great Falls MT 59404-3729 406-727-7496 Email athompson@in-tch.com Donna A. Morere, Ph.D. Clinical Neuropsychology 509 Denham Rd Rockville, MD 20851 (301) 340-1860 Email damorere@erols.com Justine Ritter Cincinnati Neurotherapy Center 8228 Winton Road, Suite 100A Cincinnati, OH 45231 (513) 521-5483 Email: wandjritter@earthlink.net Michael C. Mithoefer, M.D. Ann T. Mithoefer, BSN 208 Scott St. Mount Pleasant, SC 29464 (843) 849-6899 Email: mmit@mindspring.com Elizabeth Mavrelis, RN, MSW 200 East 80th Place Merrillville, IN 46410 (219) 752-2149 Email: mavrelis@cyberz.net State of Mind Counseling & Neurotherapy Reba Renner, MA 7195 Harvard Ct Bremerton, WA 98311 (360) 698-4786 Email: renner@web-o.net | Descanso Med Ctr for Development & Learning Leonard R Baker, MD; Ricki G Robinson, MD 1346 Foothill Blvd, #301 La Canada, CA 91011 (818) 790-1587 Email: dmcdl@aol.com Sadar Psychological Services Mitchell M Sadar, Ph.D. Angelika Y Sabar, MA 1288 Valley Forge Rd, Suite 72 Valley Forge, PA 19842 (610) 933-9440 Email: asadar@philly.infi.net Chiron Healing and Education Center Jill-Laurie Crane, MA Joseph C Crane, MA 17 Locke Lane Lexington, MA 02430 (781) 861-0349 Email: deerdancre@aol.com Email: osephc637@aol.com Ines Monguio, Ph.D. Clin. Neuropsych. Susan Grace Hellman, MS 1280 S. Victoria Ave Ventura, CA 93003 (805) 650-7484; Fax -7485 Email: sgh001@aol.com Potential Unlimited Counseling & Neurofeedback Philip A Miller, MS Susan C Berryhill, MA, MPH, LPC PO Box 1316, 223 Fifth St Ashland OR 97520 (541) 482-2780; F-3709 www.EEGpower.com Email: phil@eegpower.com Email: susan@eegpower.com Attention Deficit Disorder Clinic Robert L Gurnee, MSW, CISW, BCIA 6900 E Camelback Rd, #260 Scottsdale, AZ 85251-8042 (480) 424-7200; F-7800 www.addclinic-az-nm.com Email: add@addclinic-az-nm.com |
The Decade of the Brain is almost over. Nearly nine years to the day, the House Joint Resolution 174 designated the decade beginning January 1, 1990 as the "Decade of the Brain", the DOB. So I think it's time for an accounting. Has the DOB meant anything for our nation, our planet, or was it only hype?
(To read the resolution in its entirety, see http://www.bixler.com/brainnet/house.htm)
Science magazine reported an "explosive growth" in the number of scientists identifying themselves as neuroscientists since 1990 -- about a 1000 more each year. Besides the fact that the year 1990 actually marks the end of a decade (1981-1990) instead of the beginning (more of that later), we've all witnessed the change in mass media reporting in the last few years when it comes to brain research. It is no longer unusual for a major news weekly to feature a cover article on the brain, mental health, or related scientific issues. Nor is the entertainment field far behind. Of the 77 feature films with "brain" in the title, almost one-third of them (23) were produced in the 90s. (Who can forget "Brain-Sucking Aliens in Your Backyard" from 1991?)
Has the last decade of the millenium actually been the DOB? That is my question. As we all know, politicians love to pass resolutions but few follow them up and learn the impact of such actions, so I thought I'd take the opportunity to do my Congresswoman's job and see what became of the "Decade of the Brain". Has the scientific landscape been altered by proclamation? When it came to the brain sciences, was the final decade of the second millenium really DOB -- or DOA?
How much have brain sciences achieved during the DOB? An informal survey of biomedical research publications give us a clue. Medline includes 243,785 biomedical publications during the last 10 years. Most of these papers have nothing to do with the brain but focus on general health. This is a good thing, as it gives us plenty of controls to compare against.
An increase in publications during the '90s need not reflect an increased focus on the brain, but rather reflect other non-DOB trends in society such as more scientists at work, more research funding, the Dow Jones hitting 10,000, more journals being published, or lower ink prices. So a baseline to compare against is needed. As I used Medline for my survey, I choose a few lines of medical research against various neuroscience and mental health keywords. Here is what I found:
| YEAR | 1998 | 1990 | % Increase in Publications |
|---|---|---|---|
| Neuroscience | |||
| Hippocampus | 4041 | 2171 | 86% |
| Amygdala | 803 | 433 | 85% |
| Frontal lobe | 1782 | 744 | 140% |
| Neuron | 13,250 | 8,052 | 65% |
| GABA | 2328 | 1486 | 57% |
| Average: | 87% | ||
| Mental Health | |||
| ADHD | 667 | 283 | 136% |
| Schizophrenia | 2424 | 1514 | 60% |
| Depression | 6106 | 4209 | 45% |
| Anxiety | 3618 | 2326 | 56% |
| PTSD | 918 | 470 | 95% |
| Average: | 78% | ||
| Medicine | |||
| Lung cancer | 4490 | 3316 | 35% |
| Ovarian cancer | 1875 | 1272 | 47% |
| Cystic fibrosis | 1158 | 774 | 50% |
| Tachyrrhythmia | 1085 | 992 | 9% |
| Platelets | 5802 | 4826 | 20% |
| Average: | 54% | ||
Granted, this survey was crude, but unbiased. Terms were chosen randomly from lists. Neuroscience and mental health research apparently did draw relatively more eyes and hearts during the DOB than our "control" science, at a rate 50 to 60% higher than medical research. So the 90s was not the "Decade of the Heart" or the "Decade of the Gastrointestinal System" but the decade of the 3-pound universe!
A further look into mental health and related publications during the final decade of the second millenium was also revealing:
| Condition / Year | 1998 | 1990 | % Increase |
|---|---|---|---|
| ADHD | 667 | 283 | 136% |
| Anorexia | 755 | 578 | 31% |
| Anxiety | 3618 | 2326 | 56% |
| Autism | 360 | 202 | 78% |
| Autoimmune | 3457 | 2150 | 61% |
| Bipolar disorder | 1332 | 967 | 38% |
| CFS | 398 | 152 | 162% |
| Conduct disorder | 129 | 46 | 180% |
| Depression | 6106 | 4209 | 45% |
| Epilepsy | 2820 | 1737 | 62% |
| Fibromyalgia | 250 | 91 | 175% |
| Insomnia | 316 | 215 | 47% |
| Learning Disabilities | 169 | 131 | 29% |
| OCD | 465 | 261 | 78% |
| PMS | 155 | 137 | 13% |
| PTSD | 918 | 470 | 95% |
| Schizophrenia | 2424 | 1514 | 60% |
| TBI | 1419 | 740 | 92% |
| Tourette's | 104 | 85 | 22% |
Some interesting facts. ADHD and CFS research increased the most compared to those fields with 50 or more publications in 1990. Depression and anxiety still appear to be the bane of the Western world, and Conduct Disorder was the big up-and-comer in the '90s.
| Addiction Research | |||
|---|---|---|---|
| YEAR | 1998 | 1990 | % Increase |
| Addiction | 808 | 440 | 84% |
| Alcoholism | 1992 | 2164 | -8% |
| Cocaine | 1250 | 816 | 53% |
| Marijuana | 312 | 213 | 46% |
Research in alcoholism actually declined!
| The Decade of Brain Imaging? | |||
|---|---|---|---|
| YEAR | 1998 | 1990 | % Increase |
| Cerebral blow flow | 1326 | 929 | 43% |
| EEG | 2747 | 2184 | 26% |
| PET | 1044 | 405 | 158% |
| fMRI | 1066 | 168 | 535% |
| SPECT | 1484 | 564 | 163% |
Although EEG papers outnumbered all other brain-imaging techniques, I suspect its lead won't hold into the DOC (Decade of the Computer, 2000-2009 A.D.).
| YEAR | 1998 | 1990 | % Increase |
|---|---|---|---|
| Acupuncture | 292 | 316 | -8% |
| Biofeedback | 176 | 160 | 10% |
| Patient rights | 894 | 673 | 33% |
| Animal rights | 46 | 37 | 24% |
| Ritalin | 127 | 60 | 112% |
| Prozac | 333 | 177 | 88% |
| Placebo | 4827 | 3270 | 48% |
| Psychotherapy | 3003 | 2600 | 16% |
The DOB's coattails couldn't pull biofeedback along, with only a paltry 10% increase in publications. The amount of people researching the placebo effect overshadowed most lines of research.
A final glance at mental health research uncovered that during the last generation of research (1980 to the present): ADHD publications increased nearly 500%. No other mental health condition (except research on cocaine) could challenge its growing popularity. Sadly, biofeedback declined from 203 publications in 1980 to 176 in 1998, a drop in 13%.
P.S.S. Further reading:
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