Research on persistent closed head trauma symptomology of depression, mood swings, and/or anxiety attacks more than three years post injury has been in the area of cognitive psychology, behavioral modification, or psychotherapy. Often patients with persistent symptomology have been described as neurotic, depressed, anxious, and perhaps symptoms existed prior to head trauma. This controlled study of EEG neurofeedback training and clinical psycho-therapy for right hemispheric closed head injury attempted to determine if behavior could be altered.

Initial electroencephalographic (EEG) of twelve right closed head injury individuals were recorded on a Beckman EEG for possible future electroencephalographic neurofeedback. All twelve indivi-duals were three years or more post head injury, and had been in weekly psychotherapy for at least one year to work with their symptomology. Psychologists reported all twelve individuals, as measured by testing, and self report had mood swings, explosive anger outbursts, and anxiety attacks. No individuals had these symptomology prior to the right hemispheric closed head trauma. In addition, these individuals had made unremarkable progress in psycho therapy.

Basic EEG's indicated excessive abnormal phasic spikes with 4 to 7 hertz activity on F8T4. Six individuals, three males, three females, ages 30 to 45 were randomly chosen for EEG neurofeedback training to occur simultaneously with psychotherapy. EEG neurofeed-back was done with on line digital neurofeedback equipment, Ayers patents 4,919,143 and 5,024,235. The remaining six individuals continued only in psychotherapy for control. Based on previous re- search by Ayers in 1987, with closed head injury, EEG neurofeedback instrumentation and training was done for twenty-four half-hour sessions. Participants were trained to inhibit 4 to 7 hertz and then simultaneously produce 15 to 18 hertz. EEG neurofeedback indi-viduals progressively learned to decrease the voltage of the 4 to 7 hertz, while voltage of the 15 to 18 hertz was not lowered.

Frequencies were chosen on the basis of prior brain research that indicated that inhibition of 4 to 7 hertz and simultaneous production of 15 to 18 hertz resulted in obtaining motor control. Published research in obtaining motor control utilizing EEG feed-back has been published by Lubar in attention deficient disorders, Hauri in insomnia, Sterman in epilepsy, and Ayers in stroke, head trauma, and epilepsy. EEG neurofeedback was done on the side of head injury or F8T4.

The decision to inhibit 4 to 7 hertz activity was also based on brain research by John, E.R., Prichep, L.S., Friedman, J., and Easton, P., who found in topographic mapping of EEG and evoked potential that unipolar depressives had less beta activity and more theta activity in right frontal and right parietal than normals. Also, Shatzberg, Elliot, Lerbinger, Marcel, and Duffy did topo-graphic mapping of 31 depressed patients compared with 31 normal patients. The depressed patients had increased delta and theta activity in right posterior temporal region and increased frontal beta bilaterally. Both topographic brain mapping studies indicate the significant role of theta activity or 4 to 7 hertz activity in depression, and F8T4 EEG training.

Theta frequencies have predominantly originated in humans and animals from the hippocampus as Jung and Kornmuller first observed in 1938. Fujita and Sata in 1964, found membrane intracellular potentials fluctuated in a regular "intracellular theta rhythm" which they coupled to the extracellular hippocampal rhythmical slow activity theta in rabbits. Bremner analyzed changes in theta acti-vity using power spectral analysis and found that total power of theta increases in visceroautonomic arousal and decreases in somato-motor readiness. Could it be possible that hippocampal control of the organization of arousal and activation in closed head injured patients with their excessive production of 4 to 7 hertz activity and spikes are stuck in a constant visceroautonomic arousal of anxiety and depression and unable to decrease the theta activity which would allow for somatomotor readiness and behavior change?

Psychologists reported that the six right head trauma indivi-duals who received only psychotherapy did not improve in mood swings, explosive anger outbursts or anxiety attacks. However, clients reported better understanding of how to cope with their problem. According to testing with the Levin, Benton, and Grossman follow-up interview questions and psychological report, individuals who received EEG neurofeedback training along with psychotherapy had their mood swings, explosive anger outbursts, and anxiety attacks subside. In addition, when EEG neurofeedback was introduced after one year of initial psychotherapy, subjects and psychologists re-ported progress in therapy.

No studies to date have attempted to control data with regards to psychotherapy and EEG neurofeedback. This controlled study pro-vides information about how EEG neurofeedback training for closed head injury can effectively improve clients' symptomology as well as outcome of psychotherapy.

NATIONAL HEAD INJURY FOUNDATION, 1991. A PAPER PRESENTED AT THE NATIONAL HEAD INJURY FOUNDATION LOS ANGELES, CALIFORNIA, 1991.

Ayers, M.E., "A Report on a Study of the Utilization of Electro-encephalography (Neuroanalyzer) for the Treatment of Cerebral Vas-cular Lesion Syndromes", Chapter 7 in Electromyometric Biofeedback Therapy by Taylor, L.P., Ayers, M.E., and Tom, G., Biofeedback and Advanced Therapy Institute, Los Angeles, California, pgs. 244-257, 1981.

Ayers, M.E., "Electroencephalographic Feedback and Head Trauma", in Head and Neck Trauma: The Latest Information and Perspectives on Patients with a Less-Than- Optimal Recovery, U.C.L.A. Neuropsychi-atric Institute, page 9, 1983.

Ayers, M.E., "Electroencephalic Neurofeedback and Closed Head Injury of 250 Individuals", in National Head Injury Foundation Syllabus, Head Injury Frontiers, page 380, 1987.

Ayers, M.E., "Long-Term Clinical Treatment Follow-Up of EEG Neuro-feedback for Epilepsy", Epilepsy Support Program Newsletter, Vol. 3, No. 2, 1988.

Ayers, M.E., Official Gazette, U.S. Patent Office, Patent Number 4,919,143, "Electroencephalic Neurofeedback Apparatus and Method for Bioelectrical Frequency Inhibition and Facilitation", April 24, 1990.

Ayers, M.E., Official Gazette, U.S. Patent Office, Patent Number 5,024,235, "Electroencephalic Neurofeedback Apparatus and Method for Bioelectrical Frequency Inhibition and Facilitation", June 18, 1991.

Bremner, F.J., "The Effect of Habituation and Conditioning Trials on Hippocampal EEG", Psychonomic Science, 18:181-183, 1970.

Fujita and Sato, T., "Intracellular Records from Hippocampal Pyrami-dal Cells in Rabbit During Theta Rhythm Activity", Journal of Neuro-physiology, 27:1011-1025, 1964.

Hauri, PJ., Percy, L., Hellekson, C., Hartman, E., and Russ, D., "The Treatment of Psychophysiologic Insomnia with Biofeedback: A Replication Study", The Journal of Biofeedback and Self Regulation, Vol. 7, No. 2, pp. 223-236, June, 1982.

John, E.R., Prichep, L.S., Friedman, J., and Easton, P., "Neuro-metric Topographic Mapping of EEG and Evoked Potential Features: Application to Clinical Diagnosis and Cognitive Function", in Topo-graphic Brain Mapping of EEG and Evoked Potentials, ed. by Maurer, Springer-Verlag Berlin Heidelberg, 1989.

Jung, R., and Kornmueller, A.E., "Eine Metodik Der Abkitung Lokalisierter Potentialschwankungen Aus Subcorticalen Hirngebieten", Arch fur Psychiatrie und Nervenkrankheiten, 109, 1-30, 1938.

Levin, H., Benton, A., and Grossman, R., Neurobehavioral Conse-quences of Closed Head Injury, Oxford University Press, pages 254-260, 1982.

Lubar, J., and Lubar, J., "Electroencephalographic Biofeedback of SMR and Beta for Treatment of Attention Deficit Disorders in a Clinical Setting", Journal of Biofeedback and Self Regulation, Vol. 9, No. 1, 1984.

Lubar, J.F., "Discourse on the Development of EEG Diagnostics and Biofeedback for Attention Deficit/Hyperactivity Disorders", Biofeed-back and Self Regulation, Vol. 16, No. 3, pgs. 204-225, 1991.

Schatzberg, A., Elliot, G., Lerbinger, J., Marcel, B., and Duffy, F., "Topographic Mapping in Depressed Patients", in Frank Duffy ed., Topographic Mapping of Brain Electrical Activity, Butterworth Pub-lishers, 1986.

Sterman, M.B., and MacDonald, L., "Effects of Central Cortical EEG Feedback Training on Incidence of Poorly Controlled Seizures", Epilepsia, 19:207-222, 1978.