Brain Music Therapy A New Form Of
Neurobiofeedback
Galina Mindlin M.D., Ph.D.
Brain Music Therapy (BMT) is a
new non-pharmacological method
that treats:
• Insomnia
• Anxiety
• Depression
• ADHD
• Clinical symptoms of alcohol and
substance dependence
• Stress
• Headaches
Brain Music Therapy (BMT)
improves and increases:
• Productivity
• Concentration
• Adaptability to stress
• Performance
What Is BMT?
• BMT is an individual’s EEG
pattern expressed in
sounds
• BMT requires regularly
listening to your own
individual brain music,
which is obtained by
converting your
electroencephalogram
(EEG) to music
• BMT is a form of
neurobiofeedback
EEG Frequency Spectrum Analysis
• EEG registered and divided into
•
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equal 1 sec intervals
Frequency spectrum obtained by
Fourier harmonic transformation
K – parameters calculated by the
ratio of frequency powers for each
1 sec interval, like:
– K1=P1P1
– K2=P2/P2
– K3=P3/P3
– …
– Kn=Pn/Pn
The Principle of EEG – Music
Conversion Table
• 36 notes of 3 piano
octaves (small, first
and second), 8
duration segments
and 8 volume
gradations table is
used for conversion of
K – parameters into
music sounds
Brain Music Therapy - Brief History
• The BMT method was invented by the group
of clinicians, neurophysiologists,
mathematicians, lead by Dr. Iakov Levine at
the Moscow Medical Academy in 1991
• The subsequent studies were done by Dr.
Patrick Lemoine in France, Dr. Enrico Roberto
Guissani in Italy, Dr. Leonid Kayumov in
Canada, and Dr. Galina Mindlin in the United
States
BMT Centers in the USA
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Dr. Galina Mindlin (New York, NY, represents technology in US)
Dr. George Rozelle (Sarasota, FL)
Dr. Karla Umpierre (Miami, FL)
Dr. Catherine Moritz, Mike Cohen (West Palm Beach, FL)
Dr. Frederick Kahn, Dr. David Mitnick (Paramus, NJ)
Dr. Robin Lippert (Boston, MA)
Dr. David Moore (Chicago, IL)
Dr. Jim Evans., Dr. Jane Price, Amon Copera (Greenville, SC)
Dr. Daniel T. Merlis (Washington DC)
Dr. Orli Peter (Beverly Hills, CA)
Dr. Susan E. Klear (Santa Clara, CA)
Dr. Carol Kershaw (Houston, TX)
Dr. Vladimir Grebennikov (Richardson, TX)
Dr. Nancy White (Houston, TX)
Dr. Don DuRousseau (Purcellville, VA )
Wayne Anderson (Northern CA)
Dr. Deborah Schussler (West Chester, NY)
Dr. Steven Kahan (New York, NY)
Neurobiofeedback
• EEG training produces a real-time change in the
physiological state of cortico-thalamic and
thalamocortical pathways via operant
conditioning
• This method trains the brain to voluntarily
change its state, not only specific to the training
condition, but generalized outside
• Thus, neurobiofeedback helps break pathological
brain patterns
Neurobiofeedback Helps to:
• “Wake up” under-aroused brain areas
• “Calm down” over-aroused brain areas
• Stabilize unstable brain areas
• Achieve optimal cortical arousal
• Increase flexibility and stability
• Prolong activated cortical functioning
Neurobiofeedback training affects:
• Arousal
• Sleep/Wake Cycles
• Cognitive processes
• Sensory processing
• Inhibition of motor responses
• Mood and emotion stability
• Improvement in memory
History of biofeedback training –
Classical Conditioning (Pavlov’s Dog)
• Unconditioned Stimulus (US) elicits
Unconditioned Response (UR)
(Natural Response)
• Neutral Stimulus/Orienting Stimulus
(NS) does not elicit UR. It elicits
orienting response
• If NS is repeatedly paired with US, the
NS is transformed into Conditioned
Stimulus. When the CS is presented, it
produces Conditioned Response which
is the same as UR
• UR/CR are involuntary responses. No
new behaviors are learned during
Classical Conditioning
Barry Sterman’s Cat – the beginning of
neurobiofeedback training
• Cats were trained to increase
their internal inhibition
through operant conditioning
• Instead of expected sleep the
cats became very alert,
producing a prominent
rhythm in the range of 12-15
Hz (peak: 14 Hz) at
sensorimotor locus (SMR)
• The cats were used then, in
NASA experiments with a
rocket fuel – hydrazine that
normally causes seizures
•The trained cats
appeared to be
resistant to seizures
(25% seizure free)
Sterman’s 1967 Study for NASA
Cats exposed to rocket fuel
EEG Frequency Training Bands
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Delta
Theta
Alpha
SMR
Beta
High Beta
RANGE
Training bands
.5-3.5 Hz
0-3, 0-4, 2-4 Hz
4-7.5 Hz
4-8, 4-7 Hz
8-11 Hz
8-12 Hz
12-15 Hz (subset of beta)
12-20 Hz
15-20, 15-18 Hz
22-30 Hz
22-38 Hz
Measured in frequency and amplitude
Meta Study of EEG Biofeedback for
Epilepsy
• 82% of participants demonstrated more
than 30% seizure reduction
• Average reduction exceeded 50%
• Studies reported reduction in seizure
severity
• About 5% had complete control for up to
1year, when anticonvulsants were reduced
or entirely withdrawn
• Sterman, MB (2000) Basic Concepts and Clinical Finding in the Treatment of Seizure
Disorders with EEG Operant Conditioning. Clinical EEG, 31(1), 45-55
ADHD (Monastra Study) –
biofeedback vs. stimulant therapy
• Ritalin produced significant improvement on
TOVA and ADDES without sustained
improvement, when the stimulant was removed
• Significant reduction in cortical slowing was
shown only in EEG biofeedback group
• EEG biofeedback group showed sustained
improvement within 3 years of studies even
when stimulants have been withdrawn
– 80% of EEG biofeedback group were able to decrease
daily stimulant dosage by at least 50%
– 85% of control group had to increase ritalin
Efficacy of Neurobiofeedback for
ADHD (from numerous studies)
• Improved attention, IQ scores, behavior and
academic performance, such as:
– Impulsiveness, task completion, tantrums,
aggression, communication, organization
– Social awareness, socialization
• Positive neurophysiologic changes in EEG, ERP,
fMRI
– Cortical slowing per qEEG
– ERP enhancement correlates with improvement of
cognitive performance
– Activation of R anterior cingular area, L caudate
nucleus, Bi dorsolateral prefrontal cortex per fMRI
Neurobiofeedback Improves Residential
Substance Abuse Treatment
• UCLA HSPC approved study design
• Cocaine, Methamphetamine, Heroin
• 40 sessions of EEG biofeedback were added to
12-step inpatient program
• Control group: 27 of 61 completed studies
• EEG group: 47 of 60 completed studies
• 12 months post study:
– 36 of 47 patients were abstinent in EEG group
– 12 of 27 patients were abstinent in control
• William Scott, Thomas Brod, M.D., Stephen Siderof, Ph.D., May 2002
What Is Music?
• Organized sound oscillations, alternating
in rhythm, volume, tone, and timbre
• Art which organizes a combination of
sounds in an expressive pattern including
harmony and rhythm
• “Music is a mystery” (C. Darvin)
– Unclear role in survival and adaptation
The Evolutionary Role of Music
• Music develops along with speech and involves
the same large cortical processing area
• Unlike speech, music imposes much less specific
requirements for recognition by a large group of
people
• It may serve as a tool to unify people, as well as
an alternative expressive language (singing,
melody, rhythm)
• Music allows synchronization within a large
group of people, whereas words create
communicative infrastructure
Physiological Role of Music
• Music is a positive conditioned stimulus
• Music activates the mechanism of
synchronizing rhythmic activity of different
cortical areas
– Temporal lobe epilepsy causes musical
hallucinations
– Music can provoke epilepsy
• Usually in musicians with damage to their temporal
lobe
• Always by the same music fragment
• Amusia like Aphasia can be motor or
sensory
Physiological Role of Music
• Music is a positive conditioned stimulus
• Music activates the mechanism of
synchronizing rhythmic activity of different
cortical areas
– Temporal lobe epilepsy causes musical
hallucinations
– Music can provoke epilepsy
• Usually in musicians with damage to their temporal
lobe
• Always by the same music fragment
• Amusia like Aphasia can be motor or
sensory
Areas of the Brain Involved in
Music Comprehension
• R handed – R hemisphere
– Area 41: Initial comprehension,
pitch/tone, volume
– Areas 22 & 42: harmony,
melody, rhythm
– Angular gyrus and
supramarginal gyrus:
multimodal comprehension
with abstract processing
• L hemisphere is involved in
speech & analytical listening
– L prefrontal and L frontal
areas: appreciation and
conclusion
• Musicians:
• have a larger area 22
• use the L hemisphere for
rhythm/rate
• activate Area 19 (visual)
• activate Upper Broca area
• have an enlarged Corpus
Callosum in frontal median part
Mozart Effect
• Sonata D major for two pianos, K448
– Activates pre-frontal dorso-lateral area, occipital area,
and cerebellum
– Increases visual-spatial cognitive area
PET scan and fMRI register metabolic
changes influenced by music
• Metabolism of the R temporal and occipital
lobes increases with eyes closed
• Broca area activates with an attempt to
recognize music and with rhythmic music
• Metabolism of the R temporal lobe jumps
up with increasing music pitch
• Expanding timbre increases the activity of
the whole R hemisphere
Therapeutic Effect of Music
• Music therapy can help with:
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Relaxation
Stress reduction
Improving communication skills
Treatment of social isolation
Reduction of negative symptoms
• Music therapy enhances a pleasure, improves
cognition and neuroplasticity.
• However, its therapeutic effects are usually nonspecific and may be a short term
Brain Music Therapy
• “Brain-music” is a method of neurobiofeedback
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which involves establishing optimal rhythmic and
tonal parameters, creating meditative conditions
based on an individual’s unique EEG-pattern by
influencing cortical bioelectrical activity
Using Brain Sound Compiler, these EEG-patterns
are converted into synthesizer-based music,
tailored to the patient, and recorded on a compact
disc (CD)
BMT Is a Combination of
Neurobiofeedback and Music Therapy
• EEG is recorded and transposed into musical
sequences
• The ratio of power of the EEG signal at two
particular frequencies at single time determines
pitch, volume and length of the sound
• Listening to one’s own EEG helps to adjust the
current bioelectrical activity to the relaxed or
activated signal pattern
• The adjustment of the EEG pattern reflects the
corresponding state of mind
Procedure
• Initial brief medical evaluation and testing
with specific scales (Beck, Athens, etc.)
• EEG recording for 5-10 min with four
monopolar electrodes (channels): L/R frontal
and L/R central
• Removing of artifacts from the recording
• EEG conversion into a relaxing and an
activating musical track with a special
algorithm
• The converted EEG tracks are expressed in
piano music
How to Use BMT
• After a patient’s EEG has been recorded and
transposed into music, the patient receives two
music files, one activating and one relaxing, with
detailed instructions
• It is recommended to listen to:
– The activating file - in the morning after waking up,
or prior to intensive, demanding work
– The relaxing file - prior to going to bed, upon waking
up in the middle of the night, and during times of
stress or anxiety.
Efficacy of BMT
• BMT was shown to have 82-85% of efficacy in a
number of double blinded studies for insomnia and
appears to have same efficiency as Ambien, but
without known side effects
• BMT helped patients decrease or discontinue more
than twice the daily dosage of medications for
anxiety, depression, and ADHD
• BMT managed to completely resolve the incidence
of panic attacks for almost all patients
Unique qualities of BMT
• BMT is a “take-home” personalized
neurobiofeedback treatment with efficacy up to
85% as shown in double blind studies
• BMT does not interfere with existing
medications. On the contrary, it can either
substitute them or complement them,
increasing their efficacy.
• Thus, it allows patients to decrease the dosage
of medications and therefore attenuate
pharmacological side effects
• BMT does not have any known side effects
BMT and Insomnia
Normal Adults
• 10 normal adults - sleep pattern assessed with
insomnia scale, mood assessed with Beck
inventory
• Procedure:
– 1st week: baseline
– 2nd week: listened to relaxing music for 5-10 min
before falling asleep, activating music for 1-3 min
upon awakening
– 3rd week: placebo, non-specific music
• Results between day #7 and day #14:
– Mood improved (Beck score decreased)
– Sleeping pattern improved (Insomnia score low)
• Results between day #14 and day #21 – slow
return to the basic level
Insomnia Scores In Healthy Adults
After BMT
• P1 – basic level (days
4,7
4,6
4,5
4,4
4,3
4,2
4,1
Р3
4
Р2
3,9
3,8
1
2
Р1
3
4
5
6
1-7)
• P2 – personal BMT
(days 8-14)
• P3 – placebo BMT
(days 15-21)
• BMT improves a
patient’s sleep score
and has no negative
effects on a healthy
sleep pattern
Insomnia
• Insomnia is a symptom complex that is comprised
of difficulties in initiation or maintaining of sleep or
non-refreshing sleep, in combination with daytime
dysfunction or distress
• Insomnia can be:
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Acute (1 week or less): situational, transient
Short term (1-3 weeks)
Chronic (more than 3 weeks)
Cyclic/Seasonal
Insomnia Involves a Large Group of
People
• 28-45% of people have experienced insomnia at
least once in life for at least 1 week.
• Insomnia can be related to aging, stress, neurosis,
medical/somatic condition, pain syndrome, weather
changes, time zone adaptation, unstable day
schedule.
• Insomnia can lead to fatigue, decreased
performance and concentration, daily somnolence,
headaches and body aches
Insomnia Changes Sleeping Cycle
• Sleep Onset Latency (SOL) increases
– Rituals of falling asleep and anxiety/fears related to
insomnia develop
• The length of a sleep cycle decreases with
shortening or lack of stages 3 & 4 of slow sleep
and REM state
– Waking up after stage 2 of non-REM sleep is not
uncommon with lack of deep sleep, suppression of
delta rhythms, or increased motor activity
• The number of sleep cycles per night decreases
from 4-6 to 1-2
Insomniac Subject Sample for BMT
• 58 subjects with chronic insomnia (30 months average, 5
days/week), 35/23 m/f, aged 18-60
– group 1 (BMT): 44 subjects, group 2 (placebo): 14 subjects
– didn’t use sleeping medication for 2 weeks prior to the studies
• Problems:
– Falling asleep: 84.5%
– Frequent awakening: 76%
– Early awakening: 51.7%
– All 3 problems: 12 patients
– Level of Anxiety increased:
• personal anxiety score: 46 vs. 37 (normal)
• reactive anxiety score: 52 vs. 39 (normal)
The Typical Sleep Structure before and
after BMT Course
Polysomnographic studies prior to BMT Course
Polysomnographic studies after BMT Course
Objective Sleep Studies Results
before and after BMT
Characteristics
TST (min)
SOL (min)
Alertness during sleep
AW per hr
Completed cycles
Movements per hr
Delta sleep (min)
REM (min)
Index of Efficacy
Before BMT After BMT
324.5
431.2
56.4
9.4
57.2
17.8
3.8
1.6
3.2
5.1
9.4
3.3
32.8
67.6
58.7
96.5
0.85
0.98
Summary of BMT Efficacy for
Insomnia
• In 4 weeks of using BMT, the overall subjective sleeping
score improved by 36%, placebo effect – 15% at best
– The total sleep time increased by 50%
– The quality of sleep increased by 35.5%
– The quality of awakening increased by 28%
• Significantly decreased level (score) of personal (48 to 41,
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control: 37) and reactive (56 to 44, control: 39) anxiety
Alpha rhythm fraction and power increased; beta and theta
slightly decreased
The R hemisphere regained its ability to react to verbal
stimuli (the rhythm pattern remained different from the one
of healthy control)
Objective parameters like TST, delta wave stages, the
number of sleep cycles, REM, etc. also increased and
improved
Anxious Patients with Insomnia
(Canadian Studies)
• Participants:
– Experimental Group: 10 insomniacs, authentic
BM
– Placebo Group: 8 insomniacs, BM of a different
patient
• Methods:
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Screening PSG test
Zung Anxiety Scale
Athens Insomnia Scale
CES-D Scale
Pre- and post-treatment actigraphy
Anxious Patients with Insomnia
(Canadian Studies)
• Exclusion Criteria:
– Severe neurologic and/or psychiatric disorders
– Primary sleep disorders as judged by the PSGs
(PLMD, sleep apnea, etc.)
– Drug or alcohol abuse
– Use of medications known to affect sleep
and/or melatonin production (unless
discontinued 2 weeks prior to the study)
– Left-handed
Anxious Patients with Insomnia
Statistical Analysis
• Group differences were investigated using
a General Linear Model one-factor (Group)
multivariate analysis of variance
(MANOVA)
• Independent sample t-tests were
conducted for the questionnaire data
• Student-Newman Keuls (SNK) was
conducted for the sleep data
Results: Before and After 4
weeks of Brain Music Therapy
Zung Anxiety Scale
Athens Insomnia Scale
70
25
60
20
50
15
40
pre
post
30
20
10
0
Authentic
BM
Placebo
120
Min
Intervening
Wakefulness
pre
post
10
5
0
Authentic Placebo
BM
100
80
60
pre
post
40
20
0
Authentic Placebo
BM
Comparative Studies of BMT vs.
Ambien for Insomnia (Methods)
• Control modalities:
– Polysomnogrphy and EEG at wakefulness
– Subjective Sleeping Scale
– Psychological testing
• Spilberg scale for anxiety
• Beck scale for depression
• Athens scale for insomnia
• Leongard, Plutchek, other scales
• Cross-sectional studies: 20 patients with
insomnia, 10 normal adults, m/f – 1:1 for each
group, age – 23-47
– Each group of people was divided in half: first half
put on BMT for 10 days, then Ambien for 10 days;
second half put on Ambien for 10 days, then BMT for
10 days
Comparative Studies of BMT vs.
Ambien for Insomnia (Table1)
Signs
Time/Score
TST
Latent stage 1
Latent stage 2
Latent Delta
Latent REM
AW
Activation shift
Movement index
Control
Min %
450
21.6
4.8
24.9
100.4
21.3
4.4
66.5
Ambien
Min %
484
10.2
2.4
8.5
123.7
9
2.1
51
BMT
Min %
467
15.2
8.1
27.2
99
6.5
1.8
51.5
Comparative Studies of BMT vs.
Ambien for Insomnia (Summary)
• BMT and Ambien demonstrated comparable
improvement of sleeping conditions per
patient questionnaire and insomniac scales
• BMT and Ambien equally improved the
objective signs and characteristics of sleep
monitored by EEG/Polysomnography
• There are no known side effects and
complications of BMT
Melatonin (Brief Review)
• Melatonin is a neurohormone responsible for
sleep/wake cycle regulation, time zone
adaptation/synchronization, hypothermic
regulation, and antioxidant properties
• It is synthesized from triptophan in the
pineal gland (at night-maximal synthesis),
retina (in the daytime), and intestine
• Age-dependent, maximal in childhood
• Initiates sleep; suppression of melatonin may
cause insomnia
BMT and Melatonin Secretion
(Open, Non-comparative Studies)
• 11 people (m/f – 7/4, age 43+/-4), with chronic
insomnia and high levels of anxiety (at least 50 on
Zung Scale)
• 2 weeks of listening to a relaxing track before sleep
and an activating track after waking up
• Insomnia level assessed by Athens Scale
• Melatonin was measured from saliva for every hour
between 8 pm and 2 am by ELISA and collected at
dim light
BMT and Melatonin Secretion
(Results)
• The anxiety level dropped from 62+/-5 to
42+/-4 per Zung Scale
• The level of melatonin increased from 1.19.2 pg/ml to 25 – 40 pg/ml
• The quality of sleep significantly improved
BMT and Performance
• 50 people were studied: 42 males, 8 females (students,
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athletes, and managers), whose complaints included
stress, fatigue, and tiredness
Managers (16 people, anxiety/insomnia)
– 1-3x daily listening to activating/relaxing music as recommended
– Sleep improved from a score 19 (borderline) to 23 (normal)
– Anxiety level decreased from 42 to 36 (Spilberger scale)
• Athletes (20 people)
– 3x daily listening to activating and relaxing music for one month
– Sleep and mood stability subjectively improved
– Concentration and performance during games/competitions
improved; more games were won
• Medical Students (14 people)
– 1x listening to activating music prior to “night before exam”
studying
– Increase in average group subjective sleeping score from 2.2 to
3.1
BMT and Anxiety (Method)
• 60 patients with diagnosis of anxiety; 40 of them
experienced intermittent panic attacks
– Majority had generalized anxiety
– Agoraphobia: 33.3%, Panic attacks and agoraphobia:
30%, Social phobia: 16.6%
• Listened to relaxing music 3 times daily and
before panic attacks for 15 days
• Patients were subdivided into 2 groups by
Spilberger test
– 1st Group - with personal anxiety score less than 45,
reactive anxiety score less than 50 (30 patients)
– 2nd Group: higher level of anxiety (30 patients)
BMT and Anxiety (Results)
• Anxiety levels decreased by 8-10%
• The 1st group responded faster (in 1-2 days)
• Increased level of alpha and decreased level of theta/beta
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rhythms
R hemisphere regained assessment of verbal stimuli
Anxiety
Score
Personal Anxiety (PA)
Reactive Anxiety (RA)
Before BMT
After BMT
1st group
2nd group 1st group 2nd group
42
47
51
61
38
43
47
55
BMT and Anxiety
• Anxiety levels significantly decreased after BMT
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(decreased PA and RA by Spilberger test)
95% patients with anxiety became panic attacks free
Agoraphobia levels significantly decreased
Sociability and adaptability increased in a group with
social phobia
Placebo effect (30 patients) of non-specific BMT showed
initial 10% improvement which wore off in 1-2 weeks
By subjective report, BMT was as effective as
pharmacotherpy, but without noticeable side effects
BMT was time- and cost- effective.
BMT and Depression (Methods)
• 94 patients (64 – BMT, 30 – placebo)
– Major complaints included fatigue, tiredness, frequent
mood swings, tearfulness
– 60 patients had insomnia; 20 patients had somnolence
– 30% had panic attacks weekly, 40 patients had
agoraphobia
• Average depression level score of 43 per Beck scale
• The patients listened to BMT music for 15 – 30
days depending on the severity of depression
– An activating track in the morning and at daytime
– The relaxing track in the evening
BMT and Depression (Results)
• Significant improvement was noticed by 10 -
12 days for the mild to moderately
depressed (MMPI scale 2 less than 70 T)
• After 30 days, all patients noticed changes
toward emotional stability, increased
interest, improved ability to work, decreased
phobia, decreased insomnia/somnolence,
disappearance of panic attacks
• Beck scale dropped to 14 on average
Brain Music Therapy in the USA
• More than 2,000 patients in 3 years
• Group of 90 patients with Insomnia:
– 80% - decreased SOL, increased TST, fewer awakenings during the
night, increased reports of more restful sleep
– 15% - partial improvement
• Group of 60 patients with Anxiety D.O.:
– 85% - relief of tension, decrease in free-floating anxiety,
disappearance of full-blown panic attacks, improvement in symptoms
of social phobia and performance anxiety
• Group of 45 patients with ADHD:
– 87% - increase in concentration, attention span, productivity, and peak
performance, decrease in medication
• Group of 45 patients with Mood D.O.:
– 80% - noticeable mood stabilization, increase in energy level, decrease
in daily medication dosage, Beck scale dropped by 8 – 10 on average
Conclusion
• BMT is a novel, highly effective, personalized, non-
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pharamcological, non-invasive, “take-home”
method based on neurobiofeedback. It is shown to
be effective for treatment of insomnia, anxiety,
depression, ADHD.
BMT can potentially benefit treatment of substance
withdrawal and substance dependence
BMT can be effectively used by itself, or
complementary to medications or any other
therapeutic modalities.
BMT is safe and does not have side effects.
BMT has demonstrated sustained and long term
effects.
BMT Centers in the USA
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Dr. Galina Mindlin (New York, NY, represents technology in US)
Dr. George Rozelle (Sarasota, FL)
Dr. Karla Umpierre (Miami, FL)
Dr. Catherine Moritz, Mike Cohen (West Palm Beach, FL)
Dr. Frederick Kahn, Dr. David Mitnick (Paramus, NJ)
Dr. Robin Lippert (Boston, MA)
Dr. David Moore (Chicago, IL)
Dr. Jim Evans., Dr. Jane Price, Amon Copera (Greenville, SC)
Dr. Daniel T. Merlis (Washington DC)
Dr. Orli Peter (Beverly Hills, CA)
Dr. Susan E. Klear (Santa Clara, CA)
Dr. Carol Kershaw (Houston, TX)
Dr. Vladimir Grebennikov (Richardson, TX)
Dr. Nancy White (Houston, TX)
Dr. Don DuRousseau (Purcellville, VA )
Wayne Anderson (Northern CA)
Dr. Deborah Schussler (West Chester, NY)
Dr. Steven Kahan (New York, NY)
Theoretical Concepts on BMT
• Entrainment/Disentrainment
• Operant Conditioning
• Biological theory (neurotransmitters changes) –
Melatonin increases in 9 times in BMT users
• supports the high effectiveness in Anxiety and
Mood D.O. when people are reducing the
dosage of their medications (SSRIs)
• PET/fMRI studies are required
Sounds of BMT
Activating
Relaxing
BMT to Treat Insomnia
due to Anxiety
Principal Investigator: Dr. Galina Mindlin
Co-Investigator: Dr. Deborah Haller
Project Manager/RA: Dr. Colette Haward
Design
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Repeated measures “open” trial with 3
assessment points:
Baseline (includes BMT training session)
 3 and 6 week follow-ups
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Measures:
Pittsburgh Insomnia Rating Scale
 Spielberger State-Trait Anxiety Scale (STAI)
 NEO-FFI personality scale (BL only)
 Sleep diary (quantity/quality)
 Daytime Functioning Scale
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Hypotheses
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Patient receiving BMT will evidence decreased
scores on measures of insomnia and anxiety at
follow-up
Daytime functioning also will improve for
patients who benefit from BMT
Personality style (based on NEO-FFI) will
mediate treatment outcomes
Neurotic patients will have a poorer response
 Conscientious patients will have a better response
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Inclusion/Exclusion Criteria
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INCLUSION
CRITERIA:
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Healthy
Ages 18-75
Primary insomnia
Significant anxiety
Willing to sign
informed consent
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EXCLUSION CRITERIA:
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Rx/OTC sleep meds past 30
days
Anxiolyic/other sedating meds
Axis I Dx (other than anxiety
or insomnia)
ETOH/drug abuse past 90
days
Caffeine dependence
Works rotating shifts/travels
often across multiple time
zones
Medical Co-morbidities:
cardiac problems, other sleep
disturbance, organic brain
pathology, chronic pain,
deviated septum
Time commitment/Visit Schedule





Pre-screen phone interview to identify patients
who meet medical exclusion criteria (about 3
min)
Visit to BMT Center for EEG recording during
awake period (15 min; total session time 45 min)
Baseline visit (1 hour)
3 and 6 month follow-up visits (30 minutes)
Compensation: Patients may keep their
personalized CDs for ongoing use
Self-Guided Neurofeedback Intervention
for Anxious Insomniacs



Volunteers (n=15) with clinically significant insomnia
and anxiety were instructed to use their personalized
CDs to facilitate sleep and anxiety reduction (relaxing
track) or to stimulate focus and alertness (activating
track) on a daily basis.
Repeated measures of sleep (PIRS), anxiety (STAI),
daytime functioning (DFT) and quality of life (QOL)
were taken at Weeks 0, 3, and 6.
Participants were middle-aged (43.9/11.4), Caucasian
(60.0%) females (66.7%) who were college educated
(100%) and employed (93.4%).
Results of repeated measures tests including Speilberger
State-Trait Anxiety Scale (STAI), Pittsburgh Insomnia Rating
Scale (PIRS), Daytime Functioning Tool (DFT), Part 1
Measure
Baseline (M/SD)
Week 3 (M/SD)
Week 6 (M/SD)
p-value
Percentage
Improvement
STAI-S (SS)
66.33(11.2)
57.07(9.1)
51.67(10.3)
.000
28%
STAI-T (SS)
88.20(10.3)
72.33(15.0)
55.80(23.1)
.000
58%
PISR (Total)
107.00((28.1)
65.53(21.3)
52.00(29.0)
.000
56%
PISR Symptom
70.87(23.4)
73.20(23.7)
37.13(27.5)
.000
91%
15.53(4.9)
6.93(4.0)
7.10(4.8)
.001
119%
18.87 (4.0)
12.27 (4.1)
11.00 (6.8)
.000
72%
Fatique
5.40 (2.8)
4.13 (1.9)
3.53 (1.7)
.008
53%
Irritability
5.67 (2.6)
4.27 (2.0)
3.33 (1.9)
.000
70%
Concentration
5.27(2.3)
5.8(1.9)
5.9(2.5)
NS
12%
Energy
5.47(2.0)
6.27(1.8)
6.47(2.0)
.030
18%
Distress (#1-46)
Sleep Parameters
(#47-55)
Quality of Sleep (#5765)
Results of repeated measures tests including Speilberger
State-Trait Anxiety Scale (STAI), Pittsburgh Insomnia Rating
Scale (PIRS), Daytime Functioning Tool (DFT), Part 2
Measure
Baseline (M/SD)
Week 3 (M/SD)
Week 6 (M/SD)
p-value
Percentage
Improvement
Productivity
6.07(2.2)
6.47(2.3)
6.47(2.3)
NS
7%
Completion of
5.73(2.3)
7.00(2.3)
7.13(2.2)
.001
24%
5.53(2.3)
5.0(2.7)
4.33(2.8)
.025
28%
Interest in Sex
4.93(2.3)
6.13(2.2)
6.07(2.1)
.036
23%
Participation in
5.80(2.8)
6.33(2.7)
6.53(2.6)
NS
11%
Headache
3.87(3.0)
2.67(2.0)
2.13(1.5)
.022
82%
Muscle Tension
5.27(2.8)
4.07(2.7)
2.93(2.0)
.000
80%
Startle Response
4.93(2.5)
3.01(2.2)
2.47(2.3)
.000
99%
Routine Tasks
Vulnerability of
Emotions
Social/
Recreational
Activities
Changes in Overall Sleep Quality (PIRS),
State and Trait Anxiety (STAI) over time
Baseline
Week 3
Week 6
100
90
80
70
60
50
40
30
20
10
0
Week 6
Trait Anxiety
State Anxiety
Sleep Quality
Week 3
Baseline
0
20
40
60
80
100
Music-Based Neurotraining
Research Subject Demographics
N
Low
High
Avg
Women
15
24
55
37.7
Men
32
25
58
38.8
Combined
47
24
58
38.4
AGE
Total
Women
Men
White
Black
Latino
Asian
Pacific
Isle
Firefighters
Ops
Support
5
1
4
5
18
11
7
14
2
FAMS
24
3
21
19
2
1
1
1
47
15
32
38
4
1
3
1
Controls
8
2
6
5
1
1
1
Test Pop
39
13
26
33
3
0
2
2
1
Result showing change in Sleep Quality
Sleep Quality: Values >0 = Improvement
Ops (1 - 13); 1st Resp (14 - 32); Control (33 - 36)
16
14
12
10
Difference
8
Post-Pre
Post-Bl
Post-Avg
Linear (Post-Pre)
6
4
2
0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36
-2
-4
Post-Pre = 86.1%; Post-Bl = 91.7%; Post-Avg = 94.4%
Result showing change in Insomnia
Insomnia Index: Values <0 = Improvement
Ops (1 - 13); 1st Resp (14 - 32); Control (33 - 36)
60
40
20
0
Difference
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36
-20
Post-Pre
Post-Bl
Post-Avg
Linear (Post-Pre)
-40
-60
-80
-100
-120
Post-Pre = 83.3%; Post-Bl = 86.1%; Post-Avg = 83.3%
Result showing change in Mood
Mood Scale: Values <0 = Improvement
Ops (1 - 13); 1st Resp (14 - 32); Control (33 - 36)
10
5
0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36
Post-Pre
-5
Post-Bl
Post-Avg
Linear (Post-Pre)
-10
-15
-20
-25
Post-Pre = 63.9%; Post-Bl = 66.7%; Post-Avg = 80.6%
Result showing change in Life
Satisfaction
Life Satisfaction: Values >0 = Improvement
Ops (1 - 13); 1st Resp (14 - 32); Control (33 - 36)
40
30
Difference
20
10
Post-Pre
Post-Bl
Post-Avg
Linear (Post-Pre)
0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36
-10
-20
-30
Post-Pre = 66.7%; Post-Bl = 61.1%; Post-Avg = 63.9
Result showing change in Daytime
Function Negatives
Daytime Function (Negative)
Ops (1 - 13); 1st Resp (14 - 32); Control (33 - 36)
20
15
10
5
Difference
0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36
Post-Pre
Post-Bl
-5
Post-Avg
Linear (Post-Pre)
-10
-15
-20
-25
-30
Post-Pre = 80.6%; Post-Bl = 75.0%; Post-Avg = 80.6%
Result showing change in Daytime
Function Positives
Daytime Function (Positive)
Ops (1 - 13); 1st Resp (14 - 32); Control (33 - 36)
40
30
20
10
Difference
0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36
Post-Pre
Post-Pre
-10
Post-Avg
Linear (Post-Pre)
-20
-30
-40
-50
-60
Post-Pre = 63.9%; Post-Bl =58.3%; Post-Avg = 69.4%
Consistency Determines Success