Brain training: the good, the bad, the future.

Our brains are plastic. By that I’m not suggesting that they are literally made of plastic, nor do I mean it metaphorically, as if to comment that we are nothing more than vain consumerists (perhaps I’ll save that for another post). In this instance, I use the word as an adjective, something that is easily shaped and moulded. Our brains are just that, malleable. An electrified, soft and squishy jelly – both fragile and remarkably complex. Whenever we learn something new, our brain undergoes a re-wiring.

At the turn of the millennium, Bob the Builder took the UK charts by storm, filling the nation with a joyous and hopeful optimism that we can indeed fix anything we want! At the same time the brain training industry was born (coincidence?), taking advantage of neuroscientific ideas and using it as a highly successful marketing tactic. Over the course of the following decade, alongside the rise of smartphones, the industry boomed (providence?). By 2012, it was worth $1 billion. You had to be living under a rock to have never heard of Lumosity, the company that offers ‘serious brain training, that just feels like games… it’s based on neuroscience’. It seemed that every other person was thumbing away on their screens, becoming increasingly addicted to the delightful games and the fuzzy-feeling that accompanied their growing ‘intelligence’.

The problem is this: no one quite knows whether brain training apps do indeed enhance cognitive skills. Can playing a simple game for a few minutes a day ward off the devastation of senility? Probably (definitely) not. As the dust of brain training hysteria has settled, it has become clear that many of the skills enhanced by such games do not transfer. In other words, getting better at the game does not mean you’re getting better at life. In 2016, Lumosity’s false claims of scientific proof landed like a custard pie on their face, as the US Federal Trade Commission slapped them with a multi-million-dollar fine. Lo, how the mighty have fallen – although it’s worth pointing out that they’re still very much in business (I guess people really like games).

‘But surely,’ I hear you cry, ‘repetition of a cognitive task must improve our cognitive abilities – however else could we learn?’ I know! Perhaps criticism of brain training has gone too far? Perhaps we should clarify the direction of our critique toward the tendency of marketing executives to over-extend the truth in order to boost sales? Perhaps faceless companies should take a long, hard look at themselves and consider their moral virtues? Admittedly, I’m not entirely sure how one would look at oneself without a face. The point is, evidence suggests that cognitive training does appear to have a long-lasting effect on cognitive ability, but it depends (as ever) on how a person trains, and who that person is (Jaeggi et al. 2011). Given the limited efficacy of pharmacological drugs on improving cognitive deficits, the potential of cognitive training (a more accurate phrase for ‘brain training’) as a potential alternative/complimentary treatment of psychiatric symptoms is huge (Keshavan et al. 2011). So, what does the future of cognitive training hold within psychiatry? The answer may well be neurofeedback.

To explain what this is, I’ll start with a simple example. Every few days I go for a run. I put my headphones in my ear and record my performance using my favourite app (Nike run club – they give you badges). For every kilometre I run, a voice reports to me my distance and speed, and based on that I adjust how hard I am willing to push myself. How fast I run is usually unconscious. But, by measuring my body’s activity, I am able to adjust my performance and (hopefully) train myself to be a better runner, a process known as biofeedback.

Neurofeedback, is a type of biofeedback therapy that uses real-time displays of brain activity to teach self-regulation of brain function. There are many ways to measure brain activity, but the most common one used for the purposes of neurofeedback is electroencephalography (EEG). This method involves electrodes placed on the scalp, which record the electrical activity of the brain and plots it on a graph, producing ‘brainwaves’. But just looking at these brainwaves (as pretty as they are) isn’t particularly informative. Rather, brain activity is translated into a videogame. Yup, that’s right, a videogame that you can control with your mind! The task is usually simple, such as ‘keep the balloon floating in the air’ or ‘take the rocket ship to the moon’, and the instructions are often vague: ‘just do it’. The subject must then figure out and learn how to control the object and complete the task.

A schematic of what neurofeedback looks like

Surprisingly, the concept of neurofeedback has been around for some fifty years, but it has only recently begun to gain significant traction. The main condition in which neurofeedback has been researched and used as a therapy is attention deficit hyperactivity disorder (ADHD). Individuals with this condition struggle to concentrate their attention, having too much energy, and often act impulsively. It is also a condition that has a somewhat controversial reputation. As it often develops in childhood and is more commonly reported in boys, many have been skeptical that the condition is in fact a social construct that was ‘not discovered, but invented’ as a means to boost the pharmaceutical industry and control the natural behavior of little cheeky boys (see Thomas Szasz). But, if you’ve ever encountered a person with ADHD (particularly a grown adult), you can see it is a debilitating condition which commands some sort of therapeutic intervention to help the sufferer. Understandably, for many people the idea of filling a young body and a developing brain with chemicals is an uncomfortable thought. Neurofeedback, which is non-invasive, may well provide a valuable alternative therapy for such cases.

The neurofeedback therapy industry is still very much in its infancy, yet the potential seems large. Considering also the rapidly advancing EEG technology (including mobile systems that can be worn outside of the lab or clinic), there is capacity to better understand cognitive function in the complex and unpredictable situations that make up daily life (Kranczioch et al 2014). Furthermore, neurofeedback could also one day form part of the rehabilitation of psychiatric patients back into society. For instance, for many individuals leaving mental health units there is a high risk of relapse due to the stress of returning to everyday life. Training them using neurofeedback could well aid this transition.

But what about neurofeedback for the general population? Will we one day be using mobile EEG systems in the same way we use smartphones and brain training apps now? Who knows? There are already products on the market that you can buy. According to one company, Excellent Brain, ‘everyone has an excellent brain!’ – if that was the case, I’m not sure why we’d want to buy a neurofeedback device (some confused marketing going on there). Considering many scientists are still unsure about how neurofeedback actually works, it’s hard for me not to be sceptical about such devices. The company’s claims that their ‘low-cost, Neurofeedback training platform… (allows) customers to implement new mental processes and improve their lives’ feels a little bit like a déjà vu.

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