Nikita Byrnes met with neuroscience researcher Ana Rita to discuss the potential of neurofeedback to revolutionise treatment for mental health disorders and neurodivergent peoples
On a Tuesday in the middle of April, the world outside of the Westmead Institute for Research is overcast and windy. Inside, I am waiting to meet Ana Rita Barreiros, a neuroscience researcher and the clinical research coordinator at the Brain Dynamics Centre (“BDC”), a unit within the Westmead Institute that is pioneering research into biological markers of mental health disorders. Ana Rita has come to Australia from Portugal to obtain her PhD from the University of Sydney, a partner of the Institute. Her thesis is titled, “A comprehensive study of the effects of real-time functional MRI neurofeedback on treatment-resistant depression”. Put simply, Ana Rita is researching a solution to depression that does not respond to traditional treatments like antidepressants and antipsychotics. She is studying something that most people know little about – something called neurofeedback.
Neurofeedback is a type of biological feedback that visually presents someone’s own brain waves back to them in real time. The goal is to “train” your own brain activity, so that you can regulate your brain’s responses to various stimuli. It is at once an exciting and a terrifying prospect, to be able to rewire your brain. This type of technology could revolutionise the treatment of neurodiverse and emotionally dysregulated individuals. If it’s so powerful though, and seemingly accessible in its definition, why is it so little-known?
As I sit in the reception area, I look around and I am taken aback by the sheer immaculateness of this building, the architectural glossiness of it. Everything is painted shades of white and grey. Donors’ names are engraved in a marble wall. Ana Rita finds me and welcomes me to the building. In light wash jeans and a leopard-print shirt, she leads me up a set of stairs encased by glass walls that leads to the third floor where the BDC is based.
The design of this building is brilliant, if not terrible for acrophobics like myself. Later, Ana Rita will tell me about how the staff and researchers are so proud of the building, because it won the same architectural prize that the Opera House won when it was built. Fame and fortune abound.
I first met Ana Rita over Zoom about a month before our meeting at the Research Institute. During our first online meeting, I was struck by her animation, the passion she has for her area of study, and just how human she is. Her hands subconsciously wave around as she talks. She speaks with a lilted Portuguese accent which accentuates the mesmerising cadence to her sentences. When I ask her a question that she has to think about, she slumps forward, head tilted back and mouth open, cogs turning. When she finds an answer in the library of her brain, she swivels happily in her chair as she replies. Ana Rita is so unlike the stereotypes of neuroscientists; straightbacked, humourless, dedicated only to finding the answers to their hypothesis. And yet, her research is so far out of the bounds of every-day knowledge and discourse.
This might be because neurofeedback is an incredibly “young” path of scientific inquiry in comparison to other scientific practices. In the nineteen-sixties, Dr Barry Sterman began a Pavlovian-style experiment training the brains of cats.
Using electroencephalography (“EEG”) electrodes, Sterman found that the cats’ brains were operating on a particular rhythmic frequency. Sterman’s discovery was that with positive conditioning, we can change our brain’s physical activity. That was the beginning of neurofeedback.
I ask Ana Rita why so few people seem to know about what neurofeedback is. There are a couple key reasons, she supposes. Firstly, science –in particular, neuroscience – has evolved to use a method “so complex” that without focused study and years of training, it isn’t accessible to the everyday person. Taking me to the open-plan office space where the BDC team works, Ana Rita explains that neurofeedback data analysis is group-based, and there is a “pipeline of complicated steps” starting from data collection to data interpretation. As we walk from room to room down a brightly-lit hallway, it becomes clear that very little of her work is client-facing. Ana Rita chuckles and explains that her job isn’t as “glamorous” as everyone thinks. Her job primarily involves software-writing. She programs scripts to process the raw data that is received from the neurofeedback imaging, whether that is through EEG or fMRI scanning.
EEG and fMRI are two techniques used to collect the brain data before the neurofeedback takes place. EEG data calculates the brain’s electrical activity using electrodes on a person’s head. “We map the activity in the brain by really visualising that activity across all the electrodes in the cap,” Ana Rita explains. By comparison, fMRI involves patients lying down in a bed that slides into a circular scanning machine. It uses magnetic resonance imaging data which measures the level of oxygenation in the bloodstream and the brain. When an area of the brain is more active, it consumes more oxygen to meet the increased demand in blood flow, and that creates a similar kind of “brain map”.
Down the end of the hallway, we turn right into a series of rooms where the lights are turned off. We enter one room, turn the lights on, walk to the back of the room, open the door to enter another room, turn the lights on. Eventually, we reach the “data collection room”. It is separated into two sections with desks that bend along the walls. On the right, there is a built-in wardrobe with floorto-ceiling sliding doors. Ana Rita opens one of the sliding doors to reveal a series of giant Linux computers that store and process large amounts of EEG and fMRI raw data. She tells me that in her current study, she has one-hundred and fifty participants. “The data is so ‘heavy’,” she says, gesturing with her hands in a cupped shape, as if struggling with the weight of something invisible. The data must be pre-processed through the software that she writes before it is ready for interpretation and analysis. That’s where the computers come into play. These computers are not the average monitor interfaces, but the blocky, plastic storage devices that have fans whirring loudly, keeping them cool. Ana Rita tells me that the director of the BDC has named each computer after cricket players because they are so “powerful”. She laughs as she admits that she doesn’t know who the names are, but she doesn’t mind. It strikes me that even in such a sterile, technical environment, the people that inhabit these spaces are just that: people. They might be working on extraordinary, possibly life-changing research, but they have the same interests and downfalls as the study participants they work with.
Another reason that neurofeedback is so little-known is because even within the scientific community, each field is so specialised that it is hard for everyone to have a general understanding of each field. “Different scientific fields speak very different languages,” she observes. Telling me this, Ana Rita sighs, hands fidgeting in front of her. This field of mental-health-related neuroscience, especially, she says, receives less funding because of the “huge cultural baggage which surrounds the research”. This in turn impacts funding. She shrugs. “It’s a bit of a niche field in the neuroscience research field and in translational psychiatry.” People are a bit sceptical about this kind of research, she tells me. I understand, I think – research into the brain has always been highly contested. Research into the illnesses of the mind is difficult, because how do you understand something that you can’t see or touch? Why should we trust this technology?
On average, a new science takes an average of seventy years to become established; neurofeedback has only been “alive” for roughly fifty years. In comparison, psychology as a field of research began in the mid- to late-nineteenth century with the appearance of “alienists” who were doctors that specialised in illnesses of the mind. Mental health as a concept is still, in the twenty-first century, something that is widely misunderstood. Some people still refuse to “believe” in the connection between our physical and mental health; that severe stress can cause ulcers and stomach pains, that depression is linked to a shrinking of the hippocampus (the part of the brain that controls learning and memory). The apprehensiveness and uncertainty surrounding these technologies is unsurprising because there is so much that is unknown, and it is frightening to play around with our brains, that central part of who we are, what makes us us.
The potential for neurofeedback as an intervention is vast and wide-reaching. Dr Barry Sterman’s preliminary research in the second half of the twentieth century showed, for example, that positive conditioning could, over time, promote a sixty-five percent reduction in seizures for patients with epilepsy. Today, it is being investigated as an intervention for neurodiverse individuals, such as those with ADHD and Autism Spectrum disorders. But, Ana Rita is quick to advise me, neurofeedback can be implemented and studied “across a wide range of conditions, and even in ‘healthy’ individuals.” More than that, it’s important to study as an alternative treatment to a range of mental health issues. “When patients are given a treatment, a drug, a medication, they don’t get better,” she explains. “So, what I feel is that patients are seeking for other alternative treatments for their conditions.” So, if it is so important, why isn’t it more mainstream?
The answer is that there is simply a lack of access. One fMRI neurofeedback session can cost between seven- to eight-hundred dollars, accounting for a trained person to activate the exercises and the use of an MRI machine. “And, to have neurofeedback as an intervention”, Ana Rita clarifies, “you would need multiple sessions.” The money is in the research. People are still studying the parameters and boundaries to both the EEG and fMRI processes, still studying what strategies work best for different individuals. The money is in finding the secrets of the brain, because so much of it is unknown. All we can hope for is that in the near future, when the parameters are defined and the strategies established, that this doesn’t develop into something that some people – the kind of people whose names are engraved into the sponsored areas of this building – have easier access to over others.
Ana Rita takes the elevator down from the BDC with me and drops me off at the reception with a wave. As I leave the Research Institute, a father and son walk past the building, and I am reminded of how I first came across neurofeedback. In Richard Powers’s newest novel, Bewilderment, a widowed father in the near-future on a dying earth enrolls his neurodiverse son, Robin, in a neurofeedback trial. The experiment works brilliantly until the funding is lost, and then Robin is undone, lost to the hopelessness of a world that cannot, or will not, save itself. Powers writes: “Every one of us is an experiment, and we don’t even know what the experiment is testing.”