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 individuals 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

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=P1P1
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

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 (Pavlovs 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 Stermans 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)

Stermans 1967 Study for NASA

Cats exposed to rocket fuel

EEG Frequency Training Bands

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:

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

which involves establishing optimal rhythmic and

tonal parameters, creating meditative conditions
based on an individuals 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 ones 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 patients 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

4
2

3,9
3,8
1

1
3

1-7)
P2 personal BMT
(days 8-14)
P3 placebo BMT
(days 15-21)
BMT improves a
patients 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:

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

didnt 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,

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:

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,

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

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

(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-

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

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

Repeated measures open trial with 3

assessment points:
Baseline (includes BMT training session)
3 and 6 week follow-ups

Measures:
Pittsburgh Insomnia Rating Scale
Spielberger State-Trait Anxiety Scale (STAI)
NEO-FFI personality scale (BL only)
Sleep diary (quantity/quality)
Daytime Functioning Scale

Hypotheses

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

Inclusion/Exclusion Criteria

INCLUSION
CRITERIA:

Healthy
Ages 18-75
Primary insomnia
Significant anxiety
Willing to sign
informed consent

EXCLUSION CRITERIA:

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

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

18

11

14

FAMS

24

21

19

47

15

32

38

Controls

Test Pop

39

13

26

33

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

Post-Pre
Post-Bl
Post-Avg
Linear (Post-Pre)

0
1

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

Difference

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

0
1

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

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

Difference

0
1

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

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