If a picture is worth a thousand words, then a brain scan can do more than just show you simple brain activity. Right? At least, that's the hope of many looking to improve their mental well-being using brain mapping and neurofeedback. Brain monitoring therapies such as neurofeedback and scans such as the Single Photon Emission Computed Tomography (SPECT) scan are being used with the promise of helping you visualize how emotional trauma and several mental health issues such as depression, PTSD, and anxiety impact the brain. This, some treatment centers claim, can help doctors come up with a game plan for treatment. Recently, celebrities like Kendall Jenner, Khloé Kardashian, Lili Reinhart, and Bella Hadid have shared their own experiences with SPECT scans — and the general public has become intrigued.
This public interest reflects the rising digital trend in health care of trying to quantify mental health, says Sudhakar Selvaraj, MD, PhD, associate professor of psychiatry and director of the Depression Research Program at the McGovern Medical School at UTHealth Houston. With biological measures like heart rate and step count readily available to be tracked and assessed by anyone with a smartwatch, some people are seeking similar tools to help them understand and calculate their emotional trauma. "A lot more people are suffering. A lot more people want to do better in their existing life. Compared to pulse rate or blood pressure or body weight or a walk count and things like that, we don't have anything equal in mental health," Dr. Selvaraj tells Allure.
Meet the experts:
- Licia P. Luna, MD, PhD, assistant professor of radiology and neuroradiology at Johns Hopkins Hospital.
- Sudhakar Selvaraj, MD, PhD, associate professor of psychiatry and director of the Depression Research Program at the McGovern Medical School at UTHealth Houston.
- Theodore Henderson, MD, PhD, psychiatrist and co-founder of physician clinic Neuro-Luminance Inc.
- Donald Moss, PhD, professor and dean of the College of Integrative Medicine and Health Sciences at Saybrook University.
What is brain mapping?
In general, brain mapping involves taking raw data from neurons and turning it into a visual to show a patient their own brain activity. Licia P. Luna, MD, PhD, assistant professor of radiology and neuroradiology at Johns Hopkins Hospital explains that all neuroimaging (such as a CT scan) can be considered part of brain mapping. "Brain mapping is a type of advanced imaging technique, where images are augmented by additional data processing or analysis," says Dr. Luna. "[Examples include] maps projecting measures of behavior, cognition, language or motor functions [of the] brain regions." While these brain scans don't physically alter your brain, what they can do is give both you and your doctors insight into how your brain is functioning. This info could then potentially aid in treating certain mental health issues.
Neurofeedback is at the core of these treatments. According to Donald Moss, PhD, professor and dean of the College of Integrative Medicine and Health Sciences at Saybrook University, neurofeedback is a form of biofeedback, which utilizes electronic equipment to record brain activity of a patient so their doctors can feed that information back to their patient in real time. Dr. Moss explains that this feedback, along with instruction from their doctor, guides the patient to reduce abnormal brain activity so they can mimic that process in everyday life. During a neurofeedback session, the brain is monitored to see if it reacts positively and negatively to different cues so that the patient can learn to regulate brain function and ease symptoms of mental health conditions. Dr. Moss says this makes neurofeedback a great option for those who have not responded to standard biomedical treatment — such as drug therapy — or those looking for a way to supplement or wean off long-term medication use. "Neurofeedback is regarded as a complementary therapy because it is holistic, unifying mind and body, and engages individuals in actively improving their own health," he says. "It complements mainstream biomedical therapies, producing additional benefits through self-regulation."
What is a neurofeedback session like?
A neurofeedback session can last anywhere from 30 minutes to an hour. Patients will sit, have electrodes attached to their scalp by a cap or band around their head, and perform an activity — think examining graphics or listening to different types of music that evoke different emotions — while parts of the brain are being examined by a physician. Neurofeedback practitioners will use this EEG to identify abnormal brain patterns. Then, the computer program can start directing a patient's brainwave activity toward something more enjoyable through clear auditory or visual signals (i.e. more pleasing images or more serene sounds.) If you are in a state of distress, the auditory or visual signals will be harder to follow. All of this information is immediately given to a patient by the practitioner so that they use it to identify specific triggers and train you to start to develop coping methods and treatment strategies with their doctor for their respective mental health concern.
What is a SPECT scan like?
One common brain scan being used for brain mapping is the Single Photon Emission Computed Tomography (SPECT) scan, which detects brain blood flow and demonstrates brain function. Dr. Luna explains that SPECT scans were originally used to evaluate strokes, seizures, and brain tumors, but that over the last few decades, scientists have used them to study Alzheimer's disease, head trauma, and various psychiatric conditions such as depression and anxiety. SPECT scans, unlike neurofeedback sessions, capture 3D images of the brain and the blood flow in each of its areas for doctors to examine and draw conclusions from.
Theodore Henderson, MD, PhD, psychiatrist and co-founder of physician clinic Neuro-Luminance Inc. explains how SPECT scans work: when neurons in a particular part of the brain become more active (this happens when we think, listen to music, solve a math problem, etc.), the brain burns glucose and oxygen and calls for more blood to flow to that area. As a result, more active parts of our brain get more blood flow, and other areas that aren't active don't. During a SPECT scan, a radiopharmaceutical tracer is injected into the patient's blood through an IV, where those active neurons then pick the tracer up. The tracers, which are now attached to the firing neurons, release gamma rays that can be seen on the scan, which gives the doctor a "picture" of what the brain is doing at that moment.
The process typically takes about 40 minutes. According to the Mayo Clinic, you can expect to lie on a table while a SPECT machine rotates around you to gather the picture taken from tracers. The scan will show which parts of the brain are most active and which ones are less active, which can help practitioners identify certain disorders. SPECT scans are used to diagnose certain types of brain injuries, but Dr. Henderson also points to studies that show the scans can be helpful in the diagnosis of frontotemporal dementia, bipolar disorder, ADHD, and OCD.
Studies have indicated that a SPECT scan is also one of the most reliable brain mapping tools for differentiating between traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD), which can have similar symptoms and therefore be difficult to tell apart using other diagnostic tools. Dr. Henderson explains that, in general, SPECT scans can help either support or rule out an initial diagnosis and lead you on the right path for treatment.
"The more important way to think about a SPECT scan in the diagnostic workup of a patient is that a SPECT scan helps to see if your diagnostic impression is supported by what is actually going on in the brain," he says.
Can these brain scans actually help treat mental health issues?
Research has shown that brain scans such as neurofeedback and SPECT scans are effective in helping diagnose and manage symptoms of certain mental disorders and learning disabilities. One example of this is ADHD treatment. Dr. Moss explains that those with ADHD show "too much slow wave activity" in their cortex, especially along the midline and in the executive control area, or, the prefrontal cortex (a.k.a. the area of the brain that has executive control of our actions). Once patients are assessed, he says studies show that neurofeedback training decreases theta brain waves and increases the fast wave activity found in the cortex. This will then result in training the individual to normalize their activation patterns. Studies have shown that neurofeedback can reduce the onset of seizures and help reduce their severity, and Dr. Moss adds that for people with traumatic brain injuries, neurofeedback can help with more generalized concerns such as improving alertness, memory, and mental clarity. While he says there aren't many large research studies in these areas yet, there are case reports that show these benefits in students.
Neurofeedback has also been used as a tool to treat clinical depression. Experts at Northwestern University have used it to increase activity in the frontal cortex to improve patients' moods and create treatment plans that focus on normalizing their brain activation. That said, some experts caution against solely relying on these brain scans for mental disorders, despite preliminary research that backs up many of the claims for neurofeedback and SPECT scans. As far as some are concerned, there are still no biological tests that can definitively say you have anxiety, depression, or similar health conditions. "I personally do not refer anyone to neurofeedback therapy for conditions like depression, bipolar disorder, psychosis, fear, or anxiety," Dr. Selvaraj says. "I would recommend cognitive therapy, interpersonal therapy, or behavior therapy [for these conditions]."
These brain scans may not be for everyone.
According to Dr. Moss, anyone with known seizure disorders, migraine headaches, or a traumatic brain injury should take extra care to consult with their physician to ensure that it is completely safe for them to do, even though monitoring brain activity has minimal risk. For all patients, there can be minor side effects such as increased anxiety, headaches, faintness, or fatigue. Dr. Henderson explains that while tracers contain a small dose of radioactive technetium, which emits gamma rays, those tracers can be flushed from the body with fluids, adding that the tracers used in SPECT scan perfusions have been used for over 20 years with no evidence of allergic or adverse reactions. All this said, anyone considering a brain scan as treatment should always consult with a licensed professional before scheduling an appointment. Dr. Moss recommends this database for practitioners that are accredited with the Biofeedback Certification International Alliance (B.C.I.A.) program, but so far there isn't a formal certification process that’s accepted industry-wide.
It's important to note that some experts are still dubious of these brain mapping claims in general. "Neurofeedback uses the EEG waves [and] there are thousands of EEG studies, but none of them are clearly diagnostic to diagnose any particular psychiatric condition," says Dr. Selvaraj. "I think they are useful as a research tool in research studies, but we haven't got like, 'Come and do this test. You will have a diagnosis of XYZ.'" He goes on to explain that this kind of neurofeedback hasn't gone through rigorous clinical trial protocol. "Many of these so-called clinics are running with thin evidence [and] without any stronger scientific analysis and peer-reviewed data," he says. “That is a bigger problem.”
He adds that he isn't completely discounting the use of neurofeedback or other brain scans, as he says that in controlled instances it does prove to be effective. He just believes that more rigorous research is required before making such bold claims about the scans as mental health treatments: "There's a lot of misinformation online. I do not want these patients who have already gone through a lot of suffering and trauma to get [misled] and then not get the right treatment," he says.
Dr. Luna explains that many advancements have been made to make scans like SPECT scans more reputable, and that "the idea of including such a test within diagnostic criteria for certain mental illnesses becomes increasingly plausible" as technique and research studies continue to advance.
“Some people just want to see how their brains are working. They want to do anything they can to improve their lifestyle and efficiency," adds Dr. Henderson. "I don't object to that choice."
This article was originally published on Allure.