An interview with occupational therapist and certified neurofeedback therapist Thomas Theis.

BEE Medic: Good afternoon, Mr Theis. We are grateful to you for taking the time to talk to us today. Could you please briefly introduce yourself and explain what your job entails?

Thomas Theis: Of course, and thank you for inviting me to this interview. My name is Thomas Theis. I have been working as a state-certified occupational therapist since 1999. I opened my own practice in Kassel in 2005 and another one in Vellmar, North Hesse, in 2014. Our team currently consists of 25 employees. In addition to the traditional occupational therapy treatment fields such as neurology, paediatrics, psychiatry and orthopaedics, we have also focused on other specialised areas such as guideline-compliant, certified hand therapy and Bowen therapy. Another significant focus of our work is the application of ILF neurofeedback, an area in which we have in-depth expertise. My involvement with this topic began almost a decade ago, and I started my formal training in 2015. Shortly afterwards, team members also began to take part in relevant further training and by 2017 I had completed my certification as a neurofeedback therapist according to Othmer. Since then, I have been a member of the European lecturer team, giving lectures and offering training at various levels, such as basic, advanced and specialised courses. Nine neurofeedback systems are in operation in our practices, showing considerable success and effectiveness. As an official supervisor, I supervise colleagues both in my own team and in the network of ILF therapists here and in other German-speaking countries.

BEE Medic: You mentioned that neurofeedback is part of your therapeutic programme. Can you explain what is meant by neurofeedback?

Thomas Theis: With pleasure. Neurofeedback is a specific form of biofeedback. In biofeedback, physical parameters such as pulse, heart rate variability or skin conductivity are reported back. In neurofeedback, we use electroencephalography (EEG). This involves the measurement and feedback of changes in certain brain activities. In our practice, we specifically use ILF neurofeedback, a method developed by Sue and Siegfried Othmer and technically enhanced since 2004 by Dr Bernhard Wandernoth and his team. ILF stands for ‘Infra Low Frequency’, i.e. very low frequencies.
This approach involves placing electrodes at specific head positions according to evaluated dysregulations that emerge from the patient's medical history. Three to five electrodes are sufficient to measure the brain waves. The continuously recorded data is analysed on the computer and special filters extract relevant features, which are then visualised on a screen. This makes it possible to visualise the continuously changing brain activity almost instantaneously. The brain recognises and interacts with its own activity; the brain recognises itself as if in a mirror image. Brains are self-regulating systems. The type and nature of brain activity depends on the challenge situation. Neurofeedback is therefore an integral part of a comprehensive treatment concept not only for healthy people to improve performance, but also for patients with conditions such as depression, attention deficits or post-traumatic stress disorder.

BEE Medic: Now that you have informed us in detail about neurofeedback, could you explain how you use neurofeedback specifically in your practice?

Thomas Theis: Of course. In our practice, neurofeedback therapy is a central component of our therapeutic portfolio. We often integrate this method in combination with other therapeutic approaches, particularly in the psychiatric and paediatric fields, in order to promote concentration and impulse control in children. This is accompanied by behavioural therapy-oriented work with the parents. Neurofeedback is therefore a fundamental part of our daily therapeutic practice for a variety of clinical pictures.

BEE Medic: Can you specify for which patient groups you use neurofeedback and for which you might not?

Thomas Theis: In occupational therapy, specific therapies are prescribed in a targeted manner. Neurofeedback is used when the self-regulation of the central or autonomic nervous system is impaired. Typical indications include attention deficits in children, adolescents and adults, with or without hyperactivity, as well as self-regulation disorders such as epilepsy, migraines, panic attacks and post-traumatic stress disorder. Support from specialised trauma therapists is essential, especially in the context of trauma. We attach great importance to interdisciplinary co-operation. The decision as to whether neurofeedback will be part of the therapy plan is made in the initial consultation and is based on a careful medical history.

BEE Medic: What experiences have you had with neurofeedback so far?

Thomas Theis: The results are consistently positive. An internal evaluation in 2019 showed that the symptoms of patients using neurofeedback improved by around 50 per cent on average, which is statistically highly significant. We also observe improvements in impulse control and increased reaction speed. There is a great deal of interest within the team; many have completed relevant training courses and we are constantly benefiting from mutual exchange. I personally find the effectiveness of neurofeedback very impressive.

BEE Medic: How can neurofeedback be integrated into various occupational therapy approaches?

Thomas Theis: Neurofeedback can be used, for example, as part of hand therapy to modulate an excessive reaction of the autonomic nervous system, especially in cases of Sudeck's disease, which is also known as sympathetic reflex dystrophy. In trauma therapy, it supports the recovery of calm states in cooperation with psychotherapeutic trauma therapy, and in child and adolescent psychiatry it can be effectively combined with group therapies or special training programmes such as MST, THOP and Attentioner. Neurofeedback is a flexible tool that helps to optimise treatment outcomes in therapeutic practice.

BEE Medic: What do your patients say about their experiences with neurofeedback?

Thomas Theis: The feedback has been very positive for the most part. I am currently finalising a retrospective study with the BEE Medic scientific team, with well over 300 data sets. The effect sizes are remarkable. Patients often still remember the therapy years later and express their gratitude. Only a very small proportion of patients do not respond or respond only weakly to the treatment; in such cases we look for alternative approaches. Children are also very enthusiastic about neurofeedback; they look forward to every session and often don't want it to end.

BEE Medic: As a therapist, do you see personal benefits from neurofeedback training?

Thomas Theis: Absolutely, I appreciate the scientific methodology and the opportunity to optimise physiological processes. Working with neurofeedback offers a new dimension to occupational therapy that is analytical, combinable and at the same time extremely effective. It enriches my therapeutic practice considerably and is a source of great enthusiasm for both patients and the therapeutic team.

BEE Medic: Thank you very much, Mr Theis, for your time and the profound insights into your work with neurofeedback.

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