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PATIENT CASES
Important note: Written consent was obtained from patients, and their information has been anonymized.
CASE 1: Learning Disability
A 10-year-old boy, entering 5th grade, was brought in for evaluation due to attention problems that have persisted since childhood. The family stated that they wanted to avoid the potential side effects of medication and therefore considered Neurofeedback therapy as a drug-free method. A reputable healthcare institution they had previously consulted stated that the child was not hyperactive and that the problems could improve over time; however, the family reported that they had not observed any significant progress. The patient had difficulty quickly forgetting what he read, particularly in Mathematics. His writing skills were also noticeably disorganized and poor. Furthermore, he experienced sudden outbursts of anger, was generally in a constant state of irritability, and reported hitting his sibling and father when angry. Following a QEEG neurometric analysis, Neurofeedback sessions were applied to the areas showing deviations from the norm. In the first clinical interview after treatment, it was stated that his attention and academic performance had significantly improved. The family noted that his mathematical learning capacity had improved remarkably, that he understood and remembered topics once they were explained, and that his school performance was evaluated as "super." It was also observed that the patient's self-confidence increased, his relationships with his mother and sibling improved, and he exhibited more patient and cooperative behavior. It was learned that his learning performance in the mathematics lessons he took twice a week was very good, and he scored 100 on exams. The father stated, "Overall, we are very satisfied with this treatment and have recommended it to everyone. We always support your work in Turkey. We have referred many families to you, and their children have also benefited significantly from this treatment." After the completion of the treatment process, the WISC-R intelligence test was administered again 6 months later. The test results, evaluated according to the 1980 Turkish norms, showed a Verbal Intelligence Score of 108, a Performance Intelligence Score of 117, and a Total Intelligence Score of 114. The difference between the verbal and performance scores was found to be 19 points. Compared to the previous evaluation, an increase of 12 points in Verbal Intelligence Score, 1 point in Performance Intelligence Score, and 8 points in Total Intelligence Score was observed. These findings indicate that a significant reduction in symptoms accompanying attention problems and learning disabilities can be achieved; and in some children, the complaints can be largely eliminated.
Adolescent Cases with Learning Disabilities and Behavioral Problems
A 14-year-old male patient, an 8th-grade student, was brought for evaluation at his own request and at his family's suggestion due to attention problems, learning difficulties, and behavioral issues. His mother stated that her son was experiencing serious academic problems and had poor school performance. It was reported that the patient could not maintain attention for more than 15-20 minutes in class, played with school supplies during lessons, and distracted himself by talking to his friends. It was learned that he was particularly unsuccessful in mathematics and English, did not take responsibility for his own affairs at home, and could not spontaneously motivate himself to study. The family stated that he did not talk about his homework when he came home, had a low desire to go to school, and had difficulty learning. It was also stated that the patient constantly experienced anxiety with the thought that he "would not be successful." Behavioral evaluation revealed that he frequently fought with his schoolmates, exhibited physical aggression, and broke the glass of the school door. It was reported that he lied to his family at home, shouted when angry, broke objects around him, and swore. It was understood that he did not follow house rules, insisted intensely to change "no" to "yes," and that his mother often gave in to this pressure. It was observed that the patient attempted to exert significant control over their family in order to have their wishes accepted. The family had previously sought treatment at another healthcare facility, where the patient had been diagnosed with attention deficit hyperactivity disorder (ADHD). Treatment involved two different amphetamine-derived medications (short-acting and long-acting) and an antidepressant. The patient stated that while they could study briefly while using these medications, they did not experience any significant overall benefit. Furthermore, it was learned that the symptoms reappeared once the effects of the medication wore off. According to the family, medication treatment had not resulted in significant improvement in learning difficulties, behavioral problems, and social adjustment. Further investigation revealed that the patient had suffered head trauma from falls on hard surfaces during infancy and again around the age of one. Therefore, a QEEG assessment was conducted to investigate whether the previous head trauma played a role in the attention problems, learning difficulties, and behavioral problems. A review of the NxLink database suggested findings of "Previous Head Trauma" and "Learning Disability." Although the patient had previously been diagnosed with ADHD at another center, the NxLink database indicated that if a true ADHD picture existed in this child, it could be distinguished with approximately 97% accuracy. The WISC-R assessment revealed:
Verbal Intelligence Score: 97
Performance Intelligence Score: 99
Overall Intelligence Score: 98. The WISC-R findings did not support a clear intellectual disability or a classic learning disability. However, the subjective assessments of the patient and their family showed characteristics suggestive of ADHD according to DSM-IV criteria. Furthermore, it was observed that significant oppositional defiant behavior and conduct disorder symptoms should be seriously evaluated. The literature reports that amphetamine-group drugs should be used cautiously in children with conduct disorders; drug efficacy may be lower in this group, and the risk of addiction may increase (Kollins, 2007). Based on all these assessments, the patient was taken for Neurofeedback therapy after discontinuing his current medication. 40 sessions of Neurofeedback were applied to the areas showing deviations from normal in the QEEG neurometric analysis. In an interim assessment during the treatment process, the mother expressed that she was very satisfied with the results obtained. She stated that her son's aggressive behaviors had completely disappeared; that shouting, hitting, and swearing had significantly decreased. The mother also stated that her son, who was previously impatient and overly active, could not focus on any activity for a long time; however, after the treatment, he could maintain his attention for 1-2 hours in front of the television or computer. It was reported that he could maintain his attention for approximately 40 minutes during lessons, that he did not get bored in class, and that he did not talk to his friends. It was also reported that his teacher confirmed these positive changes. In family interviews, it was also learned that:
He became willing to learn,
He started reading books,
He complied with house rules,
He did not act insistently to get his way,
He started taking responsibility,
His sleep pattern improved. The patient stated during the consultations that he enjoys life more and that the forgetfulness problem he experienced before treatment has disappeared. After the treatment, the mother stated that the problems that had persisted for years were largely resolved. It was noted that the child, who had never apologized for his mistakes in the last 3-4 years, is now able to apologize and understand the consequences of his actions. It was reported that family relationships have significantly improved and the home environment has become more peaceful.
The family stated that the child's attention span was now very good, that he/she was fulfilling his/her responsibilities, and that he/she was quite satisfied with his/her current condition. The patient also stated that he/she did not want to revert to his/her previous state. Despite using medication for over a year, such widespread improvement in areas such as behavior, aggression, learning, motivation, adherence to rules, development of insight, and sleep patterns had not been achieved. After neurofeedback treatment, a significant improvement in attention functions was observed by supporting the brain's own regulatory capacity.
WISC-R results before neurofeedback:
Verbal Intelligence Score: 97
Performance IQ Score: 99
Total IQ Score: 98
WISC-R results after neurofeedback:
Verbal Intelligence Score: 96
Performance IQ Score: 105
Total IQ Score: 101. After treatment, an increase of 6 points was observed in the Performance IQ score and 3 points in the total IQ score.
Adolescent Cases with Attention Deficit Disorders and Learning Disabilities
A 15-year-old male patient was brought to our treatment center due to attention deficit, learning difficulties, and sleep problems. The family stated that the adolescent did not come to the center voluntarily, but was experiencing serious problems with studying, learning, and academic achievement. It was learned that the patient, a first-year high school student, could not focus on lessons for more than 15 minutes. When distracted, he reportedly daydreamed in class, doodled in his notebooks, fidgeted, constantly played with his pen, and frequently dropped items from his desk. He spoke in class but could only answer questions when asked. The family stated that the child had failed six subjects and was forced to study at home. He rarely sat down to study on his own, and was not organized or disciplined. He had difficulty reciting what he read, could not express his thoughts in an organized manner, had weak memorization skills, and insufficient academic memory. His handwriting was very poor, he did not enjoy writing, he skipped words when speaking, spoke very quickly, and had difficulty forming proper sentences. It was also learned that he suffered from chronic constipation. The mother stated that she often had difficulty understanding her son's speech and frequently had to ask him to repeat himself. When asked to repeat himself, the teenager would say, "Okay, never mind," and stop talking. In addition, he had difficulty falling asleep, was a very light sleeper, and slept for 3 hours some nights and 8 hours others. It was learned that he had previously received support from a psychologist and had been diagnosed with "attention deficit" by a psychiatrist at another healthcare facility. During this period, he used a tricyclic antidepressant and an antiepileptic drug, and this treatment lasted approximately two years. His medical history revealed that he had fainting spells starting with high fever between the ages of 3 and 7, and had used antiepileptic drugs for four years with a diagnosis of epilepsy. It was noted that he had suffered minor falls, and an EEG examination taken at age 11 was found to be normal. Because the patient's clinical history suggested a learning disability and he had previously been diagnosed with ADHD, a QEEG evaluation was planned. The review conducted in the NxLink database; It was used to evaluate both the possibility of attention deficit hyperactivity disorder (ADHD) and findings of learning disabilities. The database review revealed no findings in favor of ADHD, but findings consistent with learning disabilities were observed. In the WISC-R assessment:
Verbal IQ: 111
Performance IQ: 96
Total IQ: 104. A 15-point difference between verbal and performance scores was considered significant in terms of learning disabilities.
Neurofeedback treatment was planned for the regions showing electrical slowing in the QEEG database review. Due to controlled studies in the fields of learning disabilities and epilepsy, Neurofeedback was considered potentially beneficial for this patient. The family was advised to make some changes in their parenting approaches, and a protein-rich diet was recommended. After 20 sessions of Neurofeedback targeting the regions showing deviations from normal in the QEEG neurometric analysis, the family stated in the first interim evaluation that the adolescent had begun to participate willingly in the treatment and was calmer than before. It was noted that his speech had become more understandable, and he was a better listener and understander of others. The family also stated that his long-standing constipation problem had improved. However, it was reported that his room was still messy, he continued to swear occasionally, and his sleep problems had not fully resolved. In the last QEEG assessment conducted after the completion of neurofeedback sessions, the patient was no longer classified in the "learning disability" group. In the last meeting, the adolescent stated that he no longer received failing grades in any subject and that his attention, which previously wandered within 15 minutes, could now be maintained for 60-70 minutes. He stated that he had passed the math class the previous year, but received a 100 on the exam after treatment, saying, "I studied and understood it." The family stated that their son's impatience and impulsiveness had significantly decreased; he was able to behave more maturely when asking for something or listening to the other person. It was noted that he now prepares his own study schedule and lives his life according to this schedule. It was also learned that he started to take better care of himself, and participated in guitar lessons and sports activities. No medication was used during the treatment, and the family expressed great satisfaction with the results.
The WISC-R assessment at the end of the treatment showed:
Verbal IQ: 108
Performance IQ: 119
Total IQ: 114. Accordingly:
Verbal IQ score decreased by 3 points,
Performance IQ score increased by 23 points,
Total IQ score increased by 10 points. In addition, the difference between verbal and performance scores decreased from 15 points to 11 points. In a phone call with the family two years after the treatment, it was stated that the patient had successfully passed the university entrance exam.
It was learned that the improvements achieved with the treatment were permanent and even increased over time. This suggests that the long-term effects of Neurofeedback therapy are being utilized.
An Adult Case Presenting with Jealousy, Anxiety, and Obsessive Thoughts
A 26-year-old male patient, a college graduate and engaged, voluntarily applied to our center. He stated that he had received music education but was currently unemployed. He expressed that he had lost his dog, with whom he had been together for approximately 17 years, 20 days ago, and that he was therefore feeling down. The patient explained that he did not trust people, experiencing intense distrust and excessive jealousy, especially towards his fiancée. He stated that his fiancée, a university student, restricted his clothing and makeup, causing serious unrest in their relationship, sometimes escalating to physical violence. He said that he constantly monitored his surroundings; when sitting somewhere with his fiancée, he would change seats and try to prevent people sitting opposite them from looking at her. His family also stated that recently, he even reacted negatively to someone looking at his aunt while walking with her.
He stated that he always fixated on someone in every workplace he entered, that he had difficulty forming social relationships, that he could not make friends, and that he mostly spent time at home. He stated that when he gets angry, he shouts and pushes his mother with his hand; however, he did not engage in any behavior such as breaking objects or using foul language. It was learned that the patient has a fear of flying and frequently sees planes losing altitude in his dreams. It was also observed that she exhibited tic-like behaviors such as repetitive hand and facial movements, and touching and rubbing her hands. She stated that she thought her family was talking about her even when they were talking amongst themselves in the kitchen, and therefore she sometimes made paranoid comments. It was learned that her sleep pattern was disrupted; she could only fall asleep around 2:00-3:00 AM and woke up feeling refreshed around 2:00-3:00 PM. She stated that she experienced sudden heart palpitations about 20 days ago, that the palpitations increased when she was excited, and that she developed intense health-related anxieties. She expressed that she had anxious thoughts such as, "Am I suffering from a serious illness?" Upon examination of her developmental history, it was learned that she was born with the aid of a vacuum at 8 months and that her mother fell down the stairs during pregnancy. The patient also stated that she suffered a head injury during childhood. It was reported that her father also had significant obsessive traits in his family history. It was learned that she had received support from a psychologist before applying, but it did not help. She stated that she applied to our center after hearing about neurofeedback therapy from her surroundings and thinking that it might benefit her after researching it online. QEEG analysis was performed to assess electrical activity abnormalities and determine the appropriate Neurofeedback protocol. When the patient's QEEG was compared to that of their age group, the NxLink database suggested findings of "Previous Head Trauma."
For further evaluation, MMPI and TOVA tests were administered. MMPI results showed:
• Psychasthenia T-score: 75
• Hypochondriasis T-score: 71
Neurofeedback treatment was initiated targeting the areas showing deviations from normal in the QEEG neurometric analysis.
In the first evaluation after 20 Neurofeedback sessions, the patient reported:
• That they were more moderate,
• That their jealousy had significantly decreased,
• That repetitive hand-face movements and touching/rubbing tics had disappeared.
However, she described continuing health concerns, such as "my heart rhythm is irregular." She stated that her rhythm Holter monitoring came back normal, but a healthcare facility recommended the use of beta-blockers. During the interview, her pulse was observed to rise to 140, then drop to 120. She described a feeling of warmth and heaviness in her right hand. It was noteworthy that she repeatedly asked throughout the interview whether this palpitation was damaging her heart.
The patient also reported:
• A decrease in her skepticism,
• She enjoys life more,
• Improved sleep patterns,
• She now goes to sleep around 1:00-2:00 AM and wakes up feeling refreshed around 11:00-12:00 AM,
• The end of her fear-filled dreams.
After 40 Neurofeedback sessions, the patient and her family reported that her complaints had completely disappeared. The patient reported that feelings of jealousy had completely disappeared; in fact, her fiancé had even started to complain, "Why aren't you jealous of me anymore?" She stated that her suspicions and health-related anxieties had vanished, and she no longer had any concerns about her health. A repeat MMPI assessment at the end of treatment showed no rising clinical scale. Test results showed:
• Psychasthenia T-score: decreased from 75 to 52,
• Hypochondriasis T-score: decreased from 71 to 50.
A follow-up interview 7 months after treatment showed that the improvements were permanent. It was learned that the patient had started a new job, was working in a senior management position, and was professionally successful. The fact that the patient was leading a more functional, productive, and socially balanced life, and was able to establish a more peaceful relationship with her fiancé, were among the remarkable and satisfying results of the treatment process.
It was evaluated in the...
Adult Case with Alcohol Dependence
A 46-year-old male patient, a university graduate, applied to our center with a history of alcohol addiction that had lasted for approximately 15 years and expressed his desire to receive treatment. According to his history, his alcohol use initially began with the consumption of wine to stimulate appetite, gradually progressing to heavy alcohol consumption throughout the day. He stated that during periods of intoxication, he saw visions that no one else could see and heard threatening voices. He said he had not enjoyed life for about 15 years and had attempted suicide three times in the past. The first attempt occurred approximately 5 years ago. Evaluation revealed no active suicidal thoughts or plans.
The patient also complained of:
* Sleep disturbances,
* Waking up tired in the mornings,
* Significantly low energy levels,
* Lack of sexual desire,
* Attention and concentration problems,
* Shouting when angry. He stated that he could not communicate effectively with his wife and that he had previously sought professional help and received treatment at a center experienced in addiction treatment. However, he expressed concern that he had not benefited from these treatments in the long term and that he would have to take medication for the rest of his life. His history revealed that he had suffered multiple head injuries from falls while intoxicated. At the time of admission, he was taking:
• A carbamazepine-group antiepileptic drug,
• An SSRI-group antidepressant,
• A benzodiazepine-group drug,
• An antihistamine-group drug.
QEEG evaluation showed significantly elevated beta-wave activity and low alpha activity. In such cases, it is thought that some individuals may unconsciously use alcohol as a "self-regulation" tool to reduce excessive beta activity and increase alpha activity in their brains. NxLink database analysis suggested findings related to "Previous Head Trauma."
After starting neurofeedback treatment, the patient stated that he felt better and his self-confidence had increased since he stopped taking his medications. He stated that his irritability decreased, his relationship with his wife became healthier and more peaceful, and his sexual energy increased. The patient said he learned to control his urge to drink alcohol, consuming only 3-4 beers twice during the treatment process. However, his sleep disturbances continued for some time. Additionally:
• Auditory hallucinations ended,
• Visual perception disorders disappeared,
• Attention and concentration increased,
• He was able to read books and newspapers.
Following the completion of 43 Neurofeedback sessions, the patient stated:
• He began to enjoy life again,
• His hopes for the future increased,
• He completely quit alcohol,
• He experienced significant improvements in his work, marriage, and social life.
The patient stated that during the period he was taking medication, his sexual energy was very low and he slept approximately 15 hours a day. After treatment, he explained that his energy increased and his daily functioning improved significantly. He noted that his irritability and shouting behavior completely disappeared; he could now resolve his problems by talking and verbally express when he felt wronged. A significant increase in insight was also observed during the treatment process. The patient expressed this with the following words: “Before, I thought my wife was jealous of me; but I realized that wasn't true. I realized how harmful alcohol is and that I was actually trying to destroy myself with it.” In a phone call two years after the treatment, it was learned that the patient's alcohol-related problems had not recurred since the treatment. He stated that neurofeedback therapy had been very beneficial to him and that he was living a happy, productive, and functional life.
A Case of a Young Woman with Obsessive-Compulsive Symptoms and Anxiety Disorder
A 20-year-old female patient, a primary school graduate, presented to our center with intense obsessive thoughts, mental preoccupations, and attention problems. She stated that she excessively dwelled on certain events, that her mind was constantly "being gnawed at by something," and that she had difficulty controlling her thoughts. She described constantly trying to convince others when explaining something, repeatedly asking, "Do you understand? Do you understand?" She explained that she tried to convince her family that she was in contact with friends, even though she wasn't. She stated that in the last month, her involuntary thoughts, particularly those of a religious nature, had intensified. She mentioned that she sometimes had involuntary blasphemous thoughts and expressions related to God and holy figures, sometimes thinking these thoughts were absurd, but sometimes unsure whether they were. In addition, she described experiencing involuntary thoughts wishing for the death or separation of some close relatives. She stated that she constantly wrote down these thoughts, that she was no longer able to work, that she couldn't focus on anything, and that her concentration had severely decreased. Patient:
Reported that he/she does not enjoy life,
that he/she thinks his/her life is meaningless,
but that he/she does not have active suicidal thoughts,
that he/she sleeps a lot,
and wakes up feeling unrested in the mornings.
He/she explained that he/she masturbated about a year ago and experienced intense guilt afterward; even thinking, "I wish my sexuality would completely disappear."
He/she stated that he/she tends to constantly generate additional thoughts in his/her mind about the programs he/she watches on television, mentally expanding events. He/she also stated that he/she has difficulty walking. It was learned that when he/she gets angry, he/she experiences crises lasting approximately 30 minutes; during these crises, he/she exhibits behaviors such as shouting, crying, and tearing up paper. However, no physical aggression, breaking of objects, or cursing behavior was reported. Hallucinations and paranoid thoughts were not detected. It was learned that the patient has been experiencing obsessive thoughts for approximately 6 years; however, religiously themed thoughts have increased significantly in the last 1-2 months. Upon further investigation of the history, it was learned that:
The patient had suffered several head injuries during childhood,
Haved fallen and hit their head several times,
Been severely injured by balls,
Haved been hit on the head by a swing at age 4,
Haved hit their head again at age 20 and was disoriented.
In the last 6 years, they had received help from various health centers, received diagnoses of psychotic disorders, and:
Used an SSRI group antidepressant,
Two different atypical antipsychotic medications; however, they did not experience significant benefit. The patient had obsessive thoughts; however, it was observed that they had difficulty evaluating the irrationality of these thoughts at certain times. This situation suggested that there might be a psychotic level of thought evaluation disorder.
In pre-treatment assessments:
MMPI test results were: Depression T-score: 87,
Social Introversion T-score: 77
No significant elevation was detected in the MMPI scale related to obsessive-compulsive disorder. TOVA test and blood tests were found to be normal.
Neurofeedback treatment was planned for the patient without starting medication.
In the evaluation after the first 10 Neurofeedback sessions, the patient stated:
That their obsessions had significantly decreased,
That their repetitive questioning of "Do you understand?" had disappeared,
That their sleep pattern had improved,
That they woke up feeling refreshed in the mornings.
They also stated that they were previously overly sensitive to sounds and asked those around them to speak softly; however, this sensitivity had also decreased.
Furthermore:
That they had begun to enjoy life again,
That their anger had decreased,
That their crying, shouting, and paper-tearing behaviors had disappeared,
That their involuntary religious thoughts had significantly decreased,
That they could now more clearly understand that these thoughts were illogical.
In the final evaluation following 90 Neurofeedback sessions, the patient stated:
That her initial complaints had completely disappeared,
That she was enjoying life,
That her sleep pattern had returned to normal,
That she was now confident in her thoughts and actions.
It was learned that her sensitivity towards cats continued; however, it was not at a level that affected her daily life.
In the MMPI evaluation after treatment:
Depression T-score decreased from 87 to 52,
Social Introversion T-score decreased from 77 to 47.
Furthermore, the total obsession score on the Yale-Brown Obsessive-Compulsive Scale decreased from 20 before treatment to 0 after treatment. This result indicated a clinically significant improvement. The mother repeatedly expressed her gratitude, saying she had never seen her daughter so well and was very satisfied with the treatment.
A Case of a Young Woman with Obsessive-Compulsive Disorder and Cleaning Obsessions
A 19-year-old female university student voluntarily presented to our center due to intense cleanliness obsessions that have persisted since childhood. The patient stated that she has experienced obsessive thoughts and compulsive behaviors since approximately the age of 10-11, and that for the past two years she has lost her zest for life and believes that "life is empty." Evaluation revealed no active suicidal thoughts or plans. Due to her long-standing cleanliness obsessions, the patient described:
• Washing her hands repeatedly every 1-2 minutes,
• Consuming excessive amounts of toilet paper and liquid soap,
• Only using towels from the middle drawer,
• Spending 1.5-2 hours in the bathroom,
• Holding her loofah under running water for a long time before soaping it,
• Bathing only once a week under duress.
She also described being excessively meticulous when changing clothes; throwing away some clothes because she considered them "dirty." She stated that she didn't want to go outside due to fear of getting dirty, that she always wore sneakers, and that this even prevented her from participating in social events. She said that she sometimes found her cleaning behaviors exaggerated, but mostly believed they were necessary. She expressed that she didn't want to go to school, had difficulty getting out of bed, and constantly felt lazy. Her mother described how she was very slow when getting ready and sometimes exhibited compulsive behaviors such as:
* Checking the stove,
* Repeatedly checking the door.
Also:
* Uncertainty,
* Repeatedly thinking about whether she had offended the other person,
* It was learned that she had been biting her nails since childhood.
It was stated that the patient did not trust people and had no close friends. It was learned that she had paranoid thoughts that strangers were talking negatively about her. No hallucinations were detected. It was observed that her attention and concentration were low, and her memory was not very good. She stated that she could not maintain attention while reading books and therefore did not enjoy reading. It was stated that he could focus on his favorite subjects for about 30 minutes. When he gets angry, he exhibits shouting behavior lasting approximately 5-10 minutes; however, he does not engage in hitting, breaking things, or swearing. It was noted that he is persistent in turning "no" into "yes" within the family and often gets what he wants.
His birth history:
• The mother experienced a threatened miscarriage during pregnancy,
• The mother had blood pressure problems,
• He suffered a head trauma at the age of 7-8 due to a violent impact from a swing behind his ear,
• He received stitches to his head.
Psychiatric treatment history:
• 75 mg dose of a drug from the Clomipramine group was used, causing excessive sleepiness.
• Later, treatment with a drug from the Fluoxetine group and Thioridazine eye drops was received.
• Symptoms worsened when the medications were stopped, believing they were effective.
• Later, a drug from the Sertraline HCL group was used, but without benefit.
• Finally, treatment with Clomipramine and Escitalopram for OCD diagnosis was received, but symptoms worsened further.
Family history:
• Aunt has OCD.
• Uncle has severe handwashing compulsions.
• A cousin of the father has a history of intense handwashing and OCD.
The patient's clinical presentation included:
• Obsessive-compulsive disorder,
• Psychotic symptoms,
• Effects of previous head trauma.
All of these were considered together. The patient expressed a desire to benefit from neurofeedback therapy.
A QEEG evaluation was performed after discontinuing the medication for seven half-lives. A review of the NxLink database suggested findings related to "Previous Head Trauma." The high burden of OCD in the family history suggested a genetic predisposition. In addition, previous head traumas were considered to contribute to the clinical picture. This situation may have complicated the response to medication.
Additionally, TOVA and MMPI tests were administered. Before treatment, the MMPI showed:
• Psychasthenia T-score: 80
• Depression T-score: 75
In the initial assessment, the mother stated that medication use did not make a significant difference; However, she explained that the paranoid thoughts had decreased and her daughter had partially developed a desire to go outside.
After 10 Neurofeedback Sessions
Mother:
• Her daughter, who previously didn't want to go outside, can now go out,
• Her behavior of changing clothes, which used to be 2-3 times a day, has decreased to once a day,
• The behavior of throwing away clean clothes as dirty has disappeared,
• She can wear the same outfit twice,
• Hand washing has decreased.
It was stated that while she used to use two bars of soap in the bathroom, she now uses only one bar and can even use previously used soap. Paper towels and liquid soap consumption...
It was observed that the person's anxiety decreased. The preparation time sped up; however, it was learned that they still didn't want to get out of bed. Thoughts of uncertainty, nail-biting behavior, and feelings of distrust towards others continued; however, paranoid thoughts disappeared.
Between 20–40 Neurofeedback Sessions
During this period, fluctuations in symptoms were observed. At times:
• Increased thoughts of contamination,
• Continued nail-biting behavior,
• Continued thoughts of uncertainty,
• Continued slowness during preparation.
However:
• Significantly decreased anger,
• Increased attention and concentration,
• Better focus while solving puzzles,
• Decreased fear of going out,
• Significantly decreased frequency of changing clothes.
At the 40th session, the patient stated that their zest for life had returned, their preparation time had shortened, and their feelings of uncertainty were less than before.
After 50-60 Neurofeedback Sessions
At the 50th session, the patient reported:
• Reduced towel and paper consumption,
• Reduced nail-biting,
• Increased attention and concentration,
• Waking up feeling refreshed in the mornings,
• Significantly reduced handwashing frequency,
• Elimination of uncertainty and compulsive behaviors.
At the 60th session, their mother said that they had observed a very significant improvement, especially after the 45th session, and that "nothing was left."
Previously:
• Bath time, which used to last 2 hours, was reduced to 30-35 minutes.
• Excessive use of liquid soap and toilet paper was eliminated.
• Frequent diaper changes had ceased.
Patient:
• She was able to use the towel given by her mother.
• Her trust in people had increased.
• She could sometimes trust men.
• Nail biting had significantly decreased.
• Her attention, concentration, and memory had improved.
Also:
• “Did I hurt the other person?”
• Uncertainty,
• Checking the stove and the door,
• Stubbornness and anger had completely disappeared. During the interview, she maintained eye contact, answered her own questions, and had an energetic and smiling facial expression. No clinically significant improvement was observed in the MMPI assessment performed after treatment.
MMPI results showed:
• Psychasthenia T-score decreased from 80 to 53,
• Depression T-score decreased from 75 to 46.
Yale-Brown Obsessive-Compulsive Scale:
• Obsession score decreased from 24 to 0,
• Compulsion score decreased from 21 to 0. These findings indicated a clinically significant improvement.