Monthly summary of general news, case histories,
and introductory articles about neurofeedback
for the interested layperson
Vol. 5 No. 1 - January 2002
Past issues are available at www.eegspectrum.com/news/
Copyright (C) 2001 by EEG Spectrum International. All rights reserved.
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Clinical Interchange Conference, Oxnard, CA, October 20-22
EEG Spectrum holds an annual conference for its affiliates, called the Clinical Interchange Conference. This is a brief report on what transpired at the eighth such conference, held at the Mandalay Beach Resort in Oxnard, CA, with more than two hundred network clinicians in attendance. What distinguishes this conference from other neurofeedback conferences is the fact that everyone is largely speaking out of one neurofeedback paradigm. This may be limiting in one sense, but it is liberating in another. Everyone starts with a common set of assumptions and shared perceptions, so that conversations can be very efficient in sharing information. Also, the more basic fissures within the field were submerged. From this vantage point, we were able to address the theme of the Conference, "The Brain and Body in Balance." What is it that neurofeedback is best suited for, and what else should we be attending to?
Our keynote speaker was supposed to be Dr. George Solomon, one of the leading figures in the field of psychoneuroimmunology. But he died unexpectedly two weeks before the conference. Candace Pert was also our guest, and she pointed out that only two percent of information transfer in the brain occurs via the synaptic transmission that is our total concern in neurofeedback. That should help us keep our perspective! Helen Irlen presented on her work with Scotopic Sensitivity Syndrome, which is an overload condition on visual processing networks that we have not found how to remediate with neurofeedback to date. Unremediated, it keeps us from reaching our objectives with neurofeedback. Our own Harold Burke complemented Helen Irlen with a talk on the organization of visual processing in the brain. Dr. Joshua Prager presented on comprehensive approaches to the treatment of chronic pain, with the inclusion of neurofeedback. Dr. Karl Pribram was also with us to kibbitz.
Rollin McCraty of HeartMath made the case that the heart appears to have a mind of its own. At a minimum, it reveals itself more clearly through direct monitoring rather than through looking at EEGs. Whereas neurofeedback is a wonderful training tool, often the immediate effects on the EEG are more subtle and obscure than the effects on function. Other measures are needed. Here’s also where the autonomic measures come in. Whether or not one uses these for reinforcement, they are available as indices of subtle state shifts and hence can guide our training even in those situations where a person is not a good reporter of his or her own state. McCraty made the case for direct training of Heart Rate Variability, also known as Respiratory Sinus Arrhythmia.
With respect to neurofeedback per se, Sue Othmer took the leap of faith and announced that the priority in training should be to address the instabilities through inter-hemispheric training rather than with the hemisphere-specific (combination of left- and right-hemisphere training) that we had been recommending to date. And even when instabilities are not an issue, inter-hemispheric training can still be a useful starting point. This in turn leads us to full two-channel training as a mainstream approach, although we will for some time to come teach only single-channel training at our Comprehensive Course so as to limit the complexity confronting new practitioners. The preoccupation of our Advanced Course will be with the fuller implications of inter-hemispheric, and hence two-channel training. The abiding theme of our work has been around hemispheric differences in training. Now the perspective shifts to the mode of interaction between the hemispheres, and how their activities are coordinated. It should not be a surprise that this is an issue. The two hemispheres process information differently, which entails different organizational schema. Sharing information across the hemispheric fissure is therefore problematic, requiring its own distinct rules, and suffering its own particular shortcomings.
Another major push has been in the direction of lower-frequency training. This has also been a surprise, and perhaps a disappointment to those who had hoped that our protocol approach to date was given ex cathedra. Perhaps this still fits into the arousal disregulation model, perhaps not. In any event, it appears to be helpful to train to organize the very low frequencies in such disorders as bipolar disorder, autism, Reactive Attachment Disorder, and cerebral palsy! In fact, the lowest-frequency training to date has been done with cerebral palsy. The "regulatory challenge" of bipolar training across the hemispheric fissure is not intended to increase EEG amplitudes per se, which might be problematic, but rather to organize the timing relationships between the hemispheres. This issue will become clearer when direct comparison is made between bipolar training on the one hand and two-channel synchrony or comodulation training on the other.
The third major initiative has been to clarify frontal training. Here the inter-hemispheric bipolar training has also made its mark, being more stabilizing with respect to the classic hemispheric sensitivities that plagued us in the past. Long-term practitioners in our network recall that we pretty much put a fence around Fp2 because of difficulties with emotional disregulation that we sometimes encountered there. Yet training the timing relationships vis-à-vis Fp1 appears to be a fruitful and relatively benign undertaking. The differential effects of training at Fp1-Fp2, F3-F4, and F7-F8 have been explored.
Siegfried Othmer’s keynote address cast the net more widely. Whereas much of our training is oriented toward devising protocols that can be used for thirty minutes without hazard, and hopefully many times over, the history of techniques similar to ours is full of instances of rapid healing, brought about presumably by a sudden reorganization of brain function. Most of these techniques have a disturbing tendency to be unpredictable in their outcomes. But what if we could discern how to move the brain significantly and yet predictably toward improved organization? The existing neurofeedback protocols move the brain gently toward more controlled states. In state space, the desired states are nearby. We can get to them incrementally.
But what if the more appropriate state is on the other side of a potential barrier of the brain’s own making? We may not be able to get there as readily or at all through gentle nudges. ECT represents the extreme end of a set of techniques that attempt to promote fundamental brain reorganization in singular events. Similarly, dramatic change in one or two sessions has been reported in LSD experiments, holotropic breathwork, EMDR, and in alpha-theta work. In the latter, we expect to work over many sessions. But often the client will recall a particular session, or part of the session, as being critical for the healing that occurred, and may describe that episode as transformational. The electromagnetic stimulation techniques sometimes produce startling clinical results in mere seconds of exposure. Is there a neurofeedback technique that moves the brain compellingly but benignly to reorganize itself? I expect that there is an entirely new frontier available for us as we explore the larger reaches of the envelope of stability of persons undergoing training, so long as we are willing to shed the ground rule of protocols that are consistent with steady-state training.
Ranging even further afield, and upon reappraisal of our human condition in the shadow of September 11, the point was made that a number of well-documented phenomena such as remote viewing and other forms of trans-personal communication (common-place in alpha-theta training, in holotropic breathwork, and between twins) cannot be understood within the framework of our current science. The mechanism seems to lack the expected dependence on distance, ruling out conventional energetic models. Even quantum-mechanical non-locality is a stretch when it comes to trans-personal communication between Los Angeles and Chicago. It appears therefore that the case for a "spiritual" dimension of the universe, to use a conventional shorthand, can be made even from within science itself. Whereas this may not have direct implications for our protocol decision tree, our organization should provide a safe harbor for the discussion of such issues, without derision, denigration, or arbitrary exclusion. Moreover, it is clear that for many of our clients, the real issue is a spiritual one, in their own conceptual framework, and that perspective needs to be respected regardless of the therapist’s personal orientation.
It is so striking that neurofeedback is applicable to the entire hierarchy of healing, from the cerebral palsy child to the spiritual seeker. Within our son Brian, these issues were thoroughly intermingled, as his disregulated brain brought up issues about who he was that an eight-year-old child normally does have to confront. So often a health crisis also involves a spiritual crisis for the individual. I am mindful of the fact that this field was brought to grief initially by having EEG feedback tied up with psychedelics, and talk of altered states, etc. But we should take the evidence where it leads us. Science has advanced from the box where Logical Positivism constrained it at the beginning of the twentieth century to where conceptions of consciousness and the emotions are viable subjects of scientific study. The realm of spirituality is next. Certainly in our clinical perspective the spiritual impulse is our legitimate concern. Our work is ultimately not about symptom relief, but healing, and the spiritual dimension of the healing process needs to be affirmed in order for us to do our best work. This is the type of intellectual frontier about which Francis Bacon wrote: "The world is not to be narrowed till it will go into the understanding….but the understanding is to be expanded till it can take in the world."
Society for Neuronal Regulation Conference, Monterey
At the SNR Conference all of the major approaches to neurofeedback were in contention, ranging from the QEEG fundamentalists on the right to the dynamic normalization schemes of Val Brown and Chuck Davis’ Roshi on the left. Together with the ECNS Conference beforehand, it was an intellectual feast. Jon Frederick talked about the effects of audio and visual stimulation. Whereas there is little residual in the EEG upon stimulation at various frequencies, a decrease in delta coherence is observed. A decrease in coherence at the lower frequencies could be what we are achieving with our inter-hemispheric bipolar training as well. Juri Kropotov of the Institute of the Human Brain of the Russian Academy of Sciences showed data taken with their QEEG instrument while beta and SMR training are being done. Indeed a peak in the beta regime was observed during the actual training at C3. But of course, as we know, there is not typically a discernible residual after training. Likewise, light and sound stimulation are capable of yielding TOVA improvements, but the residual in EEG terms may be difficult to pin down.
This all argues in favor of the nonlinear dynamical model of brain function that Val Brown has been promoting. The nonlinearity in brain function starts already with the action potential, the generation of which is highly non-linear. So the nonlinearity of brain function itself is not news. What is more amazing is how far we can get in our work with the linearity assumptions that underlie our frequency-based analysis.
Our own view falls in the rational middle between the two polarized perspectives on neurofeedback. On the one hand, we take seriously all of the features revealed by QEEG analysis that are reported, and we attempt to give them a mechanisms interpretation, and then to incorporate them somehow into a mechanisms-based training schema. In this manner, QEEG findings of a disconnect syndrome at F3 have shifted our attention to include F3 in our approach to depression. Occasional QEEG findings for Reactive Attachment Disorder at F6 suggest that that site be investigated routinely in work with RAD. Clinical results will immediately tell us whether that is productive. QEEG data are clearly influencing the evolution of our mechanisms-based approach.
Val Brown has moved more toward EEG training in the abstract, independently of any connection with specific symptoms, on the one hand, or with static EEG data on the other. By keying on dynamic EEG features across the entire frequency spectrum, Val believes that the indices of disregulation are sufficiently observable at the standard sites of C3 and C4 so as to render training at other sites superfluous. Cuing people on all these indices concurrently, it is postulated, can move people gently toward self-regulation. He is decoupling training from the induction of state change, whereas we use state change as an index of training. Chuck Davis was at the conference with his new Roshi hardware, and we need to include his method within this same general model. Chuck does not need to ask in what manner your brain may be failing you. He simply sticks the brain in the feedback loop and trains away….
Knowing what we know about the specific efficacies of training at FP1 and FP2, F3 and F4, F7 and F8, as well as T3 and T4, T5 and T6, and in particular FPO, it is unlikely that we will ever collapse back to a sole preoccupation with C3 and C4. Similarly, it is unlikely that someone who has taken a bite of the QEEG apple will ever abandon it again for a purely mechanisms-based approach. All three approaches cover a lot of bases, although none covers them all optimally. So we are caught in an inflationary era where there will be lots of approaches to neurofeedback, and none will win the field entirely.
We have made a number of adjustments in our approach that accommodate emerging data from QEEG analyses, as already suggested above. This involves principally training at new sites and with more targeted inhibit bands. We are also making adjustments to accommodate the nonlinear dynamical model. Several new feedback modes are being implemented for our existing software that either target the EEG broadly or treat the EEG within the reward band differently.
One other notable development is that Jan Hoover of J&J is developing a Quantitative EEG System for the neurofeedback community, one that Thought Technology will be marketing. Jan and Barry Sterman presented on this development the day after the conference.
News & Reviews
NEW BOOKS
Kevin and Me : Tourette Syndrome and the Magic Power of Music Therapy
by Patricia Heenan
How To Keep Your Kids Off Drugs
Coping With Tourette Syndrome and Tic Disorders
Adolescence and Chronic Fatigue Syndrome
Survival Strategies for Parenting Children with Bipolar Disorder
Epilepsy and Seizures: Everything You Need to Know
Drugs and Society
A Controlled Study of Cognitive Deficits in Children With Chronic Lyme Disease.
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Children with Lyme disease have more cognitive and psychiatric disturbances even after controlling for anxiety, depression, and fatigue.
Suicide in mood disorders.
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Mood disorders in children and adolescents are frequently underdiagnosed, misdiagnosed, and undertreated.
Long-term outcome in 306 males with alcoholism.
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Age (20-39 years) and receiving outpatient treatment at initial treatment predict survival.
Disinhibitory psychopathology: discriminating conduct disorder from ADHD
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Physiological measures are used to discriminate and understand rates of comorbidity between CD and ADHD.
Long-term outcome of cognitive behavior therapy versus relaxation therapy for CFS
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Cognitive behavior therapy improves chronic fatigue syndrome symptoms to a greater extent than relaxation therapy but the lasting benefits were only moderate.
Personality dimensions in pathological gambling disorder and OCD
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Pathological gamblers may differ from OCD patients and normal controls on personality, exhibiting greater novelty seeking, impulsiveness, and extravagance.