I recently received a query asking for the "established biofeedback measurement readings that demonstrate that an individual is afflicted by brain-wave abnormalities that would be treated by biofeedback therapy."
As I see it, this is a key misunderstanding in the field of EEG biofeedback -- that symptoms must be present in the same domain as the treatment modality. I can think of no other form of therapy burdened with such a coupling. Are depressed patients treated with ECT because they exhibit a reduced amount of electrical activity in their heads which ECT provides? Are ADHD children treated with Ritalin because blood assays show neurotransmitter depletions or behavioral tests indicate childhood deficits in pill-taking ability?
Performance tests, paper-and-pencil surveys, and interviews sufficiently classify most DSM IV conditions today. (Epilepsy and traumatic brain injury may be some of the exceptions). In the future, EEG assessment will assist differential diagnoses, but current state-of-the-art EEG technology is limited in its diagnostic effectiveness. Nonetheless, I imagine a day when qEEG assessments will inform psychiatrist how much Ritalin they should prescribe to ADHD subtyped children. And for those psychiatrists with a clear understanding of prefrontal lobe deficits (i.e., ADHD), they will direct such children to so many sessions of EEG biofeedback under a particular protocol. But that day is still 2 to 3 years away.
From what I can gather from the literature, only 70% of ADHD children exhibit EEG abnormalities (e.g., unusual amounts of frontal theta). Now, ADHD children who exhibit EEG abnormalities probably do differ from ADHD children who do not in terms of prognosis and etiology, but that does not preclude a single treatment being effective for both e.g., Ritalin or neurofeedback). EEG abnormalities may eventually be used to select the optimal treatment for these ADHD psychophysiological subtypes, but if your child shows normal frontal theta activity, should you ignore his/her psychiatrist's diagnosis of ADHD? If you are depressed but do not show increased right frontal medial activation, does that mean you do not suffer from depression?
The real problem with qEEG assessment is that it is still in the exploratory phase. qEEG is a statistician's dream -- numbers by the pound! And every measurement mitigated by a host of arbitrary segmentations of the EEG signal. There is so much involved in the EEG signal, so much information about a client's condition, that until more research is done, qEEG assessment remains a scientific art.
Do I mean to say that qEEG assessments are meaningless and useless?
No, but when someone speaks of qEEG assessment today, the method typically used is spectral analysis of the EEG signal. Spectral or periodic analysis of the EEG has some validity as the EEG signal is periodic at times (e.g., alpha bursts), but EEG is often non-periodic and nonstationary and these transient and variable elements of the EEG signal are ignored by spectral analysis. Even the periodic elements such as the sinusoidal waveforms of alpha activity appear in irregular bursts. Most analyses gloss over the wax and wane and produce an average value for 30 sec to 20 min. Well, the wax and wane is important. Measuring the envelope of the alpha activity's amplitude is a simple procedure and it holds promise. If each week a dozen papers are published on cosmic topology, why aren't a dozen articles published on alpha periodicity each year?
qEEG assessment is fraught with necessary conventions -- as all measuring techniques contain. From integer-bound frequency ranges to convenient referential montages to simple baseline tasks, every piece of the puzzle is a compromise between reliability, validity, and economy. However, nature rarely follows human conventions. Rather than imposing our artificial mathematical schemas on the EEG signal, for instance, we should attempt to identify the organizational elements inherent in electrophysiological signals. Investigation of neural networks and how they organize themselves into inhibitory modules might reveal fundamental temporal elements of connectivity that have eluded us so far. (See Dynamics of the brain at global and microscopic scales: Neural networks and the EEG [http://www.cogsci.soton.ac.uk/bbs/Archive/bbs.wright.html] by Wright & Liley.) As for baselines, does one identify attention deficit in a child when he is asleep? Do parents become concerned about their child's learning abilities or mood when s/he is relaxed and watching TV? Using eyes closed conditions for baselines is a compromised where reliability (and ease of acquisition) won out over validity. Baselines conditions should be during challenging conditions -- as they are acquired in the behavioral realm. Challenging the individual with mental rotation or comprehension reading is easy to implement and should be used for identifying disorders. What is most disturbing about state-of-the-art qEEG assessment is how few people are working on improving and refining these methods? Even if they number 100 it is too few given the promise of this relatively inexpensive yet delicately sensitive technology.
I once read a Newsweek article in which EEG was described as the grandfather of neurological tools. The article fawned over SPECT, SQUIBs, MRI, PET, and other Hall of Justice acronyms. But these techniques are too expensive and lack the portability and temporal resolution offered by EEG. The ultimate outcome will again be a compromise between reliability, validity, and economy and ultimately many of these measurement techniques will be used in conjunction with one another -- and I suspect qEEG will always be included in the mix.
Here is my final pronouncement on qEEGs and neurofeedback:
qEEG assessments are NOT recommended...
Should I look for EEG abnormalities or not before doing EEG biofeedback? Would you ask the same question of yourself before taking a new medication? qEEG assessment can be particularly useful in selecting protocol for EEG biofeedback, and in the near future it will be particularly useful in differential diagnoses and selecting other treatment modalities, but in the mean time, qEEG should be used for protocol selection only and not diagnosis.
NEW BOOKS
The A.D.D. Book : New Understandings, New Approaches to Parenting Your Child With A.D.D
by William Sears, Lynda Thompson
Hardcover, 224 pages, published by Little Brown & Co., March 1998, List: $37.95
Sears and Thompson offer parents dealing with an ADD child an effective choice for treatment in neurofeedback and a refreshingly positive, supportive way for such parents to contemplate their challenging children. They emphasize qualities such as creativity, spontaneity, focus, and high energy in ADD children.
For more information, see www.amazon.com/exec/obidos/ISBN=0316779385/
A History of Psychiatry : From the Era of the Asylum to the Age of Prozac
by Edward ShorterPaperback, 448 pages, Published by John Wiley & Sons, March 1998, List: $19.95 A concise history of madness and its treatment for the past 200 years in the US and Western Europe, essentially the history of biological psychiatry. A psychopathology "Descent of Man." From the 18th century to the present, the source of mental illness devolves from the spiritual (demonic possession), to the psychological (e.g., id disorders) to the physical (neural dysfunction).
For more information, see www.amazon.com/exec/obidos/ISBN=0471245313/
Drug Addiction and Its Treatment: Nexus of Neuroscience and Behavior
Edited by Bankole A. Johnson & John D. Roache.448 pp., Lippincott-Raven, 1997. $125.
The editors examine the behavioral and biological processes involved in drug addiction and suggests ways of integrating behavioral and pharmacological treatments. The book is divided into four sections: "Behavioral Processes," "Neurobiological Processes," "New Horizons in Neuroscience," and "Treatment Application." The third section in particular may be of interest to neurofeedback clinicians as they describe state-of-the-art research techniques for studying the neurobiology of drug addiction including topographical brain mapping.
For more information, see http://www.nejm.org/public/1997/0337/0015/1094/1.htm
JOURNAL PAPERS
Differential resting quantitative electroencephalographic alpha patterns in women with environmental chemical intolerance, depressives, and normals.
Bell IR, Schwartz GE, Hardin EE, Baldwin CM, Kline JPBiol Psychiatry 1998 Mar 1;43(5):376-388
Correlation of developmental neurological findings with spectral analytical EEG evaluations in pre-school age children.
Schmid RG, Tirsch WS, Reitmeir PElectroencephalogr Clin Neurophysiol 1997 Nov;103(5):516-527
Lateral preference in post-traumatic stress disorder.
Spivak B, Segal M, Mester R, Weizman APsychol Med 1998 Jan;28(1):229-232
Authors depict a possible hemispheric imbalance in PTSD patients, with the right hemisphere playing a more active role in perceptual & cognitive processing & in regulation of biological responses.
Effects of attention training on hypochondriasis: a brief case series.
Papageorgiou C, Wells APsychol Med 1998 Jan;28(1):193-200
Attentional training produced clinically significant improvements in self-reported measures of affect, and illness-related behaviour and cognition.
Effectiveness of attention training in schizophrenia.
Medalia A, Aluma M, Tryon W, Merriam AESchizophr Bull 1998;24(1):147-152
Attentional training remediated a core attention deficit in chronic schizophrenia as well as improving psychiatric symptoms of this condition.
MEDIA REPORTS
- Michigan ranks third in nation in prescribing Ritalin
Some say schools turn to medication to control students- Ritalin's routine use raises alarm over diagnoses, goals
Critics say most students are misdiagnosed by doctors who work with teachers to keep unruly children in line. Others call the drug a godsend that has helped those with attention deficit concentrate.- Use of Ritalin in school nearly 'out of control'
Some see giving drugs as quick, inexpensive fix to deeper problem- Drug helps some, but no one is sure how it works
Experts' best guess is that it lets brain control impulses.- Parents face painful decision of putting their kids on Ritalin
Medicine is not always the best answer- Concerns: A Detroit News Panel Discussion
Struggle for self-esteem, stigma of drug duel in students' minds - Ritalin's routine use raises alarm over diagnoses, goals
Over 100 individuals sent email responses to these articles -- and these can be read online. Partly in response to this series, the Michigan state legislation drafted a bill to (1) look into the overprescription of Ritalin and (2) fund alternative treatments for ADHD/ADD.
Our Children On Ritalin [http://detnews.com/1998/metrox/ritalin/]
Readers debate Ritalin's merits [http://detnews.com/1998/accent/9803/31/03310085.htm]
Senate OK's studies of high Ritalin use [http://detnews.com/1998/metro/9803/25/03250108.htm]
Moyers on Addiction: Close to Home
Premiering Mar 29, 1998 on PBS
Journalist Bill Moyers examines addiction and recovery in America with the five-part series.
PBS has a web companion piece which features original reporting.
- Portrait of Addiction: Testimony and interviews from 9 recovering addicts.
- Science: The Hijacked Brain: The latest scientific advances in understanding and treating addiction, plus animated illustrations of the brain and the mechanism of drugs in the body.
- Treatment: Changing Lives: How treatment works, types of treatment, profiles of selected programs, and questions to ask.
- Prevention: The Next Generation: What works and what doesn't, who is at risk, and how we can protect our children.
- Policy: The Politics of Addiction: Current policy, controversial issues, and what you can do to help.
Mental Health WiseWire
WiseWire is a service that constantly scours the Net and other electronic news feeds to find documents on specific topics. Documents include Web pages, newsgroup postings, press releases, and documents from Reuters and Associated Press. Topics include Mental Health, ADHD, and other relevant topics. This service lets individuals rate the usefulness of each source and constantly adjusts the ranking of documents in a topic in response to viewer ratings. In this fashion the most appropriate documents in ADHD or Mental Health, say, rise to the top. In fact Neurofeedback Today is listed as the most important source for ADHD information according to this service ("Best of All Time" #1 ranking).This service is particularly useful in ferreting out newspaper articles on topics such as ADHD. The Net needs a central newspaper search engine that can organize articles by topic. NewsWorks [www.newsworks.com] allows a search of 140 newspapers, but the relevancy of many search results are questionable (e.g., some articles merely mention the searched term in passing).
For more information -http://ww1.wisewire.com/network.tpl?NetworkID=92303
Japanese TV-Linked Seizures - An Update
Last December 700 Japanese children suffered epileptic seizures while watching TV cartoons which included bright flashing lights. Broadcast of the Japanese cartoon "Pocket Monsters" was suspended after the incident, but it will resume broadcasts next month. TV Tokyo will air a special program on research findings into the cause of the adverse reactions and in-house safety standards on animation programs before it resumes broadcasts of the show.
Wondering if Ritalin still makes the grade - Chicago Sun-Times article
Americans consume five times as much of Ritalin as a decade ago and 90 percent of the worldwide market, drug enforcement officials say. Dr. Peter Jensen, chief of developmental psychopathology research for the National Center for Mental Health in Rockville, Md., cautions that only one-third of children diagnosed with ADHD have only ADHD - so something more than Ritalin may be needed for other problems, such as learning disabilities or aggression.For more information -http://www.suntimes.com:80/output/news1/rit22i1.htm
Talking to Strangers
Neurofeedback was discussed on only a single newsgroup this month - alt.support.attn-deficit. The discussion was heated and included personal attacks from the RTP - Ritalin Thought Police. Follow the thread yourself -- if you want to hear the same thing again and again. Where is that hundredth monkey? - search.dejanews.com/dnquery.xp?QRY=neurofeedbackChatting with Strangers - Addiction
If your substance dependent clients need to talk to someone at 3 am about their condition, or you want to talk to potential clients anytime, here are some addiction support newsgroups:-
- Addiction - Professionals -- subscribe add_med your name
- Adult Children, Al-Anon -- blank message
- Alcoholics (family members of...) -- subscribe al-anon your name
- alt.abuse.recovery - Recovering from all types of abuse
- alt.recovery - Recovery: General topics
- alt.recovery.aa - Recovery and Alcoholics Anonymous
- alt.recovery.na - Recovery and Narcotics Anonymous
EEG Biofeedback Training Course for Professionals
EEG Spectrum International presents the emerging field from a perspective well-grounded in clinical phenomenology, but it is also based on a neurophysiological model of efficacy originally proposed by M. Barry Sterman, Ph.D., and recently augmented by Andrew Abarbanel, M.D. The clinical database and the model combine to yield a variety of protocols which have proven to be effective in the treatment of behavior, mood, pain, attention and learning problems, seizure disorder and the consequences of brain injury. A coherent picture emerges about how protocol choices may be made in the face of complex presenting symptoms.The training also includes the all-important practicum section which focuses on actual operation and use of instrumentation. Additionally, opportunity is provided outside the formal curriculum for practitioners to experience training on themselves as well as discussing professional issues, marketing, and the particulars of establishing a financially successful practice based on this modality.
Faculty: Siegfried Othmer, Ph.D., BCIAC; Susan Othmer, BCIAC; M. Barry Sterman, Ph.D.; Nancy White, Ph.D. ; Julian Isaacs, Ph.D.; Pat Fields, Psy.D.; Martin Wuttke, BCIAC; William Scott, BSW, CCDP
| LOCATION | DATES |
|---|---|
| St. Louis, MO | Apr 16-20, 1998
|
| Atlanta, GA | May 14-18, 1998
|
| Encino, CA | Jun 4- 8, 1998
|
| Toronto, ONT | Jun 18-22, 1998
|
| Encino, CA | Jul 16-20, 1998
|
| Seattle, WA | Aug 6-10, 1998 |
| TOPICS COVERED |
|---|
| EEG Biofeedback Theory: Neurophysiological Basis; Research History |
| Clinical Applications: Assessment, Protocol Selection, Practicum & Case Review |
| Specialty Applications: For Behavior Modification & Performance Enhancement |
| COST (5-Day Course): $895.00
Additional Attendees from Same Facility: 30% discount Reattendees: $200.00 |
To enroll, contact Dennis Campbell
or call EEG Spectrum International at 800-789-3456 or (818) 788-2083.
Please include your name and phone number in all email messages.
Conferences for Neurofeedback Clinicians & Researchers | ||
|---|---|---|
| CONFERENCE | LOCATION | DATES |
| Assoc. for Applied Psychophysiology & Biofeedback (see below) | Orlando, FL | Apr 1-5, 1998
|
| Australian AAPB | Sydney Australia | May 23-24
|
| Society for the Study of Neuronal Regulation (see below) | Austin, TX | September 10 - 13 |
AAPB Conference: April 1 - 5, 1998
The 29th annual meeting of the Association for Applied Psychophysiology and Biofeedback will be held at the Buena Vista Palace Hotel in Orlando, Florida, adjacent to the Disney Village. Spouses and children are welcome.- Selected Keynote Speakers:
- Eugene Peniston, Ph.D. - EEG Alpha-Theta Neurofeedback Training for Addictions
- Allan N. Schore, Ph.D. - Affect Regulation, Neurobiological Maturation, & the Origin of the Self
- Bernard S. Brucker, Ph.D. - Recent Discoveries of Central Nervous System Plasticity & the Future Role of Biofeedback
- Bernard T. Engler, PhD - Self-Regulation and Aging: The Challenge in Everyone's Future
- E. Dale Walters, Ph.D. - EEG, Alpha-Theta States of Consciousness, and Self-Programming
- Allan N. Schore, Ph.D. - Affect Regulation, Neurobiological Maturation, & the Origin of the Self
Conference includes programs on geriatrics, respiratory physiology, stress management education, optimal performance, new technology, and biofeedback applications in school settings: Workshops and Short Courses
Contact AAPB for further information
10200 W. 44th Ave., Wheat Ridge, CO 80033
1-800-477-8892
e-mail aapb@resourcenter.com
www.aapb.org
1998 SSNR Conference in Austin Texas, September 10 - 13
"CALL FOR PAPERS": The Society for the Study of Neuronal Regulation (SSNR) is seeking original research papers for presentation at the 1998 SSNR Conference in Austin Texas, September 10 - 13.
Research papers will be given either as a forty minute presentation, twenty minute presentation, or poster presentation. We are also seeking workshops for the conference of either two or three hour duration. Presenters should submit abstracts of under 300 words, indicating the type of presentation desired (40 minute, 20 minute, or poster or workshop). Entries need to be submitted by via e-mail, fax, or regular mail to David Trudeau, M.D., SSNR Program Chair (see addresses below) as soon as possible (deadline by 1 August 1998). Earlier is better, as last year we quickly filled all our presentation and workshop slots.
David L. Trudeau, MD SSNR Program Chair #4402 168 E. 6th St. St. Paul, MN 55101 Fax 612.725.2292 Voice 612.298.9773 trude003@maroon.tc.umn.edu
All submissions will be reviewed by the program committee and those accepted will be assigned to the program. The program committee will determine the type of presentation for research papers (40 minute, 20 minute, or poster) based on the content of the abstract, the judgement of the committee and the preference of the presentor. Every attempt will be made to notify presentors of their position/time on the program by August 15.
The 2000 Case History Project
What is striking in the field of neurofeedback is the paucity of research and how few of the published papers can be found online. As interest grows in our field, more and more people will seek information online, including scientists from related fields such as child psychiatry and neuropsychology.
About once a day I get people emailing me for information on neurofeedback and some condition. Today it was autism, yesterday it was alcoholism, tomorrow it will be something with two or three umlauts. People desparately want more information! They do not want data smog - they want information on their level, and for most individuals that is layperson material. With this in mind I've asked EEG Spectrum International affiliates to contribute to "The 2000 Case History Project". By the year 2000 I hope to obtain a total of 2000 case histories on all conditions that neurofeedback can address. So far things are slow (as I'm announcing the project here and now), but I think it is a worth one and one which will pay back dividends to everyone in the field and out.
Here are the first steps in a (two) thousand mile journey:
The 2000 Case History Project [http://www.eegspectrum.com/articles/casehx/]
Hope to see you in Orlando! - David Kaiser, Ph.D.
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