What's New in Neurofeedback

• Education Professor Dispels Myths About Gifted Children
• Hormone Therapy Linked To Brain Shrinkage, But Not Lesions
• 'Window Into The Brain' Reveals Deadly Secrets Of Malaria
• Game Of Two Halves Leads To Brain Asymmetry
• Odors Can Alter Gene Expression In An Olfactory Neuron
• Brain Mechanisms Of Social Conformity
• Gene Therapy Eliminates Brain Tumors Through Selective Recruitment Of Immune Cells
• Race And Gender Determine How Politicians Speak

Links at http://www.sciencedaily.com/news/mind_brain/

 

DK: What follows is an argument made for licensure of applied psychophysiology, or neurofeedback, which would provide minimal standards to adhere to for members of this field and promote colleague consultations between therapists.

By Margaret MacDonald, MD and Cynthia Kerson, PhD; edited by David A. Kaiser, Ph.D.

We want to continue our discussion on the pros and cons of licensure for the clinical practice of applied psychophysiology in the state of California, a discussion first started at the BSC meeting in Asilomar this year. Applied psychophysiology refers to autonomic and central nervous system (ANS & CNS) operant conditioning, peak performance training using neurophysiology, and quantitative EEG assessment. We want to make clear to this group how we all can gain from attaining formal licensure. We are well aware that most clinicians do not have the time nor energy to spend on additional efforts to maintain the scope of their current practice; but none of us want to see our field’s reputation degraded by non-credentialed practitioners, those who practice “neurofeedback” with little training or education about physiology, biofeedback or the professional and ethical considerations of how clinical operations should run.

As biofeedback clinicians we believe we need to elevate our standing in the care community. We are medical and psychological practitioners who work with individuals who have serious mental and physical ailments. It is our hope that, by having licensure status in applied psychophysiology, we will be able to provide the public a guaranteed level of care, one which is respected by members of other medical, psychological, and therapeutic communities as well as by third-party payers. To do this, we must standardize significant aspects of our clinical practice and address current sub-optimal practices. For instance, a handful of neurofeedback practitioners offer partial refunds of session fees to any client who feels s/he didn’t get “his money’s worth” out of the neurofeedback training. An RN member argued that when a patient sees a physician for a $200 visit and is given a prescription that results in an outbreak of hives, the idea of refunding the visit fee would never be raised, nor would there ever be any slight against the physician. And any third party payer would not expect to be refunded the payment for the services performed.

In another example, a neurofeedback practitioner asked for advice regarding a rare organic brain syndrome produced by a malformation of brain tissue. This was done on an unmoderated listserver and one of the responses was that she should ignore the diagnosis and simply train to the behavior. This suggestion ignores what is well known about cortical malformations and the responder did not have the necessary experience or expertise to recommend this course of action. Neurotherapists need to work in collaboration with medical practitioners in many cases, especially when working with clinical conditions that are complex and require extensive experience. But this responder considered neurofeedback a cure-all and did not reference any scientific or clinical literature on the condition in offering his advice. Interestingly, the practitioner seeking a consultation was a medical doctor, a practitioner more qualified for dealing with organic pathology than the practitioner providing advice, but also more aware of ethical considerations in seeking advice for that with which one does not have much experience.

If we claim to care for and improve the health and wellbeing of our clients, we must have a scientific or clinical model of efficacy that addresses each individual’s complaints. We cannot proceed blindly into altering the function of the most complex organ in existence and assume all will work out well without an appropriate base of knowledge. We must be clear about what our equipment and software are capable of doing in terms of stimulation or operant conditioning and we must be clear about what our assessments mean in the context of applied psychophysiology. Unfortunately many individuals who have successfully completed certification in biofeedback or related fields are unable to meet these standards. It is our intention that a California Licensed Applied Psychophysiologist will meet a higher minimal standard of care in our field. Licensure should also help us to promote a change in terminology wrt the treatment paradigm as well. By having a separate designation for what we do, we can avoid some of the overlap with other specialties, and can thus respond as needed to symptoms and sources, rather than only to diagnostic or medical labels. For example,if a client comes in with the diagnoses of multiple sclerosis, anxiety, and marital problems and a quantitative EEG assessment reveals a frontal disconnection in the brain and all three problems are alleviated through frontal connectivity training, the current climate would dictate that we would need to be a neurologist, a psychiatrist, as well as a licensed family therapist else be vulnerable for treating outside our expertise. As long as it can be understood that these symptoms are the result of an ongoing but temporary dysfunction of the central nervous system (CNS), it is more appropriate for such a client to be handled by someone with recognized expertise in manipulating the functionality of the CNS.

Establishing educational standards and licensing procedures for practitioners requires introduction and successful passage of new legislation at the state level. The process is tedious and can span one or more two-year legislative sessions, depending upon the level of support. Further, such an endeavor is best attempted in a non-election year, when public policy changes are less likely to be politicized. Our plan is to prepare ourselves this year and submit our proposal to the state legislature in 2010. After designing the bill, we must find a legislator who will carry it through. The bill will then have to pass through policy and fiscal committees of the house and be signed in by a governor (who will not be Scharzenegger at that time) We have been in discussions with a lobbyist who has extensive experience in alternative medicine legislature in California and who is very interested in our project. If the bill is passed, there will be at least another year of work setting up the regulatory structure. Ultimately, the California Bureau of Consumer Affairs would police licensure, through an independent board developed with our assistance or through an agency within the Bureau. Initial costs to licensed persons in applied psychophysiology may be high as initial numbers may be low and we would need to support a board or bureau. But this cost would be temporary and would drop as numbers increase. There would also be a buffer period of time before all practitioners would be required to be licensed.

Grandfathering of existing practitioners will require clear and rigorous guidelines. Proof of years in practice, an applied psychophysiology exam requirement, and/or proof of a minimum level of training beyond what is currently required by BCIA may be in order. These details have yet to be determined and there will be ample opportunity for the membership of BSC and other practitioners to have input into this process. Our goal is to strengthen our field, not weaken it by excluding experienced practitioners. The public wants assurance that all members of our profession are knowledgeable and offering services at the highest possible level.Towards this end we may need to establish courses for practitioners who require additional education or clinical training.

We do want to preserve the advantages of this field over other therapeutic modalities; namely, the central role science and learning play in our work, without undermining the value and depth that clinical experience brings. By having a legally recognized designation, the “traditional” healthcare system will be less likely to disregard our endeavors. The California Medical Association (CMA) and the California Psychological Association (CPA) may lobby against our effort, because of what they may see as turf issues, but, in this first attempt at legislation, we will not be attempting to take over anyone’s turf. We seek only to license those who do not currently have any form of clinical licensure. Any efforts to regulate the practice of biofeedback by psychologists, doctors, or any others would be far too difficult at this point. We would hope to show, in the long run, that a new paradigm for care and symptom to source solutions can be recognized, legitimized, and ultimately infiltrate the public’s mindset in such a way that the traditional groups will see that they are not able to handle the public’s new expectations for treatment, and they will welcome the ability to refer to a licensed Applied Psychophysiologist.

We propose four (4) categories for licensure :

1. Neurofeedback (CNS feedback)

2. Biofeedback (ANS feedback)

3. Quantitative electroencephalography (normative comparison analysis)

4. Peak performance training using neurophysiology

Other more mundane features of the bill will establish the organization responsible for governing licensure and certification, determine what categories are licensed and criteria for inclusion/acceptance. It will also establish regulatory rules for CEs, for ethical issues, and any other issues deemed important to general policy and executive policing. The Board of Directors of ISNR is working to incorporate guidelines for a level of standard practice and equipment quality which it will advise its members to adhere to; and BCIA works diligently to incorporate a useful and practical certificate of competence. Our hope is that these programs fall within the same scope of the California licensure and are not in competition. In preliminary discussions, the ISNR, AAPB and BCIA advocate for the incorporation of licensure. However, to date we await formal advice from these groups. In the thirty or more years of this field, we have been very lucky that no significant lawsuits have affected us. However, the recent article by Cory Hammond and Lynda Kirk outlines very clearly that harm can and has been done within the practice of applied psychophysiology. We need to regulate ourselves before larger agencies decide on this issue for us. The authors and Jay Gunkelman, Past President, will draft the legislative bill during 2009. If you are interested in helping us or have comments that you would like us to take into consideration, please contact us at your earliest convenience, at one of the emails below. We will be presenting a panel on this issue at the upcoming AAPB conference in Albuquerque.

[Margaret MacDonald dr.mac@mind-connection.com, Cynthia Kerson crkerson@pacbell.net, Jay Gunkelman qeegjay@sbcglobal.net ]

Reviews NEW BOOKS

Building the Bonds of Attachment
by Daniel A. Hughes
Recommended by parents who have adopted children with attachment disorders.

Handbook of Psychological Assessment
by Gary Groth-Marnat Step-by-step guide to the classic psychological assessment tests, including Wechsler
Intelligence Scales, Bender-Gestalt, Rorschach, MMPI, and projective drawings.

Getting Unstuck; Clear Answers for Women on Why We Get Trapped in Depression, Anxiety and Eating Disorders
by Linda Mintle
Discussion of increasingly common mental health conditions affecting women.

Keeping Mozart in Mind
By Gordon L. Shaw
The latest scientific proof that music can enhance learning, including the story behind the "Mozart effect" research.

Serious Shopping: Psychotherapy and Consumerism
by Paul Bellringer
Essential reading for anyone involved with a problem gambler either as a client, partner, or family member.

Links to books at http://start.eegspectrum.com/Newsletter/oct2008.htm#section2

Adrenocortical Functioning in Boys with ADHD : Anxiety problems were associated with greater cortisol reactivity and oppositional problems were associated with adrenocortical activity.

Overtreating chronic back pain: time to back off? : Chronic back pain is not well understand in terms of basic pain mechanisms.

Neuropsychiatric symptoms in mild cognitive impairment : Neuropsychiatric symptoms are common in patients with mild cognitive impairment and the presence of multiple symptoms are associated with amnesia.

Long-term stability of resting frontal EEG alpha asymmetry in schizophrenia. : Resting frontal EEG alpha asymmetry remained stable over a 36-month interval in schizophrenia.

Alcohol addiction and the attachment system : Psychiatric symptoms severity is related to attachment system's impairment.

Links to articles at http://start.eegspectrum.com/Newsletter/oct2008.htm#section2

The figure above shows the EEG Spectrum affiliates saturation (offices per 1,000,000 residents in a state). The data in table format is below.

offices                per million residents
2	.Alabama		0.4
3	.Alaska			4.4
8	.Arizona		1.2
3	.Arkansas		1.1
61	.California		1.7
11	.Colorado		2.2
6	.Connecticut		1.7
1	.Delaware		1.1
3	.DC			5.1
19	.Florida		1.0
3	.Georgia		0.3
2	.Hawaii			1.6
3	.Idaho			2.0
11	.Illinois		0.9
1	.Indiana		0.2
5	.Iowa			1.7
3	.Kansas			1.1
2	.Kentucky		0.5
1	.Louisiana		0.2
1	.Maine			0.8
3	.Maryland		0.5
34	.Massachusetts		5.2
9	.Michigan		0.9
1	.Minnesota		0.2
0	.Mississippi		0.0
4	.Missouri		0.7
3	.Montana		3.1
5	.Nebraska		2.8
5	.Nevada			1.9
2	.New Hampshire		1.5
13	.New Jersey		1.5
4	.New Mexico		2.0
17	.New York		0.9
10	.North Carolina		1.1
0	.North Dakota		0.0
6	.Ohio			0.5
4	.Oklahoma		1.1
5	.Oregon			1.3
7	.Pennsylvania		0.6
5	.Rhode Island		4.8
1	.South Carolina		0.2
0	.South Dakota		0.0
2	.Tennessee		0.3
23	.Texas			0.9
2	.Utah			0.7
1	.Vermont		1.6
11	.Virginia		1.4
8	.Washington		1.2
0	.West Virginia		0.0
3	.Wisconsin		0.5
0	.Wyoming		0.0