Patient-Based Approaches to Cognitive Neuroscience
by Martha J. Farah
A Monthly Summary of News and Events
Vol. 5 No. 1 - January 2002
This newsletter is sponsored by EEG Spectrum International Intl, Inc.,
a leader in providing clinical service and training professionals.
Past issues are available at www.eegspectrum.com/newsletter/
Information on how to subscribe or cancel a subscription appear at the end.
The opinions related in this newsletter reflect those of the author only.
Copyright (C) 2001 by EEG Spectrum International Intl, Inc. 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
Patient-Based Approaches to Cognitive Neuroscience
by Martha J. Farah
Concussive Brain Trauma: Neurobehavioral Impairment and Maladaptation
Developmental Neuropsychology: A Clinical Approach
Adolescence and Chronic Fatigue Syndrome
Neuropsychiatric assessment of Gilles de la Tourette patients
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Hyperactive behaviors in Tourette's are comparable to those observed in basal ganglia hyperkinetic disorders.
Computational model of thalamo-cortical networks: in relation to focal attention.
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Local event-related desynchronization is often coupled with synchronization in other brain regions. The authors suggest a focus/surround model in the reticular nucleus.
Auditory evoked responses in children with attention deficit disorder.
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Children with ADD show significant delays and reduced amplitude in auditory P300s, indicating an impaired auditory system.
Learned self-regulation of EEG frequency components affects attention and EPs.
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Investigated neurofeedback band-specific effects on perceptual and motor aspects of attention measures.
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.
Neuroanatomic Structures in Bipolar Disorder
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A longer duration of bipolar illness is paradoxically associated with a larger left temporal lobe volume.
Upcoming Courses
Prerequisites:
All Adv. classes require successful completion of the 4 Day Comprehensive Beta/SMR.
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Conferences for Neurofeedback Clinicians & Researchers | ||
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| CONFERENCE | LOCATION | DATES |
| Winter Brain - http://www.futurehealth.org/2002.htm | Miami, FL | Feb 7-11 |
| AAPB - http://www.aapb.org | Las Vegas, NV | Mar 20-24 |
Part of the college application process to the Massachusetts Institute of Technology (in 1982) included writing an essay on the following topic: If you weren't a human, what animal would you like to be?
Most high school students probably considered their choice based on some ability they held in esteem -- flight, speed, strength, courage, freedom -- and chose the obvious match -- eagle, horse, elephant, tiger, or dolphin, perhaps. My preferred quality was longevity, which might have stood out among 17-year-old-boy answers. Who knows? Even then I knew the best way to ensure longevity in the animal kingdom was to avoid predation, to be above the fray of red tooth and claw. Either top predator or too big to bring down -- that would be my choice. A tiger or whale or gorilla could fit the bill, except I knew not to ignore the human factor. All of these mammals were (or are) prey to humans, hunted by us truly for food or umbrella stands. But, fortunately for my essay, there was (theoretically) a species on the planet that was not currently hunted by humans, at least not successfully: the giant ape of North America, known by some aborginal inhabitants as Sasquatch.
Before we focus on Sasquatch, let's examine our track record on identifying giant primates on this small rock, okay? First, there is and remains no fossil record of chimpanzees or gorillas (Jones et al, 1992). Presumably this is due to their limited dispersion and the ecological conditions of their ancestral and current habitats (wet, isolated). But without this evidence, I still believe they exist. (I've seen them in zoos.) By 1774, native accounts of monstrous apes began to filter out of Africa, accounts that were immediately discounted by Westerners as folk tales and myths. Starting in the mid-1800s, 40 years of concerted searching by scientists and adventurers alike finally revealed the source of these tall tales. In 1902 the physical remains of a fictional beast was finally transported out of the mountains and placed under the scientific lights of Europe. I refer, of course, to what we now know as the mountain gorilla. (The lowland gorilla was discovered/encountered by Westerners in 1847, and still people pooh-poohed the idea of a larger, high-altitude cousin.) The Komodo dragon was another creature thought to be mythical until the 20th century, and of course we've all know that the coelacanth, a fish with stumpy fins and extinct for 70 million years, never took the news of its extinction very well.
In the early 1980s, the television series In Search of produced a two-hour special hosted by Leonard Nimoy that examined the evidence for the existence of Bigfoot, aka Sasquatch. Reports of giant hairy bipeds lumbering across the Pacific Northwest go back nearly 200 years for Westerners (1811, large footprints in the snow) and possibly 12 to 14,000 years for Native Americans. One early story, from the 1830s, reports how a sasquatch carried off a Hudson's Bay Company employee's Indian wife near Fort Vancouver; she later escaped (not unlike tales we hear of Orangutan males from Borneo today). In fact prior to this century, the hairy apeman's habitat appeared to extend, like the Indians, across all of North America. Large wildmen stories are common to many American tribes, from Hopi to Sioux to Iroquois. Even Norseman Leif Erikson in 986 A.D. and Frenchman Samuel Champlain in 1603 had encounters or were warned against large ugly hairy monsters inhabiting the eastern shores of present-day Canada. (Perhaps maligning and misrepresenting one's neighbors was as common back then as it is today.)
Let me provide some more recent anthropological evidence. Gigantopithecus, the largest primate to ever roam the earth, appears in the fossil record as teeth (see figure) about 6.3 million years ago. This species thrived in Southeast Asia until quite recently. When early humans, Homo erectus, spread into Giganto's territory, they went the way of the dodo (or the giant sloth of North America, to paint a better picture). Gigantopithecus blacki is presumed to have shared a common ancestor with orangutan, not gorillas. Some contend that a few Gigantopithecus blacki may have crossed the Bering Land Bridge, the same way humans are thought to have entered the New World in our most recent migration (Ciochon et al., 1990) and that descendants remain alive (though hardly thriving) on both sides of the Bering Strait, now called by their distant cousins with the dissimilar names Sasquatch and Yeti. That Sasquatch appears to be bipedal in gait and Gigantopithecus would unlikely to have evolved this trait is problematic, but you can't please everyone.
In the '80s TV special, Nimoy reviews the various points of evidence for the existence of Bigfoot:
If all of these lines of evidence were presented as part of a court trial, Nimoy argues, the defendent would surely be sentenced. It's evidence enough to convince most jurors beyond a reasonable doubt. But the scientific world requires evidence beyond
Another example of extraordinary claims without extraordinary evidence comes from UFOlogy (a word I didn't make up). The initial enthusiasm for E.T.s can be traced back to June 24, 1947, when a pilot flying over the Cascade mountains of Washington State in search of a missing marine plane "sighted nine saucer-like aircraft flying in formation." And thus the modern paranoid age was born....
I would place the existence of a small, viable, undetected group of nocturnal Gigantopithecus descendants having staved off extinction for half a million years in a sparsely populated woodland ** well above ** the possibility of detectable reconnaissance flights from celestial neighbors, given what I know about the rarity of sustained complex life in extrasolar systems, the vast distances between stars, and the laws of physics (not to mention politics and budgetary constraints imposed on exploratory projects).
All of this leads me to a recent publication by Tobias Egner and John Gruzelier in NeuroReport. They investigate whether EEG operant conditioning can influence P300 event-related potentials: hardly a leap of logic. To me such positive results, besides being most welcomed, would sound to the casual reader as almost self-evident. I can hear the reviewer saying, "It makes senses; conditioning EEG can moderately alter temporal components of the EEG." Egner and Gruzelier do not claim that neurofeedback cures ADHD or that 20 hours interacting with a shiny box can cut relapse rates for addicts in half. Regardless of the truth, such claims are too large, too extraordinary, to be believed by fellow scientists, by anyone. People must be properly prepared for evidence, for truth. (Sadly, part of such preparation is to catch them when they're young. Convincing adults on matters of importance requires perseverance which few possess.)
Egner & Gruzelier's paper also provides evidence of protocol specificity, but only someone attuned to our subtle art would recognize this valuable contribution. Like I said, most readers of NeuroReport will come away with the conditioning-ERP connection, nothing more. This will be a very acceptable link in their minds, and more importantly, when they encounter neurofeedback in a future paper by either author or someone else, the topic will feel less unfamiliar to them.
So what is the take-home message of this article? What is Bigfoot's lesson?
If you want to survive, fly under the radar. And if you want to make a difference, still, fly under the radar. (So far I must commend our entire field at its success!) Fly under the radar but don't shy away from striking some of those outward targets, an air defense here, an intractable condition there. Remind ourselves how change never occurs at the center, always at the periphery; and from there it moves in. Change is inevitable. Instead of making large claims, make a series of small claims, in a series of small (or not so small) papers, in publications that strangers may read. Ordinary claims will be readily acknowledged, some accepted, and when enough are strung together, the mass will tip everyone into accepting it all as a new model for treating mental disorders.
You've gotton Bigfoot's message. Now take a bit of advise from the life of Einstein. Einstein's initial paper on special relativity was published because it was not recognized as valuable -- or even incremental. It was regarded as insignificant, irrelevant, possibly wrong. How lucky for Albert! Had it been recognized for what it was -- revolutionary! -- it would never have made it through peer review.