By Siegfried Othmer, PhD
Integrating the Field: The Panel Discussion
The integration of our field was the topic of the opening panel discussion at the 2016 Annual Conference of the Western Association for Biofeedback and Neuroscience (WABN). The event was an auspicious beginning for the meeting. It reflected the very spirit of mutual acceptance that is required to bring about the desired re-integration.
Panel members were Barry Sterman and Jay Gunkelman representing the more traditional academic position, with Gary Schummer and Siegfried Othmer representing the more open-ended frontier science position. What surely unites all sides on this issue is the implicit if not explicit conviction that biofeedback and neurofeedback cannot come into their own until mainstream recognition is assured. Opinions diverge on the manner of how that is to come about.
On this issue, Barry is a fundamentalist. How therapies become accepted is very clear if one’s intention is to persuade the establishment. One has to play by their rules. The alternative view is that while this may be suitable for evolutionary, incremental scientific progress within the prevailing paradigm, it is not applicable to revolutionary new developments that lie outside it. Frontier science does not fit prevailing understandings. It breaks the rules. It must be regarded on its own terms. Effectively, it defines the means by which it is to be validated.
The contrast is perhaps best illustrated with an example from the field of mathematics. The proof of what is called Fermat’s Last Theorem was highly convoluted, ranging far afield and drawing on various mathematical disciplines. It took mathematicians months to review the 150 pages of proof, and their efforts exposed an error in the proof. The author, Andrew Wiles, managed to close the loophole with yet another elegant proof within a year, and Fermat’s Last Theorem was finally proved. No one along the way ever argued that the proof had to take a particular form. The mathematician chose the path in his sole discretion. It’s whatever gets you there.
In the same spirit, one would say that the validity of EEG neurofeedback was established with Sterman’s first experiment. That is to say, once the evidence emerged in the light of day, by whatever fortuitous chain of events, it could not be ignored. Quite inadvertently, a blinded controlled experiment had been conducted. In terms of experimental design and execution, this was a case of immaculate conception. The experiment had been conducted entirely within paradigm, and all the loopholes had been closed in that very first experiment. Neither the cats nor the research staff were aware at the time of the critical experiment in which they were playing their appointed roles. Hence neither researcher bias nor placebo factors could have been involved. The conclusion was mandated: EEG Neurofeedback could affect mammalian brain function over the longer term, with profound implications for organismic functionality. This already sufficed as a permission slip for all subsequent explorations regarding the clinical implications. Nothing more was needed.
Sterman and Lubar were both conventional scientists who were thoroughly invested in the standard experimental methods. This was an asset in the conduct of the early research, but later became very much an impediment when the floodgates opened into the more exploratory investigations. Sterman adopted a strategy of narrow targeting: one clinical condition and one protocol, and Lubar did the same. It was the battering-ram approach: assailing the castle of an intransigent mainstream with the force of a single, compelling claim pounding against the gate. In retrospect, their strategy clearly failed, and Sterman realized it: “I did everything the world of science expected of me, and in the end it did not make any difference.” His intended audience of academic researchers was not only unpersuaded; they were not even engaged on the matter. Once outside of the paradigm, Sterman and Lubar were laboring in vain even with solid classical research designs.
Success was to be found elsewhere, in the realm of exploratory research at the clinical frontier. We collectively built a new castle. Unfortunately, throughout his remaining professional life Sterman resisted these initiatives on all fours, as did Joel Lubar to a lesser degree. Seen as the father of clinical neurofeedback, Sterman was a sperm donor, not a father figure. He disowned his own scientific progeny. He begat Margaret Ayers, much to his own regret. Ayers in turn in turn begat Othmers, much to her regret. She also begat Nicholas Dogris and many others. And so it went. Sterman wouldn’t have any of it. Asked why he doesn’t do neurofeedback on his own head, Sterman answered: “Because I don’t have seizures.” He continued to gaze fondly back upon his own early work and appeared not to be troubled that with respect to scientific productivity within his own field, he had turned into a pillar of salt.
Deprived of a supportive, nurturing environment much like Harlow’s monkeys on their wire mothers, the progeny propagated the judgmental climate that had been modeled for them. The perennial concern about the critical mainstream made thought leaders into their own jailers and impoverished our collective conversation. This is the mess that now needs to be left behind, and the experience of our panel discussion gives me great hope that matters are already on the mend.
In his opening remarks, Sterman highlighted the importance of observation in the scientific process, but went on to say: “I don’t care if it works, if I don’t know what I am doing.” He had contempt for the converse attitude that “I don’t care if I don’t yet understand what I am doing…if it works.” Observation was going to be the theme of my comments! I feared that Sterman might be pre-empting my talking points. I need not have worried. His reference to observation hung in the air without elaboration. His comment did, however, hint at the essence of the divide, which relates to the context in which observation takes place.
The state of affairs can be dissected nicely in terms of the left-brain/right-brain dichotomy as well as in terms of bottom-up versus top-down interaction with the empirical realm. Observation, as we know, is not a neutral process. In the words of Albert Einstein, “It is the theory that tells us what we may observe.” If the observational process relates to an experimental design, then we have a top-down process where observation is necessarily constrained to the variables being tracked. If the observations being made are goal-directed, then we don’t see the man in the gorilla suit walking through the scene.
This is nicely illustrated in Sterman’s early work, where the neurofeedback was done with UCLA graduate students. Their most prominent report was of a subsidence of anxiety and depression, and this was duly registered in the reports to the contract monitor. When we later claimed to have used SMR/beta training beneficially in application to both anxiety and depression, Sterman was completely non-plussed. “But you do temperature training for anxiety.” With regard to depression, he did not even dignify the topic with a response. He was stuck in compartmentalized, paradigm-bound thinking. His own earlier findings had not registered in memory because at the time they had not been the explicit objects of study.
The alternative empirical approach—truly observational science—was modeled for us by Nikolaas Tinbergen and Konrad Lorenz in the field of ethology. Confronted with the complexity of animal behavior, it was incumbent on the scientists not to impose their own pre-conceived notions on their investigations, lest they miss important features. The models emerged later out of their experiences, and both were recognized with the Nobel Prize for their collective work.
This is a good example of bottom-up observational science. Other examples are William James, Ivan Pavlov, Charles Darwin, and Stephen Jay Gould. Pavlov did not ‘discover’ classical conditioning in his formal experiments. He had observed in the course of his studies on gastric secretions that his dogs were already salivating when the food dishes were delivered. An initially random observation became systematic and eventually culminated in formal investigations, leading finally to established science.
The process went in natural progression from bottom-up observation to top-down experimental proof. In the words of Elmer Green: “First the findings; then the science.” It has to be that way whenever we are confronted with novelty, and there is no better example of this than Sterman’s own landmark experiment. Understanding followed the experiment; it did not precede it. Indeed, the following morning Sterman came up to me to acknowledge that the bottom-up process comes first. It’s just that those early ventures of inquiry don’t usually make it into the journals.
In our own field, the initial authorization to work with human brains in this manner had to be furnished by formal research. But as soon as this method transitioned into a clinical setting with Douglas Quirk and Margaret Ayers, the field entered its inflationary phase, expanding rapidly to cover the clinical terrain. And if Sterman is regarded as the father of clinical neurofeedback, then Margaret Ayers was the mother. Hers was an entirely bottom-up process. As Sterman will attest, she did not have a deep understanding of the underlying mechanisms or much patience for theory. But that did not matter at this stage. Margaret’s skills were observational in nature, and she reached a level of understanding of the clinical reach of SMR/beta training that was unmatched for many years.
Here in microcosm we had the juxtaposition of traditional top-down, model-driven research with bottom-up, open-ended exploratory investigations. Both had their legitimate roles to play. The latter process was well described by John Polkinghorne: “Bottom-up thinkers try to start from experience and move from experience to understanding. They don’t start with certain general principles they think beforehand are likely to be true; they just hope to find out what reality is like. If the experience of science teaches anything, it’s that the world is very strange and surprising. The many revolutions in science have certainly shown that.”
To gain elbow room in the clinical sphere, Ayers focused on minor traumatic brain injury, which held no interest for the field of medicine at the time, as well as stroke and cerebral palsy, for which the field of medicine likewise had nothing to offer. She had chosen wisely, in that she presented no threat to the pharmaceutical industry. Further, for the above conditions, clients saw almost immediate benefits of the training.
A Further Reflection on our History
The history of our field can be fruitfully surveyed in the perspective of left-brain versus right-brain orientation as well as top-down versus bottom-up methods. The essential task for the nascent biofeedback community was to bring striking novelty of insight—which had originally come to us from India and Tibet—into the embrace of Western scientific thought. We had a confluence of radical novelty with established scientific methodology. Since the process of validation was sponsored by conventional scientists, the means involved an accommodation to all the strictures of formal scientific research. To that project the new findings turned out to be unsuitable.
It might be instructive at this point to recall just how stultifying, constricting, and regimented the atmosphere has been in our field over the past thirty years, in fealty to this overriding objective. Gary Schummer spoke to this point at the panel discussion. There was, first of all, the trashing of alpha-band training on the basis of research that had been poorly done and misinterpreted to boot. Years later, Gary did a study of alpha training with HIV-positive individuals and found significant increase in immune system markers. Because this was done after alpha training had been officially discredited, his work was thoroughly (and publicly) denounced by Sterman, with whom Gary had worked for five years! What happened to “Show me the data”? Gary’s data was completely solid, and it was completely discounted. Quite simply, Sterman did not want to see new life breathed back into alpha training.
It was also a matter of firmly held doctrine at the time that the elderly brain could not be trained, and that children below seven somehow could not retain the gains—even though they could manifestly learn behavioral skills at that age. Years before, Lubar had even worked personally with very young, cognitively impaired children. In an operant conditioning design, the children had tubes run into their mouths through which sugar-sweetened water was delivered as a reward. The children were being trained as if they were lab rats!
When this design was later recalled so that everyone could have a good laugh over the early foibles in our field, Lubar took offense and defended the approach! The mere thought of it just boggles the mind. Skinner must have been rolling over in his grave. He had himself demonstrated just how trivial it is to alter behavior even in infants with infant-appropriate reinforcements. What are those? Anything that engages the infant brain, and only for as long as it does so. For years we were then living in parallel universes. Margaret Ayers and our clinician network were routinely training young children effectively, and yet Lubar continued to complain about it bitterly for many years.
As late as 1997 Lubar wrote to me as follows: “I still disagree with you strongly about the age issue. We clearly have been telling people that it is not appropriate to work with individuals below the age of seven…. The most important criticism…is the carryover problem.” All the evidence was on one side, and yet that did not count for anything. Ayers had been training young children successfully for twenty years by this time, and for us it had been nearly ten years. It was yet another conquest of empirical data by abstract theory.
For Lubar, ADHD qualified for neurofeedback as a ‘neurobiological’ condition, in contrast to anxiety and depression, which were somehow not neurobiological conditions. Who could take this seriously? And yet one had to live with this doctrine for many years, even though contradictory evidence was piling up on all sides. Lubar had psychologists in his audience who were telling him that anxiety and depression were more readily resolved with neurofeedback than ADHD, and yet he did not budge. Every clinical advance was met with concerted hazing. Claims of benefit for PMS, Bipolar Disorder, Autism, Parkinsonism, and even migraine, were all laughed out of court upon first hearing by the academics and the other gate keepers among us. (“Migraine is vascular in origin. How could you possibly help with EEG neurofeedback?”) And yet all those claims had been based on solid clinical evidence. In the words of Barbara Brown, our field was “imprisoned in behavioral control science.”
There was a complete mismatch between means, methods, and objectives. At almost every point, the prevailing understanding constrained what could be observed and even what could be talked about. Everything outside of that narrow frame was dismissed as unscientific. We had the equivalent here of the foot binding of female infants. They were sure to be stunted in their growth, and so was our field. The rejection by the mainstream we were all laboring to reverse was mirrored in microcosm within our own field. How were the claims rejected? By discrediting the claimant!
“What is a fact?” Sterman injected into the discussion at one point during the panel discussion. More specifically, the question was “What qualifies something for the status of a scientific fact?” After thinking about this for a moment, I answered: “Sufficient reproducibility.” Aspiring empirical facts can advance through a process of Bayesian inference in the clinical realm to reach any arbitrary confidence level. The next obligation is then to share that information with the professional community so that it can be independently verified by others. In our community, this natural process of diffusion of clinical intelligence was vigorously throttled in the crib.
Barry’s question took me back to a lecture by Clinton Rossiter, political scientist at Cornell back in the sixties, who said tongue-in-cheek at one point at a convocation, “I believe this so strongly that it almost becomes a fact.” The assembly roared in appreciation. Pity the poor political scientist who cannot lay solid claim to many facts of his discipline. Pity also the left-brained scientist in the neurofeedback field who claims factual status for propositions yet to be proved. The field has been full of people who believed things so strongly that they were taken to be a fact. Repeatedly, theory was invoked to deny the validity of empirical data.
Superiority was claimed for QEEG-based training via the bulldozer principle without any comparative evidence at all, never mind evidence that would be dispositive of the issue. Referential placement was deemed superior to bipolar by imprimatur. No formal comparison was ever even attempted. On the occasion of the general shift to referential placement, we went along with the crowd. When we returned to bipolar montage in our work years later, the matter was treated as highly controversial. The fact that the entirety of Sterman’s published research, and much of Lubar’s, had been based on bipolar montage was already lost from institutional memory. Referential placement had become the new fact that would bear no contravention. Just what strange world were we living in? And yet all was claimed to be in the name of science.
Inter-hemispheric placement was said to be contra-indicated, in the absence of any evidence. This despite the fact that Douglas Quirk had already been using this placement exclusively for many years, from 1970 on, with great success, along with his comrade in arms, George von Hilsheimer. We spent years with such placements as our default standard. Training in the lower EEG bands of delta and theta was denounced categorically as being too hazardous, even though that was giving us our best results at that time, in our systematic progression to lower frequencies. The abstract concern about risk prevented the actual data from being attended to by the rest of the field.
Infra-low frequency training was considered so fanciful that ethical charges were considered against us within the ISNR! It just went on and on. No novelty went unassailed. The concept of preferential training frequencies that had governed our work since the late nineties was simply ignored, even though its implications are profound for much of neurofeedback and the proposition is readily testable.
To speak of rigorous scientific thinking here is to exercise the imagination. This was a case of left-brained, top-down, model-driven thinking run amok. The proof is now in hand. Of all the criticisms leveled at our clinical claims over the years, none has been borne out. This should be no surprise. Ours was a bottom-up process, and we never strayed far from the data. When we went public with a particular claim we had first-mover advantage, and that always wrong-footed the critics. In their accounting, every new claim just served to discredit us further. In our accounting, every instance just confirmed the folly of top-down regimentation of an emerging discipline in its most creative early phase. From the moment that Doug Quirk and Margaret Ayers got their hands on the instrumentation for their clinical work, this has been a clinically driven field, with all that that implies. Almost all of the verities uttered by the arbiters of the field along the way have turned out to be wrong. I have just skimmed the surface.
Ironically, the stunted thinking that has held sway over all these years also extends to the theoretical underpinnings of neurofeedback, where the model-builders ought to be distinguishing themselves. It seems to have escaped notice that the operant conditioning model cannot possibly be the full explanation of neurofeedback. It cannot explain infra-low frequency training, for one thing, a problem that has now existed for ten years. But matters are much worse than that. It also could not explain the rapid results that were being obtained early on with SMR-beta training. Lubar even dismissed such claims on that account. ‘It is not possible to show results in less than fifteen sessions,’ he declared at the time. Either the rapid responses had to be discounted or the operant conditioning model had to be overhauled. Unsurprisingly, the data were discounted in order to leave the model intact. So the problem has existed for all these years, and yet was simply ignored even as the claim of quick results ceased to be controversial.
Further, it doesn’t seem to bother anyone that the operant conditioning model offers no insights into the supporting neurophysiology. It is a behavioral model. As essentially nothing more than a re-formulation of behavioral observations, it barely rises to the level of theory at all. In the words of physicist Jacob Bronowski, “..in the psychological sciences…the distance between fact and theory…is small.” Neuroscientist J. Scott Kelso states the problem thus: “Often what passes for theory [in psychology] is a re-description of the facts, albeit in a different language.”
Skinner was quite deliberate in his model formulation. Even as late as 1974 he asserted that “studying the brain is just another misguided quest to find the causes of behavior inside the organism rather than out in the world.” Given that mindset, the operant conditioning model is as far as you want to go, and as far as you can go. But two years earlier, in 1972, Sterman and Wyrwicka had published the first neurofeedback case study on epilepsy in a human subject. An operant conditioning design had been used to affect brain behavior selectively and specifically. Ironically, the boundary of Skinner’s black box had been breached with his own methods, but he missed the memo.
Since the operant conditioning model cannot be stretched to cover the infra-low frequency training, we could not avoid the challenge of finding a new theoretical model for our approach. Hermann Haken’s Synergetics and its concept of circular causality filled the bill. Walter Freeman has elaborated the theory nicely. The feedback model is simply unavailing when there are no discrete rewards. One must incorporate a feed-forward, predictive aspect that invokes the brain’s intentionality when dealing with a continuous signal.
Once that is accomplished, however, it is tempting to propose that the mechanism underlying even standard operant conditioning is really the same. The brain is not merely a respondent. It is an active agent looking for confirmation of its expectations, which includes looking for consistency in the various correlations it is observing at any time. This is in accord with modern theories of perception, which are neither mainly top-down nor mainly bottom-up in the steady state. Instead the process is largely dominated by the brain’s internal processing. (Remarkably, this latter insight had already been achieved by William James.)
Meanwhile, what was happening to the consensus position within the field? First of all, Sterman had already done his best to shore up the model by insisting on a refractory period after a given reward to permit the brain to consolidate the information. Now newly challenged by the infra-low frequency training, the proponents just got together to write yet another paean to the original formulation in 2011. Nothing had moved. Indeed, nothing could move! Infra-low frequency training, which had been the apparent impetus for this paper, was never mentioned.
Struggling toward a new Agenda
There has been an upside to all of the resistance over the years. The hazing to which the various ‘scientist-practitioners’ were subjected has also had some beneficial fallout.
As the late Swiss artist Friedensreich Hundertwasser has observed, “The effectiveness of the positive becomes magnified when faced with the barrier of the negative—like water piling up behind a dam. Eventually it breaks the dam and can no longer be contained.” The internal hazing has had the virtue of preparing us for the external hazing yet to come.
Thankfully the field is finally emerging from this intellectual tyranny to acknowledge what has in fact been moving the field forward, which is exploratory clinical research and instrumental innovation. What theoretical support can be found in defense of such an approach? As it happens, a sound rationale does exist.
In conventional scientific research the attempt is usually made to limit the number of variables in play to a manageable number. The experiment is then conducted in that confined parameter space. When we confront the human brain, on the other hand, its intrinsic complexity is irreducible. We are not dealing with brain slices in petri dishes. What then? Under such circumstances, the best approach is one of trial and error. At the outset, however, that just confronts one infinity (the complexity of the system) with another (the range of possible interventions).
As a practical matter, the virtue of Barry Sterman’s early research was that it gave us a firm foundation for a singular point of departure. It collapsed the infinity of trial and error all the way down to a unitary approach—in addition to furnishing a rationale for proceeding at all down this path. And whereas Sterman himself remained there for the rest of his professional life, others among us took this as a launch pad for wider explorations of the clinical frontier. And this is where the trial-and-error method paid off. It must also be admitted, however, that it took us years to leave the comfort zone of the SMR-beta training on the sensorimotor strip. It had already been a goldmine, and we were highly motivated at the time to stick with one mainline approach. It offered a broad clinical footprint, and it allowed the emerging discipline to “sing with one voice.” What came to be known as “C3beta-C4SMR” seemed to meet our objectives, and we taught that to thousands of professionals over nearly a decade.
Eventually this led to the evolution of a clinical method that bears very little resemblance to the original protocol, although the core principles remain. The parentage of infra-low frequency training is clear. The method is not only frequency-based, but also frequency-specific; placement is reasonably standard and mechanisms-based; the montage is bipolar; the differential response of the two hemispheres is respected; and the target is core regulatory function. We are dealing here with a mere generalization of the original Sterman method with respect to placement and frequency.
What a shame that Sterman declared himself to be uninterested. This became apparent when Sterman offered to survey the prevailing state of the field for his SABA Conference audience some years back. He called and we had the only conversation we have ever had about our work with infra-low frequency training. “What about the rewards at these low frequencies? What is the latency of the reward?” he asked, figuring he had me cornered. “There are no rewards, Barry. People are just watching the signal.” And that was effectively the end of the conversation, when it should have been the beginning.
This brings to mind a story related by Hershel Toomim. Early in his college career he approached a physicist to ask whether he should go into physics. “You aren’t sufficiently curious,” came the answer. Really? When considered in the context of his adopted field, Hershel had much more curiosity than most. He ended up in engineering.
This takes us back then to the matter of observations. What is the impetus? What sets us apart from the meerkats, who likely have no peer when it comes to the primacy of observational compass and vigilance. In the scientific context, there needs to be something like an insatiable curiosity, an unruly and restless spirit of inquiry, a roving mind that does not put blinders on itself, to motivate systematic, persistent observation. And finally, there needs to be a kind of provisional guiding hypothesis as well. In the clinical setting, there must be some kind of attachment bond to sustain the connection with the client, and there must be an ongoing provisional narrative to organize thinking.
This manifestly fecund process, which underpins much of empirical scientific research, has somehow been unable to shed its second-class status within our field. Instead we have historically set high evidentiary standards for ideas even to be discussed. In the early years, if something hadn’t been published, then it could not even be presented at conferences. Prevailing CEU criteria reflect this standard to this very day.
In the early years this threshold even applied to private conversations, placing professionals in a state of perpetual vigilance. The assertion of an aspiring fact would energize almost anyone in the project of calling it into question, of inquiring into its provenance. ‘Has this been published?’ If not, then the conversation might well have ended right at that point. As for the exploration of new frontiers, there appeared to be little enthusiasm. “There is such a thing as too much innovation,” according to a recent post by a member of the AAPB. It is a matter of direct relevance to the project of charting our future to inquire into how things could have gone so badly off track for so long in a field that was harboring so many mysteries while showing so much promise.
At the panel discussion I told the story of a theologian from Harvard Divinity School who reflected on his own history of adolescence to report that when he first started dating, his mother told him to “always act as if he saw Jesus walking by.” (He admitted that over time he decided to take his chances….) His mother had installed a behavioral control agent in his brain that no doubt served nicely to moderate his ardor.
Our entire field has done the same. We installed mainstream thinking as standard-setting for our enterprise, and with respect to that standard we were always coming up short. At each conference, our own behavioral control agent was on-line to censor every conversation. We could only whisper the unmentionables if we also added the disclaimer that of course the definitive research had yet to be done…only then could we be back in good graces. It became part of our cultural waggle dance to apologize for the appearance of making claims before their time. Since the practical means of doing the definitive research were always beyond us, we had effectively outsourced the final arbitration of the truth claims of our discipline. Those were the years of the Grand Smack-down, with the custodians of the field all acting in the service of the behavioral control agent that they had themselves installed in their brains.
Note the parallelism here with the Judeo-Christian tradition of our European culture. We had our priesthood; we had our doctrines; we had catechism and confirmation (certification); we had our revered texts; we had our sanctuaries (universities and hospitals); we were told that Judgment Day would be coming and that our betters would be arbitrating our claims within their sanctuaries. In the meantime, we would be in the status of sinners always falling short of the scientific ideal. Instead of ‘getting right with God’ we had ‘getting right with science.’ And just as there is no vacuum in the ethical universe of religion, in the psychological sciences a professional could never be caught without a value judgment. In that value hierarchy, new findings could always be rendered suspect because they had not yet run the gauntlet of independent verification. A listener could always seize the higher ground of resolute skepticism, our cardinal scientific virtue.
This elevation of free-ranging skepticism appears to be a particular affliction of American psychology, as pointed out by Wolfgang Köhler of Gestalt theory fame more than sixty years ago. The chief responsibility of a scientist is ostensibly to avoid making mistakes. Since our field was on probation, so to speak, after the alpha training debacle, the risk of any missteps was further magnified. Any misadventures would not only place the individual on the slippery slope to professional oblivion, but the whole field might suffer by association. Said Wolfgang Köhler:
“First, I doubt whether it is advisable to regard caution and a critical spirit as the virtues of a scientist, as though little else counted. They are necessary in research, just as the brakes in our cars must be kept in order and their windshields clean. But it is not because of the brakes or of the windshields that we drive. Similarly, caution and a critical spirit are like tools. They ought to be kept ready during a scientific enterprise; however, the main business of a science is gaining more and more new knowledge. I wonder why great men in physics do not call caution and a critical spirit the most important characteristics of their behavior. They seem to regard the testing of brakes and the cleaning of windshields as mere precautions, but look forward to the next trip as the business for which they have cars. Why is it only in psychology that we hear the slightly discouraging story of mere caution over and over again? Why are just psychologists so inclined to greet the announcement of a new fact (or a new working hypothesis) almost with scorn?
Wolfgang Köhler, Address of the President at the sixty-seventh Annual Convention of the American Psychological Association, Cincinnati, Ohio, September 6, 1959
Wherever there is doctrine, there is also heresy. And there are heretics to be banished to the outer darkness. There was Barbara Brown, first of all, and Elmer Green, exponents of the alpha training that has been so vigorously and urgently discredited. If Joe Kamiya was the father of alpha training, then Barbara Brown was its mother. She single-handedly put alpha training on the map in this country with several best-sellers written in short order in the seventies. Her compendium on alpha band research contained more than 1000 references. Barbara Brown had sent out the invitations to the first meeting of the new Biofeedback Research Society. At the 25th anniversary meeting of the AAPB, her name was mentioned only once.
When Eugene Peniston later attempted to bring Menninger’s Alpha-Theta training back into the conversation, he was subjected to character assassination by Sterman and others. There is just no other word for it. There was an organized effort to discredit him so that he would never return, and he never did. No gentler soul ever graced our speaker’s platform at the AAPB. For its part, The VA shuffled him off to a desk job in Texas, and he died without ever knowing how his research has borne fruit. Then there was Anna Wise, who was also made into persona non grata. Sterman also publicly savaged Adam Crane, developer of the first computerized four-channel Alpha synchrony trainer.
Just what was wrong with alpha training? It was those spooky altered states that people got into, of course. The academic mind could not abide the talk of transpersonal phenomena and of sudden, radical transformative experience. And yet these were certainly real enough. Once again, our thinking about how nature behaves needed to be enlarged.
We also had our different sects in the field, each of which had its own specific truth claims and did not consort well with the others. When Bessel van der Kolk first showed up at an ISNR meeting, he was shocked. “There isn’t even a field here yet, so what are people fighting about?” People were brandishing their certainties like the large phalluses of the Greek theatre. In a field to which the essential unitary quality of our regulatory regime ought to be most apparent, we were witness to an almost pathological Balkanization.
There is at least one difference between the two magisteria of religion and science (in the terminology of the late Stephen Jay Gould) that bears mentioning at this point. Men of faith can be insufferably sanctimonious, we all know, but underneath all of that fervent conviction lies the awareness that one remains in the realm of faith. Not so the scientist. As Neil DeGrasse Tyson informs us, “The good thing about science is that it’s true whether or not you believe in it.” On that basis, a scientist can be even more stubbornly immovable than a man of faith because he is convinced of his theories to the point of absolute certainty. This can lead to an equally insufferable intellectual arrogance that brooks no contradiction.
Note that Tyson is talking about science as a body of knowledge, as truth, rather than as a process for getting there. In this view, then, the truth claims of both magisteria are absolute. In the case of science, there must also be a fool-proof process for getting to the truth. Reproducibility is generally agreed to be the condition to be met by an aspiring empirical fact. “It is necessary for the very existence of science that the same conditions always produce the same result.” But what if they don’t? By now we have hard evidence from quantum mechanics that the same conditions do not always produce the same result. Our rule must be modified, as Richard Feynman has done: “It is necessary for the existence of science that minds exist which do not allow that nature must satisfy some pre-conceived conditions.” In the case of quantum mechanics, for example, we must be content with reproducibility at another level.
The history of our field has been one of a gradual shedding of certainties over the years. In every case, the claimed verities outlived their vanishing evidentiary support—if indeed such support ever existed. The beliefs had taken on a life of their own. In the words of Max Planck: “Important theories, marked for death by the discovery of contradictory evidence, seldom die before their authors.” We must have patience. “Science advances one funeral at a time.”
I recall a conversation with biofeedback therapist Jack Sandweiss many years ago in which he represented the position that the fact of our having this conversation at that moment was in principle predictable from the moment of the Big Bang. He assumed that the entire edifice of science rested on the principle of hard determinism, and he could imagine no alternative.
We may now see such certainty as quaint, but most likely we are all holding on to similar verities with which we are not prepared to part. So even the scientific edifice rests on assumptions that may have to be modified. They are therefore ultimately also provisional, faith-based if you will, and it would be helpful for all of us to adopt an attitude of greater humility with respect to our foundational assumptions.
The two magisteria are not so far apart after all. In particular, both our scientific and religious traditions are monolithic (monotheistic), seeking a unitary description of our nature that is then naturally adversarial with respect to alternative constructs. The battles of the past in our field have been a matter of a tyrannical left hemisphere insisting on having its way in the world, empowered by delusions of scientific certainty. Such certainty could be sustained only by ignoring all of the rich clinical data that was emerging at the hands of clinicians who had the gift of a functioning right hemisphere.
This tyranny of the left hemisphere is self-reinforcing. I recall an incident in which a man and his wife were arguing about whether men were more intelligent than women. After the wife cited those aspects of mental function where women tend to exhibit general superiority, the husband simply declared, “But that is not intelligence!” Unsurprisingly, the left hemisphere defines intelligence to favor what it is particularly good at. And it defines the scientific process very much in terms that are congenial to left-hemisphere competences. Until recently, scientists did not even recognize right-brain skills such as facial recognition, emotional discernment, and coming to terms with ambiguity and complexity quickly, as higher functions.
The left hemisphere indulges the fiction that it is in charge of events, and then proceeds to organize our intellectual constructs and our institutions to support that persuasion. The result was delusional at more than one level. Only the left hemisphere can get lost in its hall of mirrors, with an omega point of solipsism.
This is well illustrated in the field of psychology in its preponderant cognitive (and volitional) bias. This tilt was so great that when American psychology was given first dibs on adopting physiological self-regulation as a way of pacifying the right hemisphere, it passed on the opportunity. Right hemisphere function remained terra incognita. The field of psychology has managed to talk about ADHD, for example, entirely without reference to the emotions for the whole twentieth century. The field of psychology had passed up the best opportunity to heal its patients….and to re-balance itself.
Toward the Re-unification of the Field
We have witnessed a multi-decadal dismantling of the original vision of model-driven, prescriptive neurofeedback in the operant conditioning model to a more organically brain-based, non-prescriptive approach in which the brain itself determines its journey and we merely provide it information that it finds most useful. The field is moving from Barry’s original vision, which derived directly from his animal studies, to Sue Othmer’s:
“We are engaged in a dance with the brain, and the brain gets to lead.”
Ironically, this takes us much closer to where biofeedback has always been. It has relied mainly on continuous signals, and thresholding is not involved. (Infra-low frequency training has added the insight that volition is not a necessary constituent of successful training.) Additionally, compartmentalization is breaking down between traditional peripheral biofeedback and neurofeedback. The frequency-basis of our neuro-regulatory regime can apparently be accessed anywhere on the body. And the feedback process, in all of its aspects, gains useful intelligence from a variety of physiological measures.
The breakdown of the hegemonic regime now also allows us to cross the generational divide and welcome the new generation of techies who see both the necessity for what we are doing and the opportunity to contribute to the fulfillment of our human capacities. At the same time, they are neither scarred nor encumbered by the traumas of the past. They also do not shy from acknowledging our essentially spiritual natures, our aspirations for transcendence, our search for meaning, and our yearning for connection.
We are beginning to see the emergence of more right-brained consciousness, as was predicted long ago by British historian Arnold J. Toynbee for the 21st century. The emergence of mindfulness is part of this. Les Fehmi has already occupied that space for forty years with his Open Focus training, but now the movement is finally coming into its own.
What is called for in unifying our field is more openness, more inclusiveness, and more humility. But at the same time we are also entitled to more boldness. With respect to openness, the left coast has already moved a great deal in that direction. After all, these days we listen to a free-ranging thinker such as Nicholas Dogris without a murmur. With regard to inclusiveness we are seeing more multi-modal treatment that combines various of our traditional feedback modes. Strict sectarianism is breaking down particularly at the level of the end-user, the biofeedback clinician.
As for humility, the dictum of C.S. Lewis comes to mind: “Humility is not thinking less of yourself. It’s thinking of yourself less.” It is our collective exertions that will move things forward. Ours must be a communal enterprise, and it is not a zero-sum game. In the words of Friedensreich Hundertwasser, “When someone dreams alone, it is only a dream. When many dream together, it is the beginning of a new reality.”
Where boldness is called for is with respect to full recognition for what we have already accomplished, and the confident assertion of that reality. We now know to a certainty that the living human brain is trainable in any state of consciousness (diminished or otherwise), at any age, at any biologically relevant frequency, and for any condition that is traceable to the functional organization of our regulatory regime.
We have identified procedures that obtain clinically useful results with sufficient predictability and reproducibility to justify the attempt. That is to say, progress is ‘sufficiently predictable’—even while the final outcome is not—to motivate the initiative. So we have established the existence of a therapeutic process to a level of absolute certainty. At the same time, we have also established a means by which such procedures may be identified and refined efficiently. In short, we have established a science of neurofeedback that is sufficient to attain any specified confidence level with regard to specific propositions without resort to group studies or frequentist analysis or even controlled studies.
At the level of subtlety at which we work, no other human being on the planet is capable of serving as a suitable control. The only viable option is to have the client serve as his own control in A/B comparisons, and that is what we have done for many years now. This makes training into an itinerant process that is at every turn guided and shaped by the response to the training itself. This breaks the mold on any standard research design.
Since neurofeedback is time-consuming and expensive, the benefits need to be obvious upon inspection in nearly every case or it’s game over. As there is no point in chasing small effects, there should be no need to do statistics to bring even small effect sizes to light. With reference to Lourdes, Michael Tansey once said “I want to see crutches going up on walls.” Even back then, he saw neurofeedback as the fulfillment of that dream. For Bernie Brucker, who worked for many years with spinal cord injury using peripheral EMG feedback, this hope was realized quite literally, not only metaphorically.
The efficacy of neurofeedback is simply no longer in question, and the issue should no longer engage us. That means all talk of the placebo as an explanatory model should be categorically dismissed. The placebo effects that are worth talking about in this connection are merely another aspect of the self-regulatory competence of our brains. As such they are part of our working assumption and cannot then also be a confound in our exertions. For those of us engaged in promoting self-regulatory competence, concern about the placebo is a category error. This case was succinctly made by Robert Shellenberger and Alyce Green in 1978 in their delightful little book, “From the Ghost in the Box to Successful Biofeedback Training.”
Enlarging on this theme, we cannot look to academic research to solve our problem. We are plainly a threat to the prevailing medical disciplines in the sense that our methods stand almost entirely outside of their natural scope of competence or education. This will not change rapidly, so we will continue to have our fate in our own hands.
Consider those who have looked at the ‘best’ neurofeedback research available in the mainline literature, people such as Thibault and Raz, and Sonuga-Barke et al. They remain unimpressed; Thibault and Raz see our delusional aspirations as the equivalent of pining for the tooth fairy! They are incapable of escaping the academic echo chamber, the prison of left-brained thinking. If they were to visit the offices of Les Fehmi, Jim Hardt, Len Ochs, Paul Swingle or our own, they would get an invitation for their brain to take a journey that will most likely confound their expectations. But this is unlikely to happen.
We are figuratively back with Galileo and his telescope. The Church prelates were no fools when they passed up the chance to look through the telescope. They might well be persuaded by the evidence, and then where would they be? Their souls’ future might be in peril if they came to doubt the Church’s teachings. They chose what for them was clearly the wiser course: do not yield to the temptation to look through the telescope!
Matters are much the same presently. Our critics would rather not be persuaded of the evidence because that would ensnare them in controversy and possibly even imperil their academic careers. Academia is unforgiving of missteps. Under the circumstances, they can be heroes to their tribe by presuming to evaluate neurofeedback and finding it wanting. In time these people could even become our allies, but that will happen only by virtue of what we do rather than through yet more academic studies for them to review.
We will have to claim the high ground all by ourselves. We already hold the high ground in mental health. We just need the courage to declare that to the world. Our answer to the academic critics is that for the conditions we deal with, the NNT, the ‘number needed to treat’ in order to establish efficacy is near unity. Clinically significant progress is being made incrementally and progressively in nearly every session; learning curves are taking shape before our eyes; global functional improvements are being noted; regressions and setbacks are countered with changes in strategy. Surprising subsidence of long-term complaints may be reported along the way. It becomes inescapably obvious that an active process is involved. Nearly all clients report clinical benefit that they themselves judge to have been worthwhile. This process is nothing mysterious, however. The brain has simply been empowered in its own cause with the help of information on its own time course of function.
Dear critic: If you insist on calling this a placebo, then so be it. But in that case, ours is bigger than yours.
“To describe neurofeedback is hard—
Frequencies, wires and lard.
One stares at a screen,
With a digital scene,
Whilst the brain finally lets down its guard.”
“I used to think that the brain was the most fascinating part of the body…then I realized what was telling me that.”
“I regard therapeutics as in too undeveloped a state for us to be able to stamp out the contributions of all fanatics and one-sided geniuses.”