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The Shrinking Divide

by Siegfried Othmer, PhD

In our collective attempt to achieve mainstream acceptance, we have actually been co-conspirators in trying to fit neurofeedback into the standard models.
A t the time of the storming of the Bastille in 1789, King Louis the 16th wrote in his private journal: “Rien.” Nothing. Just a few years later, he was beheaded and himself came to nothing. One could make similar judgments about our field. No one in the suites at Pfizer is quaking in his boots at the contemplation of our ascendancy. We don’t yet count for very much. But biofeedback and neurofeedback are gradually marbling into the mainstream. The scientific foundations are being shored up; the techniques are being refined; the products are becoming ever more competent, as well as more attractive in their features; and the methods are becoming more people-friendly. Most importantly, the scope of what we can now accomplish with our methods is expanding to cover the entire realm of mental health. At the moment, the contrast between the actual prospects of self-regulation-based therapies, and the awareness prevailing in the rest of the world about their potential, could hardly be greater.

It would be fanciful to imagine that our little cadre of people engaged with feedback would finally break through where we haven’t before, and slay the dragon of an indifferent or even hostile mainstream. Rather, we are seeing a confluence of trends that collectively support our claims. There is the technology-intensive field of brain-computer interfaces. There are the emerging medical techniques for regimenting our neural networks: deep brain stimulation (DBS) and repetitive transcranial magnetic stimulation (rTMS). We now have a number of groups demonstrating fMRI-based feedback, and that entire work product is being accepted without controversy. We also have the brain toys from Mattel. These are collectively preparing the ground for the acceptance of our claims.

It is only a matter of time until it will be discovered that anything being accomplished with fMRI-based feedback can be done better, more quickly, and above all, more cost-effectively, with EEG feedback. It can be only a matter of time until it is discovered that the crudeness and complexity of rTMS is vastly over-matched by simple feedback techniques that we have been using for years.

In the above examples, the feedback option is the most efficient alternative to highly costly and extended procedures. Imagine a future in which our methods represent a reduction in cost to the insurance companies rather than a drain on their finances. In fact, it is already happening that insurance companies are referring clients for neurofeedback in preference to the alternative of hospitalization.

It will not be long before they realize that neurofeedback is an inexpensive alternative to ECT, to brain surgery for seizures, and to hospitalization in cases of suicidality. Similarly, a trial of neurofeedback should precede any decision to undertake DBS for Parkinson’s. And any treatment program for PTSD should also include Heart Rate Variability (HRV) training.

Just as the notion of brain plasticity found almost immediate acceptance within both the neurosciences and the larger culture, once the critical finding of neurogenesis in the adult brain had been made, there is the potential of a similar watershed when a critical event of some kind makes the acceptance of neurofeedback inescapable. The metaphor of water levels building up behind a dam comes to mind. The evidence in favor of our claims is building up even as the wall of mainstream resistance is being maintained. Once that wall breaks, however, the flood waters will spread widely, and will do so rapidly.

Even when that occurs, however, the golden age of self-regulation will not yet be at hand. The tendency, after all, is for institutions to maintain themselves within the status quo, and that is particularly true of the guilds, which include the health professions. In consequence, the attempt will be made variously to ‘domesticate’ the self-regulation technologies and simply recruit them into conventional practice as just another ‘procedure.’ Neurofeedback may come to be seen as ‘electronic Ritalin,’ among other things. This really sells self-regulation short.

In our collective attempt to achieve mainstream acceptance, we have actually been co-conspirators in trying to fit neurofeedback into the standard models. We have accepted the partitioning of mental disorders into discrete diagnostic categories, and we have accepted ‘placebo-controlled’ studies as the valid criterion of the validity of our claims. At the time of our own entry into this field some 29 years ago, we accepted both the operant conditioning model of neurofeedback as well as the ‘voluntary controls’ model of biofeedback. And we tried in various ways to be as accommodating to mainstream thinking as possible.

But where has this led us? An openness to clinical experience that presented itself over decades of practice has led us ultimately to a technique that cannot be explained in terms of either operant conditioning or the training of voluntary control. We present to the trainee nothing more than aspects of his own EEG. There is no guidance to the brain of any kind. The brain is merely a witness to its own activity.

This is self-regulation training in its essence, in the sense that the brain has complete discretion with regard to how it reacts to the presented signal. Voluntary control is ruled out as a factor because the information is often presented to the brain in background, while the trainee is being distracted with a movie.

Sue Othmer describes this process as a “dance with the brain, but the brain gets to lead.” This shifts the locus of control of the process to the brain, and away from the clinician. It is unlikely that the mental health professions will readily acquiesce to the relinquishing of control that is implied here, even though the clinician still plays an essential role in this process. The role is now observational rather than prescriptive, but again this goes against the thrust of development of the health professions, which are increasingly compartmentalized. The observation of the client needs to be comprehensive, readily crossing professional boundaries.

This process shreds diagnostic boundaries, on the one hand, and it does not lend itself to appraisal by standard research methods, on the other. It thrives and even depends on the individuality, the specificity, and the temporal contingency, of the response to training. In this perspective, “double-blind” is the rankest absurdity.

Even as mainstream thinking has been forced to move in a direction favorable to our larger cause, we ourselves have moved in a direction that poses an even greater challenge to conventional belief. It has, in fact, even challenged belief within our field, given its propensity to take fixed positions that give some hope of garnering general acceptance within the practitioner community. Unfortunately, it is the nature of self-regulation technologies to be itinerant, as we progressively uncover the remarkable power of the brain to restore its own functional capacities, given nothing more than information on its own regulatory activities.

The claim we make could not be simpler. Just as the brain does skill-learning by watching itself perform in life, it can similarly enhance its self-regulatory skills by watching itself in the act of self-regulation. The processes involved are the same.

This article was first published in the Summer edition of California Biofeedback, in this, the 40th anniversary year of the California Biofeedback Society.

Siegfried Othmer, PhD
drothmer.com

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2 Responses to “The Shrinking Divide”

  1. Joseph Duba, M.D. says:

    It has been amazing to view (now from a distance) the evolution of EEG Info , I took my first course with you and Sue in 1998. I remain very interested in Neurofeedback and keep looking for applications to Family Practice, this will likely remain limited without using an in-office therapist who can take the time to do sessions. Any ideas ?

    Thanks,

    Joe Duba, M.D.

    Reply

    Siegfried Othmer Reply:

    Thanks. It has indeed been an amazing journey.
    It should be getting ever easier to find a suitable therapist to work in your office, as more people are trained up.
    I suspect that a family practice would benefit from having an in-house resource like this, as so many issues among patients do not rise to the level of needing a medical remedy. Instead they need a self-regulation remedy.
    Additionally, you would gradually begin to see other MDs referring for NF, as it would be their preference to refer to another MD.

    Siegfried Othmer

    Reply

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