A Year-End Perspective

by Siegfried Othmer | December 8th, 2005

As we approach the year-end, my thinking goes to the big-picture issues as I look back on the progress the field has made over the past year and project forward to how the field of neurofeedback will likely progress in the coming year.

Several anecdotes tell the tale. At our recent training course someone commented on how frustrating it must be to be sitting on what we know and yet have the larger world just go by without any awareness of this field. Over time we have gotten used to the slow rate of “diffusion of innovation” that characterizes the health field in particular. But we also realize that the field is growing in a healthy way with the gradual but relentless accretion of new mental health professionals into the discipline.

Every new practitioner will benefit some 30-150 clients and their families over the course of a year through neurofeedback. Collectively we are helping well over 100,000 people per year in the United States. Eventually this “population pressure” will tell. They will eventually no longer just represent isolated individuals. Rather, they will encounter others who have similarly benefited. It will become a movement.

A network analysis is appropriate to this problem. In fact, it is analogous to one of the first network problems ever addressed, the familiar “six degrees of separation.” If every person who benefits from neurofeedback is seen as the central node in their own personal network of acquaintances, it will not be long before the various nodes represented by neurofeedback beneficiaries will connect through only a minimal number of links, or intermediaries. Very soon after this point is reached, the ambience in which neurofeedback finds itself will change in a favorable direction.

Among practitioners a similar network model can be applied. At the moment, the environment for professional interchange is still inhospitable. But we are close to a threshold of interconnectivity among professionals as well, and that will make the environment for the diffusion of information about neurofeedback more favorable.

Caroline Grierson just told me of having attended a lecture last week at UCLA on the topic of “Complementary and Alternative Medicine” by a researcher who makes it his business to stay on top of developments in that area. Regarding biofeedback, he stated that it was so commonplace in Europe now that it comes close to being regarded as mainstream. Caroline asked him afterwards about neurofeedback, and he knew nothing about it. At first he simply assumed that she must be talking about conventional biofeedback.

On the other side, we have just heard from Joseph Guan in Singapore, who had been asked to lecture on neurofeedback for mental retardation. Fortunately, we had the excellent data from Tanju Surmeli in Istanbul to go on, as well as the publication (in press) on the twin study of IQ improvement by Matt Fleischman.

Reported Dr. Guan after the conference:

“I gave a highly successfully presentation on neurofeedback in Jakarta, Indonesia on Wednesday, November 23. The scientific committee of the Asian Conference for Mental Retardation upgraded my presentation to a plenary session, so there was an audience of about 300 +. I had a lot of positive feedback, especially with regard to the studies on Down Syndrome and the mentally retarded subjects from Turkey.”

So what can explain the positive reaction to Guan’s presentation, on the one hand, and the difficulty that Matt Fleischman had in the United States in getting the twin paper accepted for publication? In terms of my favorite network model, we are dealing with the long links. It is impressive when Dr. Guan can cite data from different continents on the same novel topic.

The same phenomenon was also at work in our favor when Dr. Tanju Surmeli was challenged by his own Board of Psychiatry in Turkey for doing neurofeedback. When letters in his defense arrived from the United States, from Canada, from Australia, from England and from Switzerland, the Board of Psychiatry surely had to be impressed. The challenge was satisfactorily met.

A similar network analysis is being applied to the problem of the spread of the bird flu virus, or to its more virulent offspring that we may face one day. It is the long links that are the most efficacious in spreading a contagion, with–for example–some 10,000 people arriving from Asia just at LAX on a daily basis. In the absence of a viable vaccine, the planned strategy is that of a rigorous quarantine around the immediate family and its neighbors wherever the virus surfaces.

Neurofeedback has essentially suffered the problem of being quarantined not only by the research community but by various professional groups. The experience of Dr. Guan in exposing a “naïve” audience to the data is convincing in that regard. With no adverse bias going in, how could one help being intrigued by Surmeli’s data? If a body of researchers or practitioners in the United States is not similarly entranced, it is because the well has already been poisoned.

So the most effective strategy is indicated by the network model, particularly as it is applied to the problem of containing an epidemic: We should be about the business of increasing the linkages at every level of the relevant networks: among users of neurofeedback; among neurofeedback practitioners; and between the research community and clinicians. This is the very opposite, of course, from the quarantine strategy that has been in place: rogue practitioners are quarantined; deviant models are banished; disfavored instrumentation developers are publicly disgraced; certain professionals are attempting to quarantine other professional groups with respect to neurofeedback; and researchers effectively deny recognition to what has already been brought into existence clinically–the ultimate quarantine.

Most of our challenges are surely “intra-mural.” We must get our own house in order before guests will come to visit. But the network model can also be applied more generally to our interface with “near-neighbor” professional communities. Establishing network linkages to the outside can be just as helpful in achieving accepted status and diffusing suspicion.

It is quite remarkable, for example, that the world of virtual reality does not face the same challenges we do at all, even though the field is also tackling mental health issues such as anxiety, phobias, and panic. These emerging technologies are not seen as threatening anything. The same goes for such technologies as Fast Forword, Interactive Metronome, Brain Builder, and Lindamood-Bell. The question that is asked of these various technologies is the right one: Do they work? If so, then one can think about subsidiary studies on scientific issues that the technologies raise.

Neurofeedback on its own is best regarded from the standpoint of regulatory systems in general, that is to say, in the most inclusive of perspectives. But neurofeedback is also favored when it is embedded in a yet larger systems perspective, one that considers other influences on regulatory function. At one end of the spectrum that would include biochemical influences, and on the other end, psychodynamic ones. There is no natural hierarchy here that would put the psychodynamic niveau as the primary one. Considering psychodynamic factors is indispensable, but no more nor less than biochemical impediments to good neuro-regulation.

Cory Hammond recently pointed out proudly that he had espied a bump on a certain QEEG that turned out to be the first indication of a growing tumor. That is certainly commendable. But as a needed corrective to premature and unjustified triumphalism, I would like to recall the story told by Barry Sterman about how his own professional path came about. In the interest of greater proximity to a certain young lady in whom he was interested, Barry signed on to a physiology class she was taking. Concurrently he was tutoring a very difficult client. In fact, the client was so difficult that Barry suggested a psychological evaluation. The fellow was largely uncommunicative and there were other problems. The psychologist’s report was comprehensive and devastating. At the same time Barry was learning about thyroid deficiency in his physiology course, and suddenly it became clear to him that the person he was tutoring exhibited all of the signs. A basal metabolism test was recommended to the family, and by the next session Barry confronted a much more energetic and entirely functional and rational young man. ‘How can we presume to practice psychology when we are unaware of such profound physiological influences on mental functioning,’ Barry asked himself. And his path became the study of the psychophysiological underpinnings of behavior.

I don’t think psychologists ought to feel obligated professionally to equip themselves to detect nascent tumors except perhaps opportunistically as in Cory’s case. But it is not a stretch to surmise that a significant percentage of clients in a psychology practice are subject to a biochemically mediated dysfunction, and that it would be good for therapists to notice. We now know that a high percentage of autistic children and of migraineurs are subject to Irlen Syndrome. Not addressing that vulnerability will unquestionably handicap all other therapies, including neurofeedback. We are persuaded that developmental vision therapy is often helpful even after successful neurofeedback training. Most conditions showing up in our office would be helped if neurofeedback were complemented with dietary changes, with attention to specific biochemical vulnerabilities, and with lifestyle changes.

It is out of the question that a single professional should be asked to accrete all of the relevant competences to address the systemic issues of disregulation. Rather, the answer must be that the client’s needs should be met through an interacting network of professional competences. The natural “hub” of such a network should be that competence which is most integrative in perspective. That could be neurofeedback. Ironically, the field of biofeedback, which by its nature should be integrating in its orientation, is perhaps the most fragmented of health disciplines on the planet.

Nature did not incline us in that direction. Rather, it was the pernicious influence of a flawed medical model into which biofeedback professionals felt obligated to fit our discipline. However we got here, the best that could happen now is a deliberate effort to move toward a “systems” approach to problems of regulation. We can no longer afford a mental health care system that resembles the French way of shopping for groceries, with separate trips to the bakery, the dairy, the butcher shop and the vegetable grocery.

In all of the discussions that have gone back and forth over the past year with regard to professional standards, the obligatory touchstone is always that whatever is being proposed is most assuredly in the interest of the public. When I wear my “consumer” hat in these discussions, I am usually left cold. What is unambiguously at issue is the professional’s self-interest. How can anyone say with a straight face that the system of health care we have is somehow in the interest of the consuming public?

We have a combination of the best of medical procedures embedded in an almost medieval guild-oriented system of compartmentalized service delivery. Anyone who even for a moment assumes the perspective of the end user will agree that this is true. The unsatisfactory state of affairs calls into question any assertion that perpetuating such compartmentalization is somehow in the public interest. A path out of this mess is indicated by the network model. And a further perpetuation of our existing service delivery pathology would follow from the quarantine model.

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