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Catching up on Book Reviews

by Siegfried Othmer | March 24th, 2008

The Open Focus Brain - Harnessing the Power of Attention to Heal Mind and BodyIn this newsletter we take a look at two recently published books that represent two ends of the spectrum of neurofeedback approaches. They reflect divisions within the field that have remained unreconciled over the decades. They also reflect their authors, who have taken very different approaches in their scientific research.

The Open Focus Brain

This book could be said to have had a forty-year gestation period. It is a collaborative effort of Les Fehmi and Jim Robbins, and one suspects that Robbins’ recent involvement likely played a catalyst role that finally got the book to happen. The bulk of the book could equally well have been written decades earlier, as Les Fehmi’s model for his kind of neurofeedback has been consistent throughout.

Fehmi’s approach revolves around alpha training, but the salient hypothesis is that the synchrony of our neuronal assemblies strongly influences our state. By enhancing neuronal synchrony in the alpha band, we move to a calmer state of reduced arousal level. Our Western lifestyles tend to move us toward higher arousal level, and toward what Fehmi calls narrow and focused attention. This is energetically and physiologically costly. Practicing movement toward alpha synchrony allows us to explore the space in which our attention is more diffuse. We are more immersed in the experience. The work still gets done, but at a lower level of effort and with much less drain on our resources.

The world moved on past alpha training soon after it became all the rage in the psychedelic age in the late sixties. Academic research had not been able to replicate the results and thus disparaged the work. The flaws in those experiments were apparent to experts at the time, but no matter. The world had moved on. Fehmi stepped right into the problem himself in his earliest attempts to train his own alpha activity toward higher amplitudes. Hours and hours of effort yielded no measurable benefit. It is only when he gave up at the very end that the alpha amplitude suddenly popped up on the chart paper. It was state-dependent! One should not expect to train alpha in the abstract. The observed alpha amplitude would always be a reflection of the state of the person in that moment. This indeed had been the implication of Joe Kamiya’s earliest research into the subject. A trained subject could blindly identify the presence of alpha in his EEG simply by tuning into his own instantaneous state. Fehmi observed additionally that the objective criterion of success was not so much alpha amplitude per se as it was alpha synchrony. This became the organizing principle of his subsequent research.

In order to promote alpha synchrony a multi-channel system was needed, which Fehmi had to build himself in the prevailing state of the field. No funding was forthcoming for this work, even though Fehmi had an academic position at Stony Brook from which to pitch his proposals. Fehmi then went into private practice, where he had more latitude to pursue his interests and an ongoing funding source as well. The technological approach has remained largely unchanged since those early days, demonstrating a remarkable tenacity in the face of all that has happened in the field since. Moreover, Fehmi would argue that essentially everyone can benefit from this kind of EEG training, which places this approach into the very small category of “universal” protocols. Now we know that others have reported negative effects when some people are subjected to amplitude reinforcement in the alpha band. We have seen that ourselves as well. This strongly suggests that the greater benefit found with Fehmi’s approach (and the greater immunity to negative effects) must derive from the explicit training of synchrony as opposed to mere reinforcement of amplitude. The enhanced control of phase moves the brain toward better self-regulation.

Another important outcome of Fehmi’s work is that one can equally well achieve these objectives through the training of one’s attention. He calls it “paying attention to attention.” By bringing awareness to how we engage with our environment, we can readily alter the experience. Over time Fehmi discovered specific exercises that efficiently move people toward the state of “Open Focus.” Most efficient was the invitation to imagine space. It has no edges, no content, no physical properties that the visual system can concretize. There is nothing to engage with for the forty-two places in our association cortex that process visual imagery. So the brain goes into whole-brain alpha.

Colossi of ThebesA good many years ago Sue Othmer and I visited Les and Susan Shor Fehmi in their home office in Princeton, N.J. to participate in their Open Focus workshop. On that occasion I replicated Les Fehmi’s own prior experience. I tried alpha training with his synchrony trainer and couldn’t get anywhere with it. Obviously my goal-directed left hemisphere was getting in the way of the experience. When later it came time for Les to lead the group in an Open Focus exercise, however, I went into state immediately along with the others. When the verbal pathway is accessible, it is very effective indeed. At one point during the session the blissful silence was interrupted by someone barging into the room. This brought me out of a twilight of consciousness into the awareness that we had all been sitting there immobile like the colossi of Thebes. We had been there for hours and I had lost any sense of time.

This experience takes the stuffing out of the argument as to whether instrumental reinforcement or the power of suggestion is responsible for the desired state shift, or the desired clinical effects in neurofeedback. When it comes to something like alpha synchrony training in a functional brain, one can get there either way, or most likely by a combination of both. Had Les been present when I was coming to terms with his instrument, he would have guided me to success with a few suggestions; the instrumental response would have signaled my success; and things would no doubt have progressed nicely from there just with me and the instrument.

We have here a technique that can be helpful in guiding people out of a lifetime of living in anxiety states, out of panic, and out of living in pain. None of these were relevant to Les personally when he was first drawn to this approach. The greatest benefit—for him and for others—lay in the enhancement of quality of life that is made possible by moving toward Open Focus and of learning to live there. Even such a profound emotion as love can be understood in the language of attention as attending to the other with our entire selves, including in particular our emotional being. Love is an immersive experience. Unsurprisingly, alpha synchrony training can be magical for couples work. It provides a complement to verbal psychotherapy where one is drawn toward narrow and objective focus.

As I attempt to appraise what Fehmi has accomplished here in comparison with our own work, I suspect that our latest techniques are most likely quicker for symptom abatement, but they are much less likely to achieve a comparable end-point of training. There is added value in targeting EEG synchrony in the alpha band, and in the Open Focus exercises, that goes beyond what can be routinely achieved when targeting symptoms. Whereas in the past we have looked to Alpha/Theta training to move us in a similar direction, it is likely that even that approach falls short unless EEG synchrony is explicitly targeted with multi-channel training. Even then, for continuing benefit the ongoing Open Focus exercises are to be recommended. The book comes with a CD of sample exercises to initiate the reader. (See also www.OpenFocus.com)

No Child Left Behind Goals are obtainable with the NeuroCognitive Approach

This book, by psychologist Kirtley J. Thornton, takes us to a very different place in the variegated neurofeedback universe. Thornton’s prime target over the years has been specific learning deficits and the specific deficits attendant to traumatic brain injury, etc. These deficits can usually be related to a cortical signature by testing under functional challenge. They are then ameliorated by a targeted EEG reinforcement. This has been the research focus for Thornton now for a number of years, and the approach has reached a respectable level of maturity. The supporting data are by now overwhelming.

Unfortunately, this book confronts a universe that is either hostile or disinterested. Most of neurofeedback currently addresses issues of mental health. The conditions we commonly encounter are either characterized by the kind of drama that draws attention or they involve a level of misery that causes a person to seek help. Both the drama and the misery help to shepherd people to our door. Matters are otherwise for specific learning disabilities and the sequelae of traumatic brain injury. We are often dealing with functional deficits that are quite private, or they may even go unrecognized by the person at issue. We may not know of these problems until they are tested for.

Formal studies have shown that specific learning disabilities are a much greater issue in our school population than even ADHD and the related disruptive behavioral disorders. But there has been little on offer within the school systems to address them because there is no established framework in which to do that. The entire field of education finds itself in a prescientific age—to the point where any suggestion of a scientific approach will almost surely be resoundingly rejected.

On top of the specific learning disabilities that children come to school with we have the cumulative cost of minor brain injuries that are acquired along the way throughout life. The medical response is to ignore any complaints unless the patient experienced unconsciousness, in which case the person is “watched.” Nothing is ever done in most of these cases. Yet the cognitive deficits resulting from such brain insults are quite real, and may be quite persistent. Cognitive deficits do not lie within the scope of interests of most MDs likely to encounter a case of minor brain injury in the emergency room or after.

Thornton spends some time making the case for a beneficial economic impact of a societal investment in addressing these issues in the school population. The case is overwhelming, but it is unlikely to be attended to in a timely way. Cost-benefit analysis appears incapable of moving the policy agenda, or Los Angeles would have mass transit, and it would not be firing teachers wholesale right now. Unfortunately, our society manages to ignore even the problems it knows about. It doesn’t want to be burdened with yet another set of issues requiring expensive solutions. So Thornton’s elegant approach faces the task of urging a remedy for a problem that is not on the agenda. Projecting forward, however, it is only too likely that in its maturity neurofeedback will find greater application to these stealth issues than to the more obvious mental health complaints that dominate the neurofeedback field presently.

Now for the good news in this depressing environment: Just as many mental disorders essentially melt away under a neurofeedback protocol, specific cognitive deficits likewise yield readily to a targeted neurofeedback challenge. The effect sizes are not marginal. Children are routinely moved from the 30th to the 70th percentile, from the 20th percentile to the 80th, in specific academic domains. Moreover, learning curves have been documented on numerous children as they underwent the training. The effect of the training is incremental, cumulative, and progressive—even though it is not always monotonic in these compromised brains. And the likelihood of success is not minor, either. Nearly all affected children will benefit from the intervention to some extent, and most will benefit substantially. These are not data that can be readily dismissed by a scientifically tutored intelligence.

Thornton has identified a commonality among most of the specific cognitive deficits. He finds that certain cortical linkages fail to engage appropriately when challenged. These failures to communicate are then placed in a hierarchy, and the most extreme ones are trained first. Specifically, the two active sites at issue are trained toward higher coherence, or correspondence, at elevated EEG frequencies. Phase relationships are once again at issue, only in this case the phenomena are both localized and transient, whereas in Fehmi’s case they are distributed and persistent. The different properties are appropriate to activated and to resting states, respectively.

To date, Kirt Thornton has been a bit of a lone pioneer in this approach to neurofeedback. The work, unfortunately, is more labor-intensive than other neurofeedback approaches, so it hasn’t drawn fellow practitioners in great droves. But there is little doubt that the priority in the remediation of specific learning disabilities should be with a method such as this. Even within the larger domain of QEEG-driven feedback, the emphasis has been on dealing with state management issues that are apparent in baseline. Thornton is exposing a wider range of issues by placing the brain under challenge.

At this point, we are still in a policy wilderness when it comes to the remediation of learning deficits and the consequences of minor traumatic brain injury, which remain a silent epidemic. All that is needed for the dam to break is the realization that most learning deficits are software issues, not hardware problems, and that the software can now be rewritten. (See also http://www.chp-neurotherapy.com/)

A Synthesis

Despite the fact that these two approaches represent opposite poles within the neurofeedback firmament, an essential commonality has been identified. Whereas one technique strives for the greatest generality of effects and the other strives for the greatest specificity, both target the subtle and refined control of phase relationships in the cerebrum. It is appropriate to add that they have this in common with our own clinical approach to neurofeedback, which also targets phase relationships directly. Whereas all of these methods have considerable overlap in what they accomplish clinically, they each command terrain where they offer unique advantages.

Synchrony training is at its best with an intact brain, and for a person simply seeking higher levels of function and a more fully human, more multi-dimensional existence. Our kind of training targets the whole range of what we call “Disorders of Disregulation,” although it is also helpful for achieving optimum performance. And Thornton’s training is unequivocally deficit-focused. For many a nervous system it represents the indispensable remedy. The commonality, as already indicated, is that all three methods target phase relationships in the cerebrum in one way or another. Fehmi’s method targets more distributed function; Thornton’s targets more localized function; and our method addresses the orchestration of function more generally.

Unsurprisingly, Fehmi’s kind of work appeals mostly to therapists who approach their work out of a right-hemisphere consciousness, whereas Thornton’s approach appeals to the more left-brained orientation. Our approach, which incidentally emphasizes inter-hemispheric coordination as a central constituent of training, falls somewhere in between.
Due to the high level of integration in the organization of timing in the cerebrum, every technique will produce both localized and generalized effects across a wide range of disorders. When you train parts of the cerebrum, you also train the whole, and when you target the whole, even localized function benefits.

This generality of outcome naturally gives rise to the aspiration to universality among adherents of the various schools of thought. History, however, is tending in the other direction, as we see increasing proliferation of methods within the field. It is difficult to imagine a reconvergence coming out of that in a winner-take-all scenario. It is much more likely that the wisdom of each method (as it comes to be appreciated) will be incorporated by developers into their products, and that neurofeedback practitioners will become much more versatile in their approaches to the client.

Siegfried Othmer, Ph.D.

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