Archive for the ‘Clinical Methods’ Category

The Healing Power of Neurofeedback

Friday, August 18th, 2006

healing_power_book_large.jpgIt is sheer delight for me to just delve into Stephen Larsen’s new book and travel with him the remarkable journey of Len Ochs and his colleagues in the discovery and exploration of the LENS technique (which stands for Low Energy Neurofeedback System). No one could have ever predicted where the initial speculations might eventually lead. In retrospect, the journey represents an almost picture-book case of how clinical research should ideally be conducted. It may not look quite so ideal to those who actually went through it. The personal and financial crises that may have been strewn across the path along the way are mercifully not recounted. But the process can indeed be a model to the rest of us. There was no roadmap to follow. The process was willed forward by a very determined fellow, and yet he also flogged it with skepticism every step of the way. No one applied a more thorough-going critical eye than Len himself.

The initial speculations emerged out of Len’s collaboration with Harold Russell and his colleague Dr. Carter. They were making inroads on specific learning disabilities with some fairly generic audio-visual stimulation techniques at the time. The hope was to have a standard device that could be used inexpensively and across the board with lots of children. With the simple concept that one might be better off “responding” to the EEG with the stimulus rather than “driving” it open-loop, Len set out on a path that would take him to the very opposite terrain, namely toward a technique that is deployed under some fairly tight constraints and with highly individualized parameters, all done under the vigilant eye of an astute, experienced, and sensitive clinician, while taking on some of the most difficult challenges in mental health. (more…)

The Evolution of Protocol-based Training

Wednesday, June 21st, 2006

The pace of recent developments in terms of clinical approaches calls for an occasional respite to find one’s bearings and recover perspective. First of all, I am amazed that the pace of new developments in this field is not slowing down, and secondly I am surprised that the pace of development of our own approach of mechanisms-based or protocol-based training is not plateauing either.

Looking back there have been several key milestones in the development of our own approach, and each of these has contributed in comparable measure to our clinical efficacy. The first departure to which we contributed some measure of authorship was the natural pairing of “C3beta” with “C4SMR,” using differential reinforcement parameters. The second was the particularization of our work with ADHD with bipolar placements that took us off the central strip, namely the combination of C3-Fz with C4-Pz. The third was the discovery of the pairing of T3-Fp1 with T4-Fp1 for the large category we labeled the instabilities. The fourth was the discovery of the importance of reward frequency optimization in the extension of our work to treatment-refractory populations. The fifth was the discovery of the value of inter-hemispheric placement for addressing our most intractable instabilities. (more…)

Two-Channel Awake-State Training Options

Wednesday, June 21st, 2006

It is possible to record and train on two channels of EEG data at the same time with most of the EEG amplifiers and software now available. We might choose to train the two channels separately at the same time. Or we might combine the two channels in order to train on the sum and/or difference of the signals, while allowing us to see the activity in each channel separately.

Two Channels Separately and Simultaneously
We usually combine training sites within a session so that we are moving electrodes left to right or front to back in order to train two or more sites in a thirty-minute session. Some clinicians prefer training two sites simultaneously using a two-channel hook-up. When training two sites at the same time, it is necessary to set the reward frequency appropriately for each channel separately. It is of course very important to keep straight which channel goes with which site and which reward frequency. The feedback is then contingent on meeting all reward criteria at both sites. With appropriate set-up the games work the same way they do for one-channel training. There are more ways the brain can fail with two channels, so we need to set the reward percentages a little easier for each variable. We can’t really comment from our own experience on the relative efficacy of training two channels simultaneously versus sequentially. Others are training this way with good results. We still prefer to see the effects of training different sites individually during the session. At this point it still helps us optimize and identify the effects of each training site and figure out what to do for each individual. (more…)

Interhemispheric Versus Single Hemisphere Training

Wednesday, June 14th, 2006

We have explored interhemispheric training over the past years, optimizing reward frequencies, and learning the specific effects of training different sites. Now that we have started also training left and right side separately again, we need to ask when and why we would choose to do one rather than the other. At first we moved to left and right side training in order to get low enough, especially when moving to prefrontal or parietal training. With our ability to train lower with narrower filters near zero, we can now separate the issues of frequency and placement. (See EEG Newsletter 14 May 2006.) Are there some people and some symptoms for which one approach is more effective?

We have moved people from one approach to the other at times in search of a stronger or more specific effect. We are now beginning to see that many people do clearly benefit more with interhemispheric or with single side training. Our task is to sort out any general rules that might guide us in fitting the protocol to the individual client. The emerging model is one of separating problems of instability of state from those of specific activation and arousal deficits. This of course brings us full circle to the initial need and rationale for interhemispheric training — stabilizing the brain against migraines with T3-T4.

We are finding that interhemispheric training (often specifically T3-T4) is proving more effective with global instabilities of state such as migraine, seizures, asthma, panic, vertigo, irritable bowel, mood swings and traumatic brain injury. I am expecting that it will also be more effective with PTSD, night terrors, sleepwalking and fibromyalgia. It may well be that interhemispheric coherence abnormalities will prove useful in pointing to specific interhemispheric sites that need training.

Left and/or right side training is giving stronger effects with activation and arousal deficits as with ADHD, anxiety and depression, OCD and tics, agitation, muscle tension, the autistic spectrum and probably RAD. In these cases we seem to get cleaner, more targeted effects and have an easier time finding an optimum reward frequency. We will need to rethink our categories of instability and sensitivity to fit these differential effects. It may be that hyperexcitabilities are impacted more strongly with interhemispheric training, while symptoms of disinhibition respond better to left or right prefrontal training.

So should we still start with T3-T4 or move directly to left and/or right side training with some individuals? The rationale for beginning with T3-T4 was that it asked the simplest question possible so as to give us the clearest answer. It was not left or right or front or back — just up or down to find the best reward frequency. More specific placements and effects could build on that. But we have already moved to right-side T4-P4 as the starting placement for RAD and autistic clients. Here the priority is to get individuals physically calm and settled and in their bodies. T4-P4 can be easier to figure out for many people because it specifically impacts body tension and agitation and awareness. This is a good place to start and continue for some sessions with autistic and RAD clients, but ADHD and anxiety/depression clients typically need to balance right posterior training with left prefrontal. So then the starting protocol would need to be both T4-P4 and T3-Fp1. Finding the optimum reward frequency at two sites might be a large task for the first session. We have a lot of history with T3-T4 as a starting place, so this may take time to evolve. If we do start T3-T4 and then shift to left and/or right side training, there are no firm rules to guide reward frequency selection. A reasonable solution is to start on the right side with the optimal reward at T3-T4 and expect to adjust as needed. The expected reward frequency on the left side is 2 Hz higher than that on the right.

We also expect that both approaches might be useful for some clients. It would make sense to stabilize first with interhemispheric training and then add more specific single sided placements for residual symptoms. We often see migraine clients benefit from T3-T4 very specifically, but then also need work on OCD or muscle tension symptoms. In such cases we would keep the T3-T4 in the mix, while adding other sites as needed and as they prove useful.

Left and Right Prefrontal EEG Training

Wednesday, June 7th, 2006

For the last several years we have focused on interhemispheric EEG training including prefrontal Fp1-Fp2. Interhemispheric training influenced the activation of both left and right prefrontal areas and the coordination of activity between them. More recently we have moved back to left and right-side training separately in some cases. This brings us back to the issue of which functions we might impact with left-side versus right-side training.

Before interhemispheric training, we learned to carefully avoid right prefrontal training. At that time we were rewarding basic Beta and SMR frequencies, and we had found that T4-Fp2 training at those frequencies could precipitate emotional meltdowns or explosions. We now understand that right prefrontal training has a very strong impact and needs a reward frequency carefully tailored to the individual. At the time we settled on left prefrontal training (T3-Fp1 or T4-Fp1) to impact problems with attention and impulse control. (more…)

Reward Frequency — A Breakthrough in Getting Low Enough

Wednesday, May 10th, 2006

While our inhibit filters typically cover the entire 0-30+ Hz band, it is clinically useful to target the reward frequency very specifically for each individual and each site. We find that the optimal training band can be anywhere from 0 to 30+ Hz. We also find that the majority of our clients need reward frequencies much closer to 0 than to 30 Hz. Every time we find a way to train which allows more calming, it seems that we have a surprising number of clients for whom we wish we could achieve even more calming.

With interhemispheric training, we know that the optimum reward frequency at T3-T4 (or C3-C4) for a given individual reliably predicts the optimum reward for interhemispheric training at parietal or occipital sites (4 Hz lower) or frontal or prefrontal sites (2 Hz lower). Since many high-arousal clients need a T3-T4 reward frequency lower than 4-7 Hz, we are unable to train low enough when we move to the back of the head. This is often a problem for autistic, reactive attachment disorder or bipolar children, and even for very hyperactive ADHD children. (more…)


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