On the Integration of Somatic Biofeedback with Neurofeedback in Healthcare

by Siegfried Othmer | December 4th, 2015

By Siegfried Othmer, PhD

An underlying theme at both conferences, whether implicitly or explicitly, was the relationship of traditional biofeedback and neurofeedback, which is still being sorted out. This issue was put on the table right after Sue’s opening Keynote address by Eric Peper. His shotgun had three barrels, and he discharged all of them at once. “Why do you restrict your attentions to a single measure, the EEG?” he asked—perhaps not in those words.

Obviously in his mind the case had not been made. I am reminded of what Michael Tansey said in the early nineties about his conversion to neurofeedback: “With biofeedback, I was not seeing crutches going up on walls (with reference to Lourdes), but with neurofeedback I am seeing crutches being hung up on walls.” Of course, if truth be told, Bernie Brucker was seeing plenty of crutches going up on walls with his EMG training for spinal cord injury. But Margaret Ayers was working miracles, effectively, with traumatic brain injury and stroke. To this day, there is no remedy remotely comparable to neurofeedback for these conditions.

That is to say, self-regulation based therapies are really the only option for what is wrongly called minor brain injury, and EEG neurofeedback is the most effective means of mobilizing such recovery. Ayers was already working miracles when she had essentially only one protocol to work with. That was just the beginning.

Over the years, the folks who were most skeptical of our claims for neurofeedback were biofeedback people. Obviously their own clinical experience was not matching ours, our they would not have been so upset. They simply dismissed what we were saying.

This was particularly true when it came to migraines, where traditional biofeedback had perhaps the largest formal research basis to speak from at the time.

In the early nineties, it was said that neurofeedback couldn’t possibly work with migraines because it was a matter of the vasculature, not the brain. It took many more years for the mainstream to recognize the role of the brain in migraine, although Oliver Sacks had already been there back in 1970! By the time that was recognized within the biofeedback field, however, neurofeedback for migraines had already been interred as far as they were concerned.

This became painfully evident when we presented a seminar on migraine in 2004 at the AAPB. Frank Andrasik, perhaps the most extensively published author on biofeedback for migraines (and the editor of the AAPB Journal), was the moderator. Jeff Carmen presented his results for near-infrared training of cortical activation. Deborah Stokes, in her first-ever presentation at an AAPB conference, presented clinical outcomes on a cohort of 17 migraineurs. I presented case reports for our training protocol based on inter-hemispheric placement at T3-T4 with frequency optimization over the EEG frequency range, and extending all the way to 0-3 Hz. (This was just two years prior to our entry into the ILF regime.)

At the end of the seminar, two of the authorities most closely associated with biofeedback for migraines—Steve Baskin and Richard Sherman—-ripped into the presentations and sought to do damage control. Like lions going for the most vulnerable animal in the herd, they focused their ire on Deb Stokes, as she was least likely to rebut their challenge. Since what had been presented were actual cases that clearly happened, the only grounds left to attack them were to question the initial diagnoses. She could not have been working with real migraines! Deb rose to the challenge, however, pointing out that all of the cases at issue had been medically diagnosed. The critics then challenged the medical diagnoses as well! Anything to discredit what had been presented, by means fair or foul. It was a disgraceful spectacle.

By now we know how to eliminate migraine risk with high predictability. We know how to abort active migraines. We know how to abort auras. Jonathan Walker has published stunning results with QEEG-based training; we get comparable results with our ILF training; and Jeff gets comparable results with his infrared method. And all of them put conventional biofeedback for migraine risk in the shade. There is quite simply no comparison.

Jeff Carmen’s infrared thermal training with forehead placement could be seen as straddling the two camps. It is basically thermal training, but with cortical activation and control as the target. Jeff compared training in the conventional fashion using a thermistor with the infrared thermal sensor, and the outcome was not at all the same. It is true that the infrared signal from the forehead is strongly dominated by the surface temperature that is directly measured by the thermistor. But the infrared sensor is also picking up some thermal emissions from below the surface, and these may well account for the heightened sensitivity to cortical activity of the infrared method.

A second key difference is the rapidity of response of the infra-red sensor vis-a-vis a thermistor. This could likewise favor the detection of dynamic brain-derived thermal signatures.

Jeff Carmen’s infrared thermal training re-shapes the debate somewhat. The methods that redress migraine risk most effectively are those that have brain function as their target. The dividing line is no longer between EEG neurofeedback and somatic biofeedback. And when one comes right down to it, our infra-low frequency training must also be differentiated from conventional EEG neurofeedback. The slow cortical potential we train does indeed reflect cortical activation, but it is not purely neuronal in character. It is most likely also subject to other influences, including glial and perhaps vascular as well, as it is known to be influenced by the CO2 level in cerebral blood flow.

So at one level, we can argue in favor of targeting brain function by any means available—-the EEG, ILF, or infrared sensing. But at another level, both EEG neurofeedback and ILF are operating with a clear advantage: We have the frequency! Cortical function is organized in terms of frequency, and when it is engaged at that level, our sensitivity to what transpires in the brain is simply unmatched. With ILF NF we have discovered that the frequency organization extends all the way down to the circadian rhythm. Who knew?

Navigating the Coexistence of Biofeedback and Neurofeedback

We can all have our opinions about how we cohabit in the future, but we also know that the decisions will ultimately be rendered in the marketplace. I don’t see many biofeedback clinicians making their living primarily from offering traditional biofeedback services. These are typically ancillary to a more primary occupation. By contrast, neurofeedback therapists are quite likely building their practice around brain training. They are already succeeding even before insurance companies are playing much of a role. This means that the public is voting with its own pocketbook.

Meanwhile, we are all persuaded that there is really no alternative in healthcare to the universal adoption of self-regulation as an obligation for mankind in the modern world. Likewise, there is no alternative to the broad adoption of the self-care model. This is the base of common interest for biofeedback and neurofeedback.

Here biofeedback is the low-hanging fruit. It offers face validity, ease of access, personal involvement, affordability, and additivity! Every kind of training offers specific as well a general benefits. When our civilization finally gets exposed to the self-regulation technologies, autonomic regulation with the aid of somatic biofeedback will have first priority. It will eventually become universal, incorporated into the school curriculum, and thus become common knowledge.

Neurofeedback, on the other hand, will increasingly take on the heavy lifting. It will bring about a revolution in psychiatry and neurology, as well as in medical specialties such as pediatrics, gynecology, neuro-rehabilitation, and geriatrics. There is no real conflict here. We need to recognize our common interest in the promotion of the self-regulation remedy and the options for self-care. This requires that we move beyond our historical tribalism.

Siegfried Othmer, PhD

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