One Million!

by Siegfried Othmer | August 8th, 2016

By Siegfried Othmer, PhD

onemillionIt is probably worth observing that sometime over the past several years the milestone was undoubtedly passed in which the one millionth person benefited from one or another of our neurofeedback protocols, implemented on one or another of our three generations of neurofeedback systems: NeuroCybernetics, EEGer, and Cygnet. It’s difficult to be too precise about these estimates, in contrast to counting hamburgers at McDonalds! So the estimate is deliberately a conservative one.

What we have learned over the past thirty years is not only how to do neurofeedback well, but also how progress should ideally be made at this frontier. The essence of the problem is that we are confronting complexity, and in the functioning brain that complexity is irreducible. As therapists and as scientist/practitioners we have to confront the brain in all of its glorious complexity all the time.

Moreover, the therapeutic process only moves forward if it is graced with success, because we are dealing with paying customers. One is not at liberty to take leaps into the dark; one can only make small incremental changes that hopefully take one closer to the goal; and everything that is undertaken has to be in in the best interests of the client at that moment. There is no independent research agenda.

This process is utterly foreign to the way matters work in research, where the objective is usually very limited and specific, the approach highly prescribed, and the outcome criteria very definitive. At every turn, the attempt is made to strip away complexity, to limit the degrees of freedom of the system under test. And if the outcome is negative, then that is not inconsistent with good science, either. The researcher still gets paid, and still gets to write another proposal.

In trying to describe the process of protocol innovation that has emerged, it turns out that we get a lot of help from a TED talk by Tim Harford, an economics writer:

Trial, error and the God complex

The basic message is that complex systems develop successfully —when they do—through trial and error. Economies are yet another instance of complex systems that illustrate the point very well. Trial and error learning is a bottom-up process. It stands in contrast to command and control, a top-down process. Here’s where the authorities reign, and they are often afflicted by the God complex. Command and control can work for a while, as we see in China, but it does not work well over the long haul. Economics is a field very much afflicted by the God complex among its luminaries. As Kenneth Galbraith once said with great relief: It’s a good thing economists aren’t subject to charges of malpractice. They are never held to account for their prescriptions.

In neurofeedback we have a stark contrast between the trial-and-error method by which we have succeeded over the years and the top-down prescriptive method that has come down from formal research. At every step over our thirty-year history, every innovation was resolutely opposed by those possessed by the God complex, and at every step they turned out to be mistaken. There has never been an exception. Do they ever learn from that collective experience? Of course not. The God complex means never having to own up to one’s blunders. It means never having to say you’re sorry. Just like the economists.

What has developed in neurofeedback over the years is a prescriptive approach, on the one hand, and an adaptive approach on the other. The one is based on a progression toward what is deemed to be best for the brain on the basis of present understandings. The other is method based on the brain’s response to information on its own status, an iterative approach. In the former, the goal is a well-defined target. The process is narrowly focused, driven by specific expectations.

In the latter, the brain bootstraps its way to good performance, one rung on the ladder at a time. The method is open-ended, with the brain in charge of the journey. We have two feedback loops involved here. At the first level, we have the brain looking at itself in the mirror, effectively, and responding to the information. At the second level, the clinician observes the response of the client through the session, and from session to session, and on that basis guides the process to its most propitious outcome.

In the first approach, theory dominates. In the second, it is skilled observation. The scientific process of course requires both elements. In practice, however, “It is the theory that tells us what we may believe,” [Albert Einstein], and by the same token it is theory that tells you what you may observe, what you allow yourself to attend to. An orientation toward formal research tends toward a narrow and specific focus, whereas a clinical orientation promotes a broad, inclusive and integrative perspective.

By now the proof is in hand. The experience of thirty years unequivocally demonstrates the superiority of the trial and error method, the clinical perspective guided by informed observation, over theory-driven prescriptive methods. Formal research results were needed to start the process in the first place. But eventually innovation in the bottom-up manner took over. This was not true only for ourselves. It has been true for various novel approaches to brain training via neuromodulation.

Meanwhile, some academics are still stuck at the starting gate, wondering whether neurofeedback is even worth investigating, or whether it is nothing more than a placebo. To them we say simply: the world has already moved on. We are not waiting for you. It is the trial-and-error method that has allowed the clinical intelligence to occupy the bracing frontier of developments within the larger field of neuromodulation. Standard research methods are simply not up to the challenge. They have been left in the dust left by the crowd-sourcing of progress now being made possible by thousands of clinicians. This is the new era of systems-level thinking, of coming to terms with complexity, of bottom-up problem solving. This is the era in which the right-brain intelligence comes into its own.

Siegfried Othmer, PhD

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