Sometimes we who work with neurofeedback have the impression of living in a parallel universe. We live with a view of reality that is attaining increasing confirmation via formal studies while at the same time becoming much more clinically effective, yet it is a view that appears to be almost completely disconnected from mainstream thinking. This state of affairs is not unfamiliar to people who have studied Thomas Kuhn’s “The Structure of Scientific Revolutions,” but it is still somewhat breathtaking to see how long the split between the old and new paradigms can persist in the real world.

Traumatic Brain Injury

Recently Science Magazine visited the issue of blast trauma among returning veterans (Newsfocus, January 25 issue, p 406). The neurologist Ibolja Cernak had found evidence for blast trauma during the Balkan war in individuals complaining of vague symptoms of poor memory, cognitive deficits, vertigo, sleep difficulties, and behavioral disturbances. She found essentially no supporting material for her findings in the medical literature. Over the last couple of years, with the growing problem of blast injury, her findings have attracted interest.

Of course this kind of phenomenology is hardly new. The same problem was labeled shell shock in World War I. And it is only too likely that many of the varied and diffuse symptoms attributed to Gulf War Syndrome and earlier to Agent Orange may similarly have involved blast trauma. But the problem is actually much more common. We see this kind of phenomenology routinely in minor automobile accidents, with whiplash and concussions, etc. Some three million cases per year of minor traumatic brain injury occur in the United States each year. These people are largely neglected, as there is “no known medical treatment.”

The problem is that neurologists generally looked for structural signs of injury, and when these were not present, the patient’s complaints tended to be dismissed. Even Cernak alighted upon physical evidence of trauma such as enlarged ventricles and signs of bleeding. It is difficult, however, to make the leap from localized bleeding and enlarged ventricles to such diffuse and pervasive dysfunction. We know by now that the problem really lies in the subtle timing relationships among neuronal networks that have to communicate smoothly with one another. This problem does not show up in the size of the ventricles, or in fact in any test of the brain’s structural integrity, so it is easily overlooked.

We are convinced this is the problem because of the remedy we bring to bear. With neurofeedback we are directly challenging these timing relationships, while at the same time having nothing to offer for the organic deficits that may also be present. The selectivity of our remedy, and the relative completeness of the recovery that we facilitate, constitutes proof of the cause. We only address brain timing, so that must be where the problem lies.

There is no known alternative to neurofeedback as a remedy for minor traumatic brain injury. Moreover, this remedy has been available now for over thirty years. Over all this time, many head-injured people have been helped. Each of these people no doubt had a doctor who was tracking them. Many also had attorneys. It is not in the doctor’s interest to observe that a non-medical remedy had solved his patient’s problem. (“The field of medicine is not interested in the brain that heals itself.”) And it is not in the attorney’s interest to see the client’s problems solved before a settlement is reached. With everyone adhering to his or her own narrow self-interest along the way, neurofeedback does not propagate into more universal professional awareness for thirty years. A scandal indeed.

PTSD

The January issue of the APA Monitor has a rather bullish article on PTSD. On the one hand there is the assessment by Terence Keene of Boston Unversity that “the advances made have been nothing short of outstanding.” And on the other hand we have the assessment of the Institute of Medicine report that “there is still not enough evidence to say which PTSD treatments are effective, except for exposure therapies.” Those who argue with such pessimistic assessments point to high dropout rates that confound research. But aren’t high dropout rates themselves an index of treatment failure?

What has been very plain to us is that exposure therapies have not worked very well, and they are rather an imposition on the patient as well. We have seen veterans with PTSD who have spent years in therapy and don’t appear to be much better off for the experience. It is just fictional to talk of a systematic remedy here. Unsurprisingly, the entire discussion of PTSD in this article was devoid of any reference to the physiological domain. The only exception was a reference to the use of medications, and of EMDR. The mechanism of the latter was deemed to be obscure.

From our perspective, it is once again the neurofeedback remedy that points to the source of the problem. PTSD cannot be understood apart from its physiological dimension, and that physiological aspect in particular involves one-shot learning experiences by the neuronal networks. These in turn govern our visceral as well as our cognitive and emotional responding. Shaping our neuronal network function back toward more normal responding constitutes a prompt and comprehensive remedy for PTSD. Nothing else comes close. It is the remedy that proves the cause.

Now as it happens EMDR contributes evidence to our model. The essential feature of EMDR treatments is the appeal to our bilaterality with an approach that is entirely frequency or timing based. It is an approach that, much like neurofeedback, targets our brain organization in the timing domain. Unfortunately, it is largely being conducted by individuals who have not a clue about the larger picture into which their work fits. So EMDR is condemned to remain ever half a loaf.

Neurofeedback is the rest of the loaf. Here we have a comprehensive strategy for challenging the brain to reorganize its timing relationships, calm the fear response, calm emotional reactivity, organize sleep, normalize the pain response, and restore cognitive function and memory. PTSD simply vanishes in the process. It is never overtly targeted as such. It is brain timing relationships that are targeted, and the brain responds.

It is unfortunate that psychologists have taken every opportunity to date to walk away from the frontier of clinical neurophysiology. They distanced themselves from acupuncture; they were hostile to EMDR; they banished practitioners of the Emotional Freedom Technique (Thought Field Therapy) from the practice of psychology; and they have harbored those professionals who have been most consistently hostile to neurofeedback over the years. And then they huddle together to praise each other for what they can do for PTSD, when the condition in fact goes largely unremediated. At the same time, no psychologist who has used neurofeedback for PTSD would ever consider going back to exposure therapies. Indeed we occupy parallel universes.

Insomnia

The death of Heath Ledger brings to the fore an issue which is in fact commonplace. People are trying on their own to manage insomnia with their various medical options. “Heath Ledger died of acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam, and doxylamine.” None of the medications had been taken to excess when considered individually. Yet the combination was fatal.

It is well known that no medical remedy for insomnia should be used for more than a brief interval. Yet people are given no alternative. It should be no surprise, then, that insomniacs will end up self-medicating.

As it happens, neurofeedback constitutes a comprehensive remedy for insomnia. And once again, the remedy gives substance to the underlying problem: Insomnia is the inability of the brain to organize its sleep states, which again is a matter of the control of timing and frequency relationships. Medication can have a transient influence on this issue, but over the long term the brain simply adapts to the presence of the medication and the problem of insomnia resurfaces. There must be a remedy that targets the underlying issue directly, and it is neurofeedback. Unfortunately, it is not in the interest of the medical community to acknowledge a non-medical remedy, so we are condemned to continue to live in parallel universes.

Siegfried Othmer, Ph.D.

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