The 2006 AAPB Conference

by Siegfried Othmer | April 5th, 2006

It is best to report on the conference before memory grows stale. My overall impression was that creative ferment may be returning to this venue. Evolutionary developments are more likely at interfaces between disciplines than they are within monocultures, and the AAPB offers the natural forum for the interaction between biofeedback and neurofeedback. The reintegration of biofeedback with neurofeedback is the critical challenge for our field in these times. The increasing interest in my mechanisms workshop among people whose primary identification remains with biofeedback testifies to this felt need.

The AAPB is continuing its reach out to other disciplines by bringing in noted speakers, but I fear that many of these take their task too literally. They bring us their research, but they may go away with very little more than they came with. David Spiegel of Stanford talked of “Mind Matters in Illness,” but even in the very attempt to highlight the need for comfort, social support, and stress management in major illness, he ends up trivializing the mind-body connection. Perhaps we should be grateful for the fact that mainstream MDs are now talking forthrightly about mindfulness training and hypnosis. Even in that regard I suspect this is not the kind of conversation MDs are having with each other.

But even if folks like David Spiegel are taken at their word, one cannot escape the impression that we are still talking about techniques that are rather peripheral to the enterprise of medicine. That is to say, we (they) don’t expect such techniques to impinge upon the disease process directly. The whole domain of applied psychophysiology is really not in their bones, and it should be. It is the web of regulation, after all, that mediates the response to the environment, and that environment includes our interior spaces, our mental activities, and our psychological states. That regulatory regime is capable of dysfunction, and such dysfunction can eventuate in overt disease processes. Conversely, remediating the dysfunction is capable of undoing its own mischief, first of all, and even in reversing organic disease. Ours is the science that occupies the relevant turf of the Mind/Body connection, and our science is empowered by a technology that directly addresses the failure modes of regulation. This is major, and it should be central to the concerns of medicine.

Steven Wolf talked about the use of surface EMG measurements to document the effects of repetitive Transcranial Magnetic Stimulation (rTMS) in the recovery of motor control in neurorehabilitation. Much of his talk was spent in apologizing for the fact that the EMG setup had not been deployed appropriately to prove the hypothesis. He also emphasized the fact that the drive signal on the rTMS had been reduced to about 60% of the level where overt activation of muscle activity occurs.

I could only imagine what Bernard Brucker must have been thinking, having spent decades in the neurorehabilitation of specific muscle groups, guided by precise and appropriate EMG placements. And there were others in the audience who employ cortical stimulation at many orders of magnitude less than that involved in this work. The LENS system comes to mind, as does the Solomon II, and finally the Enermed, a device that uses continual pulsed magnetic stimulation at a level much smaller than the earth’s magnetic field in order to suppress migraines. As in the previous talk, one has the impression that we are traveling in separate universes.

During a luncheon meeting conducted by Frank Andrasik and Donald Moss on AAPB publications, it was disclosed that the Biofeedback Magazine will henceforth also carry articles that are subjected to peer review. The discussion migrated at one point to the issue that the documentation of a learning curve in biofeedback might go a long way to compensating for the absence of a placebo arm in a particular study. A placebo effect tends not to behave that way, so it can be ruled out. Frank at that point reminisced about the fact that in the early decades of the field a lot of emphasis was in fact placed on such data.

So on the one hand the field held itself to a higher standard, but on the other hand it also shot itself in the foot. In many cases the variables being trained did not show the expected learning curves that tracked with the remission of symptoms. We have had the same experience in EEG neurofeedback over the years. The mistake was made (it is easy to say this in retrospect) in trying to demonstrate specificity of the treatment, because indeed such specificity does not conform to the way nature and regulatory systems behave. We were doomed to fail.

Instead of looking for a learning curve in the training variable, we should look for it variously in our outcomes. Do we not improve TOVA scores gradually in our work? And do we not remediate sleep issues in our ADHD children, and pain syndromes, and appetite disregulation, and motor and vocal tics, and depression and anxiety, and bedwetting in the very same timeframe in which the CPT scores normalize? Do we not improve memory function, working memory, and other cognitive functions gradually? Do we not remediate executive function deficits broadly, but incrementally? If we assess according to a learning or a rehabilitation model we can blow away the placebo hypothesis without ever making the case for a specificity that may or may not exist.

Jaime Pineda of UC San Diego talked about the functional significance of the mu rhythm and of mirror neurons. The mu rhythm is seen as involved in the coupling of the realms of perception and of the generation of a responsive movement. This is then also the way the mirror neuron system comes into play, given its role in imitation learning and in its activation by witnessing purposive, goal-directed activity. On the basis of the observation that the mirror neuron system is not activated in autistic children, Pineda has proposed that the explicit training of the mu rhythm could be a fruitful enterprise for autistic children.

It is undoubtedly a necessity to propose a specific mechanism in order to thread the needle at the NIH, but is it not just as likely that the failure of the mirror neuron system is a mere concomitant of a more global dysfunction? For that matter, is it not arguable that autism is characterized by failures in the integration of function in whole host of areas—perceptual, cognitive, affective, visceral, and motor?
In any event, one has to be grateful that the conversation has been joined, and that graduate students are getting into neurofeedback research at UCSD. Several of them have attended our professional training course.

Sue Carter and Steve Porges, a husband-and-wife team who jointly direct the Brain Body Center at the University of Illinois in Chicago, gave talks in tandem. Sue Carter talked about her work with the social behavior of prairie voles. She makes the case for the construct of “social monogamy,” which lasts until the end of life and is enforced by a variety of life circumstances. “Sexual exclusivity is not essential to this construct…. although I wanted it to be…” After documenting the strong effect of social isolation, and showing that the mere manipulation of the animal in cages affects subsequent bonding behavior, she said that she met her husband again at the brainstem….

Readers may recall my review of Steve Porges’ talk at the Attachment Conference on his polyvagal theory, which ties together the domains of cardiac regulation, control of the facial musculature, and even of our adaptation toward the extraction of human speech from the flow of ambient noise through the common mediation via the tenth cranial nerve that emanates out of the brainstem.

All this lines up with our own thinking, in which we increasingly have to acknowledge the central role of the brainstem in the mechanisms of neurofeedback. Secondly, it elevates the role of our emotional regulation in the overall hierarchy, most particularly in its regulation of arousal, which is also the charter of the brainstem. Our glorious cortex beguiles us like Salome and her seven veils (read brainmaps), when in fact the agenda has mostly to do with simpler, more basic, and more primitive function. So we all meet at the brainstem.

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