The Re-unification of Biofeedback and Neurofeedback
by Siegfried Othmer | December 12th, 2011
This newsletter is a revised version of my first column in NeuroConnections, the joint publication of the ISNR and of the AAPB Neurofeedback Division, which I am currently serving as President. In this forum, the newsletter reaches a larger audience.
It has been observed that Americans remain personally optimistic, by and large, while becoming increasingly pessimistic about what is happening in the society at large. This is certainly the case in our household, as we survey the decline in the relative standing of our country in nearly all measures of social, intellectual, and economic functioning, while at the same time we are highly optimistic about the positive societal potential of the neurofeedback training we have been doing. These divergent perceptions make for an unrelieved sense of urgency about the societal significance of our work. With our methods we are in a position to redress many of society’s critical ills, and to do so at very moderate costs by comparison to the results that can be achieved.
We confront the challenge that our methods need to be better known in a skeptical world, and made more accessible. The barriers to such progress are almost entirely sociological and political rather than technological or even scientific. The science underlying neurofeedback may still be in its infancy, but we understand matters well enough at the practical level to know how to revolutionize the entire field of mental health and of education.
Right now a preoccupation with rising medical costs is roiling our politics and fracturing our society. The piece that is entirely missing from educated discourse on these topics is the domain of ‘mind-body therapies,’ namely applied psychophysiology. It has been a step-child in research, from Hans Berger working alone to search for the EEG signal to Barry Sterman seeing his research funding for neurofeedback dry up in 1985. It has also been derided in practice by self-appointed experts.
And yet our methods can likely bend the medical cost curve all by themselves, and they can do so in short order. Missing is an articulation of the perspective that many medical challenges are the tragic end points of a long-term trajectory of progressive disregulation, combined with the realization that the timely implementation of a self-regulation strategy can forestall or avoid many of these adverse outcomes.
One has the sense that we are close to a tipping point at which there will be a shift toward more general acceptance of our claims, much like what happened when evidence for the generation of new neurons first made brain plasticity respectable for polite discussion. We can only marginally influence such a tipping point. We can, however, position ourselves for that occurrence. Right now there is one factor above all others that militates against our being seen as scientifically mature, and that is the compartmentalization of thinking at all professional levels within the domain of health care, and the high level of internal dissension it brings in train in all organizations aspiring to address the problem.
Along those lines, one urgent project that confronts our own field is the conceptual re-unification of biofeedback and neurofeedback, and the other is a change in the tenor of our discourse toward one of greater mutual acceptance and tolerance of differences among the different approaches to neurofeedback. Ours is an intrinsically multi-disciplinary enterprise, and it is inevitable that there will be clashing viewpoints during the shakedown phase. No profession has squatters’ rights here. None has a perpetual lease, or title to intellectual property with respect to the core tenets of our discipline.
Over the twenty-two years that I have been attending meetings of the AAPB, I have always been amazed at the degree to which the Balkanization of the biofeedback field sustained itself in the face of the obvious unitary quality of our regulatory regime. Those who practiced EMG training considered themselves so distinct from the whole that eventually they spun off into a separate organization from the AAPB. Those who continued to pursue alpha training eventually found themselves so unwelcome at the AAPB that they too spun off to form their own organization. Years later, the EEG biofeedback contingent also decamped to form the SSNR in 1993. (This is now the ISNR.)
Unfortunately, the virus of compartmentalized thinking migrated with the daughter organizations into their new institutional settings. Right belief needed to be promoted, and heresies expunged. Certainty was claimed for propositions which did not deserve it. Fruitful discourse was aborted. And so here we are, with no end in sight for the basic rifts within the field. The answer, of course, lies in reaching across the breaches in support of our common objectives.
The underlying reality of our discipline is that our regulatory regime functions as an integrated whole. Autonomic regulation is not rigorously separable in the discussion; the division into central and peripheral regulation is not realistically sustainable. Hence the division into separate agendas for biofeedback and neurofeedback is going to be increasingly limiting. It is not that our prior understandings were false. It is rather a question of whether they remain useful. As the integrative nature of our regulatory hierarchy is coming to be understood, the latter perspective is simply going to be more fruitful. We now need to reach across the boundaries we ourselves have established.
Some while ago I heard a program on TED which talked about the advantage of having lots of different ideas contend with one another. The speaker drew the analogy to sexual reproduction, which brings different genetic resources into combination. Just as biological systems are most productive of change at the interface between different communities, so our intellectual growth is promoted by the engagement of divergent perspectives. Instead we tended to have the active resistance to any new initiatives. The result is that the field has fragmented into sub-disciplines divided by the instrumentation being utilized. This is a direct analogy to the fragmentation in the original biofeedback discipline according to the physiological variable being trained. To an extent, our pathology is shared by the field of neurophysiology as a whole. Said neuroscientist Christof Koch, “People are more likely to use each other’s toothbrush than they are to use each other’s protocols.”
When a new finding is brought to the attention of our community, the typical response is to ask whether the aspirational “claim” is already supported by the literature. But if we limited ourselves to living within the comfort zone of published science it would be like driving while looking in the rear view mirror. As Daniel Siegel has said, “If you had to have the science first, we would never get anywhere in science.” First comes the observation; then comes the discernment of a pattern of occurrences; and then we already have the obligation to share what we have observed with colleagues. Anecdote is not a pejorative. Sometimes even a single observation rises to significance. When I first heard from Dan Chartier of a 40-point improvement in IQ score, from 72 to 112, in one of his early clients, it was already sufficient to loosen the moorings on the belief that the IQ was essentially invariant. Something had been accomplished that had no trivial explanation.
In the sometimes lengthy progression from mere conjecture toward solid scientific status, our community should at least benignly tolerate, if not affirmatively value and support, the innovators. The constraints of peer review are often detrimental to the tender shoots of new initiatives. Peer review tends to censor or dismiss anything too far from the beaten path. This is a fact of life in mainstream science that will not change. But that is all the more reason for our community of professionals to provide a buffer to the harsher judgments of the world at large, a safe harbor for innovation within its orbit. While the world at large is bidding us to make harsher judgments, for example with respect to evidence-based criteria, within our own organization we should be moving in the opposite direction, toward softer judgments and greater openness to divergent perspectives.
Dear Dr. Othmer, I sent you an e mail awhile back describing my successful remission from spasmodic torticollis due to biofeedback treatments. I couldn’t agree with you more,. Sincerely, Daniel Sarper, Aventura, Florida.
Thanks for writing. We presented at a conference on spasmodic torticollis in Las Vegas recently, to inform attendees that there are options beyond Botox. And even when standard medical remedies deal with the cardinal symptoms of spasmodic torticollis, there are the associated issues of sleep disregulation, pain, depression and anxiety to deal with, which is where biofeedback and neurofeedback present the most attractive option for relief.
Dr. Othmer, thanks again for your clear vision and forward thinking. Your perseverance in the face of stormy opinions. It is these synergies across disciplines that are going to unlock new innovations.
As an example of another unconventional form of biofeedback, I would mention Dr. Paul Nogier’s VAS (Vascular Autonomic Signal) pulse reading system. Which is used as a readout to control various vibrational modalities such as pulsed magnetic fields, colors and sounds. The Ondamed biofeedback device is one such example, that has had modest commercial success.
These various dimensions of biofeedback technology clearly can complement each other. If we suspend “one paradigm” thinking.
Best regards,
Sieg,
I have a somewhat different viewpoint than what you’re espousing here. Yes, it would be good for there to be more openness in the overall fields of feedback technologies. However, there are profound differences in the various approaches — not only in terms of the actual equipment and software but, much more importantly, in the overall orientation and underlying philosophies supporting the various approaches.
While the neurofeedback field as a whole continues to converge towards positions we advocated years ago — and were roundly criticized by all when we did so — the progress towards convergence is more than glacial slow. I was heartened when I presented last year at AAPB – as an invited keynote — by the reception I received, esp from you and the other commentators. But what has happened since then?
The first and most important thing that has happened is the attack being launched by the so called “Standards Committee” of the ISNR. It purports to be committed to promoting and securing public safety but it really is simply the last gasp of some practitioners to capture all of neurofeedback — and essentially criminalize the rest of the field. I wonder how you feel about this? In good conscience not only can I not support the reunification of biofeedback and neurofeedback — I can’t even begin to consider the possibility of rapprochement with ISNR given this recent initiative.
How different are neurofeedback and biofeedback? That depends on the approach doesn’t it? How different is what we are doing at Zengar from others? The differences are profound — as you well know. So how can there be a reunification? Or perhaps more importantly: What form would such a possible reunification take? Under the aegis of the ISNR’s “Standards Committee” the reunification would be the outright outlawing of what we do and have done for the past decade: viz, make a fail-safe, fault-tolerant neurofeedback training system that anyone can use.
No, I don’t think it’s time for a reunification. If anything, it’s time for a new definition of what — at least — we at Zengar have been doing; otherwise we could get lumped in with all of the other approaches simply because we put sensors on the head.
No I think it’s more likely time for more direct action than “reunification”. And the first item on that agenda should be to call an end to the witch hunts against neurofeedback trainers. And I wonder where you stand on these aspects of the issues you raise.
val
Val—
In my newsletter I was thinking mainly at the conceptual level of how each sub-field articulates its understanding of its own discipline. These divergent perspectives no longer serve us well. I was not thinking so much at the organizational level, where indeed a convergence of perspectives is much more unlikely. Institutional arrangements militate against a melding of perspectives; they intrinsically move in the direction of sharpening distinctions. The Balkanization of the field mirrors the sectarian splits we see in the major religions, and for much the same reason. Specific items of belief are elevated as being core, and thus the general unifying principles underneath are eclipsed.
I agree that the ISNR in particular has been held in thrall to a very narrow view of neurofeedback, to the detriment of its organizational health. The Standards document only compounds the error. I don’t expect this to be understood within the organization. And even if this is understood, it is probably not fundamentally alterable. This is all of a piece with the whole diagnostic, disease-ridden enterprise, which is irrevocably stuck in its own paradigm.
Fundamental change therefore has to come from outside the existing institutional frameworks—once again. That is what your organization is doing, and ours as well. What worries the hegemonists is that already at this point the vast majority of neurofeedback is being done beyond the reach of the rule makers within the ISNR and the BCIA. That’s always been true, of course, and that trend will only continue. Once the threshold of general acceptance is crossed, it is likely to accelerate. And once reimbursement of neurofeedback is installed, it will accelerate even more. The parsimony of third-party payers will assure that outcome. The cake will be sitting on the table, and most people will be told that they cannot have a piece…. With a technology as accessible as neurofeedback, the informed public will find a way to get its needs met.
The core issue is whether access to self-regulation technologies will be gated by the medical elites, or whether as a matter of essential civil liberties access to information about one’s own physiological variables may not be restricted. If it cannot be restricted, then it can also be acted upon arbitrarily. And if it can be acted upon arbitrarily, then advice in that regard can be legitimately offered by anyone to aid in the cause of improved self-regulatory capacity.
Now when it comes to specific technologies within the general sphere of physiological self-regulation, some indeed require competent guidance, and ours is among them. So we are in fact acting directly in the service of the licensed health care community for the propagation of our technology. But this does not mean that ours is the only way to go, and we don’t expect a monolithic discipline to emerge.
Siegfried Othmer
Dr. Othmer, your reply to Dr. Brown, in my opinion does a service to the field of NFB in delineating the conceptual from the organizational. Alan Shore (2009) heralded a paradigm shift in the view of psychoanalytic self-psychology and its interface with neuroscience in an article published in Self and Systems. Compartmentalized, narrowly defined ways of looking at behavior are outmoded. The bi-directional influence of biology and psychology on each other that has been demonstrated by neuroimaging requires a more comprehensive approach to behavior. I think this includes a collaboration of NFB and all other forms of BFB. Shore, of course, is referring to an implication for “talk” therapy, but it would seem logical to extend the implication to all forms of BFB. The contemporaneous use of HRV and NFB couched in an empathic alliance would appear to be one example of physiological and psychological modalities naturally colluding for beneficial effect. Why should the conceptual and practical collusion be fractured by organizations?
Shore, A. (2009). Relational trauma and the developing right brain, an interface of psychoanalytic self psychology and neuroscience. Self and systems. New York: New York Academy of Sciences.