Volume 3, Issue 9, March 17, 2005

Musings on Mechanisms

Author: Dr. Siegfried Othmer

We just returned from our Advanced Training Course in Dallas, Texas, which was unusual because it was not populated largely by people who had come through our own Introductory Training Course at some time in the past. This made for a more lecture-oriented course than usual, and it also provided more of an engagement with the QEEG-based perspective on NF training. Jonathan Walker was in attendance, and it is well-known that he has gradually moved over time from the protocol-based training that he did originally to more exclusively QEEG-directed NF. This fruitful interaction at the training course makes this once again a topic for our newsletter.

Dr. Walker indicated that he has largely moved away from training according to power anomalies in the QEEG to training coherence anomalies. With that shift, he is also seeing more systematic changes in the QEEG that are consistent with training objectives. (We have gotten a similar message from Joe Horvat, who also trains coherence.) Nevertheless, the idea of adjusting training on the basis of in-session reports was foreign to him. After all, he does not do the hands-on training himself, so the whole notion that a single session could yield useful, observable change was a novelty.

As it happens, an opportunity for just such a demonstration opened up at the course. One attendee was sitting front and center on the second day, laid low with a resounding headache. Well, one demonstration is as good as another, so the person was invited to try the training in order that Sue could demonstrate the process of frequency optimization. We had just covered assessment strategies, so the person reported on this prevailing state with great specificity at each break in the training. After no more than ten minutes, Sue asked again about the headache. After consulting his physiology for a lingering moment, he pronounced it gone. Remarkably, even with a person so tuned in to the process Sue still had to ask about the headache that had been so dominant only a few minutes before.

After the training course we spent the day at Sherene McGee’s home office, where she showed us her implementation of the inter-hemispheric training for Bipolar Disorder. Lisa Black was also there to share some of her QEEG data, so that got us back onto the same turf of QEEG-based training in which Lisa had originally been instructed at the University of North Texas. The emerging pre-post data indicated not only that inter-hemispheric training can change the QEEG significantly, but even that the changes can sometimes exceed those obtained with QEEG-based training.

So both at the course, and again the day after, the question arose that if inter-hemispheric training is effective not only symptomatically but also in QEEG terms, what is the mechanism? We are not even close to identifying a mechanism, since an explanation would have to encompass the frequency specificity that we find with all sensitive individuals. But some speculations are in order. First of all, the inter-hemispheric training can be thought of as “anti-coherence” training. Secondly, it yields success broadly, meaning “anything but” a state of coherence between the sites. Thirdly, it is not amplitude training in the usual sense. That is to say, whereas Dr. Jonathan Walker says that he never up-trains coherence in delta, Sue has people lining up at the door for inter-hemispheric training at 0-3 Hz.

It does not challenge the belief system of any neurofeedback practitioner to be told that training to normalize coherence excesses and deficits should lead rather systematically to success in changing coherence. And if the data show that inter-hemispheric training also effects broad changes in coherence over the scalp, that too can be accepted. But how is it that inter-hemispheric training can be helpful even in cases of “disconnect syndromes,” or coherence deficits? We suggest the argument is as follows: If we do inter-hemispheric training across the boundary of a disconnect syndrome, then any response of the brain to the neurofeedback challenge must involve bringing the two regions into engagement. That helps to normalize inter-site communication relationships even if the immediate challenge is in the wrong direction. This, I think, goes to the heart of matter. What we need to do is challenge regulatory networks at a very benign, low level. The result of such a challenge, multiply repeated, is to effect better regulation.

Some support for this conjecture is offered by cases in which there is an obvious focus. Both Sterman and Walker have found that referential training at the site of the focus is often not the most efficacious option. Yet matters are different with inter-hemispheric training, and perhaps with coherence training as well. Here the issue is linkage between sites, and the training in both cases may serve to re-integrate the rogue region.

If we are challenging the brain in a direction so as to ameliorate a known deficit, we would call it normalization training. If we challenge it where there is not a problem, we would see the training in terms of an exercise model. And if we challenge the brain in an ostensibly wrong direction, we see it as an analogy of the homeopathy model. Irrespective of the specific nature of the challenge, the fundamental response of the brain is in terms of improved functioning of the regulatory networks.

These understandings may be fine as far as they go, but they do not explain the parameter sensitivity of inter-hemispheric training. Why should we have to pick the conditions under which exercise takes place so narrowly? So we still have some work to do on the models. But both the QEEG-based coherence training and the inter-hemispheric training illustrate the power of training phase. That is presumably the mechanism of action also of the ROSHI and of the LENS system, yet these two could hardly differ more in the “specificity” of their reinforcement parameters. They probably represent extremes on the continuum, with inter-hemispheric training and conventional QEEG-based training lying somewhere in between.

Given the realities of clinical practice, the propagation of neurofeedback broadly into the mental health disciplines probably argues for the reliance on the least demanding techniques as a first point of departure. This would include HEG and ROSHI in first order, along with conventional protocol-based NF training. With increasing complexity of cases, one can then bring in the techniques that are more demanding of the clinician, and more demanding of resources: QEEG-based training and the LENS system.

If someone does just QEEG-based training, he will find no evidence to contradict the proposition that QEEG-based training works. The same is true of dowsers. If one finds water only by means of dowsing, one will never be convinced that dowsing may not be reliable. Every success counts as a datapoint for dowsing. Every failure is assigned to lack of water, not to the failure of dowsing. One has to step outside of the bounds of the model in order to see its flaws. Unfortunately, some people are quite unwilling to step outside of their QEEG-based model, to the point that they fear being contaminated with heresy---so much so that they will not expose themselves to it. The analogy to dowsing goes further, in the sense that if these people fail with QEEG-based training, they will send the client home with the assurance that neurofeedback has nothing to offer them. This blinkered perspective reminds me of the Japanese soldiers who were sitting for years in their foxholes on some of the Pacific Islands, not knowing that the war was long over. The world had moved on, and so has the world of neurofeedback.

Second topic:

“Study: Lobsters Feel no Pain when Boiled”

A study sponsored by the Norwegian government conveniently found that lobsters and other crustaceans probably don’t suffer even if they “tend to thrash in boiling water.” “It is unlikely that they can feel pain,” said the report. The same issue has been acute in Maine, where lobster biologists maintain that the reactions to boiling water are escape mechanisms, not a conscious response or an indication of pain. How convenient.

For just a moment I am tempted to recall favorably the discipline of positivism and behaviorism, which insisted that we should not speculate as scientists about things we could not measure. We should confine ourselves as scientists to observable phenomena. And when it comes to that, the behavior of the lobster is certainly consistent with an awareness of aversive stimuli. That’s a rather basic function intended to keep animals alive, and goes back all the way back to amoebas. Whether or not the perception of an aversive stimulus rises to the level of excruciating pain we really have no way of knowing. We don’t even know it with respect to people unless they tell us.

All of which brings me to the matter of Terri Schiavo. I recall an anecdote by Nancy White in which a guitarist routinely visited folks in coma or persistent vegetative state and played to them. On one occasion he became aware that one of his regulars was about to have life support systems removed by hospital staff. Alarmed, he put his guitar aside and spoke animatedly to his companion. “If they don’t see a sign of life out of you by tomorrow, they are going to pull the plug on you.” He stayed around until hospital staff arrived, continuing to speak urgently to his companion. As it happened, the patient was able to come through with a sign of life, and the plan to remove life support was shelved.

It is remarkable that the “belief system” of the medical enterprise has remained untouched by all the cases of spontaneous recovery from coma, and all the induced recoveries by people such as Margaret Ayers. It is assumed that if there is no capability of motor output, then there is nobody home. Most recently an imaging study was done on a coma patient, the surprising outcome of which was that there are actually things happening in cortex that correlated with events in the outside world. Input was being processed even if output was not available.

So why is there this bandwagon rolling downhill programmed to remove Terri Schiavo’s feeding tube. If the entire support she needs to live consists of food, then she is not in worse state than locked-in syndrome patients that are routinely being kept alive in civilized countries. Support groups are coming forward with information that Terri Schiavo responds to her mother, undergoes a sleep-wake cycle, follows visual cues, and responds to music. There are numerous signs of vitality. We’re not talking about Karen Ann Quinlan here. There are no life support systems on which she is dependent. How did we even get to this point? Significantly, no imaging work has been done here for the benefit of the attending physicians (“If you don’t want to treat, then don’t make the diagnosis. If you don’t want to make the diagnosis, then don’t order the test....”). Of course no neurofeedback has been done to see if her scope of function can be enlarged.

Both with respect to the lobster and Terri Schiavo scientists are acting on mere belief, yet they dare to call it science. The recent scandals at the FDA, at the drug companies, and at the NIH should convince one that science does not function well in the service of either a political, legal, or a capitalist agenda. Science is done best when it is its own reward.

Dr. Siegfried Othmer