March 18 , 2003

Frontal Training: Theory and Practice

Author: Sue Othmer

Early work in neurofeedback was primarily on the central strip, and for me, central and temporal placements continue to be the starting placements for training. But frontal training has become an important and regular component of training over the past year or two. I now think of training on the central strip for normalization and stabilization of arousal level. This is already very powerful in reducing symptoms that arise when one slides down the over or under arousal end of the performance-versus-arousal curve. Frontal training adds a new piece – organization and control of brain function.

The front half of our brains organizes and executes output, while the back half processes and integrates input from the body and outside world. The frontal lobes are involved in coordinating the selection of goals and plans of action, while initiating desired behaviors and inhibiting undesired behaviors. And they oversee the execution of behaviors to their successful completion. As the most recently evolved and slowest to develop part of our central nervous system, the frontal lobes are vulnerable to neurodevelopmental disorders. John Bradshaw’s book (see above) looks at Tourette syndrome, OCD, ADHD, autism, depression and schizophrenia as syndromes involving significant developmental deficits of frontal circuits.

When we measure the cortical EEG and reward changes in it’s frequency components, we are surely exercising circuits involving subcortical loops – not just normalizing cortical function. We know that thalamocortical loops are involved in establishing the cortical EEG rhythms that we measure and train. When training frontal sites, we are tapping into frontostriatal circuits, which connect from frontal cortex to basal ganglia to thalamus and back to cortex. These circuits are involved in the initiation and control of output – movement, thought and emotion. Understanding these frontostriatal loops helps us understand the specific symptoms that arise with various neurodevelopmental disorders as well as neurodegenerative disorders such as Parkinson’s. We place our electrodes on the scalp and measure the cortical EEG, but we should always remember that we are training more extensive circuits.

Looking at the organization of the frontal lobes, we move from the central sulcus forward from primary motor strip to premotor areas to prefrontal cortex, as we move to higher levels of organization and control. In exploring the effect of training frontal sites, it is clear that frontal and prefrontal training affect different functions and yield very different results. Training frontal sites generally results in increased initiation and coordination of output. While training prefrontal sites improves inhibitory control on undesired emotions, thoughts and actions, and improves planning and organization of desired behaviors.

Frontal interhemispheric bipolar training at F3-F4 strongly impacts depression – affecting motivation and initiation of behavior as well as mood. Moving down to F7-F8, and closer to Broca’s area, we see increased vocal output involving language and music, and improved word finding. Prefrontal training at Fp1-Fp2 has a very different effect – calming and organizing. This is a strong piece for inhibiting unwanted thoughts and movements. The feeling with training might be described as satisfaction. There is a reduced need to repeat thoughts or behaviors in order to reach completion or satisfaction.

There has been considerable focus on abnormal anterior cingulate activity related to obsessive-compulsive symptoms. The cingulate monitors discrepancies between the current state and desired state and initiates behavior to improve state. OCD involves the inability to recognize completion of the chosen activity and achievement of the desired state. So the behavior is repeated over and over. Some neurofeedback practitioners are training at midline frontal sites to impact this cingulate over activity. I find a strong effect on reducing OCD symptoms and tics with prefrontal training at Fp1-Fp2. Whereas F3-F3 may have the opposite effect, increasing the initiation of behaviors. A possible explanation for the prefrontal effect on OCD lies in the strong functional linkage between the prefrontal cortex and anterior cingulate, over which it exerts inhibitory control.

There is much to be learned about the effects of EEG training at other frontal sites. As we move forward, we affect higher functions. As we move medially and ventrally, we can expect to have more effect on emotional and social functioning. With more experience, we might be able to fine-tune the impact of training with much more subtlety.

Please visit the EEG Bulletin Board to view my PowerPoint presentation on frontal training presented at this year’s Winter Brain Conference.

Books on Frontal Lobe Function and Dysfunction

The Executive Brain, Frontal Lobes and the Civilized Mind by Elkhonon Goldberg is a well-written and interesting book. It tells the fascinating story of Goldberg’s own life including his studies with Alexandr Luria and his escape from the Soviet Union. We learn about the front half of our brains and the executive functions by which it plans and carries out our various behaviors. This is directly relevant to our neurofeedback work because it helps us understand the constellation of symptoms we are presented with clinically, and it helps us think about where to train so as to impact specific brain functions.

Developmental Disorders of the Frontostriatal System, Neuropsychological, Neuropsychiatric and Evolutionary Perspectives by John L. Bradshaw is a more technical book on disorders involving frontal lobe dysfunction. Autism, depression, schizophrenia, ADHD, Tourette’s syndrome and OCD are discussed as neurodevelopmental disorders, which arise with dysfunction of specific frontostriatal circuits. Again this is helpful for our understanding of these common clinical conditions and how we might best target neurofeedback training.