January 8, 2004

Synergy

Author: Siegfried Othmer

The most appropriate theme for the new-year newsletter is probably “synergy,” as we have seen the beginnings of a multiplier effect in which niche products potentiate other product developments, and developments in one domain of biofeedback reinforce those in another. The products at the heart of these developments might be termed “keystone” products. None fit the bill as much as the emerging BioExplorer software. It supports the ROSHI II+ as well as the Pocket Neurobics. In the future, it may also support the J&J C2. The BioExplorer is still largely a developer’s tool at this point, but it is in the process of becoming a versatile software option.

Another kind of synergy is illustrated by the C-2 itself, in that it supports not only EEG and peripheral feedback but Len Ochs’ LENS system and Peter Litchfield’s CO2-monitoring system. A similar situation prevails for the Pocket Neurobics, in that it supports HEG as well as conventional neurofeedback (either autonomously or through the BioExplorer).

A yet different kind of synergy is represented by the ROSHI II+, which can complement any conventional neurofeedback system. Right now it interfaces with the BioExplorer for data acquisition and complementary neurofeedback strategies. The ROSHI provides a comparable level of sophistication and subtlety for the inhibits that our conventional neurofeedback provides for the rewards.

And finally, a qualitatively different kind of synergy is represented by HEG, which also supplements conventional neurofeedback. At a minimum HEG can be helpful in all conditions where pre-frontal training is called for. One of the key advantages of both HEG and ROSHI is that they require no subtle clinical judgments for proper operation. There is no substantial learning curve, except for the fact that one needs to have expectations calibrated through some extended use. These complementary methods therefore lighten the burden on the clinician, as well as projecting well into a home use situation.

Synergy is emerging at another level, as illustrated by work with migraines. It is by now apparent that a breakthrough has occurred in outcomes with medically intractable migraines, and this breakthrough is not restricted to conventional neurofeedback. Rather it encompasses HEG as well. Both techniques are clearly superior to the thermal and EMG training that originally put peripheral biofeedback on the map for headaches. Whereas the mechanisms are not yet understood to anyone’s satisfaction, the data are unambiguous. The recognition may dawn on people that an explanation is required here that accounts for both of the disparate findings, and that subsequently it will no longer be possible to claim uniqueness for one approach with respect to the other.

An external forcing function seems to be needed to overcome the parochial divisions that have plagued our field since the early days. At almost every level, the tendency is toward splitting rather than coalescence, toward differentiation as opposed to unification. The abiding hope by the various promoters appears to be that one technique or another will win out in the marketplace and displace the others. Recent history indicates that this will not happen—things are headed the other way. The selective advantage of one system over others was never greater than at the beginning. That gave us such a great head start at NeuroCybernetics. But as time goes on, the diffusion of technology serves as a great equalizer. New departures such as the NeuroCarePro quickly inspire and fertilize other design efforts. Novelty has become very perishable, lasting perhaps only a single software generation.

So, given that the strategy of hogging the entire field is by now threadbare, the better evolutionary alternative is to maximize the synergy between systems. Then an incremental advantage in one of the critical components (the keystones) offers distributed benefits to many. Those systems that have lots of “linkages” to others will have an advantage going forward. This would seem to favor BioExplorer first of all, and beyond that ROSHI and HEG. The Pocket Neurobics and BrainMaster have the evolutionary advantage of being simple to modify, so they benefit from shorter software generations. That should pay off for both.

All the above having been said, the fundamental reunification that may be in store for us between neurofeedback and biofeedback will also favor the generic programs that cover nearly all of the bases: The new Biograph from Thought Technology and BioTrace from the Dutch group and Tom Allen. So where are we when all is said and done? We are at a period of considerable flux in the technology, and this is not a point at which one would want either to put all the eggs in one basket or to consent to plateau indefinitely with the familiar hardware and software.

The development of our practice over the past year has been solidly in the direction of working with the more severe, challenging end of the clinical distribution. This has meant the implementation of a home use strategy. Just last week, two families from out of town completed their 20-session program here and each took a BrainMaster system home under their arm. There is no end in sight for their children working with these systems. Not every family can sustain such a commitment, but working with those who can is turning out to be very satisfying. Little whirlwinds of activity have been set loose here and there around the world to bring about progress that is not a large drain on Sue’s time, except for the occasional mid-course correction.

Over the course of the coming year, we will see how the ROSHI and HEG systems fit into this picture, in that neither of these require much supervision for competent utilization. Early on it was really on my conscience that we had nothing more economical than a $6500 remote-use NeuroCybernetics system to send home with people. Now a family can go home with a combination of an improved BrainMaster, a ROSHI, and HEG for considerably less than that amount.

I estimate that our little “industry” serves between 150,000 and 200,000 people per year; that some 6% of all licensed psychologists in the country have had some formal exposure to neurofeedback either through courses or conferences to date; that manufacturer’s collective sales are probably running at $9M per year; and that the total funds expended by the public and third party payers for neurofeedback amounts to more than $150M/year, perhaps much more. These numbers would mean that the manufacturers and other support organizations are a “tax” on the whole operation of at most 6%. Much of that tax is an investment in the future. It is in any event not out of line.

What the manufacturers are doing can be seen as one way of taking advantage of scale. This is easy for us when they are taking the initiative and all of the risk. The advantages of scale appear just as cogently elsewhere, however. Marketing, for example. Only here the argument is less easily made because clinicians see the downside of growing competition as well as the upside of collaboration. The field is no longer starved for resources for technology development. It is, however, still starved for resources to spread the word.

All these arguments favor a focus on the new book, “ADD: The 20-Hour Solution” as a marketing vehicle for neurofeedback. We simply need to make this happen by populating clinicians’ offices with books for sale; by handing the book out to school principals and school psychologists; and by sending it out to any opinion-maker that you know. If that is done in any quantity, then by next year we may no longer be “ghosts” in the field of mental health. We can grow quite satisfactorily from this base under almost any scenario, perhaps comforted by the thought that gradual growth is more readily manageable, but realizing also that at any time our persistent advocacy could break things open…