End of August, 2008, San Antonio, TX
Wednesday night: Past, Present and Future of NF from our luminaries.
Tom Budzinski is an amazing raconteur spinning neurofeedback and neuromodulation stories going back to 1966 and speculations on into the future.
Joel Lubar thinks Z-score training is big.
Barry Sterman is lucid and entertaining even with too much to drink. He describes our early meetings as being composed of the scientific researcher types versus the levitators, who wear robes.
At a meeting in 1969 the members are divided: shall we call it autoregulation or biofeedback? Some wing nut says the Teamsters may not like autoregulation. So biofeedback it is.
Vince Monastra's all day workshop on treating ADHD.
Demoralization is a common comorbitity. Treat attention first, then other issues may resolve, if not treat them. (This is different than the paradigm of treating arousal first, then attention then memory systems).
Get your 20 grams of protein in the morning or else. Bipolar meds take 20 points off IQ. His office has a Lego pit.
Vince sees extreme theta/beta ratios under task of 8:1 vs. 3:1 in normals. He trains to that criteria. But don't expect significant change before 20 sessions. More on this ratio later.
Vince does an extremely thorough intake insisting on all kinds of records and tests. But not always a QEEG. After a couple of visits he says, no we are not going to do neurofeedback now. Come back and see me in a month. I object: it is often obvious when interviewing an ADHD family that we have a genetically inherited neurological disorder and those genes belong to you-know-who. No, you must do the history to avoid having a 65% success rate. There are many things that mimic ADHD.
Vince also has a well regarded parenting book. One theme: You mess up, then make amends.
I had a nice conversation with the Myers' of Boston Biofeedback, regular ISNR attendees. Some people find freebie newspapers to be a better advertising source than the regional glossy mags. Others say the opposite. I encourage a few people to check out Google ad words to begin pay per click internet advertising to drive local people to your web site. "A no brainer."
Thursday morning. The student award paper is about enhancing eye microsurgeon skills. SMR training which is better than Alpha/theta training. Results: surgeries 25% faster and r = .7 better. Best done 2x week.
Russell Barkley says QEEG is most sensitive diagnostic tool for ADHD.
Jay Gunkleman on predicting medication response to stimulants. Phenotypes are not subtypes? Beware of your database seeing slow alpha as theta.
Dirk DeRidder shows us brains of reptiles and other mammals. The sea squirt has a nervous system until it finds a home rock. Then it eats it brain. No TV involved. To treat tinnitus train delta down and alpha up at CZ.
Barry Sterman tells some of the cat story. Look for an NF article in the journal Sleep this year. SMR training reduces sleep latency and improves memory without increasing resting SMR. I wonder if there are "network effects"?
In the hall, Marvin Sams likes HRV for eating disorders. He wishes he could do the Mirasol eating disorder study again because he would be able to beat his already astonishing results. See AlertFocus.com for summaries.
Walter Freeman, a grand old man, gave a talk on integrating chemical (MRI, SPECT), EEG and MEG brain imaging. Let's live Z-score to your phenotype with that! "That was the best presentation I've heard since I was at MIT." It was at least one SD over my head. There are 13.7 billion neurons in each hemisphere.
Tom Brod. Thanks for offering to email us your presentation. Non linear means a small change can require a large accommodation. LENS sends one trillionth the exposure of a cell phone. (Later I heard others dispute this.) Beverly Rubik says: in biofields cells whisper and listen to each other.
Give the brain a mirror and it is fascinated. It wallows in information about itself; it becomes absorbed in self-interaction.
Small group on alcoholism. High beta at CZ is related to relapse. Some practitioners do only a little alpha-theta training near end of treatment. I wonder if slow alpha at PZ is a marker or a predictor of alcoholism? The 75% success rate holds at 7-10 year follow up. Drop out rates are high even at in-patient facilities, but SMR training helps that.
"The only active ingredient in NF is your intention, Ed Hamlin."
The Respiratory Arterial Pressure Wave
Workshop by Elliott and Edmonson on HRV as a pulse wave. Coherence.com.
If you cut the vegus nerve HR goes to 90 with no HRV. I bemoan that there is no hardware or software protocol to find your optimal breathing rate.
Steven believes everybody's optimal breathing frequency is 5 breaths per minute. Even in and out. HRV correlates well with skin conductance and alpha waves. Self-governance. Relaxation bridges: eyes, jaw, tongue, throat, breathing, hands, urinary, anal, feet. Nobody has hypertension and at least a 13 beat swing in their HRV.
Eat a balanced diet, take adequate rest, get moderate exercise and do RSA breathing 2 times a day for 10 minutes.
Frank Andraisik shows the diverse and compelling research case for biofeedback. If the medical, scientific, insurance and government establishment doesn't accept all that research then Kuhn's revolution is not being televised. BF is as good as meds, but don't degrade and results last. We get 50% (30-60%) success rates with BF. For NF 70-90%.
What kind of headache is that? There are lumpers and splitters.
Medication rebound is now called medication overuse.
Hand cooling is almost as useful as hand warming.
Siegfried is training at .001 Hz: yes, that is a 100 second brainwave.
Finding the right reward frequency is vital, but once you've got the sweet spot it will cure what ails you. Sue used to start high and move down; now she starts low and moves up to better avoid adverse reactions.
Jeff Carmen starts with 10 min of pIR HEG. BF sessions are 20 minutes.
Friday August 29.
Nice results on Q with just one session on the Stress Eraser for anxiety.
Progress of Neurofeedback
Tanya gives a talk urging us to develop standard methods for disorders moving in the direction of a standard of care. We must do more and better research so that we can be accepted by the scientific and medical communities. My ire builds. Incensed, I rush to mike and say no. This is no time to reign in our methods to standards of validated protocols. Few, if anyone, in the room only does the theta/beta ratio training used in our best published studies for ADHD. We are flourishing with innovation and artistry; this must be encouraged.
ISNR is a BCIA club and a QEEG club (despite the utter lack of published studies supporting that either of these are a good idea). ISNR is too a small tent. Where are all the other kinds of practitioners? Those who use systems by Val, Van Deusen and Othmer.
And even more research as a path to acceptance? If publishing research worked then biofeedback would be accepted for our strongest indications such as migraine. if only If data would convince biofeedback would be covered by insurance and there would be thriving practices based on referrals. There used to be hundreds of people in my Pennsylvania Biofeedback Society, now just a couple of dozen. If research worked then CES (Cranial Electrical Stimulation) would not have over 100 secret articles plus the 2 dozen unknown animal studies. Why is biofeedback being dropped from textbooks and curricula? While my rant was not booed, opposing comments were applauded. I appreciated those who consoled me that I do have a point. (And that it sits atop my pointy head).
Eran Zaidel wonders why theta-beta ratio training doesn't change that value. There must be a network effects on a meta control system. But Vince Monastra does see that value change. Is this a difference due to measuring under task?
Mario Beauregard presents an elegant research design on depression. Only heart disease is more of a burden to society than major depression. 5-15% suicide. He induces sadness with movies to study the decreased cerebral blood flow. Not theta or alpha, only beta is abnormal. NF is done with Clockwork Orange challenge: "You boss is concerned about the quality of your work." Now figure out how to keep the brainwave bar high. And they do, with meta cognitions and other counter toxic thought strategies that Albert Ellis would endorse. I realize that my neurofeedback is all done with movies which may have some of this same effect.
NF has 74% success rate (no longer meet criteria for MD). I asked about the 26% failures. Non-responders are the non-believers.
Cory Hammond on depression. Cory blasts the big pharma bias in studies. Keep researching until you get a good study to publish. Results evaporate with non active placebo. Bob Gurnee sees 12 sub-types of depression. Bipolar is tougher to treat especially if rapid cycling. You have treat the client-state that shows up that day. Anxiety can be located anywhere.
Bob Gurnee tells me that if you train the brain to certain value it stays there for good or ill. You can't rely up the wisdom of the body to self-correct and select only best states.
I'm noticing rampant confusion among the presenters due to the issues of phenotype, sub-group, and measurement conditions.
Over lunch a man told me he was looking for a person to do some work. I knew exactly the right guy and made the introductions. As a long time career consultant I would like to have my fingerprints on a good career move.
In the hall I see Jonathan Walker pressing down on some guys arm. I always thought muscle testing was hokum I say, but no he assures me, it works great. Okay, so I've got a toothache and my dentist says I need a root canal, but I'm not exactly sure which tooth it is. Can you check? So I put my arm out and he mutters some options. The decision tree takes surprising turns. He divines that I have an infection. Further that I need 400 mg of amoxicillin 4xd for 6 days. He even calls the script into a local pharmacy! That night I have a confidential treatment that takes the pain away for the rest of the conference.
Nick Dogris reports amazing results for LENS on ADHD.
Very few don't respond in 15 sessions.
Jonathan Walker does a difference map between EO and task. He finds that poor readers deactivate critical areas of the brain under task.
As I wander the vendor area I try Jon Cowan's Pleasurizer. This device has wonderful face validity for the mind-brain connection. You can see your focus bar go up and down as your fades in and out. A clear mirror. Jon induced some of my pleasant memories and my blue graph rose as my heart swelled with joy. What a high!
I tell Tom Brownback with his really very highly systemized approach, that I have anus envy.
I am slowly tilting, yawing and rolling on a table with pRoshi glasses and relaxation coming through the headphones. I overhear that a woman has a blinding migraine and she has to get to a conference PDQ. She was brought over from Toomin's booth. I quickly get up and help her on the table and gently massage her feet. Next day I discover she is a psychiatrist and that the migraine was completely aborted in 15 minutes and she slept like a log that night.
The stock brokerage firm E.F. Hutton had a TV commercial where 2 people are having a conversion in a crowed restaurant. One says, my broker is E.F. Hutton and E.F.Hutton says " At which point the place goes silent. Neurofeedback is the opposite. As soon as you say neurofeedback, everybody stops listening.
Joel Lubar finds that theta/beta ratio is strongest in youth, but not in adults where more than 5.5 alpha/beta ratio is a better marker at PZ EC. He doesn't like autothresholding; instead set a goal, now try to beat it. Joel imparts lots of practical wisdom, even when standing still.
Advanced Z-score training, Tom Collura.
Everybody is raving about live Z-score training. I find it a pleasure to watch the amplitudes resolve then the coherences in just a few sessions. EO an EC resolve together without specific attention. Beware of training down several peak performance patterns without clinical complaints. Beware of dismantling coping/compensating patterns too soon such as cognitive dissonance in PTSD.
Why don't I see aberrant theta/beta ratios in my ADHD kids? Because resting theta/beta is not that big of marker. ADHD is a frontal lobe dysfunction. I can't wait to see if this jumps up under task.
I hear the PR committee is meeting. I propose the question: Shall we devote our efforts at courting philanthropists or buying lobbyists. They decide to make a brochure.
Saturday night dinner.
During the open comment period I regret not saying that in the fund raising community it is called planned giving. I have put ISNR in my last will and testament and urge others to do the same.
Martijn Arns suggests we add the word Neuromodulation to the name of the International Society for Neurofeedback and Research. He wants to include rTMS and direct current stimulation. At my table we ponder the name: International Society of middle aged psychologists who do Qs.
Michael Thompson points out that the ISNR logo has a cardio wave. I notice that it flat lines.
There is a ground swell for Leslie Sherlin to be the permanent conference chair and get paid for it, but he cuts off the question.
Late into Saturday night there is an ample supply of good looking, high spirited women who like to dance. It was not always so. Among Leslie Sherlin's talents is the ability to boogey on down. Next day I ask Leslie "Don't you have any enemies?" He assures me he does, but I think he is just being agreeable.
I will consider advertising for cases that are expected to take a long time such as bi-polar, depression, OCD, ADHD and autism. Anxiety and insomnia clear up too quickly for both bread and butter.
My most fascinating conversation was with Jim Kowal. He looks like Alan Alda and projects that same depth of humanity. He described his work with EMDR and hypnosis with trauma and multiple personality disorder. I got strategy to try with my refractory bulimic. Elicit a 'day in the life' grade school autobiography starting with kindergarten. I'm looking for a year she can't remember. I'm expecting she will lose details about 5th or 6th grade. Nice try, but it doesn't work on her.
"Stress is like breathing carbon monoxide. You don't know your are breathing it until it kills you."
Jim said the EMDR conference really has it together. How do you record in and out times for CEUs when 700 people are gathered for a key note address? The UPC codes on your name tag are swiped at the door.
Everybody agreed that this ISNR meeting was a big winner. Yes the European meetings are more scientific, this one better for practitioners.
Ron Swatzyna is predicting medication response and monitoring toxicity.
At least CNS Response and BRC are working on pharmacology and EEG and wonder if they use the same markers and give the same advice. I wonder the same about our several eminent Q readers.
Give coke heads SMR up and theta down with motivational interviewing. Now you tell me, too late for George Bush.
Everybody was talking about amplitude and coherences. I did not hear variability mentioned nor the EO-EC transition. I miss Val Brown and wish he were welcome.
Juri Kropotov finds ERP to the best discriminator of ADHD and he finds two types.
Jay Gunkleman is one of the masters at creating EEG and Q-guided NF treatment plans. He reads genotype and phenotype distinctions. He gets 20 point IQ jumps in addicts.
I'm off to the airport, but the fun continues. I have a nice conversation with Dirk DeRidder in Brookstone. He thinks we need a good explanation of NF with mechanism of action before medical schools will embrace us. I have a pleasant lunch with Jeff Carmen and Glenn Weiner before boarding my plane.
I am so high and excited to have had such sustained exhilaration for the entire conference. The intellectual stimulation was rich and the fellowship sublime. I fully expect the ramifications of this experience to transform my private practice.