Therapy with the Brain in Mind An Introduction to the Clinical Application of Neurofeedback

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1 Therapy with the Brain in Mind An Introduction to the Clinical Application of Neurofeedback

2 Wes Center, PhD, LPC-S Board Certified Professional Christian Counselor National Certified Counselor President & Clinical Director of Focus for Living Neurofeedback practitioner > 6 years Adjunct Liberty and clinical supervisor in Texas This presentation will be available online for all attendees at on Oct 5 th

3 The Human Brain is Very Complex in terms of development, organization, & function Resource intensive 100+ Billion neurons ~ ,000 connections 1+ Trillion glial support cells 2% of body s total weight Consumes 20-30% of calories Consumes 20% of resting O 2 Consumes 40-60% of glucose

4 The Human Brain is Very soft somewhere between the consistency of soft butter & a raw egg Composed of: 77-78% water 10-12% lipids glial fat 8% protein, 1% carbs, 2% soluble organics, 1% inorganic salt Encased in a very hard & sharp skull Vulnerable to blunt force, concussive, & rapid acceleration-deceleration forces

5 The Human Brain is Bilaterally symmetrical A neurochemical, neuroelectrical organ Functionally organized Location specific functions Distributed network functions and problems in certain brain regions tend to cause specific problems in function Involved in every aspect of human functioning including the spiritual life

6 The Brain has Localized Areas of Function Generalized & Coordinated Movements Skilled Movement Activation Creative Thought Writing Intellect Judgment Reflection Emotional Reaction Visual Memories Fear Memories Stereognosis Proprioception Reading Auditory Memories Verbal (Speech & Interpretation) Visual Processing

7 The Gear Shifter of the Brain ACG contributes to mental flexibility, cooperation, attention; helps the brain to make transitions between states of arousal & mental activity; suppresses ritualistic motor movements & tics; part of the executive function network

8 The Gear Shifter of the Brain PCG shares in the memory-making processes; provides spatial orientation; monitors eye & sensory monitoring services

9 What is Neurofeedback? Electroencephalogram (EEG) Biofeedback, Brainwave Biofeedback, or Neurofeedback Biofeedback is the use of instrumentation to mirror psychophysiological processes of which the person is not normally under conscious control but can be brought under voluntary control Neurofeedback applies instrumentation to mirror psychophysiological processes reflected in the brain s electrical activity Based on 2 Tenets That brain electrical activity - the EEG - reflects current brain functioning that in turn affects overall functioning That the EEG can be trained

10 Differential DC Amplifiers 19 ch. for qeeg assessments & whole-head training 4 ch. for miniassessment & training

11 Goals of Neurofeedback Ensure correct regulatory function in the neuro-modulating systems of the brain Encourage global neurophysiological change Correct specific, distinct, identifiable disorders that are the consequence of underlying disregulation

12 Self-report Measures Assessment Biopyschosocialspiritual History Amen Checklists/Screening Tools General Sx Brain System Screens indicated by presenting problem ADHD - LD - ASD - PTSD - Anxiety/Depression MicroCog (18+) or Neurodiagnostic CL QIK Continuous Performance Task Test Head Injury Questionnaire (everyone)

13 Technology Advances EEG provides high temporal and spatial resolution that can be correlated with other imaging methods including fmri and DTI

14 What is LORETA? Low Resolution Electromagnetic Tomographic Analysis Source localization of brain events in 3D space Instantaneous, 3D, discrete, linear inverse solution for EEG Resolution to 7 mm voxel size, voxels Broadmann areas and ROIs are identified

15 qeeg Assessment Measures brain wave activity, normally at 19 or more locations on the scalp Is analogous to a brief movie of the brain s electrical activity & preconscious state Is non-invasive Converts the analog EEG signal into digital form so that the signal can be analyzed and compared to a normative database

16 International Placement

17 qeeg Assessment Recording Conditions Eyes Open Eyes Closed Reading, Mental Math, etc. (when indicated) Artifacts in the Recording Eye movement Fontalis and/or Temporalis muscle movement Jaw, Neck, & Shoulder tension Tongue Any gross muscle movements, even in the hands or feet

18 Norm Referenced Database Z-Scores Compares the subject s EEG to the FDA registered LifeSpan database of normals Norm group for comparison is of the same sex, age, and handedness The mean of each reference group = 0 The subject s EEG is converted to a Z-score and compared to the mean of the reference group Subject s differences from the mean are stated in terms of standard deviations (+/-) from zero

19 Unfiltered EEG

20 Microvolts (mv) Absolute Power A reflection of the electrical activity (in mv/hz) being measured by the sensor irrespective of the physical characteristics of the skull.5-5 Hz 5-8 Hz 8-12 Hz Hz Hz Hz Hz

21 Microvolts Absolute Power d Delta sleep, self-awareness & identity.5-5 Hz 5-8 Hz 8-12 Hz Hz Hz Hz Hz

22 Problems Associated with d High-amplitude rhythmic d is a hallmark indicator of traumatic brain injury Demos, John N. (2005). Getting started with neurofeedback. New York, NY: W. W. Norton. Thatcher, R. W., Walker, R. A., Gerson, I., & Geisler, F. H. (1989). EEG discriminant analyses of mild head trauma. Electroencephalography and Clinical Neurophsiology 73: Thatcher, R. W., et al. An EEG severity index of traumatic brain injury. Journal of Neuropsychiatry and Clinical Neuroscience 13:77-87

23 Filtered EEG - d

24 Microvolts Absolute Power Theta practiced meditation, emotional awareness, creativity, drifting attention q.5-5 Hz 5-8 Hz 8-12 Hz Hz Hz Hz Hz Demos, John N. (2005). Getting started with neurofeedback. New York, NY: W. W. Norton. Thompson, M., & Thompson, L. (2003). The neurofeedback book. Wheatridge, CO: AAPB.

25 Filtered EEG - q

26 q Patterns Adaptive patterns are associated with Creativity & spontaneity Practiced meditation Problem patterns Excessive or laterally asymmetrical Depression & mood disorders Anxiety & emotional disregulation Generally, EEG slowing ( Hz) is associated with foggy thinking, slow reaction time, poor calculation, poor judgment & impulse control Demos, John N. (2005). Getting started with neurofeedback. New York, NY: W. W. Norton. Thompson, M., & Thompson, L. (2003). The neurofeedback book. Wheatridge, CO: AAPB.

27 Microvolts Absolute Power Alpha idling, rejuvenating, peaceful, calm, relaxed, needed for balanced attention between internal & external focus a.5-5 Hz 5-8 Hz 8-12 Hz Hz Hz Hz Hz Demos, John N. (2005). Getting started with neurofeedback. New York, NY: W. W. Norton. Thompson, M., & Thompson, L. (2003). The neurofeedback book. Wheatridge, CO: AAPB.

28 Filtered EEG - a a is peaking at 8.5 Hz globally rather than at 10 Hz

29 a Patterns Adaptive patterns are associated with Calm, inner peacefulness Practiced meditation Posterior Dominant Rhythm 10 Hz Problem patterns Excessive amplitudes frontally or laterally asymmetrical (LH > RH) Depression & ADHD Daydreaming in children Cognitive deficits when amplitudes are asymmetrical in posterior regions Demos, John N. (2005). Getting started with neurofeedback. New York, NY: W. W. Norton.

30 Microvolts Absolute Power Beta 1 (Low Beta) external awareness & focus, b Hz 5-8 Hz 8-12 Hz Hz Hz Hz Hz Demos, John N. (2005). Getting started with neurofeedback. New York, NY: W. W. Norton. Thompson, M., & Thompson, L. (2003). The neurofeedback book. Wheatridge, CO: AAPB.

31 Microvolts Absolute Power Beta 2 narrow external awareness & focus, vigilance.5-5 Hz 5-8 Hz 8-12 Hz Hz Hz Hz Hz b 2 Demos, John N. (2005). Getting started with neurofeedback. New York, NY: W. W. Norton. Thompson, M., & Thompson, L. (2003). The neurofeedback book. Wheatridge, CO: AAPB.

32 Microvolts Absolute Power Beta 3 intense external awareness & focus, hypervigilance.5-5 Hz 5-8 Hz 8-12 Hz Hz Hz Hz Hz b 3

33 13-24 Hz b Positively associated with Focus Analytic activity External orientation Relaxed cognitive processing Maximum amplitudes are seen in the frontocentral regions Indicator of systemic arousal

34 13-24 Hz b Excess amplitudes are negatively associated with ADHD & Learning Disorders OCD Sleep Disorders Bruxism Depression & Anxiety Disorders In the clinical population it is common to find RH > LH in amplitude b q amplitude ratio Demos, John N. (2005). Getting started with neurofeedback. New York, NY: W. W. Norton. Thompson, M., & Thompson, L. (2003). The neurofeedback book. Wheatridge, CO: AAPB.

35 Microvolts Absolute Power Hi Beta decreased self-awareness & focus, increased external locus of control Hi b.5-5 Hz 5-8 Hz 8-12 Hz Hz Hz Hz Hz Demos, John N. (2005). Getting started with neurofeedback. New York, NY: W. W. Norton. Thompson, M., & Thompson, L. (2003). The neurofeedback book. Wheatridge, CO: AAPB.

36 Acts Upon Awareness Attention Inhibition Memory Location In Brain Alpha 8-12 Hz Attention Perception Theta 4-7 Hz Beta Hz Motor Control Neural Connections Gamma Hz Perception Perception Neural Connections Attention Memory Awareness

37 The Gear Shifter of the Brain Excess mv in the MCG (Cz) or over the ACG (Fz & Fpz) in q, a, and b are dysfunctional patterns associated with depression Deficient mv in a and b and an increase in q in the ACG is an indication of under arousal such as that seen in the Inattentive Type of ADHD

38 Brain Connectivity Anatomical (Structural) Connectivity: Pattern of structural connections between neurons, neuronal populations, or brain regions. Functional Connectivity: Pattern of statistical dependencies (e.g. temporal correlations) between distinct (often remote) neuronal elements. Van Wedeen, Achard et al. (2006) J. Neurosci. 26, 63 Effective Connectivity: Network of causal effects, combination of functional connectivity and structural model.

39 EEG Connectivity Measures Asymmetry The Brain s Balancing Act Coherence Who s Talking to Whom? Phase Tortoise or Hare?

40 Asymmetry Asymmetry Z-scores reveal to us whether the brain waves between the various parts of the brain are balanced Excessive activity may indicate an overtiring of brain cells Insufficient activity may suggest brain cells are not firing sufficiently to maintain proper brain function

41 Asymmetry

42 Coherence In order for us to understand the complexity of the world and to make and execute decisions the different parts of the brain must share information Coherence is one of the measurements on how well the brain is able to perform this inner self-talk This measure gives us an indication of how efficiently our brain is working to connects and disconnects different parts of itself to accomplishes a particular task

43 Excessive Coherence Hypercoherence tends to indicate two or more areas of the brain are overly connected or locked together Results in lack of functional connectivity Reduces or prevents participation with specified network Results in loss of specific & global function The brain has become overly dependent on those areas & is not efficiently processing & executing information This over dependency tends to result in poor day-today performance

44 Deficient Coherence Hypocoherence is the EEG sign of a brain not able to efficiently connect cortical areas to perform specific task Lack of functional differentiation Not available to flexibly participate with other network components Often a form of network compensation Autism is an exception

45 Hypercoherent Hypocoherent Coherence

46 Phase Many of the brain s functions are timed events, the energy from one part of the brain arriving at another area at just the right moment to perform a specific task. Excessive Phase statistics mean the signals arrive too early; deficient, too late. In either case, the brain is not able to do its job with peak efficiency (except in the cases of savants & the unusually gifted)

47 Phase Slowed Advanced

48 NFB Treatment Planning Link patient s symptoms to functional area anatomy Review the qeeg report for confirmation of the other assessments location of dysfunction or disregulation Select appropriate sites for training for 4 channel training or whole-head training & training protocol

49 Treatment Plan min. sessions 10 minute Heart Rate Variability (HRV) training minute NFB session minute CBT or Psychoeducational therapy session Home training HRV training Audiovisual Entrainment with Cranial Electric Stimulation ANT Therapy, bibliotherapy, relaxation training, traditional CBT interventions

50 Live Z-score NFB Z-Score DLL Variables & Thresholds

51 LZT 248 Targets to Train 26 x x 6 = 248 (104 power, 144 connectivity)

52 Z-Score Training Guidelines EEG deviation(s) should be consistent with clinical presentation(s) EEG normalization should be reasonable Consider coping, compensatory traits Consider peak performance traits Consider phenotypes & recommendations Monitor subjective & clinical changes

53 Getting Started Read books on the current practice of NFB Demos, Getting Started with Neurofeedback Swingle, Biofeedback for the Brain Thompson & Thompson, The Neurofeedback Book Read the literature of the field there are thousands of published EEG studies Be prepared to spend some money it takes a minimum of $6K to get started (equipment, training, supplies, etc.) and another $3K to get BCIA certification

54 BCIA Blueprint Course Getting Started Online and face-to-face formats 36 CEUs for Psychologists, LPC, LMFT, RN, LCSW Meets the educational requirements for certification & scope of practice provisions Face-to-face training advantages Combination of didactic & hands-on with the equipment Often compted to those purchasing systems

55 Getting Started Online training advantages Somewhat less expensive if you aren t purchasing equipment Work around your schedule Often a better option for those who like to study at their own pace Online training disadvantages No hands on experience No interaction with peers

56 Getting Started Becoming BCIA certified BCN File an application to begin the process Completion of the BCIA Blueprint 10 hours of self-regulation 100 hours of client contact experience 25 hours of supervision with a BCIA approved mentor Pass the BCIA Neurofeedback exam

57 Purchasing Equipment Amplifier, cables, sensors, and software for Z- Score and all basic training functions: 2 channel systems $2K - $4K 4 channel systems $3K - $5K 10 channel systems $7K - $30K 19 channel systems $6K - $75K Neuroguide qeeg software $3K - $10K (basic software with no add-ons is $2995) Computers must have fast processors, 4GB of memory, & 1 GB of video memory

58 Biofeedback Certification International Alliance Mission: BCIA certifies individuals who meet education and training standards in bio and neurofeedback and progressively recertifies those who advance their knowledge through continuing education. BCIA W 44 th Avenue, #310 Wheat Ridge CO

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