Interpreting Assessments

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Answers to your Questions

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About the Brain
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The Business of a Practice

Please remember, TQ7 is neither a diagnostic nor a research tool, though it could be used for either. Diagnoses don’t provide much guidance in figuring out how to train the brain to change desired behaviors, and it’s useless to start an assessment with a diagnosis already in mind. The TQ7 is meant to be a practical way of identifying trainable issues in the electrical pattern of the brain. I don’t guess anyone knows whether the problem causes the pattern, or vice-versa, or neither. They often seem to co-exist, and training the patterns will often result in changes in the desired direction.

The brain-trainer system is based on the belief that subcortical drive issues (like anxiety) trump cognitive issues. Would you not expect a very anxious person to have difficulty focusing? There is too much competing mental chatter going on. So the training plan developed using the TQ always focuses on more basic, subcortical issues first and moves up to the cognitive ones, because if you train cognitive issues first, the results don’t “stick”.

The process involves going through the activation patterns starting from Tone issues (seen on the Heads page) and ENDING with the cognitive issues. The reason why I stress the process of looking at the EEG in the order I do is that we can easily imagine a situation where a client with emotional drive issues might have a difficult time paying attention, processing cognitively, etc. If we just train the cognitive issues without dealing with the emotional drive that underlies it, it is likely that our results will be transitory at best.

It is very common to see people who, as children, perhaps were given the “hyper” label grow up without the signs of hyperactivity. The Filtering category focuses on the impulsive, distractible, emotionally labile person who has difficulty falling asleep. Whether or not this lack of ability to control the interface between the outside and inside world results in a level of activity that bothers others, the problems are the same. People with Filtering problems as children generally grow up to be people with anxiety problems as they become adults. The Filtering and Processing groups often have a great deal of overlap, so the fact that one may perhaps see a scooped EEG pattern in one area and downhill patterns in the others is not unusual.

The whole idea of testing the protocols is to find out which one(s) provide the desired effects for a client and focus on those. If you try a protocol and get effects other than those desired, then you tick that one off the list and go ahead with those that get the desired effects.

Descriptive, Not Normative

I prefer that you don’t use the word “norms” when talking about the TQ. The process of norming a database is a complex and rigorous one, and I have great respect for the folks who go through that process. There are already a few assessments out there which claim to be normed for (I assume) marketing purposes but are not. Going out and grabbing a bunch of assessments (and then selecting which ones you think qualify) without any of the screening and statistical techniques that turn data into a normative database is not the same as truly calculating norms. That’s certainly beyond me–if I were interested in it.

As I have said a number of times, the TQ philosophically stays away from the concept of norms, because I don’t think most people are interested in becoming “normal” (assuming there is such a thing). So the TQ uses data descriptively. You can say that a client has a brain that is dominated by slow activity, but you shouldn’t necessarily say that the brain activity is TOO slow or “abnormally” slow. If the client uses slow brain activity (e.g. a poet, therapist, creative person, inventor, etc.), then training to reduce that activity just because it doesn’t fit a “norm” is a bad idea in my mind.

The TQ does include some rough guidelines (some with more research basis than others) to allow us to turn numbers blue (lower than expected) or red (higher than expected). Again these are for descriptive purposes. A trainer, looking at the report page or the analyze page can pretty quickly get an idea just from the colors whether a brain is dominated by slow or fast activity or seems to be roughly in the expected range. How that fits with what the client wants to change is the key to developing an appropriate training plan.

Diagnosing

Be very careful (I know you spent a lot of time and money learning to diagnose) coming up with a label and looking for support for it in the assessment. If you can do so, forget the labels and look at the EEG with fresh eyes. You can always slap the label on later, if there is really any benefit to doing so.

First Steps

The rule I use in looking at the TQ is very simple: look at the brain through the window of what the client wants to change.

If you look at the Analyze page, beginning with the section entitled Heads (the Heads page), there are a series of categories we look for (Disconnect, Hot Temporals, Reversals, etc…) Each of these categories is briefly defined (in terms of EEG markers) on the Analyze page.

So first understand what THIS brain is doing by looking at the displays. Is it dominated by slow or fast activity? Is there a hump of alpha in the middle or not? Does the alpha drop down strongly when the eyes are opened or the client is performing a task?

In the Reports and Histogram sections, you can get a sense of relationships among the frequencies from the ratios. Theta/Beta tells you about the main processing style of the client (creative/intuitive vs. logical/rational). Alpha/Theta tells you about the client’s ability to observe him or herself. If alpha is flat, the client can’t observe his own thoughts and feelings and bring them into full awareness. If the alpha is very high, she may be stuck in the observer mode, not actually experiencing her own life.

There is a lot of information about the brain in a TQ–and a lot of ways of looking at it.

My rule of thumb in the assessment process is to look for what is there rather than looking for any specific thing. I recognize that anyone has a tendency to focus attention on one or a few particular issues that seem to be most problematic, but it is important in the assessment to (in the Subjective, the Symptom Checklist, etc.) describe the behavior/mood/performance in as much detail as possible. Then we are more likely to identify the real brain issues that underlie a whole set of issues and be able to help the client move to change them all.

Ratios

The Theta/Beta ratios are roughly based on the Monastra work, using primarily targets for adults. The Alpha/Theta ratios are based on some targets I learned many years ago when just starting. Peak frequencies and coherences are somewhat the same in terms of where they came from. Again, take the blue and red as descriptive indicators–not diagnostic.

When a ratio is red (higher than expected) that suggests that the top number is dominating (alpha in the case of the A/T ratio); when it is blue (lower than expected), that suggests that the bottom number (fast alpha 10-12 Hz) is dominating.

1. A/T ratios low and T/B ratios high: suggests Theta is high (vs. alpha and beta); train theta down

2. A/T ratios low and T/B ratios low: suggests Alpha is low (alpha low vs. theta; beta is not); train alpha up

Theta/Beta Ratio

Most adults will have a relationship of theta (4-8) to beta (13-21 Hz) around 1.2-2.0 with eyes open,

Theta/Beta ratios are a way of comparing a brain’s preference for creative/intuitive image-based thought versus logical/rational language-based thought. The higher the ratio, generally, the more difficulty a person will have with getting detail by listening and reading, staying focused on such material and doing tasks in steps and sequences.

The ratio in an adult will often run from 1.2 to 2.0, and the person will be able to attend effectively to most any type of task. The ratio that is higher suggests the person will have difficulty not drifting off into his thoughts. The ratio that is lower often indicates a person may be anxious or obsessive, perhaps with racing thoughts, though language processing will not usually be a problem.

The Theta/Beta ratio is a power ratio, with theta defined as 4-8 Hz and beta as 13-21 Hz. These are the definitions we used for the article on Theta Beta ratios in Neuropsychology back in 99 headlined by Lubar and Monastra. They’ve become a standard.

So, yes, Lubar/Monastra, for example, identified cutoff points for the Theta/Beta power ratio that separated ADHD (a rather broad diagnosis to start with) from “normal”. Problem is that I’ve rarely seen a creative person, a psychotherapist, an artist, etc. who didn’t–by that definition–come out ADHD. Slow wave activity (as represented by theta in the ratio) represents subconscious access and memory access. That might not be of much benefit to an accountant, but intuition and creative thought are pretty important to many other people. By their definition, people with VERY low Theta/Beta ratios should have fabulous attention; but they don’t. They may be very anxious, have noisy interior monologues going on or be hyperactive and distractible (see the discussion of Filtering vs. Processing forms of attention problems in the Level2 workshop on the categories we use in the TQ).

We would ordinarily look for these patterns with eyes closed, not necessarily eyes open, because eyes closed is where we would hope to see middle frequencies dominate the EEG. In addition to looking at SMR levels with eyes open at C4, I would also pay attention to theta/beta ratios to identify Filtering and Processing issues. Filtering clients often have LOW theta/beta ratios (lots of fast activity as well as lots of slow–just very little in the middle bands) that often RISE (but into or closer to the target range) at task. Processing clients usually have HIGH T/B ratios and/or they “reverse activate”–rise out of or further out of the target range–at task. The scoop pattern with eyes closed–inability to produce the middle frequencies–is another indicator of Filtering problems.

Alpha-Theta Ratio

I judge alpha adequacy in relation to theta. If alpha/theta ratios in the parietals are around 1.5 or higher with eyes closed, that’s pretty good alpha–enough to support the functions back there if you choose to try reducing beta. Also training down beta and up alpha if the ratio is a bit lower than 1.5 may work okay.

Low Peak Alpha

Alpha peak frequency can be lower than 10 and still be “normal” in children. The same is not true for adults. As peak frequency in alpha begins to slide, we expect to see semantic memory issues, losses in short-term/working memory, fogginess, difficulty with learning new material. If you choose to believe that these are “normal” changes in adults over 50, then there’s no sense training them. But if an adult has this EEG pattern and these problems, then training to speed up the peak alpha frequency will usually help to resolve the target issues. The slow peak frequency, and the dropping overall peak frequencies at task, both suggest a brain that is tired. If there are emotional drive issues, stress, etc., then over a period of half a century, they are likely to result in a tired brain.

Alpha Reversal

Having alpha reversals in the frontals (or in all homologous site pairs–F3/F4, C3/C4, P3/P4 and T3/T4–for alpha and beta reversals) does not mean that a person is “depressed”. It means there is perhaps a predisposition to move toward lower energy states, darker moods, a tendency to see the world through dark glasses, threats as opposed to opportunities. If those are issues, then training to deal with the alpha reversal can be helpful. Beta reversals are more likely to relate to irritability, anxiety and agitation. Finally, poor alpha blocking (shifting out of alpha when the eyes are open or the client is at task) can be an artifact of slow alpha (some of the alpha is actually down in the theta band, so it behaves as alpha would, thus the ratio of alpha/theta does not show much change). It can also mean that the client is staying in the auto-pilot state when he’s supposed to be landing the plane. Failure to de-synchronize from alpha generators so the neurons in the cortex can actually do their job has a significant effect on cognitive processing.

Rigidity and compulsiveness can be related to frontal midline issues (what we call Blocking) or to high levels of coherence in faster frequencies (the Locking pattern), among other things.

Maps Page

The maps and power maps in the TQ assessment have colors assigned based on the relative values or percentages of amplitude and power of an individual frequency relative to the total. Those are not norms. They are useful for identifying hot spots (e.g. a spike of alpha at Fz).

If you look at the Maps page, you can usually very clearly see if there are frequencies with higher percents on the midline than the two lateral sites. There will be a brighter (or lighter) band running from the front to Cz. If you see that in the low frequencies, like delta, theta or slow alpha, that would suggest an underactive cingulate–not able to effectively do its job–perhaps one tired by severe demands on its emotional regulation function over years. I always start looking at an assessment with an overview, trying to get an overall sense of the brain’s “style”. If the first segment on the Analyze page (Histograms, I think it’s called) shows lots of red in the fast% line, that suggests the brain’s style is to produce a lot of fastwave activity regardless of demand. If that’s the case, then I may decide (especially looking at the graph in the Blocking section) that the lower amount of fast activity (i.e. slower cingulate) is actually probably a good thing. If you have a bright band from Fz to Cz in beta or high beta and above, then that very well may indicate Amen’s “hot cingulate”. The cingulate is working extra hard to control the flow of emotional inputs into the prefrontal to participate in decision making. This can certainly be related to excessively intellectual approaches to living (obsessiveness, compulsivity, even addictions) and it often shows as denial.

Power Maps

The main benefit of the power maps is that they really put red flashing lights around any patterns that appear. I rarely use them.

Heads Pages

The reason there are two heads pages (one for absolute amplitudes, the other for relative amplitudes or percents) is that either one can give an erroneous impression. If all the amplitudes in a site are higher (or lower) than all the amplitudes in another, then comparing a single frequency band can make there appear to be a differential, when there really is not. The percents can be misleading if there is a particular frequency that is much more dominant at one site than another.

Why no Fz-Oz Coherence Data

It’s mostly because those sites are so far apart that the coherence would be expected to be almost nil, and because I don’t have any basis for knowing what values we should use in comparing them.

Slow Brains

It’s not uncommon for delta to be greater than theta in an assessment, but the combination of the two suggests that the brain is dominated by slow wave activity and will thus have difficulty with logical/rational tasks, language-based processing, sequential/hierarchical thought, etc.

The Training Plan

Testing Protocols

The brain-trainer approach was to test each protocol in one session by itself. Start with the first one we identified (using the series: temporals, frontal reversals, f/b reversals, blocking, locking/coherence, etc.) Watch for changes (and ideally ask someone who is relatively close to you also to report any small changes they notice) in the 24 hours following a session and write them down.

After you have tested all the protocols, normally one or a couple will stand out as having had the best responses. You can choose one and do that consistently, sometimes combine the two into a single protocol (though not always feasible), combine them time-wise within a session or alternate them in sessions. You keep training what is working until the result seems to stabilize and lasts for a week or more without additional training. Then you can stop, or you may choose to move on to another protocol to work on the next issue.

One Other Point about Protocols

There are indeed certain protocols which really do seem to work fairly well for specific problems, but for every one of those, there are ten that people use without understanding what or why they are using, purely out of a kind of “religious” adherence to someone else’s approach or out of superstition (it worked once…).

I repeat (ad nauseam, I’m sure to many of you) that the brain will tell you what the protocol should be. Find out what the client wants to change, look at the activation patterns in the brain, link them up and train to change the patterns that help explain the client’s problems. Test them and use the one that works best.

It’s so pathetically simple that it doesn’t even really deserve to be called an approach. Only because there are so many magical protocols in our field would this simple, logical way of looking at the data, making and testing a hypothesis, be anything other than the standard.

The whole idea of the TQ is that it gives us a way of looking at the brain through the window of what the client wants to change. Unlike a QEEG, it is not “normative”. Rather it is descriptive. So looking at a number and saying, “oh, that’s too high, we better train it,” is NOT the way I would use it.

Order of Testing Protocols

Remember that you always start by ruling out Tone first, then Balance. One of the best indicators of Tone problems is a tendency to deteriorate significantly in the face of negative experience: literally to become like a child. When negative emotions hit Tone clients, cognitive perspective on their experience is swamped in an instant.

Balance is second. It shows up with the normal or lower theta/beta ratios in the central and frontal areas with eyes closed, combined with beta levels higher at P3 and P4 than they are at F3 and F4 or higher at Oz than at Fz. You may also find beta stronger at F4 than at F3 or alpha imbalances (more left than right, more front than back). I usually start with alpha up/theta down training at P4 (remember to define your alpha at 10-13 Hz and your theta at 3-9Hz if there is slowing in alpha).

Thoughts on Establishing Training Plans

The whole idea of the training plan is that you test each of the options and work with the one that seems to have the best response/works the best. Don’t keep working on something that’s not providing results; try other options from your training plan and see if you find one that the brain DOES respond to.

I’ve never been a big fan of sculpting the EEG according to what it should look like. High fast wave coherence isn’t an issue for me, but if the client experiences rigidity of thought, obsessiveness or compulsiveness and has high frontal coherence in fas twaves, then I’d try to find what impacted those training objectives.

What I would expect as someone goes from baseline eyes open to task is a reduction in all frequencies. Alpha and theta are higher amplitude frequencies, so reducing them reduces overall activity. And beta is a local frequency. It’s not altogether clear to me that trying to increase beta amplitudes is such a hot idea. I think training helps to improve maintenance of the activity over time, but not necessarily amplitude. When theta goes down, beta probably does as well in much training–just not as much, so the ratio may change.

Whole-Brain Training

Take a look at the video on our YouTube channel: Whole-Brain Training
http://youtu.be/x-EBlGCV8iY
I’ve found notes I wrote back as long ago as 2008 talking about the concept of brain circuit training, but only in the past year or so, with a base of a few dozen trainers who had taken my courses and were under my supervision here in Brazil, did I have a reasonable base for testing it out. The idea as you heard it in the courses years ago was based on the Othmers’ earlier versions of the “sweet spot”. In short, you try a bunch of stuff until the client says “Aha!” and then you keep doing that. The problem was always–with protocols as with magical frequencies–many clients never said AHA. In fact they didn’t notice much difference no matter what we did.

The approach to training plans changed somewhat a while back, when I began producing plans that included 2-3 different trainings for each session. There might be trainings that worked the same thing (e.g. synchrony) at multiple sites; or they might train the same sites to do multiple things (e.g. synchrony, symmetry, activation). These were based on what patterns appeared in the assessment. But I still suggested going through the plan once and then picking what “worked best” and focusing on that in later trainings.

I had the experience (wrote about it on braintrainer) of spending some time online with a trainer who was having absolutely spectacular results with literally every one of her clients (verified by the psychiatrist and neurologist in her practice who worked with her on the clients). She kept telling me it was the plans I was providing for her, but I told her that she was doing something different. As we talked she told me she was doing exactly what I had taught her–and proceeded to describe the opposite of what I had told her! I know my Portuguese isn’t ideal, but I don’t think it’s that bad! Here’s what she was doing: She was NOT trying to pick the best training after one cycle through the options. She just kept cycling through. She was NOT dropping a training if a client didn’t like it or had a bad reaction to it. She would discuss with the client what about the training had bothered them…and then repeat it 5 sessions later.

I’ve learned most everything I know from the people I’ve trained (clients and other trainers), so I paid attention to her and suggested on braintrainer (and on my Brazilian group TLCpro) that people try using the plan that way. The results were, to say the least, gratifying. It made sense. Everything in the plan was there because it was a clear pattern in the brain related to the client’s training goals. Why not keep training ALL of them instead of picking just one. It was also common that a client would really like a training the first time they did it…and then have no response at all the next time. Training through the cycle, we cleared certain issues in the first round or two that freed up the brain to experiment with changing other patterns in later sessions. It was very much the same idea as circuit training using multiple modalities (e.g. stretching, weight training, aerobics) and working different areas with different exercises in a circuit.

[The] comment earlier today that she had seen changes in what I taught reminded me of having had the same experience in my early years training per Lubar’s teachings. I guess I like the fact that I’m still learning, and I hope I keep implementing what I learn into the latest version of brain-trainer.

Working without an Assessment–the Recipe Approach

Recipes are used because they do work a reasonable percentage of the time. But there is certainly likely to be a big difference between what you get when you eat something made by my mom from a recipe of hers-and what you get if I make the recipe. The people who create the recipe (in this case) have years of experience with thousands of cases and probably have a great intuitive feel for what is happening as they follow it–and the ability to adjust. Some trainers are unlikely to have brought any of that to the process. Conditions affect the results (making a cake at 5000 feet above sea level is different from making one in Miami) and ingredients affect the outcome. So the “following” the recipe is not always the same. Just often enough that people can do it and get good results much of the time. As for the practitioners, they got paid for their sessions whether you got the results or not.

When you only know one recipe, and you follow that recipe blindly and end up with unexpected results, you have a serious problem: You have no idea what else to do, since you have no idea why you did what you’ve already done. The first step is to tell you, “don’t worry, it’s temporary; it’s actually good for you, no matter how bad it feels.” When that doesn’t pan out the next step is…blame the client! Finally, send him to someone else.

If you’re seeking training, ask a prospective trainer how they go about deciding what to train. If you don’t hear something about looking at the brain before deciding how to intervene in its operations, thank them and leave. Ask them what systems they’ve trained in and how much experience they have. This may be just a personal prejudice, but I’m always a little nervous around folks who have one source for their knowledge. There are a number of systems focusing on professional training that have sought to create a cocoon for those who enter their doors. You buy their equipment, take their trainings, go to their workshops, participate on their lists, etc. It’s nice for the trainer–no pesky questions entering your mind to make you think outside that particular box. But it makes them one-dimensional and overly averse to any form of uncertainty. The terrible truth is that there are MANY systems for doing neurofeedback, and all of them have some kernel of the truth. I’ve never taken a workshop that I didn’t learn something! I’ve learned enough to know that almost NOTHING will turn out the way I expected it to, so I have to really pay attention and be ready to respond. But if I’m religious in any of my beliefs about brain training it would be (big surprise): only an egotist or a fool starts mucking around with another person’s brain without knowing what it’s already doing!

Understanding Montages

Whenever I write montage descriptions, I use Active CH1/Ref CH1/g(round)/Active CH2/Ref CH2. If I am suggesting a one-channel montage, it will be just Active CH1/Ref CH1. I leave out the ground, because the ground can be placed anywhere on the client’s body. So a 2-channel would be T3/A1/g/T4/A2; a one-channel bipolar would be T3/T4.

You Don’t Change It, The Brain Changes Itself

It’s really hard for many who are trained in the area of mental health care to get this concept: it’s the BRAIN that is changing. You aren’t changing it; it’s changing itself. If you’ll just let it look at itself in a series of mirrors (feedback) until it finds one it likes, it will change in positive directions–even better if YOU stay out of the way. Remember the poor kid trying to learn to ride a bike with a helpful uncle/father/brother “telling him” how to do it. It takes 5 times as long as if you just help him up when he falls (feedback) and brush him off and let him try again. I long ago stopped trying to “understand” 1. WHY a brain is the way it is; that’s psychology and, if you give the brain information about what it’s doing, it’s not necessary. Certainly psychology can be very helpful in guiding the client/family/support system to break through the homeostasis and letting the person move into a new space, but “processing” the history doesn’t usually require any help; 2. WHAT the brain will respond to among the various options; just test and notice (you know, the “scientific method”) and do what the brain says it likes and follow instead of trying to lead. If it’s critical to the TRAINER that a proper name be given to the constellation of symptoms–even knowing that this won’t in any way help determine how to CHANGE them using NF–then swell. Go for it. But the most efficient and respectful way of brain training I have found is to look at the symptoms that are problems for the client, identify possible brain patterns that relate to those symptoms, see which ones the brain responds to changing and give the client the credit.

Of course there are expected activation relationships in the brain. Many of these come from the QEEG data that has been developed over the years. The TQ is not creating a new standard; it is an attempt to give you largely the same information you would get from a Q in a more efficient and more focused way. It does not compare brain sites against normative databases (not, by the way, US databases but simply “normal” subjects selected from various sources depending on who puts it together) in terms of absolute and relative amplitude, phase, coherence, multiple ratios, etc. It is a very detailed look at brain activation compared against what someone has determined to be normal, and it produces pages of what are called “Z” scores–numbers representing the number of standard deviations the individual brain is from the mean of the normal brains in each of the many different measures. The result is rather like trying to figure out what an animal is by looking at a microscope slide of some of its cells. However, the Q has helped to identify a number of overall relationships in brain activation and related them to various performance, function or mood problems. The TQ simply allows you to gather this data in a short period of time, using readily available equipment, and it focuses your attention–when you look at the data through the window of the client’s desired changes–on the most likely relationships.

As I’ve said in most of my trainings, I avoid this entire discussion, because I rarely share the assessment with potential clients. I focus on the training plan with them and on their role in helping to select the correct training approach. That not only avoids my having to explain all that data and where it comes from and what’s important in it–it avoids the problem down the road of having the parent/client come back and say, “yeah, we’re seeing changes, but golly: look at the parietal beta!” Nobody ever comes in with a goal of creating changes in the assessment file relationships, but if you aren’t careful you can train them to start thinking THAT is what is important instead of the client.