Caveat about Symptoms

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One of the things you will discover when you start working with neurofeedback training is that its effects are often so broad that many of us find the process of diagnosing to be relatively useless. Instead, for those who work with my assessment, we simply look at relationships between the brain activation pattern and the client’s desired changes and let that guide our training.  We don’t talk about “treatment objectives”; we teach training plans and behavioral objectives.  Train for what you see and what you want to change, and don’t worry too much about what someone calls it.

Brain Patterns Don’t Correspond to the DSM

My issue with diagnosis is that most of the DSM diagnostic categories are almost entirely useless in terms of guiding protocol and placement choices.  Depression, for example, can show up in a frontal alpha reversal, or extremely high levels of alpha frontally or very slow left-side EEG or low parietal alpha levels or even very high levels of fast activity temporally–and probably a number of others as well.  Same for anxiety disorders, attention disorders, all the various sensory processing disorders, etc.  I also agree that the tools (the TQ Assess files) are ways of focusing the process of gathering information, and I hope I regularly stress the importance of determining what and where to train based on what the client’s issues and training objectives are.

I found years ago that it was much more valuable to define your training goals without diagnostic categories.  Someone may have told you that you “have” obsessive-compulsive disorder, or maybe you’ve just decided that for yourself based on family history or reading on the internet.  The bottom line is the “OCD” is just a name given to a batch of behaviors, moods, symptoms. It really says nothing at all about what is the cause of them.  With brain training, you should focus on identifying those issues that are most problematic for you and which you  most want to change. Some will fit into OCD, others may not.

In addition, when you use the word “cure”–much as when you use the diagnostic shorthand–you are placing yourself mentally in a way of looking at problems which is almost the opposite of brain training.  If you “have OCD”, then you have a “disease”.  Nothing YOU can do about that, right?  It’s not your fault, and it’s outside your ability to impact.  You need to find someone to “cure” the disease, even knowing that mental health disorders aren’t generally curable.  If you focus on identifying the behaviors, moods and performance issues that would make your life better or easier or more enjoyable, then you leave the door open to the option that YOU can change those things.  Make no mistake: in brain training–even if you work with a great trainer–it’s not the trainer who makes the changes–it’s YOU!  Your brain learns new ways of dealing with the demands on it. That’s not a cure. It’s a set of changes you made in your own life.

There is an old saying, “when your only tool is a hammer, every problem looks like a nail.”  Psychologists believe that problems are psychological, because they’ve learned how to deal with them that way.  Physicians believe they are chemical and can only be treated with medications.

There is a great deal of experience and evidence in published studies that “psychological” problems can indeed be resolved both faster and more permanently by changing the activation patterns in the brain and body that hold them in place.  The client does not have to “process” or remember traumas.  By shifting the way the brain produces and distributes energy (which the client does for himself), problems such as anxiety, depression, addictions, obsessions/compulsions, inattention, poor emotional regulation and many others simply go away.  For most clients, this is much more desirable than digging back through old experiences and feelings to try to find the “source” of a negative habit pattern–still with no assurance that it will change!

That is not to say that counseling and coaching are not important parts of helping the client (and support system) adjust to the change.  They can work together very effectively.

Don’t Aim for Normal

In my mind, the goal of brain training is not to make us all fall within X standard deviations of someone’s mean; rather, it is to give each individual a tool to allow him to increase his/her range of options and make him more fully himself.  The best hunters and pioneers are likely to have less activated thalamic activity, because they live on the edge, need to be able to get a lot of information very quickly, respond in ways that others might consider impulsive, etc.  The best accountants probably have very different levels of thalamic control to enable them to stay extremely focused on routine detail in the midst of a great deal of information.  Which one is right?

Symptoms-Based Work is Limiting and Unhelpful

One beginner belief—perhaps fantasy—is that knowing a diagnosis or describing some behaviors/symptoms will tell us what the brain is doing and thus how we might train it.  That’s the holy grail of NF and has been the source of a dozen magic-bullet training approaches over the 20 years I’ve been in this field.  My belief, based on working with thousands of people, is that this kind of information may be mildly helpful—certainly needs to be gathered—but only occasionally provides much training guidance.  You need to look at the stable activation patterns–the energy habits–that a specific brain has developed over time to deal with its experience of the environment.

A real-world example involves four cases of highly anxious children/adolescents from 9-15 years who I worked with simultaneously.  The symptoms/diagnoses looked almost exactly the same.   In one of the cases, when we looked at assessment data, we found that her temporal lobes were dominated by very fast activity, particularly on the right side.  The second had extreme fast-wave coherence across the front of his brain.  The third had both right/left and front/back reversals of beta–significantly more beta over the right and posterior areas than over the left and frontal.  The fourth had no posterior alpha activation and a spike of slow alpha in the left-frontal area (probably related to a head injury).  I don’t mean to suggest that these were the only findings related to anxiety in these cases.  These were the ones that, when trained, resulted in clear improvements in the symptoms (including several symptoms that had nothing to do with anxiety.) I suppose we could have just tested out the 7-8 patterns that are commonly associated with anxiety to see if anything worked, but the assessment helped us to focus more specifically on those present in the clients’ brains.

One of the problems with symptom-based work is that we know parents and clients “forget” things–sometimes outright lie. Or we don’t ask the right questions. With NF you may find that the questions are different from those you are accustomed to asking.

For example, we know that the symptoms of sleep deprivation match those of many mental health categories. NF is often remarkable in resolving sleep problems, and I believe that doing so should always be in the top rank of training objectives. When the client improves sleep efficiency, many other things get easier or go away.

Train to Client Goals, Not Symptoms

There are many reasons to train to client goals rather than chasing down specific symptoms.

1.  One of the problems with trying to provide neurofeedback approaches to respond to a couple of specific symptoms is that they can relate to a variety of brain activation issues.  Without knowing anything about your client’s EEG or more about the other kinds of things that are present in his experience (is he impulsive, what is his emotional character, what kinds of cognitive issues does he deal with, what is his sleep pattern, etc.) we are simply shooting in the dark.

2.  In addition, many symptoms are in the eye of the beholder.  What feels like anxiety to me, may not feel like anxiety to someone who has been that way his whole life.  And many people who are “depressed” need to be told by others, because they don’t notice the very small changes over time, or they have never experienced anything else.  Also, in the brain-trainer system we don’t necessarily consider an activation pattern to be unhealthy.  If someone has a left/right alpha reversal, the chances are very high that they will see the world as a more negative place than a person who does not have this pattern, but the person may be perfectly comfortable that way.  Is it unhealthy?  Or just different?

I have certainly seen clients who had reversals or hot temporals or hot frontal midlines, etc. who did not experience any symptoms they wanted to change.  That’s why the brain-trainer approach is to start with the client’s objectives and look at the brain through that window.

My view is to provide the client with a means of developing toward the kind of person he or she wants to be.  If Einstein doesn’t mind losing his keys all the time, then don’t train down his theta!

3.  The primary symptom, while it may be what you want to see change most rapidly, can also send you down a wrong or too limited road in terms of training if you don’t look at the whole picture.  When the client is dominated by a single issue, he can’t really tell you very well about the “foundation” issues, because he simply doesn’t know about them.  If you don’t dig down to them, you can end up repairing the framing around a window without knowing that the whole house is off square because the foundation is sinking on one side.  For example, if someone complains of clenching teeth, my first question would be, “do you think the fact that someone clenches her teeth this way is completely unconnected to any other issues in her life?”  I’d be interested in knowing whether she’s anxious, has sleeping difficulties other than clenching her teeth, has other physical issues, etc.

All I hope for is that the assessment process aims me in good directions that help move the client where he or she wants to go and which result in those changes becoming stable. 

4.  I don’t think I’ve ever seen a client who had some issue of mood, learning, behavior, performance, etc. they wanted to change who did not have any activation patterns that seemed to fit with that issue.  The more you understand about the brain, the more you can make sense of the “trickier” patterns.  For example, a person starting out as a trainer knows that inability to pay attention is related to too much theta compared with beta.  A client comes complaining of attention problems with a very LOW theta/beta ratio–LOTS of beta compared with theta.  How is this possible?  Perhaps the client has so much beta that there is anxiety or racing thoughts, which make it difficult to pay attention. Perhaps there is slow alpha, or alpha does not block, or perhaps coherences are very low between some sites, or perhaps there is strong delta activity.  Any of these could result in difficulty paying attention.