(1)
Swingle Clinic, Vancouver, BC, Canada
Keywords
BraindrivingAVSUnconditioned stimuliAutismEmotional traumaTaskingEmergency treatmentsMagnetic stimulationLight and sound stimulation, which is used in Audiovisual Stimulation (AVS) devices, does affect brainwave activity. These devices are often preprogrammed to provide stimulation in the Theta or Alpha ranges to enhance quieting and relaxation. Stimulation in higher ranges or specifically in the high Alpha range is designed to improve cognitive functioning. AVS stimulation in the high Alpha range does result in localized increases in APF (Pfurtscheller et al. 1988), and stimulation close to one’s own APF results in greater enhancement than stimulation rates that are double one’s range (Frederick et al. 2005). It has also been shown that EEG changes associated with noncontingent (i.e., not contingent on EEG) AVS do not result in changes after the stimulation is terminated.
The protocols to be described in this section can be quite complex, in the sense that many contingencies can be associated with specific EEG events. One can have lights go on or off coincident with sounds going on or off or any other stimuli including electrical, electromagnetic, or vibration. The presentation or removal of these stimuli can likewise be complex. For example, the “push/grab” protocol could be the presentation of an Alpha-enhancing harmonic when the Alpha amplitude falls below some threshold, but an Alpha frequency light (e.g., 11 Hz) is presented when the Alpha amplitude is above threshold. The harmonic “pushes” the Alpha and the flashing light entrains the Alpha when the amplitude is above threshold.
For emergencies, when clients are in severe anxiety and distress, one generally uses slow frequency amplitude enablers. For example, one might have slow frequency lights presented when Beta amplitude exceeds threshold, a Theta-enhancing harmonic presented when Theta is below threshold, and electrical stimulation of acupuncture point P6 (Pericardium 6, on the dorsal surface of the wrist) when Theta amplitude is above threshold. The latter acupuncture stimulation point has been shown to enhance Theta amplitude in the occipital regions of the brain (Swingle 1998).
There are several products for delivering harmonics contingent on EEG or other biofeedback events. Many EEG feedback systems have built-in, or optional, methods for delivering light or sound stimulation contingent on the EEG. There are also several stand-alone products that will interface with any biofeedback system that has sound output. The stand-alone systems are simply sound-activated electronic gates that permit control of any on/off function of electrical devices. The devices can include light and sound systems, CD players, electrical stimulation sources, and even devices like electric trains and wireless toys.
There are also software products that will deliver specific sounds contingent on biofeedback events. Some of the major EEG platform manufacturers have braindriving options for delivering both sound and visual stimulation. Braindriving software suites are also offered by a variety of software companies that allow clinicians to program complex contingencies for light and sound stimulation.
The cases presented in this section were treated with protocols using the Braindryvr Cascade system. This is a stand-alone system that is an acoustic gate to present the stimulation contingent on EEG events. The acoustic gate is triggered by the sound output from the EEG (neurofeedback) system. The Braindryvr Cascade will work with any biofeedback system with sound output.
It would perhaps be useful at this point to offer a few examples of stimulating or braindriving the EEG. The most straightforward example is a child with CADD, in which the only remarkable feature of the ClinicalQ is high-amplitude Theta activity over the sensory motor cortex (location Cz). The usual treatment for this condition is Theta inhibit, Beta enhance neurofeedback over location Cz. The number of sessions required to treat this disorder using “conventional” neurofeedback is between 40 and 80 (Lubar 1991). One can reliably and permanently remediate this simplest form of ADD in 15–20 sessions using braindriving technology (Swingle 2001). In between one-third and one-half of the neurotherapy sessions, braindriving is included. When Theta amplitude is below the training threshold, the game icons move and the child hears the reward tone. When the Theta amplitude goes above the training threshold, then the game icons stop moving and the child does not hear the reward tone, but a Theta-suppressing harmonic is presented via the Braindryvr Cascade, which suppresses Theta amplitude.
A more complicated example is in the treatment of seizure disorders. A common treatment for epilepsy is to enhance the amplitude and/or frequency of SMR operant responses over the sensory motor cortex (locations C3, Cz, and C4). One should also set an inhibit on Theta because if Theta amplitude increases when the SMR amplitude increases, there is a likelihood that seizure activity will remain unchanged or become worse even though SMR amplitude is increasing (Lubar and Bahler 1976). Using braindriving technology, one can cascade the units so the Theta-suppressing harmonic is presented when Theta amplitude increases above threshold, and the SMR-enhancing harmonic is presented when SMR amplitude drops below threshold. The braindriving technology can be used alone (i.e., no visual feedback) or with visual feedback displays.
Prior to all braindriving sessions, the efficacy of the UCS should be assessed. Because braindriving is an aggressive therapy, the changes are often sizable, but one should expect some after session regression towards pretreatment levels. The resulting after treatment level is usually above pretreatment level. Often to stabilize the braindriving gains, the client is shifted to straightforward neurofeedback. Braindriving can also be added to regular neurofeedback protocols by having the UCS sound as the feedback with the client instructed to keep the sound “off.” If the UCS lights are presented on goggles with look-through lenses, the child can be reading, writing, doing math, etc. while the implicated area of the brain is under braindriving treatment. This has been found to be very effective for facilitating skill acquisition (e.g., written output).
In most cases, braindriving is not used exclusively in the treatment of any condition but is combined with conventional neurofeedback. This is a practical clinical decision since the method of researching this technology has been to add it to the neurotherapy, observe the changes in the EEG, and determine if the enhancements are sustained in the ongoing neurotherapy treatment sessions. There have been cases in which braindriving has been used exclusively but there have been cases in which there were circumstances mitigating conventional neurotherapy (e.g., severe autism).
Braindriving is particularly effective for treatment of infants. Prior to the use of classical conditioning protocols in neurotherapy, neurotherapists would not treat infants because they could not get adequate QEEG measurements, and more importantly, because they do not believe that neurofeedback could be effective because the child was not capable of volitional attention to the feedback contingencies. Braindriving can be used with any client whether or not they are capable of volitional attention and engagement in the process. Thus infants, demented adults, delayed children, and comatose patients can be treated with the braindriver methodologies.
The following two cases illustrate the use of braindriving with infants. The first was a 9-month-old male infant with West Syndrome, a condition characterized by infantile seizures. Prognosis is generally not good with these infants with some estimates of only about 5 % of treated children achieving relatively normal cognitive and motoric development. Treatment with vitamin B6 and the Ketogenic Diet has been found to be successful in addition to antiseizure medications. The latter, however, carries the potential for cognitive impairment or delay as a side effect.
This child came for intensive treatment (up to three sessions per day) for a 3-month period. Upon his arrival at the clinic, this child had no seizure-free days. His Theta/Beta ratios were 4.8 (Cz) and 5.9 (O1), and his Theta/SMR ratios exceeded 10 at all locations over the sensory motor cortex. Preliminary assessment of the Theta suppressive effect of OMNI indicated a 12.8 % decrease. Assessment of the EFT (the EFT procedure is described elsewhere in this book) acupuncture tapping treatment procedure indicated an increase in SMR of 55.7 % and an increase in Theta amplitude of 69.7 %. Assessment of EFT with OMNI indicated an increase of Theta amplitude of 16.0 % with SMR amplitude increase of 38 % indicating that home use of EFT with OMNI would efficaciously reduce the Theta/SMR amplitude ratio. The parents administered the EFT with OMNI protocol (three repetitions of the EFT sequence per session) at least 15 times per day during their stay in Vancouver. They were instructed to continue the home treatment at least five times per day after returning home following treatment at the clinic.
The braindriving protocol used for this infant was OMNI on when Theta amplitude was above threshold and vibration of a soft cuddly toy bear when the amplitude of SMR was above training threshold. One can debate whether the vibration of the soft toy was a reward (instrumental conditioning) or the application of an unconditioned stimulus (classical conditioning). The bear vibration did increase the amplitude of the SMR in pretest.
At the start of the treatment, the infant had no Seizure Free Days (SFD). After the first month of treatment, the child had 45.0 % SFD; at 2 months 57.1 % SFD; at 10 weeks 87.7 % SFD; at end of treatment after 3 months 100 % SFD.
The second case was a 22-month-old male child diagnosed with “genetic degenerative brain disorder” with infantile seizures and spasms. The child also had limited use of his arms. Although there are many degenerative brain disorders, the parents reported that their child’s condition was terminal, and that the only therapeutic options were to, essentially, sedate and medicate to inhibit seizures until the child died. The parents wanted to try neurotherapy to control the seizures/spasms and to be able to minimize medications that had sedating effects so they could have a relationship with their child until he died. The parent’s report of the child’s condition was verified by the referring physician.
The treatment paradigm was similar to the above case of the infant with West Syndrome. At intake, the child’s frontal Delta amplitude was 29.1; the Theta/SMR ratio was over 8 at all locations over the sensory motor cortex; summated 16–25 Hz and 28–40 Hz amplitudes at location Fz was 31.4. The treatment of this child included the home EFT protocol and Craniosacral Therapy (CST) as part of every in-office neurotherapy session. One such session, focused on decreasing the Theta/SMR amplitude ratio at location C4, included OMNI presented when Theta amplitude was above training threshold and vibration of the toy cuddly bear when SMR amplitude was above training threshold. At the start of the session, the Theta/SMR ratio was 6.20 and following the treatment session the ratio was 4.28, a change of −31 %. Follow-up report from the parents included: “child was alert and interactive; many seizure free days; regained partial use of arms; died 16 months after treatment.”
Autism is a good example of conditions in which braindriving technology is particularly efficient. Many Autistic Spectrum Disorder (ASD) clients lack the capability to participate effectively in volitional forms of neurofeedback. They simply cannot attend to the feedback screens or feedback sounds. There is evidence, of course, that the simple sound feedback will result in learning with positive results. However, the braindriving techniques are markedly more efficient and effective because the client need not be attentive and the stimuli being contingently presented are classically conditioning the desired brainwave state. Hence, very severely disabled ASD clients can be effectively treated with braindriving techniques. As the ASD client progresses, the protocols are gradually shifted to more volitional paradigms. During the transitional phases, both braindriving and volitional neurofeedback paradigms are presented simultaneously.
Standard Braindriving Protocols
The protocols for braindriving can be exceedingly complex. One can program the braindrivers to present light, sound, electrical stimulation, vibration, and electromagnetic stimulation in a wide variety of combinations all of which are contingent on specific EEG events. In most clinical settings, the majority of clients can be efficiently treated with a few standard braindriving protocols.
The first decision that the clinician must make is whether to suppress or to increase brainwave amplitude. The second decision is to select the braindriving stimuli based on whether the stimuli are to suppress or to entrain the selected brainwave. For example, an 18 Hz flashing light can be used to suppress Theta if the onset of the light is made contingent on Theta amplitude exceeding some threshold. This same light frequency can, on the other hand, be used to enhance Beta amplitude if it is presented when Beta amplitude exceeds a training threshold. The former uses the 18 Hz light to suppress slow frequency amplitude, and the latter uses the 18 Hz to entrain Beta.
Several examples of braindriving protocols are shown in Figs. 6.1, 6.2, 6.3 and 6.4. Figure 6.1 shows the data associated with braindriving Beta down at location O1 for a client with a deficient Theta/Beta ratio. Common complaints associated with this condition, as previously discussed, include problems with stress tolerance, sleep quality, and self-medicating behavior. Concentration can also be poor because of “brain chatter.” As the data indicate, contingent stimulation of the Heart 6 (palmer ulnar surface slightly above the wrist crease) acupuncture meridian (bilateral) resulted in a decrease in the amplitude of Beta and an increase in the amplitude of Theta. The resulting increase in the Theta/Beta ratio after this 20 min session was 76.1 %. Subjective reports following this session was of profound quiescence. Recall, the efficacy of the UCS for this client is pretested before the braindriving session.
Fig. 6.1
Braindriving Beta down @ O1 with H6 stimulated > T
Fig. 6.2
Braindriving low Alpha down @ Fz with OMNI and 11 Hz visual > T
Fig. 6.3
Braindriving Theta down @ Cz with 16 Hz and OMNI > T
Fig. 6.4
Braindriving Alpha @ Pz with 11 Hz and SERENE < T
Figure 6.2 shows the data from an elderly client who was experiencing problems with memory and cognitive efficiency. Alpha slowing, measured in this case with the Alpha density ratio of lo-Alpha/hi-Alpha, can be an age-related decline. These declines can be effectively treated with brain-brightening protocols such as those developed by the late Budzynski et al. (2007). Braindriving also has been shown to be particularly effective for these clients as the data shown in Fig. 6.2 indicate. The protocol was to present both the OMNI harmonic (a blend of sounds that reliably suppresses Theta amplitude) plus 11 Hz visual stimulation whenever 8–9 Hz brainwave amplitude crossed the training threshold. As indicated, the pretreatment L/H Alpha ratio was 2.83 which dropped to 2.76 after the first 2 min of treatment. By the end of treatment, the ratio was 1.78, which is a 37.1 % decrease. Further sessions, either neurofeedback or braindriving, would be required to bring this ratio into efficient range (below 1.50). Once the L/H Alpha ratio is in an acceptable range, clients with persistent age-related decline are assessed and treated between two and four times per year to maintain efficient Alpha peak frequency.
Figure 6.3 shows a braindriving session with a client with the common ADD condition of elevated Theta amplitude as measured at location Cz. By the end of the session, the Theta/Beta ratio had decreased by about 30 %.
One very important use of braindriving is for treatment of emotional trauma. Obviously, this procedure should be used only by licensed providers experienced in dealing with clients affected by posttraumatic stress. The blunted Alpha response, discussed earlier, is a marker for unresolved emotional stress. There are several methods for releasing and processing this emotional state including EMDR, hypnosis, and experiential psychotherapies to mention but a few. Braindriving can markedly accelerate this process in a positively synergic manner.
The data shown in Fig. 6.4 show emotional release with one of the “Alpha push” protocols. As the data indicate, as the Alpha amplitude starts to increase, this client experienced an emotional release, lasting about 8 min. Many therapists stop the braindriving at this point and continue with a procedure such as EMDR or experiential therapy or simply letting the client silently experience the emotional release. In this case, the client continued with braindriving and started the recovery phase after about 8 min. After the session, the client was probed regarding the experience. She reported an emotional episode which she described in some detail. Brief therapeutic intervention resulted in an emotional redefinition of the event, a desired outcome of such therapy.
The following basic protocols are based on two available braindriving channels. If only one channel is available, the clinician can use one of the two features of each protocol depending on desired effects on brainwave amplitude.
For clinicians with two EEG systems and two braindrivers available, protocols can be used to drive two different areas of the brain simultaneously. For example, clients with depression who show one of the disparities in the frontal regions of the brain can have each of the two frontal lobes targeted independently. Sounds and lights can be presented to each ear and each eye independently to aggressively balance the brainwave amplitudes in the frontal cortex.
Although a more eloquent sounding terminology could be used, I have found in my clinic that the terms “Suppress,” “Push,” and “Grab” are never confused. Clinicians and technical staff all understand that “Suppress” means to reduce amplitude, “Push” means to enhance amplitude, and “Grab” means to catch elevated amplitude with an entraining stimulus to increase time above threshold.
Suppress/Suppress
In this preparation, both stimuli are designed to suppress brainwave amplitude. To suppress Theta, for example, one can have 18 Hz light stimulation presented through the LED goggles and an OMNI harmonic presented through headsets. As the name of this protocol implies, both the light and the sound stimuli are presented when Theta amplitude exceeds the training threshold. For an ADD child with excessive Theta amplitude at location Cz, the stimuli would “go on” whenever the amplitude of Theta exceeded the training threshold. If the training threshold was set for 30 %, then the lights and the sound would come on during the 30 % of the time when Theta amplitude exceeded the specific threshold.
Push/Push
As the name implies, this procedure is designed to increase the amplitude of a specific brainwave. The set-up is exactly opposite to the suppress/suppress protocol. The stimuli designed to increase the amplitude of a specific brainwave would “go on” when the treatment brainwave is below the training threshold. For example, if the clinician wants to increase the amplitude of Alpha, then light stimulation, such as 11 Hz, and the SERENE harmonic would be presented whenever the amplitude of Alpha dropped below a threshold. In this case, the training threshold would be set around 70 % so that the lights and the harmonic are presented about 30 % of the time and the Alpha amplitude would be above threshold about 70 % of the time. As the percent time above threshold increases, the threshold value is increased to maintain the 70 % above threshold average.
Push/Grab
This is an effective procedure for increasing Theta amplitude for clients with traumatic stress, addictions, and anxiety disorders. The SERENE harmonic is presented whenever Theta amplitude drops below threshold, and a Theta frequency light (7.8 Hz appears to be especially effective) is presented whenever Theta amplitude is above threshold. The push/grab protocol can be used whenever the clinician has stimuli available that will entrain and augment a particular brainwave band. Combinations might include 11 Hz lights with SERENE for increasing Alpha amplitude, 18 Hz lights and OMNI to increase Beta amplitude, and 4 Hz lights and SERENE to increase Theta amplitude.
An example of the push/grab protocol is a 78-year-old male client who has a problem with excessive alcohol use and a sleep disturbance. At intake, this client’s Theta/Beta ratio at location O1 was 0.54 and had increased to about 0.80 after some neurotherapy sessions. The ratio at O1 was 0.84 at the beginning of the braindriving session. The “push” stimulus was SERENE and the “grab” or entraining stimulus was 7.83 Hz lights. The lights were presented when Theta amplitude was above threshold, and SERENE was presented when Theta amplitude was below the training threshold. The session was 30 min in duration, and at the end, the client’s ratio was 1.20, with an increase of 42.8 %.
Combinations with the SWEEP Harmonic
The SWEEP harmonic can be very effective when combined with any of the light frequencies. SWEEP balances the frontal brain regions, but it also has a soothing effect on many clients so it can be used for both attention- and focus-oriented treatments as well as relaxation-oriented treatment. Some common combinations include increasing Theta amplitude in the occipital regions with 7.8 Hz lights; increasing Alpha amplitude at Pz with 11 Hz lights; and decreasing HighBeta/Gamma at location Fz with 3 Hz lights.
Case Examples
Push Protocol
As discussed above, the clinician may elect to use only a single stimulus for braindriving. In this case, for example, only one sound stimulus was used to “push” the Alpha amplitude. The client is a young woman under treatment for a severe anxiety disorder that manifested eating difficulties and poor immune functioning as evidenced by incessant colds and flus. Increasing Alpha amplitude in the occipital region of the brain (location Oz) has been shown to enhance immune functioning (increased CD4+ lymphocyte count) (Shummer et al. 2013).
Of several areas requiring treatment, one prominent brainwave feature was a markedly deficient Theta/Beta ratio at location O1. Her ratio was 0.57, whereas normative would be between 1.80 and 2.20. The neurotherapeutic treatment for this condition is to enhance Theta amplitude and/or decrease Beta amplitude at location O1. Generally, one does not commence treatment with these brainwave bands nor at that exact location but gradually approaches the training bandwidths and locations starting in areas and with bands that are easier for the client to master. Hence, training initially was to increase Alpha amplitude by braindriving the Alpha at location O1. The potentiating harmonic for Alpha amplitude enhancement, SERENE, was presented to the client anytime the Alpha amplitude dropped below the training threshold. The baseline Alpha amplitude was 3.2 microvolts (μV) which increased to 8.4 μV after 20 min of braindriving. Consistent with what one finds with Alpha/Theta neurofeedback training, when Alpha amplitude increases, Theta tends to increase as well. In this case, the Theta amplitude increased by 15.4 % (from 5.2 to 6.0 μV).
Push/Suppress
The push/suppress protocol is used when one wants to suppress one brainwave range and enhance or “push” a second brainwave range. A good example of this situation is in the treatment of seizure disorders in which one wants to enhance the amplitude of the Sensory Motor Rhythm (SMR), which is 13–15 Hz, and suppress Theta amplitude.
The client in this case is a 50-year-old man who did not have a seizure disorder. He was under treatment for posttraumatic diffuse body pain and severe sleep quality difficulties, a condition that likely would be diagnosed as fibromyalgia in conventional medical/psychological practices. His initial ratio of Theta to SMR (13–15 Hz) was 4.40, whereas a normative range is below about 3.00. At the session to be reported here, his starting Theta/SMR ratio was 3.29. The braindriving protocol was to present the Theta-suppressing harmonic, OMNI, when Theta amplitude exceeded the training threshold and to present the SMR-enhancing harmonic, SERENE, when the amplitude of the SMR dropped below the training threshold. Baseline measurements at the start of the session indicated a Theta amplitude of 5.6 μV and SMR amplitude of 1.7 μV. At the end of the session, the Theta amplitude remained unchanged at 5.6 μV, but the amplitude of the SMR had increased to 4.0 μV for a ratio of 1.40. It is unusual to have large changes like this, but this case nicely shows that even with driving techniques, the brain “knows what it needs”—a concept most neurotherapists embrace, in that Theta remained unchanged while the SMR amplitude increased even though both were driven. This client reported a marked improvement in the diffuse body pain at the next session.
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