Professor David Gilden

“Just the thought of sitting through a meeting or going to the movies makes me feel anxious,” says Susan, who asked to be identified by her first name only, in fear of being stigmatized by Attention Deficit Hyperactivity Disorder (ADHD). “My mind is bouncing around like a ping-pong ball and I can’t focus on one thing for longer than a few minutes.”

Susan is among the estimated 5 percent of American adults who, according to the National Institute of Mental Health, are living with ADHD, a neurobiological condition marked by impulsive behavior and a lack of focus.

University of Texas at Austin psychologist David Gilden’s research findings suggest the underlying problem doctors have diagnosing ADHD may be in recognizing that it is not an issue of attention, but rather a problem of timing. According to his research, people with ADHD have a much quicker sense of the here and now, such as the moment it takes to thread together two sentences in a classroom lecture. This timing glitch often causes them to fall out of sync with the rest of the world.

Once diagnosed, the symptoms of ADHD are often managed with stimulant medication, but according to Gilden, to effectively treat the disorder clinicians need to have a clear understanding of the underlying deficit.

“The first thing in any treatment is understanding what it is that’s being treated,” Gilden says. “At this time, that’s missing. People have been focusing on ADHD as if it’s an attention disorder, but I don’t think that’s what it is.”

Using drums, Legos, puzzles and Play-Doh, Gilden and his team of researchers are searching for the root cause of ADHD. By allowing their study participants to tinker with the toys in an unconstrained environment, the researchers are able to track timing differences in their natural behaviors.

“ADHD is not about inattention,” Gilden says. “It’s a disorder in the way people thread moment-to-moment experiences together. Children with ADHD are often disruptive because their world is moving at a much faster pace and there’s always going to be a mismatch between their world and ours.”

As part of his research, Gilden measured how people with and without the disorder tap along to the beat of a metronome. The respondents then continue tapping at the same pace for three minutes after the metronome stops. Although both groups were able to tap to the beat at 60 beats per minute, the participants with ADHD lost the rhythm when the tempo slowed down to 40 beats per minute.

“The slower the tempo, the more likely people with ADHD will be less internally consistent with themselves,” Gilden says. “It’s not that they’re inattentive, it’s just that their world is moving along at a slightly faster clip.”

To measure the timing disruptions, Gilden and his team videotaped the hand movements of more than 60 undergraduate students as they worked on various projects like piecing together a puzzle, building Lego structures or molding Play-Doh.

After conducting a frame-by-frame analysis of the action sequences of each hand movement (such as touching a puzzle piece and fitting two pieces together) the researchers found significant differences in timing between ADHD and non-ADHD participants.

Although both groups used similar action sequences and constructed their Lego and Play-Doh projects in the same order, the participants with ADHD took about one-third of a second longer carrying out a task like fitting two Lego pieces together.

“One-third of a second seems like a short amount of time, but in psychophysics, this is a huge timing difference because it only takes the average person one-tenth of a second to initiate an action,” Gilden says. “This is a very puzzling discovery because although their minds are moving at a faster rate, they’re actions are more spacious.”

Sifting Through the Noise
While all the participants moved freely during the study, Gilden, who holds a doctorate in astronomy, found a hidden structure in the patterns of their actions. He found each moment-to-moment fluctuation in hand movements resembles 1/f noise (pronounced one over F), which is not an audible noise, but a mysterious wave-like pattern that appears in natural and unnatural surroundings. Investigated by scientists for more than a century, the noise has yet to be explained.

Gilden is the first to show that 1/f exists in human consciousness. In a 1995 study published in Science, he found that all humans produce the noise. However, his recent studies have shown that the noise is much harder to detect in people with ADHD, as their movements are more erratic.

From fluctuating weather patterns, to the beating of a heart, to pitch and loudness in music and speech, our world is full of 1/f noise. To illustrate this highly complex concept, Gilden plays a piano rendition of Summer Samba. In between the fluctuating tempos and repetitive melodies, he explains how the patterns in music achieve 1/f noise.

“When you listen to this song, you’ll find that it follows a formula of repetition and surprise folded into a pattern of organization,” Gilden says. “Music is the blend between the ordered states and disordered states, and that’s exactly what 1/f achieves.”

To measure cognitive timing differences between people with and without ADHD, Gilden and his team of researchers analyze their hand movements as they build Lego structures in an unconstrained environment. (click to enlarge)

Using Gilden’s research, James Cutting, professor of psychology at Cornell University, studies how editing techniques in filmmaking follow the pattern of human attention. In a recent study, he found the basic shot structure and scene clusters in movies have evolved over the years to resemble the pattern of 1/f noise.

By timing the scenes just right, moviemakers can capture the viewers’ attention without overly taxing their attention span, Cutting says. If the audience hears something the brain doesn’t recognize as the correct sequence – such as quick zooms and pans – they’re unable to make the connections and their minds wander.

Gilden’s research shows compelling evidence that people think, focus and refocus their minds, all at the speed of 1/f, Cutting says.

“When you’re working on a task, sometimes you’re good at it, sometimes you drag and sometimes you zone out,” Cutting says. “We experience these periods of fluctuation throughout our daily lives. And each of these fluctuations creates waves that essentially form a 1/f pattern.”

By applying this theory to ADHD research, Cutting says Gilden is on the right track to understanding the underlying deficit.

Understanding Attention
More than 5.4 million children in the United States have been diagnosed with ADHD according to the Centers for Disease Control. And as that number continues to grow, Gilden says researchers and clinicians need to find out if the disorder has anything to do with attention.

“What is attention? It’s such an abstract concept,” Gilden says. “Attention involves focusing and letting go at the same time, but other than that – I’m not sure what it is.”

This has made treating the disorder particularly difficult. After being diagnosed with ADHD, people are often prescribed psychotropic drugs that come with an array of side effects like mood swings and loss of appetite. The problem with this method, Gilden says, is that clinicians are treating a condition that they do not fully understand.

Without a clear understanding of attention, psychologists have made very little progress in identifying cognitive deficits in ADHD, Gilden says.

“You can’t find a cure until you understand the underlying problem,” he says. “If a doctor suspects you have the flu, he can prescribe a drug specifically targeted for that virus. But when psychologists diagnose people with ADHD, they need to understand what the deficit is before prescribing a full spectrum of treatment that has nothing to do with the condition.”

To seek out the underlying deficit, he examines the disorder from an entirely new perspective by applying an anthropological approach to his research.

“The problem with most ADHD research involving time-pressured experimental trials is that people with the disorder tend to be more erratic,” Gilden says. “We’re interested in the natural flow of behavior. Instead of giving them time-pressured tasks, we allow them to generate their own thoughts and actions.”

Diagnosing a Growing Epidemic
So what is behind the rise in ADHD diagnoses? That is the question plaguing millions of parents every year. Is it a biological illness, environmental toxins or a mere alibi for rambunctious children?

Despite decades of research, the underlying problem still remains unclear. However, recent mounting evidence in brain studies has shown that the deficit is caused by a stunted dopamine system, the brain’s reward pathway that associates stimuli with pleasurable expectations.

Using Play-Doh, the researchers examine how people with ADHD move to the beat of a faster cognitive tempo. Over time, Gilden aims to create diagnostic tools using drumming, Play-Doh and other methods to replace current diagnostic tests, which he believes are ineffective.

Since dopamine is also involved in memory, learning and motivation, the chemical helps people pay attention to the information they need to survive. However, those with ADHD might not be recognizing salient information due to an impaired dopamine system, Gilden says.

In a current study, funded by the National Science Foundation, Gilden and his team are examining how the effects of dopamine dysfunction play into the production of 1/f noise. They found that when participants with ADHD are thrust into a stress-induced environment involving time-pressured tasks, their behavior resembles the kind of noise that a radio makes when not tuned to a station – what scientists call a white noise.

This finding suggests that situations like structured classroom activities, final exams and prolonged meetings are not conducive to people with ADHD. Gilden says researchers, parents and teachers need to take a step back and look for new ways to help people with the disorder adjust to the world around them.

“Our research is motivated by the idea that there is something deeply wrong with the accepted view of ADHD and how people with ADHD are understood,” Gilden says.

The harmful effects of ADHD sometimes persist into adulthood, and many adults who have it do not know it. As a result, they fail to seek treatment and continue to struggle at work or in school and in their personal relationships.

Over time Gilden hopes to create a diagnostic tool using drumming and other methods to replace other diagnostic tests, which he says are ineffective.

Professor David Gilden and his graduate research assistants, Maryam Ezell (left) and Laura Marusich, examine frame-by-frame hand movements in videos to measure cognitive timing differences between people with and without Attention Deficit Hyperactivity Disorder. (click to enlarge)

Caryn Carlson, professor of psychology and assistant chair of the Psychology Department at the university, says findings from Gilden’s research could help teachers capture their students’ attention through strategically timed lectures and classroom activities.

“There is typically a mismatch between the demands of the classroom environment and the attention style of children with ADHD,” Carlson says. “This may be characterized by an inability to focus during extended desk work sessions, missing task instructions due to distractibility and making careless errors.”

Carlson cites other research findings that show the consequences of untreated ADHD, even after children are finished with school, can have a profound impact on their lives.

“When children fail to master critical early academic skills, the effects on school performance can become cumulative and result in failure, frustration and demoralization,” Carlson says.

Looking back, Susan says she wishes her teachers developed classroom activities that were more conducive to students like herself who were chronically bored and restless.

“Back then, I was all over the place,” Susan says. “I couldn’t handle the structure and the teachers didn’t know what to do with me. For the longest time, I thought something was very wrong with me, which is why I have such poor self-esteem. If I was diagnosed early on – who knows – I may have achieved my goal of becoming a history professor.”

Watch A Related News Video
http://austin.ynn.com/content/279818/health-works–ut-researchers-study-adhd-diagnosis

Original article by Jessica Sinn at University of Texas.

To gain some understanding of the quantitative affects of grounding on health, M.D.s Karol and Pawel Sokal of the Military Clinical Hospital, Bydgoszcz, Poland conducted five different experiments wherein blood chemistry was assessed before and after subjects were electrically connected to Earth.

Find links to the original articles at the end of this page.

Their experiments included these five blood assays:

1. serum calcium phosphate homeostasis and iron concentration
2. electrolyte concentration
3. thyroid hormone levels
4. glucose concentration
5. immune response to typhoid and tetanus injection

The basic earthing method involved electrically connecting the human subject to a copper plate measuring 60mm x 250mm placed upon damp ground.  A copper wire ran from this plate to a second plate secured to the lower part of each subject’s leg, the goal being emulation of the electrical connectedness of a bare human foot being placed firmly on the ground as might be so in a culture or circumstance where one is barefoot.

The rationale for their interest – as expressed, and that of Ober and Oschman, is whether our modern existence is resulting in malady and disease as a consequence of electrical insulation from Earth – Earth being “the reference ground” for the global electrical system and in theory “all life” – the latter being the question of interest. The potential problem arises due to our electrical “isolation” from Earth, i.e. we tend not to go barefoot, we tend not to sleep in contact with Earth, our homes and offices tend to be electrically insulated from Earth, etc.

The results of their study are quite striking…They find that across all 5 areas, statistically significant changes in blood chemistry occur when the human organism is grounded vs. when it’s not. Grounding yielded:

• Decreased serum concentration of iron, calcium, and phosphorus in combination with reduced excretion of calcium and phosphorus – this suggesting storage of these minerals by the body. (The authors point out that the physiological affects of grounding are opposite those of weightlessness.) Even a 1 hour contact with Earth resulted in lowering of calcium and phosphorus concentrations. Alternatively, a 1 hour break with Earth following the period of overnight rest while grounded caused calcium and phosphorus levels to rise.
• Changes in thyroid hormone levels, thereby demonstrating grounding’s influence on metabolic action.
• A decrease in blood glucose in subjects with diabetes.
• Following typhoid and tetanus injection, grounding yielded a decrease in sodium, potassium, magnesium, iron, total protein, and albumin concentrations and an increase in transferrin, ferritin, and specific globulins, indicating heightened immune response, thereby demonstrating that immune function can be potentiated via grounding. Like electrolyte levels, changes in all of these factors reversed when contact with ground was interrupted for 1 hour.

The authors emphasize that grounding results in calcium-phosphate homeostasis that is opposite that of weightlessness, where it is known that astronauts lose bone mass rapidly during space flight. The current understanding of this phenomenon is that it is the loss of gravity and weight bearing that interrupts normal bone maintenance. The Sokal’s postulate that the loss of Earth’s electrical influence on the body may be an important mediating factor.

Stephen Elliott has conducted research on grounding and human biopotential and holds US Patent # 7349194: Method and system for electrically connecting the human organism to Earth so as to facilitate an electrical current between the human biopotential and Earth for the purpose of promoting health, well-being, and performance. You can find out more about Stephen’s research here: http://www.coherence.com/press.htm

References
Earthing The Human Body Influences Physiologic Processes by M.D.s Sokal and Sokal

Chronic Disease: Are We Missing Something? by James Oschman, PhD.

Heavy drinkers tend to behave impulsively in response to temptation. Meanwhile, their “reflective,” or controlled, responses – the thoughts that would help them resist drinking – are often weak. Most therapies, including Cognitive Behavior Therapy, primarily address the reflective responses. “They deal with the reasons and strategies” for sobriety, said University of Amsterdam experimental psychologist Reinout W. Wiers, the study’s lead author.

To boost treatment success, his team developed cognitive-bias modification, or CBM, which, for the first time, “tries to turn around those impulsive responses.” This newly developed CBM variety employs video-game-like “approach-avoidance tasks”: pushing or pulling a joystick in response to images on a screen. Pulling zooms in on the image, as if the participant were “approaching” it. Pushing zooms out, in “avoidance.”

The team’s earlier studies found that heavier drinkers, shown images of alcoholic beverages or soft drinks, are faster to “pull” the alcohol than lighter drinkers – but CBM can turn this “approach bias” into an “avoidance bias.”

Could CBM help serious alcoholics? In this study Wiers and his collaborators – Carolin Eberl and Johannes Lindenmeyer of the Salus Clinic in Lindow, Germany, and Mike Rinck and Eni S. Becker of Radboud University – recruited 214 inpatients at the Salus Clinic. Three weeks after detoxification, the patients were assessed for their craving for alcohol, as well as their attraction to it, indicated by joystick and word-association tasks.

One group of patients then received CBM: they were trained to push away pictures of alcoholic drinks. The control groups either received “sham” training or none at all. Four 15-minute sessions were conducted on four consecutive days.

When retested a week later, the CBM participants’ “approach bias for alcohol had changed to an avoidance bias, on a variety of tests,” said Wiers. The control groups showed no such changes.

Then the patients began abstinence-based cognitive behavior therapy, a structured method that helps people identify and challenge the thinking patterns that perpetuate their self-destructive behaviors. Treatment lasted about three months. A year later, the researchers assessed the patients’ success in staying sober.

As is typical, many patients had relapsed – but only 46 percent of the CBM trained group compared with 59 percent of the others. Although the researchers cannot be absolutely sure that CBM made the difference, joystick and word tests left them “strongly confident,” said Wiers, that “adding this intervention to regular treatment helps people stay abstinent.”

One still-abstinent patient told a story illustrating this point. At a party, looking for a Coke, the man opened the refrigerator, but found it full of beer. “Immediately, he made the push movement” – he closed the door. “In the heat of the moment, when temptations is high, you have to take that immediate first step in the right direction or it becomes very difficult,” commented Wiers. “CBM helps people take this step, before they have time to consciously think, ‘Should I take a drink?’”

Material adapted from Association for Psychological Science.

Lesions of the brain microvessels
Lesions of the brain microvessels, visible on cerebral MRI images, can be of various kinds: white-matter hyperintensities, and, more rarely, silent infarcts leading to loss of white-matter tissue.

They result from a deterioration of the small cerebral arteries that supply blood to the brain’s white matter – the material which ensures, among other things, the passage of information between different parts of the brain.

These lesions are observed in almost all elderly people. However, their severity varies greatly from one individual to the next. Moreover, it has been shown that they are more severe among hypertension sufferers and diabetics.

A large quantity of hyperintensities leads to many cerebral complications: cognitive deterioration, increased risk of Alzheimer’s disease, depression, movement disorders and increased risk of stroke. Moreover, according to several studies, the presence of a large quantity of this type of brain lesion increases the risk of cognitive deterioration (reasoning, memory, etc.) and of Alzheimer’s disease.

These factors expalin why the research team coordinated by Christophe Tzourio, director of the Inserm-Université Pierre et Marie Curie Mixed Research Unit 708 “Neuroepidemiology,” advanced the hypothesis that migraines could “damage” the brain.

To test this hypothesis, researchers evaluated the impact of migraine on cognitive function. The team used the EVA study-group of individuals aged over 65 years who were recruited from the general population in Nantes and monitored over a 10-year period. Cerebral MRI was performed on more than 800 of the participants, and these individuals were also questioned about their headaches by a neurologist.

“The advantage of this cohort is that it involves relatively elderly individuals. However, since migraine often begins before age 30, if it did indeed have a deleterious and cumulative effect on the brain, then we should observe cerebral damage and a higher level of cognitive decline among the migraine sufferers,” explains Christophe Tzourio.

The cognitive tests performed involved an evaluation of the volunteers orientation in time and space, their short-term memory, and their capacity and speed to correctly carry out specific tasks.

The results show that 21% of people suffer or have suffered from severe headaches over the course of their lives. For more than 70% of these, this involves migraines, some of which are with aura (see more on this below). The MRI scans for those participants having severe headaches confirm that they are twice as likely to have a large quantity of microvascular brain lesions as subjects without headaches.

In contrast, the cognitive scores were identical for individuals with or without severe headaches and for those having or not having cerebral microvascular lesions.

Among participants having a migraine with aura (2% of the total sample), a specific increase in silent cerebral infarcts and certain lesions was observed; hence, this confirmed previous studies, but without detectable cognitive harm.

“This is a very reassuring result for the many people who suffer from migraine. In spite of the increased presence of lesions of the brain microvessels, this disorder does not increase the risk of cognitive decline. Therefore, we have not observed negative consequences of migraine on the brain, ” concludes Tobias Kurth, lead author of the study, who designed and carried out these analyses.

Migraine and brain lesions: a suspected link
Headaches (or cephalgias) are very common among the general population. This is particularly the case for migraine, which is a very painful, chronic and debilitating variety of headaches. It is estimated that around 12% of adults and 5 to 10% of children are afflicted. This totals 11 million migraine sufferers in France.

There are two types of migraine: (1) migraine without aura, which is by far the most frequent, and (2) migraine with aura (15% of migraines). Migraine aura involves the appearance of, often visual, phenomena (zigzag lines of light, the impression of viewing the world through frosted glass, etc.) in the minutes preceding the appearance of the headache.

The mechanisms of migraine and migraine aura are still largely unknown. However, it is suspected that a transitory contraction of the blood vessels could be responsible for a reduction of blood flow in the brain promoting the appearance of migraine aura. Much research elsewhere has shown that people suffering from migraine with aura have an increased risk of cerebral infarction (or strokes). Extremely fortunately, this risk remains low among migraine sufferers. However, the research confirms the existence of a link between migraine and blood vessels in the brain.

Material adapted from INSERM (Institut national de la santé et de la recherche médicale).

Download / Reference
Tobias Kurth, Shajahal Mohamed, Pauline Maillard, Yi-Cheng Zhu, Hugues Chabriat, Bernard Mazoyer, Marie-Germaine Bousser, Carole Dufouil, & Christophe Tzourio, “Headache, Migraine, and Structural Brain Lesions and Function: the population-based EVA MRI Study.” BMJ 2011; 342:c7357 doi: 10.1136/bmj.c7357 (Published 18 January 2011).

The researchers found that approximately one third of adolescents with any mental disorder received services for their illness (36.2%). Disorder severity was significantly associated with an increased likelihood of receiving treatment, yet only half of adolescents who were identified as having severely impairing mental disorders had ever received mental health treatment for their symptoms [1].

In the article titled, “Service Utilization for Lifetime Mental Disorders in U.S. Adolescents: Results of the National Comorbidity Survey–Adolescent Supplement (NCS-A),” Dr. Merikangas and colleagues examined the rates of treatment for specific mental disorders in the NCS-A. The NCS-A is a nationally representative, face-to-face survey of 10,123 adolescents aged 13 to 18 years in the continental United States [2]. Diagnostic assessment of DSM-IV mental disorders were measured using a modified version of the World Health Organization (WHO) Composite International Diagnostic Interview. The service questions for adolescents and parents were primarily derived from the Service Assessment for Children and Adolescents (SACA).

The authors examined rates of treatment for DSM-IV disorders from the NCS-A, and correlated the severity, number of disorders, and comorbidity in a nationally representative sample of 6,483 adolescents, ages 13 to 18 years old, for whom information on service use was available from an adolescent and a parent report. Sociodemographic correlates were also evaluated.

Treatment rates were highest in those with attention-deficit/hyperactivity disorder (ADHD) (59.8%) and behavior disorders, such as oppositional defiant disorder (ODD) and conduct disorder (CD) (combined 45.4%). The picture is more discouraging for those adolescents with anxiety, eating, or substance use disorders for whom less than 20% received treatment [1].

Furthermore, the investigators found that Hispanic and non-Hispanic Black adolescents were less likely than their White counterparts to receive services for mood and anxiety disorders, even when such disorders were associated with severe impairment. In the article, Merikangas and colleagues comment, “marked racial disparities in lifetime rates of mental health treatment highlight the urgent need to identify and combat barriers to the recognition and treatment of these conditions” [1].

Reflecting on the lack of treatment for adolescents with severe mental disorders, Merikangas and colleagues state, “National shortages of mental health specialists for children remain widely prevalent. Recruitment, training, and promotion of child and adolescent mental health professionals remain leading priorities. Strains on available treatment resources are likely to grow as coverage is extended to large groups of currently uninsured American young people.”

The National Comorbidity Survey Adolescent Supplement (NCS-A) and the larger program of related NCS surveys are supported by the National Institute of Mental Health (U01-MH60220) and the National Institute of Drug Abuse (R01 DA016558) with supplemental support from Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation (Grant 044708), and the John W. Alden Trust. The NCS-A was carried out in conjunction with the World Health Organization World Mental Health Survey Initiative.

This work was supported by the Intramural Research Program of the National Institute of Mental Health. The views and opinions expressed in this article are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or U.S. Government.

Listen To the Podcast
An interview with Dr. Merikangas is available by podcast here.

Material adapted from Elsevier.

References / Abstract
1. Merikangas KR, He J, Burstein M, Swendsen J, Avenevoli S, Case B, Georgiades K, Heaton L, Swanson S, & Olfson M. Service Utilization for Lifetime Mental Disorders in U.S. Adolescents: Results of the National Comorbidity Survey–Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry. 2011;50(1):32– 45.

2. Merikangas KR, He J, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades, & Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents : Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry. 2010; 49:980-989.

Relaxation Revolution: Enhancing Your Personal Health Through the Science and Genetics of Mind Body Healing

Herbert Benson and his teams at Harvard Medical School and Massachusetts General Hospital have been researching the “relaxation response” for approximately 35 years. Their earlier research was documented in numerous scientific journals and popular books, including The Relaxation Response (1975), Beyond The Relaxation Response (1985), and Timeless Healing (1997).

In these older works, Benson and company enumerated the many mental and physical health benefits of a general protocol that they refer to as the Benson-Henry Protocol that involves a) elicitation of the “relaxation response trigger,” which includes breathing more slowly and deeply, progressive relaxation, and adoption of a passive attitude toward one’s own thoughts, followed by, b) conscious positively oriented visualization/affirmation. The benefits cited include a myriad of health enhancements including reduced anxiety, depression, blood pressure, and pain, enhanced sleep, and numerous others. These changes are both short term and long term in nature, i.e. the Benson-Henry protocol has demonstrated its ability to influence both acute and chronic conditions.

The Process Of Gene Expression

Their major breakthrough in understanding, initially reported in 2008 in the journal PLoS ONE, is that “mind-body practice,” typified by, but not limited to the Benson-Henry Protocol, changes the way that genes “express.” This refers to the way that DNA or “genes” are transcribed into RNA, RNA into proteins, proteins into cell structure and function, and cell structure and function into the human organism at large. In this way, “gene expression” is the most fundamental of biological processes. Listen to the discussion on National Public Radio: Just Breathe – Body Has A Built In Stress Reliever.

The study compared the genetic expression of 19 men and women in good health, all in their mid-30s to early 40s and of varying ethnic and racial backgrounds, with that of 19 “expert” mind body practitioners. Expert participants had practiced yoga, meditation, or prayer for an average of 9.4 years. A blood sample was drawn from each of the 38 participants and spun in a centrifuge separating the red and white blood cells from plasma. Genetic material was then removed from the blood cells and analyzed by a scanner that identified all of the 54,000 genes from each participant and determined differences in activity and expression. Of the 54,000, 2209 or ~4% were found to express differently in the group of experienced mind body practitioners as compared to the control group.

The really exciting part is this: within the 2209 that expressed differently are the genes known to relate to stress and related diseases including those that regulate immune function, govern inflammation, and contribute to premature aging. Furthermore, the genes that expressed differently between groups are those that are already known to be associated with robust health, where their positive expression is the opposite outcome of the same genes and their negative expression. In other words, the same genes that might express in a way that builds health, in the absence of mind body practice, tend to express in a way that detracts from health – making these genes central players in aging and the formation of disease.

Benson and team went on to determine if the gene expression of their control group was modifiable via mind body exercise. Each of the 19 control participants engaged in an 8 week program of mind body exercise involving: a) eliciting the relaxation response trigger which involved repetition of what is in effect a mantra of neutral or positive personal connotation, progressive relaxation, and slow, deep, natural breathing, and b) visualization, such that once deeply relaxed, one visualizes themselves in a peaceful environ in radiant health and free of affliction.

After 8 weeks a blood sample was again drawn from each of the control group participants and gene expression evaluated and compared against their former sample as well as that of the experienced group assessed earlier. Amazingly, 1561 genes had changed their expression. Secondly, 433 genetic “signatures” were already similar to those of the experienced practitioners. Benson and team determined the probability of this occurring by chance to be 1 in 10 billion.

Of particular interest is gene expression and cancer where Benson and team found the gene expression of those who practice mind body methods to be counter to that associated with various cancers. In fact, the gene expression observed in seasoned practitioners was found to be consistent with the gene expression associated with certain cancer therapies.

Stephen Elliott is a frequent contributor to the BMED Report. Stephen is the principle author of The New Science of Breath and Coherent Breathing: The Definitive Method. He’s an avid researcher in the field of cardiopulmonary functioning, and the inventor of  “Valsalva Wave Pro” and “BreatheHeart” – biofeedback instruments that monitor the “Valsalva Wave”  in the circulatory system produced during resonant breathing, and its outcome, breathing induced heart rate variability (HRV).  (See www.coherence.com and www.valsalvawave.com, respectively).

In Part 1 of this 2-part series, I provide an overview of pain tolerance, factors that affect pain tolerance, and assessment of clinical pain. Today’s Part 2 focuses on a detailed discussion of several guided imagery and healing techniques, such as “Mind Controlled Analgesia,” positive and negative imagery, and the importance of relaxation. Readers are encouraged to first review Part 1 to better understand the topics explored in this second and final discussion of pain and guided imagery.

Guided Imagery and Healing
Mental images – formed long before we learn to understand and use words – lie at the core of who we think we are, what we believe the world is like, what we feel we deserve, and how motivated we are to take care of ourselves. They strongly influence our beliefs and attitudes about how we fall ill, what might help us get better, and whether or not any medical and/or psychological interventions will be effective or even helpful. For these reasons, learning how to guide our patients’ imagery can be an enormously powerful tool for modern pain therapists.

A mental image can be defined as a thought with sensory qualities. It is something we mentally see, hear, taste, smell, touch, or feel. The term “guided imagery” refers to a wide variety of mind/body techniques, including simple visualization and direct suggestion using imagery, metaphor and story-telling, fantasy exploration, game playing, dream interpretation, drawing, and “active imagination” where elements of the unconscious are invited to appear as images that can communicate with the conscious mind.

Once considered “mumbo-jumbo,” or at best, an “alternative” or “complementary” approach, guided imagery is finding widespread scientific [9] and public [10] acceptance, and nearly ever bookstore now offers guided imagery self-help CDs or DVDs [11].

Research on the omnipresent placebo effect, the standard to which we compare all other modalities (and find relatively few more powerful), has provided some of the strongest evidence for the power of the imagination and positive expectant faith in healing.

If people can derive not only symptomatic relief, but actual physiologic healing in response to treatments that primarily work through beliefs and attitudes about an imagined reality, then learning how to better mobilize and amplify this phenomenon in a purposeful, conscious way becomes an important, if not critical, area of investigation for modern medicine.

Imagery Has Physiological Consequences
In the absence of competing sensory cues, all the systems in the body respond to imagery as they would to a genuine external experience. For example, take a moment to imagine that you have a big, fresh, juicy yellow lemon in your hand, just plucked this morning. Allow an image of this lemon to form in your mind’s eye so you can fully sense its heaviness and smell its fresh, lemony tartness. Now, imagine taking a knife and carefully cutting out a thick, juicy section from the lemon. In a moment, I’d like you to imagine taking a big bite of the lemon slice, and as you do, feel that sour, tart lemon juice explode in your mouth, saturating every taste bud so fully that your tongue begins to curl as your lips pucker up…

To the extent you were able to imagine this vividly, even as you read it, the image probably produced some salivation, for the autonomic nervous system easily understands and responds to the language of imagery.

Here is the crux of the matter: If imagining a lemon makes you salivate, what happens when you imagine that you are a hopeless, helpless victim of never-ending pain? Doesn’t it tell your body’s intrinsic healing systems to stop and give up?

Imagery, Attention, and Worrying
Some people feel that they have little ability to create images in their minds, but everyone can cultivate this talent to an amazingly high degree. In fact, the most common way that people use imagery is by worrying. What we worry about is never happening in the real world, only in our imagination. We regret the past, which has already happened, or become fearful about the future, which is a total fantasy since it has not happened yet.

People in pain worry all the time. They worry that their pain will never end and that they will remain helplessly immobilized by something they cannot control and cannot endure. As a result, they usually have little difficulty describing an image of their pain at its very worst. I’ve often heard phrases like, “a swarm of fire ants are chewing on the nerve”, or “a gigantic elephant is sitting on my chest.” These are familiar and powerful images that immediately come to mind as soon as the first symptoms of pain emerge.

There is an old saying that “whatever you give your attention to grows,” whether it is your garden, your children, your worries and fears, or your experience of pain. Because patients tend to worry about pain at its worst much of the time, this image gets a lot of attention. As a result, it grows very large and soon becomes a major focus of the patient’s life experience.

These negative images can also become self-fulfilling prophecies, for they have the power to create their own reality in the body, just as thinking of a lemon can make you salivate. If a patient experiences pain as “a sizzling hot poker that is constantly being stabbed into my knee”, or as “a lion gnawing on my back, tearing deeper into my nerves with every bite”, such images can have profound physiological effects that can increase the experience of suffering and interfere with the body’s natural pain relieving abilities [12].

Negative Imagery as a Habit
Over time, thinking about the image of pain at its worst becomes habitual, and despite reassurance from health care providers, family, and friends, patients tend to remain constantly anxious that it will occur again. While it may be counterintentional to focus so much attention on this horrible image, many patients feel that they are unable to stop thinking about it, just as they were unable to quit smoking or lose weight. Painful negative imagery has become a habitual way of thinking.

How do you best break an old habit? By learning a new one that is incompatible with the old one, and then by thoroughly reinforcing the new habit until it replaces the old one. In other words, to stop a patient’s habitual way of thinking that pain will always be unbearable, we need to create a new image of pain that is incompatible with the old one, and then reinforce it by giving it as much attention as possible.

Table 2. An image of pain at its best. (click to enlarge)

Once this image comes to mind, I ask the patient to draw a picture that represents their pain at its best. If a patient has difficulty creating a positive image of pain, it is usually because they are highly anxious and so uncomfortable that they do not want to acknowledge that pain can ever be “at its best.” In such cases, it is very helpful to teach them basic relaxation skills using other guided imagery techniques such as Conditioned Relaxation [13].

The Importance of Relaxation
While anxiety, fear, stress, and emotional upset do not usually cause pain, these emotions can greatly amplify the pain signal and/or significantly reduce tolerance when they continue unabated over time.

When a patient becomes stressed and afraid that their pain is going to get out of control, the pain signal becomes increased which makes pain less tolerable and more difficult to handle. Teaching patients how to relax can help to calm their nervous system and often reduces or eliminates the amplification effects of anxiety and stress.

We usually begin by having patients sit down or lie down, close their eyes, and focus all of their attention on their breathing. Once they do, we ask them to make their breathing a little bit slower, deeper, quieter and more regular. This alone can be highly effective in reducing stress and anxiety. A simple relaxation exercise is included in Table 3.

Table 3. Basic relaxation training (click to enlarge)

Next, we ask them to bring to mind a place that is very beautiful, peaceful, safe and comfortable – a place that they love to think of in their imagination. It might be a real place they’ve actually visited, or a place they’ve totally invented. Once there, we ask them to notice what they see, hear and smell, what the temperature is like, and what time of day it is.

As they pay attention and focus on different sensory cues, their body’s regulatory systems respond as if they are actually in such a place. This shifts the autonomic nervous system into more parasympathetic activation, generating the relaxation response.

Thanks to recent studies with functional MRIs, we now know that when people imagine that they see trees, flowers and a beautiful blue sky, they actually activate the occipital areas of their brains. When they imagine hearing sounds, they activate the temporal lobes of their brains. As they imagine the different senses, they actually activate different parts of the brain that normally process those senses.

In other words, when the brain concludes that “This looks like a beautiful, peaceful place, it feels like it, it sounds like, and it smells like it,” the entire body responds by becoming more relaxed, just as if it were there.

Mind-Controlled Analgesia
This guided imagery technique can be used once patients have drawn their pictures of pain at its worst and best (see Figures 2a and 2b, respectively). Mind Controlled Analgesia (MCA) is designed to elevate pain tolerance by transforming the first image into the second.

Figures 2a & 2b. Pain at its worst and best (click to enlarge)

After inducing relaxation as discussed above, typical suggestions for MCA are shown in Table 4. After learning MCA, patients are reminded that every time that they start to bring the picture of pain at its worst to mind, they need to immediately transform it into the picture of pain at its best, remembering that they have the ability to tolerate their pain, and it is time to put that ability into practice.

Table 4. Mind Controlled Analgesia (click to enlarge)

If your patient reports that their mind wanders or they find it difficult to concentrate, make sure they’ve removed anything distracting from their environment and encourage them to stay with it. Tell them not to be alarmed or frustrated, and to simply imagine that any distracting thoughts are like passing butterflies, flittering off into the distance. Suggest that they let them go and return their attention to remembering that they know how to tolerate pain.

Resources
If your patients are still having difficulty mastering Mind Controlled Analgesia, I recommend that you refer them to a Certified Interactive Imagery Guide (SM). These are licensed clinicians and health educators who have been rigorously trained and then certified by the Academy for Guided Imagery. More information and a free referral directory can be found online at www.AcadGI.com.

Patients can also benefit by listening to pre-recording CDs that contain “over the counter” strength guided imagery exercises. While not as personalized as working with a certified imagery guide, they provide an inexpensive way for patients to learn on their own. When using CDs, its important for the voice of the guide to be pleasing to the listener, and that the pacing (or speed) of the imagery is comfortable and relaxing. If the suggestions are offered too quickly, the experience can become frustrating since the images do not have enough time to fully develop. And if it moves too slowly, the experience becomes very boring and listeners then doze off to sleep. CDs created by the author are available at www.acadgi.com/imagerystore.

The Academy also trains health care providers who are interested in incorporating guided imagery into their practices. The introductory program requires only thirteen hours of home study, after which they are able to begin utilizing the basic techniques that are suitable for many acute and chronic pain problems.

David E. Bresler, PhD, LAc, DiplAc (NCCAOM)

Practical Pain Management is a monthly journal that contains tutorial articles designed to help diagnose and treat various aspects of pain. This publication is sent free of charge to medical practitioners in the United States.

Citation / Material adapted (with permission) from:
Bresler, D. (2010). Raising pain tolerance using guided imagery. Practical Pain Management, July/August, 10(6), 25-31.

References
1. Woodrow KM, Friedman GD, Siegelaub AB, and Collen MF. Pain Tolerance: Differences According to Age, Sex, and Race. Psychosomatic Medicine. 1972. 34(6): 548-556.
2. Lowery D, Fillingim RB, and Wright RA. Sex Differences and Incentive Effects on Perceptual and Cardiovascular Responses to Cold Pressor Pain.” Psychosomatic Medicine. 2003. 65: 284-291.
3. Brown JL, Sheffield D, Leary MR, and Robinson ME. Social Support and Experimental Pain. Psychosomatic Medicine. 2003. 65: 276-283.
4. Kalat JW. Biological Psychology, 9th edition. 2007. p. 212.
5. Ikeda H, Heinke B, Ruscheweyh R, and Sandkùhler J. Synaptic plasticity in spinal lamina 1 projection neurons that mediate hyperalgesia. Science. 2003. 299: 1237-1240.
6. Excerpted from Bresler DE. Mind Controlled Analgesia. LA: Imagery Resources. 2008. Available from www.acadgi.com/imagery store.
7. Bresler DE. Free Yourself From Pain. Simon and Schuster. NY. 1969. Currently available from www.acadgi.com/imagery store.
8. Bresler DE. The Pain Relationship. Pract Pain Manag. Jan/Feb 2001. 1(1): 10-11.
9. Astin JA, Shapiro SI, Eisenberg DM, Forys KL. Mind-body medicine: state of the science, implications for practice. J Am Board Fam Pract. 2004. 165(2): 131-147.
10. Eisenberg DM, Davis RB, Ettner SI, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA. 1998. 280(18): 1569-1575.
11. An excellent selection of pre-recorded guided imagery CDs can be found by visiting the Imagery Store at www.acadgi.com.
12. Bresler DE. Physiological Consequences of Guided Imagery. Pract Pain Manag. Sept/Oct 2005. 5(6): 63-67.
13. Bresler DE. Conditioned Relaxation. LA: Imagery Resources. 2009. Available from www.acadgi.com/imagerystore.

Background

Some parents who take their child to a mental health clinic for assessment report that the child has rapid swings between emotions (usually anger, elation, and sadness) coupled with extremely high energy levels. Some researchers suggest that this is how mania – an important component of bipolar disorder – appears in children. How mania and bipolar disorder are defined in children is important because rapid mood swings and high energy are common among youth.

Furthermore, many experts believe that overdiagnosis and misdiagnosis of bipolar disorder in youth may play a role in the increasing numbers of children being diagnosed with and treated for bipolar disorder. In choosing proper treatment, it is important to know whether children with rapid mood swings and high energy have an early or mild form of bipolar disorder, or instead have a different mental disorder.

In the Longitudinal Assessment of Manic Symptoms (LAMS) study, Robert Findling, M.D., of Case Western Reserve University, and colleagues assessed 707 children, ages 6-12, who were referred for mental health treatment. Of the participants, 621 were rated as having rapid swings between emotions and high energy levels, described as “elevated symptoms of mania” (ESM-positive). Parents of the other 86 children did not report rapid mood swings. These participants were deemed ESM-negative.

Results of the Study

At baseline, all but 14 participants had at least one mental disorder, and many had two or more. Attention deficit hyperactivity disorder(ADHD) was the most frequent diagnosis, affecting roughly 76 percent in both the ESM-positive and ESM-negative groups. However, only 39 percent were receiving treatment with a stimulant, the most common medication treatment for ADHD, at the start of the study.

Only 11 percent of those with rapid mood swings and high energy (69 out of 621) and 6 percent of those without these symptoms (5 out of 86) had bipolar disorder, meaning that only this small percentage had ever experienced a manic episode, as defined by the current diagnostic system. Of the children with rapid mood swings and high energy, another 12 percent (75 children) had a form of bipolar disorder that includes much shorter manic episodes.

Compared to children without rapid mood swings and high energy, those with these symptoms:

• Reported more symptoms of depression, anxiety, manic symptoms, and symptoms of ADHD
• Had lower functioning at home, school, or with peers
• Were more likely to have a disruptive behavior disorder (oppositional defiant disorder and/or conduct disorder).

Significance

Given that 75 percent of ESM-positive youth did not meet the diagnostic criteria for any bipolar disorder, the researchers suggest that bipolar disorder may not be common among children who experience rapid swings between emotions and high energy levels. Nevertheless, children with these symptoms experience significant impairments due to mood and behavior problems.

The researchers also noted that ESM-positive and ESM-negative youth were prescribed psychotropic medications – including antipsychotics – at similar rates. Further study may provide insight into how serious mental illnesses should be treated in children.

What’s Next

The study participants will be re-assessed every 6 months for up to 5 years, allowing the LAMS researchers to determine which children with rapid mood swings and high energy develop bipolar disorder later in life. Such research may inform efforts to identify early markers or predictors of the illness as well as possible protective factors.

Material adapted from NIMH.

Reference

Findling RL, Youngstrom EA, Fristad MA, Birmaher B, Kowatch RA, Arnold E, Frazier TW, Axelson D, Ryan N, Demeter CA, Gill MK, Fields B, Depew J, Kennedy SM, Marsh L, Rowles BM, Horwitz SM. Characteristics of Children With Elevated Symptoms of Mania: The Longitudinal Assessment of Manic Symptoms (LAMS) Study. J Clin Psychiatr. Epub 2010 Oct 5.

Initially, the book provides an introduction to the importance of fat and oils, as the human brain is nearly 60% fat. Although the daily news on your television tells you that all fat is “bad,” it is not true! Actually, it is true that the brain can get into big problems when we put the wrong fats and oils into our mouth.

Dr. Schmidt lists at least 50 disorders that are associated with poor fat and oil nutrition, such as bipolar disorder, age related memory loss, Alzheimer’s disease, attention deficit/hyperactivity disorder (ADHD), autism, and multiple sclerosis.

“Brain fats” are building blocks for the brain. 75% of myelin (i.e., insulates the cellular axons to speed communication) comes from fat, and cell membrane synapses have a very high concentration of long-chain fatty acids. Moreover, receptor cell membranes contain molecules of phospholipids.

The author provides a high level of detail of and focus on important brain fats including:

DHA (Docosahexaenoic Acid)
DHA is a long chain omega-3 fatty acid and your diet can be (or not) an essential source of DHA. A major sources of DHA is cold water fish (e.g. salmon, mackerel, herring, etc.)

ALA (Alpha-Linolenic Acid)
ALA is an omega-3 fatty acid that the body needs to produce DHA (discussed above). Also, ALA is important in the messenger function of nerves. ALA is found in a small number of foods, such as flaxseed oil and hemp seed oil.

GLA (Gamma-Linolenic Acid)
GLA is not truly a brain fat. GLA is converted into PGE1 (Prostaglandin E1) which in turn has a significant effect on brain function, such as reducing inflammatory processes.

Other fatty acids discussed include phosphatidylcholine (PC) and phosphatidylserine (PS).

Signs of fatty acid imbalance include dry skin, frequent urination, excessive thirst, brittle nails, irritability, etc. Blood tests (i.e., red blood cell fatty acid profiles or plasma fatty acid profiles) are useful to determine fatty acid status. However, blood tests do no precisely reflect brain levels. Yet, the good news is that if an individual makes dietary changes in an attempt to improve his or her fatty acids, “blood values will likely show improvement” (pg. 59).

Information on diet and supplements (e.g., fish oil, etc.) are discussed and the appendixes provide specific information on omega-3 food sources, mercury levels in many fish, and more.

The author advocates “The Smart-Fat Diet” whereby the key appears to be learning how to balance total fat with adequate essential fatty acids. The author also includes some important information for vegetarians.

Dr. Schmidt reports that most diets today contain too much omega-6 and too little omega-3. Balance, balance, balance! Even excessive omega-3 has its own problems. (e.g., tinnitus). Additionally, “increasing antioxidant food and nutrients is a must when fatty acid intake is increased” (pg. 195) (e.g., vitamin E is one example).

Discussions of how to obtain high quality oils, phospholipid supplements (i.e., phosphatidylcholine and phosphatidylserine) and problems with low fat diets are also covered in some detail. Helpful appendixes are provided, such as “14 strategies for healing with fats and oils.”

I recommended this book for those of us interested in brain health, and I found the practical information on food sources very helpful. The next step is to talk with my internist to get these blood tests.

Alan T. Fisher, PhD
Psychologist

Reference (with link to Amazon)
Michael A. Schmidt, Ph.D. (2006). Brain-Building Nutrition: How Dietary Fats and Oils Affect Mental, Physical, and Emotional Intelligence (3rd Ed.). Frog Books.

Van den Bergh, a Belgium neuropsychiatrist, provides an expert review of pediatric ADHD and neurofeedback research, and he illuminates the sometimes complex neurophysiological deficits in ADHD. In addition, the author provides a detailed examination of the quantitative electroencephalographic (EEG / QEEG) characteristics of people with ADHD, as well as coverage of a broad range of psychophysiological topics that include LORETA (low resolution electromagnetic tomographic activity) brain imaging and slow cortical potentials (SCP) neurofeedback.

A major contribution of this new work, and possibly a ground-breaking one, is that Dr. Van den Bergh identifies a relationship among sleep-disturbance EEG research and ADHD pathology. This lead to the discovery that children with ADHD have brainwaves that are similar to healthy people who are sleep deprived. Think about that for a second, and the behaviors that typify ADHD become less mysterious. The author explains why SMR- (sensorimotor rhythm) neurofeedback is an effective and long-lasting non-medication treatment for ADHD given that SMR brain waves are the daytime equivalent of nighttime sleep spindles, which are disturbed in ADHD. In short, Dr. Van den Bergh argues that SMR-neurofeedback targets and corrects the core neurophysiologic problems in ADHD.

Throughout the book, Dr. Van den Bergh further argues that ADHD is not a disorder of “will-power,” or the desire to misbehave, as it is so often perceived by others, but instead represents a distinct neurological condition that should receive compassion instead of scorn from parents and teachers. The author also outlines steps that clinicians, parents, and teachers can take to improve the lives of those with ADHD, particularly children.

Discount Code: BMEDREPORT (use all caps and one word; 20% off plus free shipping; Offer Extended until 08/28/11). The discount code is valid only for direct purchases from the publisher, BMED Press.

Neurofeedback And State Regulation In ADHD: A Therapy Without Medication is also available worldwide from major online book retailers, including Amazon and Barnes and Noble.

Link / Reference
Van den Bergh, W. (2010). Neurofeedback and State Regulation in ADHD: A Therapy Without Medication. Texas: BMED Press.

Full Disclosure: Christopher Fisher, PhD, the Managing Editor of BMED Report, is also CEO of BMED Press.

Kristen Lester, the lead author of the study published in the Journal of Consulting and Clinical Psychology and a researcher at the National Center for PTSD, used two randomized, controlled studies of cognitive-behavioral therapy for the treatment of women with sexual assault and sexual abuse histories. These two studies were collapsed in order to gain a sufficient sample size to compare women of differing ethnic backgrounds. Ultimately, there were only enough Caucasians and African-American women in the sample to compare (rather than also examining people from other ethnic backgrounds).

Lester and her colleagues were not unsurprised to see that the dropout rate was higher for African-Americans as this is a finding of other studies. However, they were surprised to find that African-American women, even when taking into account those who had dropped out of treatment, were able, as a group, to reduce their PTSD to levels similar to the Caucasian women, who were more likely to stay in the protocol. A closer examination of the data showed that the differences between the two groups was primarily due to the greater improvement in symptoms of African-American who dropped out compared to Caucasian women who failed to complete treatment.

A tentative explanation for what seems like contradictory findings is that African-American women may have been more motivated to seek treatment, given the stigma associated with seeking help for psychological symptoms among the African-American community. Therefore, they may have been able to benefit more quickly given their high motivation level. A related but alternative explanation is that African-American women had a high expectancy for treatment being beneficial if they were to get to the point of actually seeking services. This is in line with the premise of solution-focused therapy, a strengths-based counseling model, in which “pretreatment change” is considered a factor to exploit. The idea is that the very act of committing to an appointment to seek help often makes people feel better. Asking about “what has already changed between the time you made the appointment and now” builds momentum on the change that has already occurred.

The researchers of the study were unable to test if “therapist matching,” seeing if therapists and clients being matched on ethnicity contributed to African-American retention, because there were so few African-American therapists.

Reference
Lester, K., Artz, C., Resick, P., & Young-Xu, Y. (2010). Impact of race on early treatment termination and outcomes in posttraumatic stress disorder treatment. Journal of Consulting and Clinical Psychology, 78, 480-489.

Now Koch and Fried, along with former Caltech graduate student and current postdoctoral fellow Moran Cerf, have found that individuals can exert conscious control over the firing of these single neurons – despite the neurons’ location in an area of the brain previously thought inaccessible to conscious control – and, in doing so, manipulate the behavior of an image on a computer screen.

The work, which appears in a paper in the October 28 issue of the journal Nature, shows that “individuals can rapidly, consciously, and voluntarily control neurons deep inside their head,” says Koch, the Lois and Victor Troendle Professor of Cognitive and Behavioral Biology and professor of computation and neural systems at Caltech.

The study was conducted on 12 epilepsy patients at the David Geffen School of Medicine at UCLA, where Fried directs the Epilepsy Surgery Program. All of the patients suffered from seizures that could not be controlled by medication. To help localize where their seizures were originating in preparation for possible later surgery, the patients were surgically implanted with electrodes deep within the centers of their brains. Cerf used these electrodes to record the activity, as indicated by spikes on a computer screen, of individual neurons in parts of the medial temporal lobe – a brain region that plays a major role in human memory and emotion.

Prior to recording the activity of the neurons, Cerf interviewed each of the patients to learn about their interests. “I wanted to see what they like – say, the band Guns N’ Roses, the TV show House, and the Red Sox,” he says. Using that information, he created for each patient a data set of around 100 images reflecting the things he or she cares about. The patients then viewed those images, one after another, as Cerf monitored their brain activity to look for the targeted firing of single neurons. “Of 100 pictures, maybe 10 will have a strong correlation to a neuron,” he says. “Those images might represent cached memories – things the patient has recently seen.”

This is an illustration of the 'closed-loop' from the patient viewing the image on the screen, to the acquisition system recording the activity of single neurons in his/her brain, to the system which perform the detection and filtering of spikes from the selected brain regions and the decoder which identifies the thought in the patient's brain and sends the data to the computer for visualization of the patient's thoughts. (Credit: Created by Moran Cerf and Maria Moon/Caltech)

The four most strongly responding neurons, representing four different images, were selected for further investigation. “The goal was to get patients to control things with their minds,” Cerf says. By thinking about the individual images – a picture of Marilyn Monroe, for example – the patients triggered the activity of their corresponding neurons, which was translated first into the movement of a cursor on a computer screen. In this way, patients trained themselves to move that cursor up and down, or even play a computer game.

But, says Cerf, “we wanted to take it one step further than just brain–machine interfaces and tap into the competition for attention between thoughts that race through our mind.”

To do that, the team arranged for a situation in which two concepts competed for dominance in the mind of the patient. “We had patients sit in front of a blank screen and asked them to think of one of the target images,” Cerf explains. As they thought of the image, and the related neuron fired, “we made the image appear on the screen,” he says. That image is the “target.” Then one of the other three images is introduced, to serve as the “distractor.”

Two neurons - one corresponding to the concept of Marilyn Monroe, and another corresponding to Michael Jackson - are pitted against each other. The subject is asked to fade in one image on the expense of another. (Credit: Created by Moran Cerf and Maria Moon/Caltech)

“The patient starts with a 50/50 image, a hybrid, representing the ‘marriage’ of the two images,” Cerf says, and then has to make the target image fade in – just using his or her mind – and the distractor fade out. During the tests, the patients came up with their own personal strategies for making the right images appear; some simply thought of the picture, while others repeated the name of the image out loud or focused their gaze on a particular aspect of the image. Regardless of their tactics, the subjects quickly got the hang of the task, and they were successful in around 70 percent of trials.

“The patients clearly found this task to be incredibly fun as they started to feel that they control things in the environment purely with their thought,” says Cerf. “They were highly enthusiastic to try new things and see the boundaries of ‘thoughts’ that still allow them to activate things in the environment.”

Notably, even in cases where the patients were on the verge of failure – with, say, the distractor image representing 90 percent of the composite picture, so that it was essentially all the patients saw – “they were able to pull it back,” Cerf says. Imagine, for example, that the target image is Bill Clinton and the distractor George Bush. When the patient is “failing” the task, the George Bush image will dominate. “The patient will see George Bush, but they’re supposed to be thinking about Bill Clinton. So they shut off Bush – somehow figuring out how to control the flow of that information in their brain – and make other information appear. The imagery in their brain,” he says, “is stronger than the hybrid image on the screen.”

According to Koch, what is most exciting “is the discovery that the part of the brain that stores the instruction ‘think of Clinton’ reaches into the medial temporal lobe and excites the set of neurons responding to Clinton, simultaneously suppressing the population of neurons representing Bush, while leaving the vast majority of cells representing other concepts or familiar person untouched.”

Material adapted from California Institute of Technology.

Reference
Cerf M, Thiruvengadam N, Mormann F, Kraskov A, Quiroga RQ, Koch C, & Fried I. (October 28, 2010). On-line, voluntary control of human temporal lobe neurons. Nature, 467(7319): 1104-8.

The work in the paper, “On-line voluntary control of human temporal lobe neurons,” is part of a decade-long collaboration between the Fried and Koch groups, funded by the National Institute of Neurological Disorders and Stroke, the National Institute of Mental Health, the G. Harold & Leila Y. Mathers Charitable Foundation, and Korea’s World Class University program.

During the many years that I directed the UCLA Pain Control Unit, one of the most valuable things I learned was that it is possible for someone to have pain and yet not suffer. When two patients were admitted with similar diagnoses, histories, demographics, and objective findings, we would often find tremendous variability in how well they were coping with pain and its consequences.

The poorly coping patients were anxious, depressed, unable to sleep, work, or engage in personal relationships, and they grieved their inability to function as well as they did previously. Many were stuck in anger about their pain or denial about its impact on their work and family relationships. Most regretted various choices they made that led to the pain experience, and many tearfully mourned their loss of health, function, purpose, meaning, income and relationships. Clearly, they were suffering and had little, if any, tolerance to their pain.

The highly coping patients reported much greater tolerance to pain in general, as well as a consistently positive attitude and focus on the future. “You don’t go forward looking backward,” one said. Although they had to make major lifestyle adjustments to cope with pain, most continued working as best they could. Many benefited from strong family or church relationships and support. All were eager to learn about any treatment alternative that might be of help, and most remained hopeful and optimistic about the future.

Pain Tolerance
Pain tolerance can have a huge impact on how patients respond to any type of medical treatment. With this understanding, we established five primary goals for the UCLA Pain Control Unit:

1. To correct the underlying condition causing pain, if possible.
2. To reduce or block the pain signal from reaching consciousness.
3. To increase tolerance to pain so that it interferes less with work, sleep, relationships, and lifestyle activities.
4. To increase the ability to self-manage pain, and decrease dependence upon medications and medical care.
5. To treat people in pain, rather than pain in people.

In the clinical situation, there are limitations in our ability to reverse severe physical pathology such as in treating degenerative neurological diseases, so our first goal often remained unmet. The Unit was based in the UCLA Department of Anesthesiology and despite our use of many interventional pain management techniques, we were also not always successful in blocking pain.

However, we found that guided imagery could be used to raise pain tolerance, facilitate restful sleep, elevate mood, increase motivation, reduce dependence, and promote self-management. Guided imagery techniques enabled us to best meet our remaining three goals, and they became one of the most effective ways to help our patients reduce suffering even when “nothing more (medically) can be done.”

Increasing pain tolerance is the basis of effectiveness of some of our most potent analgesics. I’ve long believed that opiates have little to do with pain, and everything to do with suffering and the inability to tolerate pain. When people in pain are given an injection of morphine, they often state that “it still hurts, but it doesn’t bother me.” This represents enhanced central tolerance to pain rather than decreased pain intensity, yet it enables patients to become significantly more comfortable and functional in their lives. Other techniques that mimic or stimulate endorphin release, such as acupuncture, may also be effective because of their ability to raise pain tolerance.

Factors Affecting Pain Tolerance
Pain tolerance is defined as the amount of pain that a person can withstand before breaking down emotionally and/or physically. Pain tolerance is distinct from pain threshold or sensitivity, which is the minimum stimulus necessary to produce the experience of pain.

The ability to tolerate pain has been studied by numerous researchers in their laboratories, and many interesting findings have been published. For example, experimental studies have demonstrated that pain tolerance decreases with age, that men have higher pain thresholds and tolerances and lower pain ratings than women, and that whites tolerate more pain than Asians [1, 2].

Other studies have shown that the presence of an individual who provides passive or active support reduces experimental pain. Whether the person who is with them during the painful event is a friend or a stranger, just the presence of another human helps subjects to tolerate a much higher level of pain than when alone [3].

How relevant the results of such experimental pain studies are for clinical practice remains a controversial issue. Subjects in experimental studies know how and why the pain is being caused and that it will not continue for long or permanently harm them. This is not the case for people in chronic pain who often feel that their suffering will never end.

Some believe that regular exposure to painful stimuli will increase pain tolerance by helping the body to build “immunity” to the pain. However, the opposite appears to be true, for repeated painful experiences can teach a person how severe pain can become and how difficult it can be to get relief. In addition, greater exposure to pain results in more painful future exposures due to synaptic sensitization [4, 5].

Assessing Clinical Pain Tolerance

Table 1. An image of pain at its worst. (click to enlarge)

Once a clear image of their pain has formed, a variety of helpful Interactive Guided Imagery^sm techniques can be employed, which I have described in detail elsewhere [7]. For example, an experienced imagery guide can invite the patient to enter a dialogue with their pain, to ask why it’s there, what it wants, what it needs, what it has to offer, and under what circumstances it would be willing to leave. This can reveal important information about the source of the pain experience and how well patients relate to their pain [8].

A Picture of Pain At Its Worst
I strongly encourage all clinicians to provide colored marking pens and paper so their patients can draw the image that represents their pain at its worst. Let your patients know that they do not have to be an artist and that their drawing can be as simple, abstract, or comprehensive as they want.

As they say, “A picture is worth 1000 words” and a close examination of such patient drawings can reveal critical information about their pain experience that you will not find revealed in any medical history or standardized psychometric tests.

For example, Figure 1 (the featured image of this article at the very most top position) shows a drawing by a patient with post-laminectomy pain who has been totally victimized by chronic pain. He ultimately revealed that the pressure on the clamp that was making his pain unbearable was being applied by a close family member who he could not control. By resolving this family conflict and learning to use imagery techniques for pain control, this patient was able to raise his pain tolerance sufficiently to permit his return to gainful employment. While this patient obviously has artistic talent, such pictures can be as simple as stick figures while still providing clues to the patient’s pain.

Another picture drawn by a patient with migraines – depicting hands clamping the legs, tearing out guts, punching the jaw, choking the neck, pulling out an eyeball still attached to its optic nerve, pulling hair, and stabbing and shooting pointblank into the head – clearly is not tolerating the pain well.

The SUTS Scale
The second assessment technique is equally simple. Many clinicians use a SUDS (Subjective Units of Discomfort) scale to measure pain intensity by asking, “On a scale of 0 to 10, where 0 represents no discomfort, and 10 represents the greatest discomfort you can imagine, how uncomfortable is your pain right now?”

We can also utilize a SUTS scale (Subjective Units of Tolerance Scale) by asking, “On a scale of 0 to 10, where 0 represents no ability whatsoever to deal with or tolerate pain, and 10 represents the greatest tolerance, endurance, and strength you can imagine yourself achieving, how well are you tolerating your pain right now?” As I record their tolerance ratings, I respond by saying, “How would you like to learn a way to make it 20, 30, maybe even 100?” and rarely get turned down.

In Part 2 of this series, I explore guided imagery and healing, positive and negative imagery, and the importance of relaxation, as well as discuss guided imagery techniques, such as “Mind Controlled Analgesia.”

David E. Bresler, PhD, LAc, DiplAc (NCCAOM)

Practical Pain Management is a monthly journal that contains tutorial articles designed to help diagnose and treat various aspects of pain. This publication is sent free of charge to medical practitioners in the United States.

Citation / Material adapted (with permission) from:
Bresler, D. (2010). Raising pain tolerance using guided imagery. Practical Pain Management, July/August, 10(6), 25-31.

References
1. Woodrow KM, Friedman GD, Siegelaub AB, and Collen MF. Pain Tolerance: Differences According to Age, Sex, and Race. Psychosomatic Medicine. 1972. 34(6): 548-556.
2. Lowery D, Fillingim RB, and Wright RA. Sex Differences and Incentive Effects on Perceptual and Cardiovascular Responses to Cold Pressor Pain.” Psychosomatic Medicine. 2003. 65: 284-291.
3. Brown JL, Sheffield D, Leary MR, and Robinson ME. Social Support and Experimental Pain. Psychosomatic Medicine. 2003. 65: 276-283.
4. Kalat JW. Biological Psychology, 9th edition. 2007. p. 212.
5. Ikeda H, Heinke B, Ruscheweyh R, and Sandkùhler J. Synaptic plasticity in spinal lamina 1 projection neurons that mediate hyperalgesia. Science. 2003. 299: 1237-1240.
6. Excerpted from Bresler DE. Mind Controlled Analgesia. LA: Imagery Resources. 2008. Available from www.acadgi.com/imagery store.
7. Bresler DE. Free Yourself From Pain. Simon and Schuster. NY. 1969. Currently available from www.acadgi.com/imagery store.
8. Bresler DE. The Pain Relationship. Pract Pain Manag. Jan/Feb 2001. 1(1): 10-11.

Hypertension falls into two broad categories, “primary” or “essential” hypertension, and “secondary” hypertension. Primary hypertension, which accounts for 95% of all cases, is “hypertension with no identifiable cause”. Secondary hypertension is that for which there is an identifiable cause, for example loss of circulatory, pulmonary, kidney function, etc. There’s an elephant in the room and its called “essential hypertension” – how can 95% of instances accounting for 100s of millions of cases in the US alone be without known etiology?

This article suggests that a large percentage of cases of essential hypertension are in fact attributable to suboptimal respiration and proposes that the broad category of “essential” hypertension be reconsidered as, a) those cases that respond promptly and favorably to respiration intervention, and b) those that do not. Those cases that do can be reclassified as “respiration responsive.” Where hypertensive symptoms are not responsive to respiration intervention, other pathologies might be considered as the root cause, for example, dysautonomia, or even early stage “secondary hypertension”.

Breathing is thought to affect blood pressure via the motive force that it applies to the movement of blood, in effect aiding the heart and vascular system in circulating blood throughout the body. This force is effected via the “thoracic pump” (see Figure 1) which generates negative pressure in the lungs during inhalation causing blood to rush through the vena cava and right heart filling the dense pulmonary capillary bed. The right heart facilitates this process via increasing heart rate yet with relatively low stoke volume and pressure (hence the need for increased rate). During the period of inhalation, blood flow out of the lungs into the left heart and arterial tree is slowed, reduced volume resulting in reduced arterial pressure. To limit this fall in volume and pressure, the arterial tree constricts to maintain pressure within viable range, however, blood volume and pressure in the arterial tree still fall.

Figure 1 - The thoracic pump alternating between venous/right heart and arterial/left heart.

During exhalation, the large volume of blood that was stored in the lungs during inhalation is ejected into the pulmonary veins and the left heart under positive pressure, making its way into the arterial tree as a wave. This wave, referred to in medical texts as “the respiratory arterial pressure wave,” can be on the order of hundreds of milliliters of blood. As this occurs, the heart slows down and stroke volume increases in order to move this large quantity of blood through the left heart into the aorta. During the period of exhalation, blood pressure in the arterial tree rises, however, the arterial tree relaxes, increasing its volume in order to accommodate the wave of blood and to prevent arterial pressure from rising too much. However, blood volume and pressure in the arterial tree still rise.

The net effect is that when one breathes slowly, deeply, and rhythmically, the diaphragm does much of the “work” of drawing blood through the venous circulation to the lungs, a job that otherwise falls to the right heart. During exhalation, because of the large volume of blood being ejected by the lungs, the heart slows down. In other words, the heart gets to rest during inhalation because the diaphragm is facilitating venous flow and the heart gets to rest during exhalation because the diaphragm is facilitating arterial flow. When the diaphragm is not “contributing,” the job of maintaining blood flow and pressure falls to the heart and vascular system. Then the result of slow deep rhythmic respiration is an overall decrease in work performed by the heart and vascular system and with this decrease a reduction in systemic pressure. It is believed that while the heart gets more rest, the overall rate of blood flow actually increases, i.e. circulatory efficiency is maximal when we breathe slowly, deeply, and rhythmically.

When one is not breathing “adequately” the process described above makes little contribution to circulatory efficacy. To put it in perspective, the adult diaphragm has a maximum range of 10 centimeters of movement. Most adults breathing normally employ only 1 centimeter of this range. To effect desired changes in blood pressure, the range of diaphragm movement must be increased, ideally in to the 4-6 centimeter range, i.e. where 50% (vs.10%) of diaphragm range is normally employed. If one is to undertake to modify their breathing pattern in order to maintain healthy blood pressure, this re-training of diaphragm range may occur gradually.

Figures 2 and 3 demonstrate the blood volume in the capillary circulation as measured at the earlobe. Figure 2 is the respiratory arterial pressure wave of “non-breathing” and Figure 3 is that of resonant breathing. Figure 2 demonstrates little change in either volume, pulse amplitude, or heart rate. Figure 3 demonstrates dramatic variation in all three, this outcome being a function of slow, deep, rhythmic operation of the diaphragm and thoracic pump.

Figure 2 - Respiratory arterial pressure wave of typical shallow breathing (Instrument: Valsalva Wave Pro)

Figure 3 - Respiratory arterial pressure wave of resonant breathing (Instrument: Valsalva Wave Pro)

The association between respiration and hypertension can demonstrated in the moment with many primary hypertensives by assessing their blood pressure before and after a period of deep rhythmic respiration where it is typical that average blood pressure [(systolic + diastolic)/2]drops substantially, for example 10 -20 mmHg even within a 10 minute period. Where it may be 130/80 before breathing intervention, it may be 110/70 after, a delta in average blood pressure of 15mmHg.

Figure 4 - Blood volume variability increasing during resonant breathing (Instrument: Valsalva Wave Pro)

There are additional quantitative diagnostic indicators that can also be employed easily to determine if respiration is facilitating increased circulatory effectiveness and the internal changes that result in reduced systemic pressure. These include variation in blood volume during respiration as measured in the capillary circulation, and variation in the heart rate, which is thought to be an outcome of autonomic regulation due to variation in blood volume and pressure.

Figures 4 and 5 demonstrate blood volume variability and heart rate variability increasing over the course of 10′s of seconds while employing resonant breathing.

Figure 5 - Heart rate variability increasing during resonant respiration (Instrument: Valsalva Wave Pro)

If breathing relatively slowly, deeply, and rhythmically does not facilitate variation in either blood volume or heart rate, the data seems to indicate that there will be little change in blood pressure after vs. before the initial “diagnostic” breathing intervention. This being said, if blood pressure is relatively high, and if significant positive changes in blood volume variability, and its correlate heart rate variability can be facilitated, blood pressure will almost certainly be reduced over the course of 8-12 minutes of resonant “coherent” breathing.

Stephen Elliott is President and life scientist for COHERENCE – The New Science Of Breath. He is the principal author of The New Science Of Breath (2004) and Coherent Breathing – The Definitive Method (2007). Stephen is the creator of the instrument Valsalva Wave Pro which allows monitoring and training of the “Valsalva Wave”, the heart rate, and the pulse wave.

Stephen’s research colleague is Dee Edmonson, R.N., BCIAC-EEG (www.neurologics.us).

A new study, led by researchers at Washington University School of Medicine in St. Louis, found mild traits, not strong enough to provoke a diagnosis of autism, seem to be present in the siblings of affected children at significantly higher rates than seen in the general population.

“Mild symptoms, called quantitative traits, may be confounding studies that compare children with autism to their siblings,” says first author John N. Constantino, MD. “Researchers presume one child is affected, and the other is not, but our findings suggest that although one child may have autism while the other does not, it’s very possible both children are affected to some degree by genes that contribute to autism.”

Genetic factors exert their influence in different ways. Some families have only a single child with autism and no other affected children. But in other families, more than one child may be affected, or other siblings may have a number of autism characteristics.

The study found that approximately one in five siblings thought to be unaffected experienced language delays or speech problems early in life. The researchers also noticed many female siblings had subtle traits, but few had full-blown autism spectrum disorders. Boys are thought to be affected four times more often than girls. But when the researchers used standardized methods to account for the presence of quantitative traits, the rate looked more like three affected boys for every two affected girls.

This graph tracks the symptoms of girls in one category of families affected by autism. Yellow denotes girls with histories of language delay and autistic traits who were never formally diagnosed as having an autism spectrum disorder (ASD). Blue represents unaffected girls, red represents those diagnosed with ASD. Credit: Image courtesy of The American Journal of Psychiatry. Copyright © 2010 American Psychiatric Association. Used with permission.

“The gender difference may not be as pronounced as we once thought it was,” Constantino says. “If we rely only on a professional diagnosis of autism to determine who is affected, then boys vastly outnumber girls. But it may be that many girls are being missed.”

The data comes from almost 3,000 U.S. children in 1,235 families who are part of the Interactive Autism Network, a national online research registry at www.IANproject.org. Developed by study co-author Paul Law, MD, director of medical informatics at Kennedy Krieger Institute in Baltimore, the network has more than 35,000 participants who share information to help advance autism research.

For this study, parents provided information about their children using the Social Responsiveness Scale, a survey developed at Washington University that identifies traits associated with autism and autism spectrum disorders such as Asperger Syndrome and Pervasive Developmental Disorder.

About 10 percent of children with autism have genetic mutations believed to directly lead to the disorder. In others, common gene variations create small increases in susceptibility. When a child has an accumulation of quantitative traits, that child will be diagnosed with autism or a related disorder, but siblings can have subtle quantitative traits without reaching the threshold for a diagnosis.

“It’s not an all-or-nothing condition,” Constantino says. “When we look only at the full syndrome for inherited traits, we miss a lot of individuals who may have genetic susceptibility and subtle aspects of autism. In other words, many siblings of children on the spectrum have significant, subclinical traits of autism, but, for whatever reason, they never actually develop the disorder.”

Constantino, the Blanche F. Ittleson Professor of Psychiatry and Pediatrics and director of the William Greenleaf Eliot Division of Child and Adolescent Psychiatry at Washington University, compares it to the difference between insulin resistance and diabetes. Not all people with insulin resistance are diabetic, and some never develop diabetes, but they are at a much higher risk for the disease. The same thing is true for autism, he says.

One striking finding was that among siblings, 20 percent had received a diagnosis of language delay or speech problems early in life. And half of them had particular qualities of speech that are autistic in nature. So the investigators believe that what is aggregating in these families is more than just the full syndrome of autism. In about 11 percent of families, more than one sibling has autism, and in many others, these subtle, quantitative signs and symptoms indicate many undiagnosed children are affected as well.

That is important, Constantino says, because in studies involving DNA tests, brain imaging or biological comparisons between affected children and their unaffected siblings, researchers traditionally assume undiagnosed children are unaffected. But this study would suggest that’s not necessarily the case.

The study also found quantitative traits of autism tended to occur more frequently in children from families with more than one fully affected child. In families with only one child with autism, it was much more common for that child’s siblings not to have any evidence of quantitative traits. And the study also found that it was less common for siblings to be affected with those traits than for non-identical twins — a finding suggested by pooling the results of this study with a recent twin study from Law and his colleagues at Kennedy Krieger Institute that used exactly the same methods and the same family registry.

Law and Constantino say their findings provide insight into the inheritance patterns of autism and its associated traits. Although those severely affected with autism spectrum disorders seldom have their own children, those who are affected with quantitative traits of autism usually grow up to be parents themselves, and understanding how best to predict patterns of transmission in families and identifying the specific genetic and environmental factors underlying those patterns could offer hope for new, more effective interventions that could be used early in the lives of affected children, Constantino says.

Audio Interview
Audio Interview With Lead Researcher, John N. Constantino, MD (click to listen)

Material adapted from Washington University School of Medicine.

Reference
Constantino JN, Zhang Y, Frazier T, Abbacchi AM, Law P. Sibling recurrence and the genetic epidemiology of autism. The American Journal of Psychiatry, vol. 167 (11), published online Oct. 1, 2010. http://ajp.psychiatryonline.org.

The study also found significant overlap between these segments, known as copy number variants (CNVs), and genetic variants implicated in autism and schizophrenia, proving strong evidence that ADHD is a neurodevelopmental disorder – in other words, that the brains of children with the disorder differ from those of other children.

The research, published today in the journal The Lancet, was largely funded by the Wellcome Trust, with additional support from Action Medical Research, the Medical Research Council and the European Union.

“We hope that these findings will help overcome the stigma associated with ADHD,” says Professor Anita Thapar. “Too often, people dismiss ADHD as being down to bad parenting or poor diet. As a clinician, it was clear to me that this was unlikely to be the case. Now we can say with confidence that ADHD is a genetic disease and that the brains of children with this condition develop differently to those of other children.”

ADHD is one of the most common mental health disorders in childhood, affecting around one in 50 children in the UK. Children with ADHD are excessively restless, impulsive and distractible, and experience difficulties at home and in school. Although no cure exists for the condition, symptoms can be reduced by a combination of medication and behavioural therapy.

The condition is highly heritable – children with ADHD are statistically more likely to also have a parent with the condition and a child with an identical twin with ADHD has a three in four chance of also having the condition. Even so, until now there has been no direct evidence that the condition is genetic and there has been much controversy surrounding its causes, which some people have put down to poor parenting skills or a sugar-rich diet.

The team at Cardiff University analysed the genomes of 366 children, all of whom had been given a clinical diagnosis of ADHD, against over 1,000 control samples in search of variations in their genetic make-up that were more common in children with the condition.

“Children with ADHD have a significantly higher rate of missing or duplicated DNA segments compared to other children and we have seen a clear genetic link between these segments and other brain disorders,” explains Dr Nigel Williams. “These findings give us tantalising clues to the changes that can lead to ADHD.”

The researchers found that rare CNVs were almost twice as common in children with ADHD compared to the control sample – and even higher for children with learning difficulties. CNVs are particularly common in disorders of the brain.

There was also significant overlap between CNVs identified in children with ADHD and regions of the genome which are known to influence susceptibility to autism and schizophrenia. Whilst these disorders are currently thought to be entirely separate, there is some overlap between ADHD and autism in terms of symptoms and learning difficulties. This new research suggests there may be a shared biological basis to the two conditions.

The most significant overlap was found at a particular region on chromosome 16 which has been previously implicated in schizophrenia and other major psychiatric disorders and spans a number of genes including one known to play a role in the development of the brain .

“ADHD is not caused by a single genetic change, but is likely caused by a number of genetic changes, including CNVs, interacting with a child’s environment,” explains Dr Kate Langley. “Screening children for the CNVs that we have identified will not help diagnose their condition. We already have very rigorous clinical assessments to do just that.”

Dr John Williams, Head of Neuroscience and Mental Health at the Wellcome Trust, which has supported Professor Thapar’s work for ten years, says: “These findings are testament to the perseverance of Professor Thapar and colleagues to prove the often unfashionable theory that ADHD is a brain disorder with genetic links. Using leading-edge technology, they have begun to shed light on the causes of what is a complex and often distressing disorder for both the children and their families.”

Material adapted from Wellcome Trust.

The research could lead to advances in the use of music to help regulate a person’s mood, and promote the development of music-based therapies to tackle conditions like depressive illnesses. It could help alleviate symptoms for people who are dealing with physical pain and even lead to doctors putting music on a prescription that is tailored to suit the needs of an individual.

“The impact of a piece of music on a person goes so much further than thinking that a fast tempo can lift a mood and a slow one can bring it down. Music expresses emotion as a result of many factors,” says audio engineering specialist Dr Don Knox, project leader. “These include the tone, structure and other technical characteristics of a piece. Lyrics can have a big impact too. But so can purely subjective factors: where or when you first heard it, whether you associate it with happy or sad events and so on. Our project is the first step towards taking all of these considerations – and the way they interact with each other – on board.”

Raymond MacDonald, Professor of Music Psychology at Glasgow Caledonian University, is also playing a central role in the initiative.

The team has already carried out an unprecedentedly detailed audio analysis of pieces of music, identified as expressing a range of emotions by a panel of volunteers.

A studio mixing desk used in the research

“We look at parameters such as rhythm patterns, melodic range, musical intervals, length of phrases, musical pitch and so on,” says Dr Knox. “For example, music falling into a positive category might have a regular rhythm, bright timbre and a fairly steady pitch contour over time. If tempo and loudness increase, for instance, this would place the piece in a more ‘exuberant’ or ‘excited’ region of the graph.”

The team are now about to start their assessment of the impact of lyrics, and then hope to focus on how individuals use and experience music at a subjective level.

The computer software in action

“By making it possible to search for music and organise collections according to emotional content, such programs could fundamentally change the way we interact with music,” says Dr Knox. “Some online music stores already tag music according to whether a piece is ‘happy’ or ‘sad’. Our project is refining this approach and giving it a firm scientific foundation, unlocking all kinds of possibilities and opportunities as a result.”

Material adapted from Engineering and Physical Sciences Research Council.

“We have been able to decode spoken words using only signals from the brain with a device that has promise for long-term use in paralyzed patients who cannot now speak,” says Bradley Greger, an assistant professor of bioengineering.

Because the method needs much more improvement and involves placing electrodes on the brain, he expects it will be a few years before clinical trials on paralyzed people who cannot speak due to so-called “locked-in syndrome.”

The University of Utah research team placed grids of tiny microelectrodes over speech centers in the brain of a volunteer with severe epileptic seizures. The man already had a craniotomy – temporary partial skull removal – so doctors could place larger, conventional electrodes to locate the source of his seizures and surgically stop them.

An array of 16 microelectrodes - known as a microECoG grid - is arranged in a four-by-four array and shown next to a US quarter-dollar coin with a Utah state design on its 'tail' side. University of Utah researchers placed two such microelectrode grids over speech areas of a patient's brain and used them to decode brain signals into words. The technology someday might help severely paralyzed patients 'speak' with their thoughts, which would be converted into a computerized voice. Credit: Spencer Kellis, University of Utah (click to enlarge)

Using the experimental microelectrodes, the scientists recorded brain signals as the patient repeatedly read each of 10 words that might be useful to a paralyzed person: yes, no, hot, cold, hungry, thirsty, hello, goodbye, more and less.

Later, they tried figuring out which brain signals represented each of the 10 words. When they compared any two brain signals – such as those generated when the man said the words “yes” and “no” – they were able to distinguish brain signals for each word 76 percent to 90 percent of the time.

When they examined all 10 brain signal patterns at once, they were able to pick out the correct word any one signal represented only 28 percent to 48 percent of the time – better than chance (which would have been 10 percent) but not good enough for a device to translate a paralyzed person’s thoughts into words spoken by a computer.

“This is proof of concept,” Greger says, “We’ve proven these signals can tell you what the person is saying well above chance. But we need to be able to do more words with more accuracy before it is something a patient really might find useful.”

People who eventually could benefit from a wireless device that converts thoughts into computer-spoken spoken words include those paralyzed by stroke, Lou Gehrig’s disease and trauma, Greger says. People who are now “locked in” often communicate with any movement they can make – blinking an eye or moving a hand slightly – to arduously pick letters or words from a list.

University of Utah colleagues who conducted the study with Greger included electrical engineers Spencer Kellis, a doctoral student, and Richard Brown, dean of the College of Engineering; and Paul House, an assistant professor of neurosurgery. Another coauthor was Kai Miller, a neuroscientist at the University of Washington in Seattle.

The research was funded by the National Institutes of Health, the Defense Advanced Research Projects Agency, the University of Utah Research Foundation and the National Science Foundation.

Nonpenetrating Microelectrodes Read Brain’s Speech Signals
The study used a new kind of nonpenetrating microelectrode that sits on the brain without poking into it. These electrodes are known as microECoGs because they are a small version of the much larger electrodes used for electrocorticography, or ECoG, developed a half century ago.

This photo shows two kinds of electrodes sitting atop a severely epileptic patient's brain after part of his skull was removed temporarily. The larger, numbered, button-like electrodes are ECoGs used by surgeons to locate and then remove brain areas responsible for severe epileptic seizures. While the patient had to undergo that procedure, he volunteered to let researchers place two small grids - each with 16 tiny 'microECoG' electrodes - over two brain areas responsible for speech. These grids are at the end of the green and orange wire bundles, and the grids are represented by two sets of 16 white dots since the actual grids cannot be seen easily in the photo. University of Utah scientists used the microelectrodes to translate speech-related brain signals into actual words - a step toward future machines to allow severely paralyzed people to speak. Credit: University of Utah Department of Neurosurgery. (click to enlarge)

For patients with severe epileptic seizures uncontrolled by medication, surgeons remove part of the skull and place a silicone mat containing ECoG electrodes over the brain for days to weeks while the cranium is held in place but not reattached. The button-sized ECoG electrodes don’t penetrate the brain but detect abnormal electrical activity and allow surgeons to locate and remove a small portion of the brain causing the seizures.

Last year, Greger and colleagues published a study showing the much smaller microECoG electrodes could “read” brain signals controlling arm movements. One of the epileptic patients involved in that study also volunteered for the new study.

Because the microelectrodes do not penetrate brain matter, they are considered safe to place on speech areas of the brain – something that cannot be done with penetrating electrodes that have been used in experimental devices to help paralyzed people control a computer cursor or an artificial arm.

EEG electrodes used on the skull to record brain waves are too big and record too many brain signals to be used easily for decoding speech signals from paralyzed people.

Translating Nerve Signals into Words
In the new study, the microelectrodes were used to detect weak electrical signals from the brain generated by a few thousand neurons or nerve cells.

Each of two grids with 16 microECoGs spaced 1 millimeter (about one-25th of an inch) apart, was placed over one of two speech areas of the brain: First, the facial motor cortex, which controls movements of the mouth, lips, tongue and face – basically the muscles involved in speaking. Second, Wernicke’s area, a little understood part of the human brain tied to language comprehension and understanding.

This magnetic resonance image (MRI) of an epileptic patient's brain is superimposed with the locations of two kinds of electrodes: conventional ECoG electrodes (yellow) to help locate the source of his seizures so surgeons could operate to prevent them, and two grids (red) of 16 experimental microECoG electrodes used to read speech signals from the brain. University of Utah scientists used the microelectrodes to translate brain signals into words - a step toward devices that would let severely paralyzed people speak. Credit: Kai Miller, University of Washington. (click to enlarge)

The study was conducted during one-hour sessions on four consecutive days. Researchers told the epilepsy patient to repeat one of the 10 words each time they pointed at the patient. Brain signals were recorded via the two grids of microelectrodes. Each of the 10 words was repeated from 31 to 96 times, depending on how tired the patient was. Then the researchers “looked for patterns in the brain signals that correspond to the different words” by analyzing changes in strength of different frequencies within each nerve signal, says Greger.

The researchers found that each spoken word produced varying brain signals, and thus the pattern of electrodes that most accurately identified each word varied from word to word. They say that supports the theory that closely spaced microelectrodes can capture signals from single, column-shaped processing units of neurons in the brain.

One unexpected finding: When the patient repeated words, the facial motor cortex was most active and Wernicke’s area was less active. Yet Wernicke’s area “lit up” when the patient was thanked by researchers after repeating words. It shows Wernicke’s area is more involved in high-level understanding of language, while the facial motor cortex controls facial muscles that help produce sounds, Greger says.

The researchers were most accurate – 85 percent – in distinguishing brain signals for one word from those for another when they used signals recorded from the facial motor cortex. They were less accurate – 76 percent – when using signals from Wernicke’s area. Combining data from both areas didn’t improve accuracy, showing that brain signals from Wernicke’s area don’t add much to those from the facial motor cortex.

When the scientists selected the five microelectrodes on each 16-electrode grid that were most accurate in decoding brain signals from the facial motor cortex, their accuracy in distinguishing one of two words from the other rose to almost 90 percent.

In the more difficult test of distinguishing brain signals for one word from signals for the other nine words, the researchers initially were accurate 28 percent of the time – not good, but better than the 10 percent random chance of accuracy. However, when they focused on signals from the five most accurate electrodes, they identified the correct word almost half (48 percent) of the time.

“It doesn’t mean the problem is completely solved and we can all go home,” Greger says. “It means it works, and we now need to refine it so that people with locked-in syndrome could really communicate.”

“The obvious next step – and this is what we are doing right now – is to do it with bigger microelectrode grids” with 121 micro electrodes in an 11-by-11 grid, he says. “We can make the grid bigger, have more electrodes and get a tremendous amount of data out of the brain, which probably means more words and better accuracy.”

Material adapted from University of Utah.

The authors used a cohort study of 20,430 people living in Norwich, UK and examined 12 different genetic variants which are known to increase the risk of obesity. The researchers tested how many of these variants each study participants had inherited from either parent. They then assessed the overall genetic susceptibility to obesity by summing the number of variants inherited into a ‘genetic predisposition score’.

Most individuals inherited between 10 and 13 variants, but some had inherited more than 17 variants, while others fewer than 6. In addition the researchers assessed occupational and leisure-time physical activities in each individual by using a validated self-administered questionnaire. The researchers then used modeling techniques to examine whether a higher ‘genetic predisposition score’ was associated with a higher body mass index (BMI)/obesity risk and, most importantly, they also tested whether a physically active lifestyle could attenuate the genetic influence on BMI and obesity risk.

The researchers found that each additional genetic variant in the score was associated with an increase in BMI equivalent to 445g in body weight for a person 1.70 m tall and that the size of this effect was greater in inactive people than in active people. In individuals who had a physically active lifestyle, this increase was only 379 g/variant, or 36% lower than in physically inactive individuals in whom the increase was 592 g/variant. Furthermore, in the total sample each additional obesity-susceptibility variant increased the odds of obesity by 1.1-fold. However, the increased odds per variant for obesity risk were 40% lower in physically active individuals (1.095 odds/variant) compared to physically inactive individuals (1.16 odds/variant).

These findings challenge deterministic views of the genetic predisposition to obesity that are often held by the public, as they suggest that even people at greater genetic risk of obesity can benefit from adopting a healthy lifestyle.

The authors say: “Our findings further emphasize the importance of physical activity in the prevention of obesity.”

Download
Physical Activity Attenuates the Genetic Predisposition to Obesity in 20,000 Men and Women from EPIC-Norfolk Prospective Population Study.

Material adapted from Public Library of Science.

“Sometimes drug companies hide or downplay information about serious side effects of new drugs and overstate the drugs’ benefits,” said Donald Light. “Then, they spend two to three times more on marketing than on research to persuade doctors to prescribe these new drugs. Doctors may get misleading information and then misinform patients about the risks of a new drug. It’s really a two-tier market for lemons.”

Light said that three reasons why the pharmaceutical market produces “lemons” are:

1. Having companies in charge of testing new drugs,
2. providing firewalls of legal protection behind which information about harms or effectiveness can be hidden,
3. and the relatively low bar set for drug efficacy in order for a new drug to be approved.

According to his study, independent reviewers found that about 85 percent of new drugs offer few if any new benefits. Yet, toxic side effects or misuse of prescription drugs now make prescription drugs a significant cause of death in the United States.

Light’s paper, “Pharmaceuticals: A Two-Tier Market for Producing ‘Lemons’ and Serious Harm,” is an institutional analysis of the pharmaceutical industry and how it works based on a range of independent sources and studies, including the Canadian Patented Medicine Prices Review Board, the Food and Drug Administration, and Prescrire International.

The foundation for the paper is the work Light did for a forthcoming book he edited, titled The Risk of Prescription Drugs, which is scheduled for publication this fall by Columbia University Press.

In both his paper and his book, Light describes the “Risk Proliferation Syndrome” that is maximizing the number of patients exposed to new drugs that have relatively low efficacy and effectiveness but have greater risk of adverse side effects. Building on clinical trials designed to minimize evidence of harm and published literature that emphasizes a drug’s advantages, companies launch massive campaigns to sell it, when a controlled, limited launch would allow evidence to be gathered about the drug’s effects. Companies recruit leading clinicians to try using the drug for conditions other than those for which it is approved and to promote such off-label or unapproved uses. Physicians inadvertently become “double agents” — promoters of the new drug, yet trusted stewards of patients’ well-being, said Light. When patients complain of adverse reactions, studies show their doctors are likely to discount or dismiss them, according to Light.

Despite the extensive requirements for testing the efficacy and safety of each new drug, companies “swamp the regulator” with large numbers of incomplete, partial, substandard clinical trials, Light said. For example, in one study of 111 final applications for approval, 42% lacked adequately randomized trials, 40% had flawed testing of dosages, 39% lacked evidence of clinical efficacy, and 49% raised concerns about serious adverse side effects, said Light.

“Just recently, major reports have come out about biased, poor trials for Avandia and Avastin,” Light said, who noted that orphan drugs are tested even less well.

“The result is that drugs get approved without anyone being able to know how effective they really are or how much serious harm they will cause,” Light said. The companies control the making of scientific knowledge and then control which findings will go to the FDA or be published.

“A few basic changes could improve the quality of trials and evidence about the real risks and benefits of new drugs,” Light said. “We could also increase the percentage of new drugs that are really better for patients.”

Material adapted from American Sociological Association.

These children are significantly more likely than their older classmates to be prescribed behavior-modifying stimulants such as Ritalin, said Todd Elder. Such inappropriate treatment is particularly worrisome because of the unknown impacts of long-term stimulant use on children’s health, Elder said. It also wastes an estimated $320 million-$500 million a year on unnecessary medication – some $80 million-$90 million of it paid by Medicaid, he said.

Elder said the “smoking gun” of the study is that ADHD diagnoses depend on a child’s age relative to classmates and the teacher’s perceptions of whether the child has symptoms.

“If a child is behaving poorly, if he’s inattentive, if he can’t sit still, it may simply be because he’s 5 and the other kids are 6,” said Elder, assistant professor of economics. “There’s a big difference between a 5-year-old and a 6-year-old, and teachers and medical practitioners need to take that into account when evaluating whether children have ADHD.”

ADHD is the most commonly diagnosed behavioral disorder for kids in the United States, with at least 4.5 million diagnoses among children under age 18, according to the Centers for Disease Control and Prevention.

However, there are no neurological markers for ADHD (such as a blood test), and experts disagree on its prevalence, fueling intense public debate about whether ADHD is under-diagnosed or over-diagnosed, Elder said.

Using a sample of nearly 12,000 children, Elder examined the difference in ADHD diagnosis and medication rates between the youngest and oldest children in a grade. The data is from the Early Childhood Longitudinal Study Kindergarten Cohort, which is funded by the National Center for Education Statistics.

According to Elder’s study, the youngest kindergartners were 60 percent more likely to be diagnosed with ADHD than the oldest children in the same grade. Similarly, when that group of classmates reached the fifth and eighth grades, the youngest were more than twice as likely to be prescribed stimulants.

Overall, the study found that about 20 percent – or 900,000 – of the 4.5 million children currently identified as having ADHD likely have been misdiagnosed.

Elder used the students’ birth dates and the states’ kindergarten eligibility cutoff dates to determine the youngest and oldest students in a grade. The most popular cutoff date in the nation is Sept. 1, with 15 states mandating that children must turn 5 on or before that date to attend kindergarten.

The results – both from individual states and when compared across states – were definitive. For instance, in Michigan – where the kindergarten cutoff date is Dec. 1 – students born Dec. 1 had much higher rates of ADHD than children born Dec. 2. (The students born Dec. 1 were the youngest in their grade; the students born Dec. 2 enrolled a year later and were the oldest in their grade.)

Thus, even though the students were a single day apart in age, they were assessed differently simply because they were compared against classmates of a different age set, Elder said.

In another example, August-born kindergartners in Illinois were much more likely to be diagnosed with ADHD than Michigan kindergartners born in August of the same year as their Illinois counterparts. That’s because Illinois’ kindergarten cutoff date is Sept. 1, meaning those August-born children were the youngest in their grade, whereas the Michigan students were not.

According to the study, a diagnosis of ADHD requires evidence of multiple symptoms of inattention or hyperactivity, with these symptoms persisting for six or more months – and in at least two settings – before the age of seven. The settings include home and school.

Although teachers cannot diagnose ADHD, their opinions are instrumental in decisions to send a child to be evaluated by a mental health professional, Elder said.

“Many ADHD diagnoses may be driven by teachers’ perceptions of poor behavior among the youngest children in a kindergarten classroom,” he said. “But these ‘symptoms’ may merely reflect emotional or intellectual immaturity among the youngest students.”

Material adapted from Michigan State University.

IBMT was adapted from traditional Chinese medicine in the 1990s in China, where it is practiced by thousands of people. It is now being taught to undergraduates involved in research on the method at the University of Oregon (UO).

The new research – published online the week of August 16-21 ahead of regular publication in the Proceedings of the National Academy of Sciences – involved 45 UO students (28 males and 17 females); 22 subjects received IBMT while 23 participants were in a control group that received the same amount of relaxation training. The experiments involved the use of brain-imaging equipment in the UO’s Robert and Beverly Lewis Center for Neuroimaging.

A type of magnetic resonance called diffusion tensor imaging allowed researchers to examine fibers connecting brain regions before and after training. The changes were strongest in connections involving the anterior cingulate, a brain area related to the ability to regulate emotions and behavior. The changes were observed only in those who practiced meditation and not in the control group. The changes in connectivity began after six hours of training and became clear by 11 hours of practice. The researchers said it is possible the changes resulted from a reorganization of white-matter tracts or by an increase of myelin that surrounds the connections.

“The importance of our findings relates to the ability to make structural changes in a brain network related to self regulation,” said Posner, who last fall received a National Medal of Science. “The pathway that has the largest change due to IBMT is one that previously was shown to relate to individual differences in the person’s ability to regulate conflict.”

In 2007 in PNAS, Tang, a visiting scholar at the UO, and Posner documented that doing IBMT for five days prior to a mental math test led to low levels of the stress hormone cortisol among Chinese students. The experimental group also showed lower levels of anxiety, depression, anger and fatigue than students in a relaxation control group.

In 2009 in PNAS, Tang and Chinese colleagues, with assistance from Posner and UO psychology professor Mary K. Rothbart, found that IBMT subjects in China had increased blood flow in the right anterior cingulate cortex after receiving training for 20 minutes a day over five days. Compared with the relaxation group, IBMT subjects also had lower heart rates and skin conductance responses, increased belly breathing amplitude and decreased chest respiration rates.

The latter findings suggested the possibility that additional training might trigger structural changes in the brain, leading to the new research, Tang and Posner said. The researchers currently are extending their evaluation to determine if longer exposure to IBMT will produce positive changes in the size of the anterior cingulate.

Deficits in activation of the anterior cingulate cortex have been associated with attention deficit disorder, dementia, depression, schizophrenia and many other disorders. “We believe this new finding is of interest to the fields of education, health and neuroscience, as well as for the general public,” Tang said.

In their conclusion, the researchers wrote that the new findings suggest a use of IBMT as a vehicle for understanding how training influences brain plasticity.

IBMT is not yet available in the United States beyond the research being done at the UO. The practice avoids struggles to control thought, relying instead on a state of restful alertness, allowing for a high degree of body-mind awareness while receiving instructions from a coach, who provides breath-adjustment guidance and mental imagery and other techniques while soothing music plays in the background. Thought control is achieved gradually through posture, relaxation, body-mind harmony and balanced breathing. A good coach is critical, Tang said.

Material adapted from University of Oregon.

Reference
Yi-Yuan Tang, Qilin Lu, Xiujuan Geng, Elliot A. Stein, Yihong Yang, Michael I. Posner. Short-term meditation induces white matter changes in the anterior cingulate. Proceedings of the National Academy of Sciences, 2010; DOI: 10.1073/pnas.1011043107

If the new test used by the Northwestern researchers had been used in such a real-world situation with the same type of outcome that occurred in the lab, the study suggests, culpability extracted from the chatter could be confirmed.

In other words, if the test conducted in the Northwestern lab ultimately is employed for such real-world scenarios, the research suggests, law enforcement officials ultimately may be able to confirm details about an attack – date, location, weapon — that emerges from terrorist chatter.

In the Northwestern study, when researchers knew in advance specifics of the planned attacks by the make-believe “terrorists,” they were able to correlate P300 brain waves to guilty knowledge with 100 percent accuracy in the lab, said J. Peter Rosenfeld, professor of psychology in Northwestern’s Weinberg College of Arts and Sciences.

For the first time, the Northwestern researchers used the P300 testing in a mock terrorism scenario in which the subjects are planning, rather than perpetrating, a crime. The P300 brain waves were measured by electrodes attached to the scalp of the make-believe “persons of interest” in the lab.

The most intriguing part of the study in terms of real-word implications, Rosenfeld said, is that even when the researchers had no advance details about mock terrorism plans, the technology was still accurate in identifying critical concealed information.

“Without any prior knowledge of the planned crime in our mock terrorism scenarios, we were able to identify 10 out of 12 terrorists and, among them, 20 out of 30 crime- related details,” Rosenfeld said. “The test was 83 percent accurate in predicting concealed knowledge, suggesting that our complex protocol could identify future terrorist activity.”

Rosenfeld is a leading scholar in the study of P300 testing to reveal concealed information. Basically, electrodes are attached to the scalp to record P300 brain activity — or brief electrical patterns in the cortex — that occur, according to the research, when meaningful information is presented to a person with “guilty knowledge.”

Research on the P300 testing emerged in the 1980s as a handful of scientists looked for an alternative to polygraph tests for lie detection. Since it was invented in the 1920s, polygraphy has been under fire, especially by academics, with critics insisting that such testing measures emotion rather than knowledge.

Study participants (29 Northwestern students) planned a mock attack based on information they were given about bombs and other deadly weapons. They then had to write a letter detailing the rationale of their plan to encode the information in memory.

Then, with electrodes attached to their scalps, they looked at a computer display monitor that presented names of stimuli. The names of Boston, Houston, New York, Chicago and Phoenix, for example, were shuffled and presented at random. The city that study participants chose for the major terrorist attack evoked the largest P300 brainwave responses.

The test includes four classes of stimuli known as targets, non-targets, probes, and irrelevants. Targets are sights, sounds, or other stimuli the person being questioned already knows or is taught to recognize before the test. Probes are stimuli only a guilty suspect would be likely to know. And irrelevants are stimuli unlikely to be recognized.

“Since 9/11 preventing terrorism is a priority,” Rosenfeld said. “Sometimes you catch suspicious people entering a building. You suspect that they’re terrorists, and you have some leads from the chatter. You’ve heard they’re going to attack one city or another in one fashion or another on one date or another. Our hope is that our new complex protocol – different from the first P300 technology developed in the 1980s – will one day confirm such chatter in the real world.”

In the laboratory setting, study participants only had about 30 minutes to learn about the attack and to detail their plans. Thus, Rosenfeld said, encoding of guilty knowledge was relatively shallow. It is assumed that real terrorists rehearse details central to a planned attack repeatedly, leading to deeper encoding of related memories, he said. “We suspect if our test was employed in the real world the deeper encoding of planned crime-related knowledge could further boost detection of terrorist intentions.”

Material adapted from Northwestern University.

Reference
Ming Lui & J. Peter Rosenfeld (2010). The application of subliminal priming in lie detection: Scenario for identification of members of a terrorist ring. Psychophysiology, Volume 46 Issue 4, Pages 889 – 903.

“Experts have long sought a clear behavioral marker of suicide risk,” says Harvard Professor of Psychology Matthew K. Nock, an author of two papers describing the new assessments of suicidal behavior. “The current approach, based on self-reporting, leads to predictions that are scarcely better than chance, since suicidal patients are often motivated to conceal or misrepresent their mental state. We sought to develop more sophisticated, objective measures of how psychiatric patients are thinking about suicide. Our work provides two important new tools clinicians can use in deciding how to treat potentially suicidal patients.”

Our work provides two important new tools clinicians can use in deciding how to treat potentially suicidal patients, said Harvard Professor of Psychology Matthew K. Nock (right), who worked on the study with Christine B. Cha (left), a doctoral student in psychology. (credit: Jon Chase/Harvard Staff Photographer)

Nock and colleagues report on the tests in two papers, one in the current Journal of Abnormal Psychology and a second published in Psychological Science. Unlike many previous efforts focused on biological markers of suicidal behavior, their work identifies two behavioral markers: subjects’ attention to suicide-related stimuli, and the extent to which they associate death or suicide with themselves.

In one study by Nock’s group, 124 patients in a psychiatric emergency department were administered a modified Stroop test measuring speed in articulating the color of words on a computer screen. Suicidal individuals were found to pay more attention to suicide-related words than to neutral words.

“Suicide Stroop scores predicted six-month follow-up suicide attempts above and beyond well-known risk factors such as a history of suicide attempts, patients’ reported likelihood of attempt, and clinicians’ predictions regarding patients’ likelihood of attempt,” says co-author Christine B. Cha, a doctoral student in psychology at Harvard.

A second study adapted the Implicit Association Test developed by Harvard psychologist Mahzarin R. Banaji, using reaction times to semantic stimuli to measure 157 subjects’ automatic mental associations – in this case, the strength of associations between words related to “self” and words related to either “life” or “death/suicide.” Participants were shown pairs of words on a screen, with response speed revealing unconscious associations between the terms. For instance, a rapid response to stimuli associating self with death/suicide suggests a strong unconscious association between the two.

Nock and his colleagues found that those participants with strong associations between self and death/suicide were six times more likely to attempt suicide within the next six months than those holding stronger associations between self and life.

“These findings suggest that a person’s implicit cognition may guide which behavior he or she chooses to cope with extreme distress,” Nock says. “More specifically, an implicit association with death/suicide may represent one of the final steps in the pathway to suicide.”

Material adapted from Harvard University.

The negativity bias shows up in lots of ways. For example, studies have found that:

• In a relationship, it typically takes five good interactions to make up for a single bad one.
• People will work much harder to avoid losing $100 than they will work to gain the same amount of money.
• Painful experiences are much more memorable than pleasurable ones.

In your own mind, what do you usually think about at the end of the day? The fifty things that went right, or the one that went wrong? Like the guy who cut you off in traffic, what you wish you had said differently to a co-worker, or the one thing on your To Do list that didn’t get done . . .

In effect, the brain is like Velcro for negative experiences, but Teflon for positive ones. That shades “implicit memory” – your underlying expectations, beliefs, action strategies, and mood – in an increasingly negative direction.

And that’s just not fair, since probably most of the facts in your life are positive or neutral. Every day, lots of good things happen, such as a lovely sunset, someone is nice to you, you finish a batch of emails, or you learn something new. And lots of other good things are ongoing aspects of your world (e.g., your children are healthy, life is peaceful in your corner of the planet) or yourself (e.g., personal qualities like determination, sincerity, fairness, kindness).

Besides the sheer injustice of it, acquiring a big pile of negative experiences in implicit memory banks naturally makes a person more anxious, irritable, and blue. Plus it makes it harder to be patient and giving toward others.

In evolution, Mother Nature only cares about passing on genes – by any means necessary. She doesn’t care if we happen to suffer along the way – from subtle worries to intense feelings of sorrow, worthlessness, or anger – or create suffering for others.

The result: a brain that is tilted against lasting contentment and fulfillment.

But you don’t have to accept this bias! By tilting toward the good – “good” in the practical sense of that which brings more happiness to oneself and more helpfulness to others – you merely level the playing field.

You’ll still see the tough parts of life. In fact, you’ll become more able to change them or bear them if you tilt toward the good, since that will help put challenges in perspective, lift your energy and spirits, highlight useful resources, and fill up your own cup so you have more to offer to others.

And now, tilted toward absorbing the good, instead of positive experiences washing through you like water through a sieve, they’ll collect in implicit memory deep down in your brain. In the famous saying, “neurons that fire together, wire together.” The more you get your neurons firing about positive facts, the more they’ll be wiring up positive neural structures.

Taking in the good is a brain-science savvy and psychologically skillful way to improve how you feel, get things done, and treat others. It is among the top five personal growth methods I know. In addition to being good for adults, it’s great for children, helping them to become more resilient, confident, and happy.

Here’s how to take in the good – in three simple steps.

1. Look for good facts, and turn them into good experiences.
Good facts include positive events – like the taste of good coffee or getting an unexpected compliment – and positive aspects of the world and yourself. When you notice something good, let yourself feel good about it.

Try to do this at least a half dozen times a day. There are lots of opportunities to notice good events, and you can always recognize good things about the world and yourself. Each time takes just 30 seconds or so. It’s private; no one needs to know you are taking in the good. You can do it on the fly in daily life, or at special times of reflection, like just before falling asleep (when the brain is especially receptive to new learning).

Notice any reluctance to feeling good. Such as thinking that you don’t deserve to, or that it’s selfish, vain, or even shameful to feel pleasure. Or that if you feel good, you will lower your guard and let bad things happen.

Barriers to feeling good are common and understandable – but they get in the way of you taking in the resources you need to feel better, have more strength, and have more inside to give to others. So acknowledge them to yourself, and then turn your attention back to the good news. Keep opening up to it, breathing and relaxing, letting the good facts affect you.

It’s like sitting down to a meal: don’t just look at it – taste it!

2. Really enjoy the experience.
Most of the time, a good experience is pretty mild, and that’s fine. But try to stay with it for 20 or 30 seconds in a row – instead of getting distracted by something else.

As you can, sense that it is filling your body, becoming a rich experience. As Marc Lewis and other researchers have shown, the longer that something is held in awareness and the more emotionally stimulating it is, the more neurons that fire and thus wire together, and the stronger the trace in memory.

You are not craving or clinging to positive experiences, since that would ultimately lead to tension and disappointment. Actually, you are doing the opposite: by taking them in and filling yourself up with them, you will increasingly feel less fragile or needy inside, and less dependent on external supplies; your happiness and love will become more unconditional, based on an inner fullness rather than on whether the momentary facts in your life happen to be good ones.

3. Intend and sense that the good experience is sinking into you.
People do this in different ways. Some feel it in their body like a warm glow spreading through their chest like the warmth of a cup of hot cocoa on a cold wintry day. Others visualize things like a golden syrup sinking down inside, bringing good feelings and soothing old places of hurt, filling in old holes of loss or yearning; a child might imagine a jewel going into a treasure chest in her heart. And some might simply know conceptually, that while this good experience is held in awareness, its neurons are firing busily away, and gradually wiring together

Any single time you do this will make only a little difference. But over time those little differences will add up, gradually weaving positive experiences into the fabric of your brain and your self.

(For more on Taking in the Good, please see Chapter 4 in Buddha’s Brain: The Practical Neuroscience of Happiness, Love, and Wisdom)

* * *

Rick Hanson, Ph.D., is a neuropsychologist and founder of the Wellspring Institute for Neuroscience and Contemplative Wisdom. A summa cum laude graduate of UCLA, he teaches at universities and meditation centers in Europe, Australia, and North America. His work has been featured on the BBC and in Consumer Reports Health, U.S. News and World Report, and other major magazines.

Rick’s most recent book is Buddha’s Brain: The Practical Neuroscience of Happiness, Love, and Wisdom and is being published in ten additional languages. An authority on self-directed neuroplasticity, he edits the Wise Brain Bulletin and has a weekly e-newsletter, Just One Thing. His articles have appeared in Tricycle Magazine, Insight Journal, and Inquiring Mind.

He enjoys rock-climbing and taking a break from emails. He and his wife have two children. For more information, please see his full profile at www.RickHanson.net. You can find him on the social web at http://www.facebook.com/BuddhasBrain and http://www.YouTube.com/BuddhasBrain

The study used a new video based on one used in a now-famous experiment conducted in the late 1990s by Simons and his collaborator, Christopher Chabris, now a psychology professor at Union College in New York. In the original video, two groups of people – some dressed in white, some in black – are passing basketballs back and forth. The study subjects were asked to count the passes among those dressed in white while ignoring the passes of those in black.

Test your own skill at this task:

Simons and Chabris found that many of those who viewed the video failed to notice when a person in a gorilla suit walked into the game, faced the camera, pounded on its chest and then sauntered out of view. The gorilla was on screen for nearly nine seconds, yet half of those who watched the video didn’t see it.

This finding was a particularly dramatic example of “inattentional blindness,” the failure to see something obvious when focusing attention on something else.

The video is now so well known that many people know to look for a gorilla whenever they are asked to count basketball passes. Simons decided to use its notoriety to his advantage. He created a similar video, again with teams of white- and black-clothed players, the same rules, and a chest-thumping gorilla.

Before reading further, try the task for yourself:

Simons wanted to see if those who knew about the gorilla before viewing the video would be more or less likely to notice other unexpected events in the same video.

“You can make two competing predictions,” Simons said. “Knowing about the invisible gorilla might increase your chances of noticing other unexpected events because you know that the task tests whether people spot unexpected events. You might look for other events because you know that the experimenter is up to something.” Alternatively, “knowing about the gorilla might lead viewers to look for gorillas exclusively, and when they find one, they might fail to notice anything else out of the ordinary.”

As in the earlier experiment, of those who had never seen or heard about the gorilla video, about half missed the gorilla in the new video. Those who knew about the original gorilla video all spotted the gorilla in this experiment. However, knowing about the gorilla beforehand did not improve the detection of other unexpected events. Only 17 percent of those who were familiar with the original gorilla video noticed one or both of the other unexpected events, while 29 percent of those who were unfamiliar with the original gorilla video spotted one of the other events.

By modifying a famous experiment involving a person in a gorilla suit and two teams of people passing basketballs back and forth, Simons demonstrated that expecting the unexpected does not improve one

This difference between the “familiar” and “unfamiliar” viewers of the video is not statistically significant, Simons said, but the study does demonstrate that being primed to the possibility of unexpected events does not enhance one’s ability to notice other unexpected events.

“The main finding is that knowing that unexpected events might occur doesn’t prevent you from missing unexpected events,” Simons said. “People who are familiar with the purpose and conclusions of the original study – that people can miss obvious events when focused on something else – still miss other obvious events in exactly that same context. Even when they know that the experimenter is going to fool them, they can miss something that’s obvious, something that they could spot perfectly well if they knew it was there.”

The video itself, called “The Monkey Business Illusion,” was a finalist in the Neural Correlate Society’s Best Illusion of the Year contest in May, where Simons donned a gorilla suit and presented the new video himself.

Take a look at his presentation:

Most of the vision scientists in the audience knew about the original gorilla video, and yet most still missed one or both of the other unexpected events in the video.

Simons is the co-author, with Chabris, of “The Invisible Gorilla, And Other Ways Our Intuitions Deceive Us,” a new book that focuses on common – and yet false – intuitions about how our minds work that often are wrong. Visit The Invisible Gorilla for more information about the book and other videos demonstrating the limits of visual awareness.

Material adapted from University of Illinois at Urbana-Champaign.

Schoomaker explained that with the increasing numbers of Soldiers returning from combat with severe wounds, reports of medication abuse and suicides with pain as a possible factor are troubling.

“While these issues might not be directly related to pain management, I felt a thorough evaluation and assessment of current pain-management practice was indicated,” Schoomaker said.

He said part of the problem is that severely injured Soldiers, like those in Warrior Transition Units, are often prescribed multiple medications and sometimes seen by several different doctors, which can cause inconsistencies in care. But he maintained that this is not just an Army problem – it is a problem throughout the U.S. healthcare system.

“This is a nation-wide problem … we’ve got a culture of ‘a pill for every ill,’” agreed Brig. Gen. Richard W. Thomas, assistant Army surgeon general.

“As a physician, the hardest thing to deal with is patients with chronic pain,” said Col. Jonathan H. Jaffin, director of heath policy and services, Army office of the surgeon general. “So many of us went into medicine to relieve suffering, and chronic pain is frustrating because we want to relieve that pain.”

The task force visited 28 military, Veterans Affairs and civilian medical centers between October and January to observe treatment capabilities and best practices. Schoomaker’s said his goal is to form a pain-management strategy that is holistic, multidisciplinary, and puts Soldiers’ quality of life first.

“This is an opportunity to change medical care and the way we take care of patients,” noted Thomas.

Schoomaker stressed that Army practices have always been in compliance with America’s medical regulations, but he thinks the Army can do better.

“Everything we do in the Army, even managing a toothache, is all in compliance with national standards … what we want to do is set the bar higher,” Schoomaker explained.

Schoomaker’s higher standards include offering treatment alternatives that might not yet be prescribed in average doctor’s offices, but which patients are already seeking out on their own, such as acupuncture. He said the Army has looked at research on the effectiveness of complementary techniques, and he would like to see them integrated into traditional medical treatment.

“Programs such as biofeedback and yoga have been subjected to scientific randomized trials and have been proven to be effective,” Schoomaker said.

Biofeedback involves measuring body signals — such as temperature, heart rate, muscle tension and brain waves — to help patients with relaxation techniques and pain reduction.

Schoomaker said he is hopeful that Soldiers will be receptive to alternative methods of care once they see that the treatments work.

“Seeing success is the best way to convince people of the usefulness and the need for other approaches,” agreed Jaffin.

The 109 recommendations are divided into four areas: to provide tools and infrastructure that support pain management, build a full spectrum of best practices, focus on Soldiers and families, and synchronize a culture of pain awareness, education and intervention.

Schoomaker said the recommendations that can be put into policy under his authority will be implemented in the coming months, and the 2010 National Defense Authorization Act asks the secretary of defense to integrate a pain-management policy into the military health-care system no later than March 2011.

Material adapted from the United States Army.

I remember the first time I saw one, in a neuropsych class: the instructor put on rubber gloves to protect against the formaldehyde preservative, popped the lid off of a lab bucket, and then pulled out a brain.

It didn’t look like much, a nondescript waxy yellowish-white blob rather like a sculpted head of cauliflower. But the whole class went silent. We were looking at the real deal, ground zero for consciousness, headquarters for “me.” The person it came from – or, in a remarkable sense, the person who came from it – was of course dead. Would my brain, too, end up in a lab bucket? That thought gave me a creepy weird feeling completely unlike the feeling of having my heart or hand in a bucket some day – which gets right at the specialness of your brain.

That blobby organ – just three pounds of tofu-like tissue – is considered by scientists to be the most complex object currently known in the universe. It holds 100 billion neurons (see the schematic illustration just below) amidst another trillion support cells. A typical neuron makes about 5000 connections called synapses with other neurons, producing a neural network with 500 trillion nodes in it. At any moment, each node is active or not, creating a kind of 0 or 1 bit of information. Neurons commonly fire five to fifty times a second, so while you’ve been reading this paragraph, literally quadrillions of bits of information have circulated inside your head.

Your nervous system – with its control center in the brain – moves information around like your heart moves blood around. Broadly defined, all that information is the mind, most of which is forever unconscious. Apart from the influence of hypothetical transcendental factors – call them God, Spirit, the Ground, or by no name at all – the mind is what the nervous system does. So if you care at all about your mind – including your emotions, sense of self, pleasures and pains, memories, dreams, reflections – (and who doesn’t?) then it makes tons of sense to care about what’s going on inside your own brain.

Until very recently, the brain was like the weather: you could care about it all you wanted, but you couldn’t do a thing about it. But new brain imaging technologies like functional MRI’s have revolutionized neuropsychology much as the invention of the microscope transformed biology. According to Dr. Alan Lesher, CEO of the American Association for the Advancement of Science, our knowledge of the brain has doubled in the past twenty years.

These breakthroughs have informed – and been informed by – practical applications in psychotherapy. For example, trauma therapies have been improved by research on memory, while the results of interventions such as EMDR have suggested new lines of investigation. Like other therapists, I feel clearer about a client’s mind because more is known about his or her brain.

I’m also a meditator – started in 1974, at the tail end of college – so it’s been inspiring to see something similar happening with contemplative practice. Some of the most interesting studies of brain function have been done on long-term meditators, the Olympic athletes of mental training. For example, experienced meditators actually have thicker cortical layers in the brain regions responsible for self-awareness and the control of attention.

This illustrates a fundamental point with extraordinary potential: when your mind changes, your brain changes, both temporarily – with the momentary flicker of synaptic activity – and in lasting ways through formation of new neural structures. Therefore, you can use your mind to change your brain to benefit your whole being – and every other being whose life you touch.

The new neuroscience, combined with the insights of clinical psychology and contemplative practice, gives you an historically unprecedented opportunity to shift your brain – and thus your mind – toward greater happiness, love, and wisdom.

And that’s what this blog is about: skillful means – from the intersection of psychology, neurology, and contemplative practice – for relieving distress and dysfunction, increasing well-being, and deepening mindfulness and inner peace.

We’ll focus on scientifically informed but eminently practical tools, skills, and perspectives – things you can use in the middle of daily life: on the job, in traffic, raising kids, when you’re nervous or mad, or working through a sticky conversation with your mom or your mate. For example, the next several entries in this blog will look at the power of gratitude to undo the threat reactivity of the brain, how to weave positive experiences into your brain and your self, and the three neural circuits of empathy.

With just a little understanding of your own brain, you can reach down inside the enchanted loom of your very being and gradually weave greater strength, insight, confidence, contentment, and loving intimacy into the tapestry of your life. That’s the great opportunity here: your brain is not in a bucket, it’s alive and pulsing with possibility, waiting for the skillful touch of your mind to guide it in increasingly wonderful directions.

I hope you’ll join me on this incredible journey.

Rick Hanson, Ph.D., is a neuropsychologist, author, and teacher. A summa cum laude graduate of UCLA, he founded the Wellspring Institute for Neuroscience and Contemplative Wisdom, and teaches at universities and meditation centers in Europe, Australia, and North America. His work has been featured on the BBC and in Consumer Reports Health, U.S. News and World Report, and other major magazines.

Rick’s most recent book is Buddha’s Brain: The Practical Neuroscience of Happiness, Love, and Wisdom (with Rick Mendius, M.D.; Foreword by Dan Siegel, M.D. and Preface by Jack Kornfield, Ph.D.), which has been praised by numerous scholars, therapists, and teachers, including Tara Brach, Ph.D., Roger Walsh, Ph.D., Sharon Salzberg, and Fred Luskin, Ph.D. An authority on self-directed neuroplasticity, he edits the Wise Brain Bulletin, and his articles have appeared in Tricycle Magazine, Insight Journal, and Inquiring Mind; his Your Wise Brain blog is on Huffington Post, Psychology Today, and other major websites. He has a chapter – 7 Facts about the Brain That Incline the Mind to Joy – in Measuring the Immeasurable, as well as several audio programs with Sounds True. His first book was Mother Nurture: A Mother’s Guide to Health in Body, Mind, and Intimate Relationships (Penguin, 2002)

Rick is currently a trustee of Saybrook University. He also served on the board of Spirit Rock Meditation Center for nine years, and was President of the Board of FamilyWorks, a community agency. He began meditating in 1974, trained in several traditions, and leads a weekly meditation gathering in San Rafael, CA. He enjoys rock-climbing and taking a break from emails. He and his wife have two children. For more information, please see his full profile at www.RickHanson.net. You can find him on the social web at http://www.facebook.com/BuddhasBrain and http://www.YouTube.com/BuddhasBrain

“This is great news for cancer survivors who deal with persistent and debilitating side effects from their cancer and its treatments long after their primary therapy ends. There are few treatments for the sleep problems and fatigue survivors experience that work for very long, if at all,” said Karen Mustian, Ph.D., M.P.H., the study’s lead investigator and assistant professor of Radiation Oncology and Community and Preventive Medicine at the University of Rochester Medical Center’s James P. Wilmot Cancer Center. “Yoga is a safe and simple technique that can have multiple benefits for survivors who are looking for solutions.”

People being treated for cancer often report sleep problems and fatigue. Yet, they, along with many doctors and nurses, expect the problems to end when surgery, chemotherapy or radiation therapy is complete. However, studies show that as many as two-thirds of survivors experience them for months after, sometimes years, and they also report sleep aids aren’t effective, said Mustian, one of a handful of scientifically trained exercise psychologists and physiologists specializing in cancer in the United States.

The randomized controlled phase II/III study enrolled 410 early-stage cancer survivors, primarily women who had breast cancer, between 2006 and 2009. Half of them attended a twice-a-week specialized yoga program that was developed by Mustian.

Participants in the yoga group reported improved sleep quality and less fatigue, and a better quality of life while reducing the use of sleeping medications following the four-week program. The control group showed increased use of the sleep medications and reported reduced sleep quality, greater fatigue and a poorer quality of life.

The specialized yoga program, designed by the Mustian and colleagues at the University of Rochester, is called YOCAS® (Yoga for Cancer Survivors.) It includes breathing exercises, gentle Hatha and restorative yoga postures and mindfulness exercises. Yoga Alliance-certified instructors who were trained to deliver the YOCAS® program at cancer centers in nine cities across the country.

Over the years, the benefits of yoga have been debated in the scientific community. Until recently, there were few studies of yoga and an even smaller number of the studies were with cancer patients or survivors. These studies were small and lacked consistency in yoga techniques, making it difficult for researchers to determine clear benefits of its use.

While Mustian is pleased with the success of the program, she’s suspects it’s the breathing, postures and mindfulness components of gentle yoga, individually or in combination, that improve sleep, fatigue and quality of life. “It is also possible that the YOCAS® program works through many different biological, psychological and social pathways simultaneously,” she said, adding that stress and anxiety reduction help initiate relaxation.

Mustian received funding from the National Cancer Institute and the Office of Complementary and Alternative Medicine to develop a large study and gather definitive data.

She is a scientist with the James P. Wilmot Cancer Center and its NCI Community Clinical Oncology Program Research Base. She plans to launch a follow-up study looking at a self-directed, home-based yoga program for survivors that is currently in development

NOTE: The YOCAS® video and instructional training materials used in this clinical study were designed to measure the effect of a standardized yoga program in a controlled setting with specially trained yoga instructors. It is not available to the public at this time.

Material adapted from University of Rochester by CFisher.

Without further delay, it is not surprising that cost analysis among physicians is not a reliable marker of quality. The true marker which everyone looks for is “the highest quality physician care for the lowest cost.” However, no algorithm to date has been able to successfully decipher these qualities amongst doctors. Serious efforts are underway at Centers for Medicare and Medicaid (CMS) to create this benchmark as health care costs continue to soar.

CMS currently uses a system called Physician Quality Reporting Initiative (PQRI). This system, in theory, is plausible; however, CMS seems to approach analysis from a monetary standpoint, which blurs the quality of care. Here is a basic example of how it works: A physician or group registers for PQRI through CMS (it is currently voluntary). Then over the next year they must report on every patient regarding certain core measures: 216 for the year 2010. These measures range from depression to urinary incontinence to electronic medical records and everything in between. The physician is encouraged to report 3 or more of the 216 measures on at least 80% of patients to meet compliance. If the doctor reaches this compliance, they will receive a 2% “bonus” of all Medicare collected receipts for their tax ID number.

For a real world example, a Urologist has met compliance when a female patient, age 65 years or older, is asked about urinary incontinence (measure 48), diagnoses the type of incontinence (measure 49), and creates a plan for treatment (measure 50). That sounds pretty simple, and it is. Why would the government offer extra money for this relatively normal interview? Well, first it applies to all physicians, so they are actually targeting primary care more than specialists. It would be hard to believe that a urologist would not inquire about, nor offer to treat urinary incontinence. Next, it saves CMS money. Older women with incontinence have 3 choices: treatment, absorbency pads, or run to restroom. It turns out that treatment is the cheapest option; no surprise because CMS wants to reward doctors for addressing it. Absorbency pads are expensive and the cost is solely the patient’s responsibility (i.e., not covered by insurance). Each absorbency pad may cost up to $1 per pad, and a patient may use 3-5 pads per day. That is $90-$150 per month for pads in a population that usually has a fixed income. Instead, many senior women opt to go without the pad, and run to the restroom. This is the most expensive treatment for CMS because for everyone women that runs and subsequently falls and fractures a hip, it costs CMS several thousands of dollars in medical expenses related to these injuries. If the same women is started on a medication for $20 per month and lives 20 years, it only costs $4800. Now you can easily see their interest in treatment.

The question raised is, “Why is this bad? How does this negatively impact quality care?” First the idea is not bad. It is well established that preventive medicine saves money and improves quality of life. As an osteopathic, urologic surgery resident, it is one of my core tenants to provide preventive medicine. The problem is the means to the end. In some states, various insurance companies require all physicians in the state to participate in PQRI. The insurance company then rates physicians from 1 to 5 (best to worst depending on PQRI reporting numbers). Then they assign copays to each physician accordingly. For example, the physician rate #1 category has a patient copay of $5 and the physician #5 category has a $100 co-pay. The patients may choose any physician, but they are much more likely to select a higher ranked doctor (based on PQRI alone) because of copay rates and artificial quality rankings. Physicians that do not volunteer to participate in the PQRI CMS system are automatically rated at the #5 category. Once a physician is rated #5, the only way to become re-rated is obtain electronic medical records, which easily costs $50,000+. As you can ascertain, CMS is trying to force physicians into this system via financial avenues; be it right or wrong.

Regarding quality of care, a patient looks in their insurance book for a doctor and has to not only choose a doctor rated #1-5, but also what co-pay their are willing to pay. On the surface, why would one pay more for a “bad doctor?” In reality, are all the good doctors in the #1 category? And the bad doctors in the #5 category? Absolutely not. They are just meeting or not meeting the requirements demanded upon them by insurance companies and CMS. Potentially, a doctor rated in the #1 category could get the required 3 measures, misdiagnose and mistreat your disease process with the most expensive treatment, and stay #1. Obviously quality, cost effectiveness, patient care, and quality of life are not aligned in this scenario.

As a resident surgeon, I cannot participate in PQRI as I have an educational license and do not bill any patient for my care. Also, a little known fact is that my paycheck actually originates from CMS. I want to be clear that I am not saying CMS is wrong for starting PQRI, as I agree with the ideology of preventive care and lowering the cost of health care. However, I disagree with it being tied to rankings that are artificial and monetarily gain incentivized. These rankings give patients a false sense of quality care. They are simply established to save insurance and CMS money. I guarantee that some of the highest quality care I have given patients did not include these ever expanding, but limited, core measures.

This leads us back to where we started; how do we rank physicians for the highest quality of care with the lowest health care cost? I am not sure that I have the answer, but PQRI and other systems do not either. I believe the rankings should be a sophisticated algorithm of preventive care, evidence based medicine, patient outcomes, patient population, and over health care cost. Patient population is included because as physicians become ranked, especially surgeons, there is a drive to “cherry pick” patients for surgery (i.e., do not offer surgery to high risk patients as they may lower rankings disproportionately even though they are in the most need for an intervention). The idea of demanding high quality care and cost effective medicine is a necessity. Unfortunately, the means to develop this in a tangible manner seems out of our grasps at the present time.

Jason D. Fisher, DO, MBA
Urological Surgery Resident

Introduction (Continued)
Hypertension is a condition where the pressure of the blood in the vascular system, specifically the arterial system, is excessive. The body manages the flow and pressure of blood via a number of mechanisms. These include varying the capacity (the internal dimensions) of the arterial tree, varying the output of the heart, and managing the volume of fluid in the circulation, primarily a function of the kidneys.  All of these are managed by the body in “real time,” i.e., on an ongoing basis – while we work, while we play, while we sleep.

“High blood pressure” or hypertension exists when blood pressure is in excess of 120/80 (or the recently revised 115/75), the first number being systolic pressure and the second, diastolic pressure. For either systolic or diastolic pressure to be high, one or more of the mechanisms that maintain blood pressure in a healthful range fail to perform their regulatory function.

All three mechanisms, arterial capacity, heart output, and kidney throughput, are automatically managed by the autonomic nervous system. Therefore, we can say that hypertension is an instance where the autonomic nervous system is either performing its task of managing blood pressure correctly – based on correct assessment of physiological status, it is performing its job in error. If it is the former, then it is the physiological status that is at issue. If it is the latter, then it could be considered a form of dysautonomia.

There is strong evidence that blood pressure is highly related to the “state” of the autonomic nervous system, where the state of excitation or “sympathetic” emphasis correlates highly with higher blood pressure and the state of relaxation or “parasympathetic” emphasis correlates highly with lower blood pressure. This makes sense because arterial capacity,  heart rate, and heart output are directly under autonomic control. “Heart rate variability” (HRV), or the degree to which the heart rate varies, also correlates highly with autonomic status: lower variability correlates highly with sustained sympathetic bias and higher variability correlates with increased parasympathetic (vagal) action.

Heart rate variability is also known to correlate with respiration, where slower, deeper, more rhythmic respiration correlates highly with increased HRV and faster, shallower, more arrhythmic respiration correlates highly with diminished HRV.  This raises two questions, a) Does blood pressure correlate with heart rate variability? b) Does blood pressure correlate with the frequency, depth, and rhythmicity of respiration?

Research Hypothesis
In this article, researchers Elliott and Edmonson present preliminary findings regarding the first question, does blood pressure correlate with heart rate variability?

Fig 1. (click to enlarge) Respiratory Arterial Pressure Wave, Pulse Wave, and Heart Rate (from Valsalva Wave Pro)

Their hypothesis is this… Slow, deep, rhythmic breathing results in the phenomenon of the respiratory arterial pressure wave (or more completely the arterio-venous wave) which is known to rise and fall by 20mmHg. (Medical Physiology, Guyton & Hall, 2002). The respiratory wave is depicted in the first and second red graphs at the top of Figure 1.

This respiratory arterio-venous wave is believed to be the physiological impetus for “breathing induced heart rate variability,” the bottom blue graph. Changes in blood flow and pressure resulting principally from respiration are detected by baroreceptors, specialized neurons distributed throughout major arteries. The autonomic nervous system uses baroreceptor input to coordinate heart rate, heart output, and vascular capacity to facilitate the respiratory wave. It is noted that other factors, e.g. stretch receptors in the chest, heart, etc. are also involved in this autonomic sensing and regulation.

When the arterio-venous wave is low, heart rate variability is low; when the arterio-venous wave is high, HRV is high. Neither the respiratory wave or its result, HRV, can be high if arteries are not relaxed during the exhalation phase of breathing. If arteries are relaxed during the exhalation phase of breathing, blood pressure cannot be high. Therefore, if correct, there should be an inverse correlation between HRV and blood pressure, i.e., high blood pressure and high HRV should be mutually exclusive, this being our hypothesis for Part I of the study.

Fig 2. (click to enlarge) One Hundred Three (103) Measurements of Blood Pressure and HRV

Research Results
The study consists of 103 instances of data collected from 42 clients after each engaged in 8-12 minutes of Coherent Breathing with HRV biofeedback. Because the Part I goal is simply to understand the real time relationship between blood pressure and HRV, both of which are considered variables, each assessment can be considered unique. It should be noted that 15/23 or 65% of hypertensives no longer demonstrated hypertensive pressures after the 8-12 minute period where the boundary is 100mmHg average blood pressure [(systolic+diastolic)/2]. As the impact of breathing with HRV biofeedback  is a Part II consideration, those results will be presented in a future article.

Figure 2 presents the data, where it is seen that all of the data instances fall into the upper left, lower left, or lower right quadrants. There is one instance in the upper right but it is extremely close to the normo-tensive boundary of 100 mmHg. From this we can conclude that there are virtually no instances where average blood pressure is above normotensive and heart rate variability is above 13 beats. (HRV is measured in beats difference between the peak heart rate and the valley heart rate . The bottom graph of Figure 1 is an example of the heart rate varying.) The data is summarized by Figure 3.

Fig 3. Four Quadrant Summary of Data

The power trend line of Figure 2 curves gently upward as we move to the left, demonstrating stronger effect and nonlinearity in the relationship. In fact, if segmented there is a very dramatic difference in the correlation between blood pressure and HRV to the left and right of 13 beats, the correlation coefficient ≤13 beats being -0.62 and the correlation coefficient >13 beats being -0.05.

The linear trendline of Figure 4 demonstrates the strength of the effect ≤13 where we see that 1mmHg in average blood pressure relates to .3 beats of HRV; conversely, 1 beat of HRV relates to 3.3 mmHg average blood pressure. Again, please zoom in to see the graphic more clearly.

Fig 4. Correlation Below 13 Beats

Discussion
The large difference in correlation below vs. above 13 beats suggests that the physiological mechanisms of blood pressure and HRV are closely linked in lower HRV ranges and less so in higher HRV ranges. Additional research to confirm these results and further characterize this “range” is warranted. The data is reasonably supportive of the Part I hypothesis that high blood pressure and high HRV are mutually exclusive as there are no instances where blood pressure is above normo-tensive and HRV is above 20 beats (our “Hi” HRV boundary). The full report also presents systolic and diastolic pressures and their correlation with HRV. Please visit www.coherence.com for more details.

Stephen is life scientist and President, COHERENCE L.L.C. in Allen, Texas (www.coherence.com)

Dee Edmonson, R.N., BCIAC-EEG practices neurotherapy at the Neurotherapy Center of Plano. (www.neurologics.us)

First, chronic pain is related to the supraspinal nervous system activity (ie. Thalamus, Insula, Sensory Cortices, Anterior Cingulate, and Prefrontal Cortex). Second, studies support that self-hypnosis has direct effects on the supraspinal sites. Third, self-hypnosis is effective in decreasing the severity of pain.

Also of interest, brief information on EEG brain activity associated with hypnosis is discussed. Specifically, beta activity (faster brainwaves) tends to decrease, while alpha activity (mixed slow and mid-range brainwaves) shows increases. Neurofeedback research substantiates that individuals can learn to alter their brainwaves; hence it is likely that an individual may be able to create a “hypnotic-like” state through neurofeedback training to enhance response to hypnotic suggestions.

The author discusses three possible ways to enhance the effectiveness of self-hypnosis that includes:

• “using virtual reality hypnosis,
• combining hypnosis with EEG-biofeedback (neurofeedback) training, and
• providing self-hypnosis training much earlier in the course of the development of a chronic pain problem.” (pg. 236)

Readers interested to read more on chronic pain management and neurofeedback/hypnosis are referred the to the October – December, 2009 issue of the Journal of Neurotherapy (p. 196-213) for another article by Mark P. Jensen, Ph.D., et. al.

Alan T. Fisher, Ph.D.

Reference
Jensen, M. (2009). Hypnosis for chronic pain management: A new hope. Pain, 146 (3, 5), 235-237.

Participants were randomly allocated to the Transcendental Meditation program or health education control group, and assessed with a standard test for depression – Center for Epidemiological Studies-Depression (CES-D) – over 9 to 12 months.

“Clinically meaningful reductions in depressive symptoms were associated with practice of the Transcendental Meditation program,” said Sanford Nidich, EdD, lead author and senior researcher at the Institute for Natural Medicine and Prevention at Maharishi University of Management. “The findings of these studies have important implications for improving mental health and reducing the risk of cardiovascular morbidity and mortality,” said Dr. Nidich.

(click to enlarge) This graph shows the reduced symptoms of depression through Transcendental Meditation in older adults at risk for CVD. Combined Study #1 and #2. N=112. (Credit: Maharishi University of Management)

Participants in both studies who practiced the Transcendental Meditation program showed significant reductions in depressive symptoms compared to health education controls. The largest decreases were found in those participants who had indications of clinically significant depression, with those practicing Transcendental Meditation showing an average reduction in depressive symptoms of 48%. Measurements with the Center for Epidemiological Studies Depression (CES-D) Rating Scale were taken at baseline, 3-month posttest, and 9-12 month posttest, comparing Transcendental Meditation to health education controls.

(click to enlarge) This graph shows the reduced symptoms of depression through Transcendental Meditation in older adults with indications of clinically significant depression. Combined Study #1 and #2. N=36. (Credit: Maharishi University of Management)

“These results are encouraging and provide support for testing the efficacy of Transcendental Meditation as a therapeutic adjunct in the treatment of clinical depression,” said Hector Myers, PhD, study co-author and professor and director of Clinical Training in the Department of Psychology at U.C.L.A.

The results of these studies are timely. For older Americans, depression is a particularly debilitating disease, with approximately 20% suffering from some form of depression. Overall, 18 million men and women suffer from depression in the United States. Depression is a major risk factor for cardiovascular disease, with even a moderate level of depressive symptoms associated with increased cardiac events.

“The clinically significant reductions in depression without drugs or psychotherapy in these studies suggest the Transcendental Meditation program may improve mental and associated physical health in older high risk subjects,” said Robert Schneider MD FACC, director of MUM’s Institute for Natural Medicine and Prevention.

“The importance of reducing depression in the elderly at risk for heart disease cannot be overestimated,” said Gary P. Kaplan MD PhD, Clinical Associate Professor of Neurology NYU School of Medicine. “Any technique not involving extra medication in this population is a welcome addition. I look forward to further research on the Transcendental Meditation technique and prevention of depression in other at-risk elderly populations, including those with stroke and other chronic diseases.”

Material adapted from Maharishi University of Management by CFisher.

James Orbinski’s, Sarah Harland Logan’s, and Sevil N-Marandi’s Viewpoint: Patents Skew Biomedical Research Toward Problems of the Rich World
If patents represent a bargain between the claimant to intellectual property (IP) and the state, and on balance should benefit society, a key question in this age of globalization is “which society?” The United Kingdom’s Royal Society, an independent academy of science, rightly argues that “uses of intellectual property that benefit people in one part of the world but conspicuously fail to benefit others, or even act to their detriment, are not what the [patent] system is supposed to be about” [40].

For developing countries, patents can impede medical care by pricing medicines and other health care technologies (HCTs) out of the reach of patients or their health care systems. Pharmaceutical companies have little interest in pricing drugs for developing country markets because they are seeking to maximize global not national profits, and do not want to set a low price precedent that would increase demand in wealthy countries for similar low prices [41]. For those with a purchasing power less than what is needed to meet minimal needs—i.e., most of the 3.8 billion people who live on less than US$2 per day [42]—access to HCTs is little more than a discomforting dream. Further, if a treatment is too expensive, other factors that can affect medicines availability, such as drug distribution systems and rational drug use policies, become moot. Indeed, it was only when generic competition lowered the price of antiretroviral therapy for HIV—from more than US$15,000 per patient per year in 2001 to less than US$99 in 2007—that the policy debate shifted from whether such therapy was possible in resource-poor settings to how to strengthen health infrastructure to provide comprehensive HIV health care for people in such settings [43, 44].

To increase access to existing HCTs, governments can make use of fully legal safety provisions of the World Trade Organization’s Trade in Intellectual Property Rights Agreement (TRIPS). These provisions include compulsory licensing, which allows a government to force a drug company to license its patent to a local generic producer who must pay a royalty to the patent holder. But a government is allowed to issue a compulsory license only after price negotiations with the patent holder have failed. Nevertheless, compulsory licensing remains a valuable tool, as memorably shown in 2001 when South Africa issued compulsory licenses to produce selected anttiretroviral drugs. Although 39 pharmaceutical companies attempted to sue South Africa’s government for allegedly infringing on their patent rights, they ultimately chose to withdraw this lawsuit in the face of immense public pressure [45]. The confrontation led the World Trade Organization to issue its November 2001 Doha Declaration, which affirmed that “the TRIPS Agreement does not and should not prevent members from taking measures to protect public health” [46].

Current patent laws also skew biomedical research to products that yield high profits rather than to global priority health needs in both developed and developing countries. Currently, malaria, pneumonia, diarrhea, and tuberculosis, which together account for 21% of the global disease burden, receive 0.31% of all public and private funds devoted to heath research [47],[48]. More than 1 billion people—the overwhelming majority of whom are in the developing world—suffer from neglected tropical diseases, those for which there are inadequate or nonexistent treatments and a paucity of research and development [49]. Of the 1,556 new pharmaceutical compounds that appeared on the market between 1975 and 2004, just twenty of these drugs—1.3%—were for tropical diseases and tuberculosis [50].

The international debate around patents has been largely framed in terms of “protection for” versus “access to” IP. If the framing of the debate shifts to a focus on research and development, this is likely to strengthen the leverage of developing countries to change the dynamics of IP negotiations in trade agreements [51]. Entirely shifting the debate from IP rights to the R&D gap may help tackle the fundamental problem of a monopoly-based innovation and access system. One example is nonexclusive licensing practices, such as those used by the not-for-profit Drugs for Neglected Diseases Initiative. The initiative finances R&D up front and offers the outcome of its research on a nonexclusive basis to generic producers, allowing for technology transfer and competition among multiple producers [51].

Furthermore, universities currently hold important patents on many life-saving drugs, including the antiretroviral drugs stavudine (Yale University), abacavir (University of Minnesota), lamivudine (Emory University), and enfuvirtide (Duke University) [52]. In recognition of these university patents, Universities Allied for Essential Medicines proposes that “when a university licenses a promising new drug candidate to a pharmaceutical company, it should require that the company allow the drug to be made available in poor countries at the lowest possible cost” [53]. Another alternative to overcoming current patent barriers is the use of patent pools, as proposed by the WHO, Médecins Sans Frontières, and UNITAID [54],[55]. Here, a number of patents held by different entities, such as companies, universities, or research institutes, are pooled and made available to others for production or further development—of, for example, pediatric formulations or fixed-dose formulations. The patent holders receive royalties that are paid by those who use the patents. The pool manages the licenses, the negotiations with patent holders, and the receipt and payment of royalties.

Other innovative policy proposals, such as the Heath Impact Fund (a strategy to create a publicly funded “pot of gold” that would attract the private sector to create R&D innovations that effectively address priority global heath needs) [56], should be implemented. However, using patents as the financial incentive to encourage the pharmaceutical industry to develop drugs for the world’s poor is of limited use where the market is nonexistent because neither governments nor patients can afford the end product [57]. Instead, framing the issue around global R&D, as opposed to international IP rights, will aid in developing public–private partnerships and a set of novel policy alternatives that support approaches to addressing the public health needs of developing nations [58].

The patent system as it affects access to and innovation for HCTs is broken. The system must be reformed so that public goods—such as genuine innovation and access to HCTs—are not sacrificed on the altar of private gain. This reform must prioritize the public good, use innovative policy tools to harness the private sector where it is possible to do so, and create public R&D capacity where market forces and actors are likely to continue to fail.

Material adapted by CFisher from:

Gold ER, Kaplan W, Orbinski J, Harland-Logan S, N-Marandi S, (2010). Are Patents Impeding Medical Care and Innovation?. PLoS Med 7(1): e1000208. doi:10.1371/journal.pmed.1000208

References
Please see the original open access article for the extensive reference list. Numbered references in this current article match the references in the original article.

The trial was sponsored by a $3.8 million grant from the National Institutes of Health–National Heart, Lung, and Blood Institute, and was conducted at The Medical College of Wisconsin in Milwaukee in collaboration with the Institute for Natural Medicine and Prevention at Maharishi University of Management in Fairfield, Iowa.

The nine-year, randomized control trial followed 201 African American men and women, average age 59 years, with narrowing of arteries in their hearts who were randomly assigned to either practice the stress-reducing Transcendental Meditation technique or to participate in a control group which received health education classes in traditional risk factors, including dietary modification and exercise. All participants continued standard medications and other usual medical care.

The study found:

• A 47 percent reduction in the combination of death, heart attacks, and strokes in the participants
• Clinically significant (5 mm Hg average) reduction in blood pressure associated with decrease in clinical events
• Significant reductions in psychological stress in the high-stress subgroup

According to Robert Schneider, M.D., FACC, lead author and director of the Center for Natural Medicine and Prevention, “Previous research on Transcendental Meditation has shown reductions in blood pressure, psychological stress, and other risk factors for heart disease, irrespective of ethnicity. But this is the first controlled clinical trial to show that long-term practice of this particular stress reduction program reduces the incidence of clinical cardiovascular events, that is heart attacks, strokes and mortality.”

“This study is an example of the contribution of a lifestyle intervention – stress management – to the prevention of cardiovascular disease in high-risk patients,” said Theodore Kotchen, M.D., co-author of the study, professor of medicine, and associate dean for clinical research at the Medical College. Other investigators at the Milwaukee site included Drs. Jane Kotchen and Clarence Grim.

Dr. Schneider said that the effect of Transcendental Meditation in the trial was like adding a class of newly discovered medications for the prevention of heart disease. “In this case, the new medications are derived from the body’s own internal pharmacy stimulated by the Transcendental Meditation practice,” he said.

Material adapted from Medical College of Wisconsin by CFisher.

Specifically, the study found the TM technique:

• Produces a unique state of “restful alertness,” as seen in the markedly higher alpha power in the frontal cortex and lower beta and gamma waves in the same frontal areas during TM practice.
• Creates greater alpha coherence between the left and right hemispheres of the brain suggesting the brain is working as a whole.
• Enhances an individual’s sense of “self” by activating what neuroscientists call the “default mode network” in the brain. (This is considered the natural ground state of the brain, glimpsed by neuroscientists during eyes-closed rest but more fully activated during Transcendental Meditation practice.)

(click to enlarge) These raw EEG tracings during eyes-closed rest (left) and Transcendental Meditation (right) represent 18 tracings over 6 seconds. The top tracings are from frontal sensors; the middle tracings are from central sensors; the bottom tracings are from parietal and occipital sensors (back). Note the high-density alpha activity in posterior leads during eyes-closed rest, and the global alpha bursts across all brain areas during Transcendental Meditation practice. Credit: Cognitive Processing, Volume 11 (2010), Issue 1

“The finding of significant brain wave differences between students practicing the Transcendental Meditation technique and those simply resting with their eyes closed is especially convincing because subjects were randomly assigned to conditions, and testing was conducted by a researcher unaware of the experimental condition to which the subject had been assigned,” said David Haaga, Ph.D., coauthor and professor of psychology at American University.

(click to enlarge) These are eLORETA images of sources of alpha EEG during TM compared to eyes-closed rest in the default mode network (the white areas). Credit: Cognitive Processing, Volume 11 (2010), Issue 1

“Research has already shown that simply closing one’s eyes and relaxing increases the default mode. A significant additional finding of this new study is that activity in the default mode increases during TM compared to simple eyes-closed rest,” said Fred Travis, Ph.D., lead author and director of the Center for Brain, Consciousness, and Cognition at Maharishi University of Management. “Different meditation techniques entail various degrees of cognitive control. Thus, activation patterns of the default mode network could give insight into the nature of meditation practices.”

Previous published research, funded by the NIH, shows TM practice decreases high blood pressure, atherosclerosis, cholesterol, stroke, and heart failure.

Material adapted from Maharishi University of Management by CFisher.

Some have worried that multivariable training with LZT is too complex for the trainee to comprehend.  Quite the contrary.  During the training, the subject is simply watching a DVD or animation, or playing a game, or listening to music or sounds.  The complex protocol calculations still control all feedback as if there were just another training variable.  The trainee experience can be whatever is conventional or familiar, relative to the “signaling” method.   The brain readily seizes on information that relates to a well-targeted state, regardless of the metrics underlying the state.  The fact that we can ride a bicycle demonstrates that we can readily integrate millions of bits of information into a cohesive whole, combined with the mind and body responses, and that it can become effortless.  The more comprehensive the information, the more likely the brain is to understand and interpret it.  And this is a brain process, not a conscious mental process.

This is not unlike the difference between simple muscle fitness training, versus a more comprehensive activity like dance or athletics.  When applied in a comprehensive whole-head training approach, live Z-scores transform neurofeedback into an entirely different kind of experience for the brain’s self-regulatory mechanisms.  Nonetheless, the trainee continues to watch movies, play simple games, listen to music, as before, and by allowing the training to occur, lets their brain learn a new and profound new set of activations and connections.

Currently, we encourage the majority of our users to use the comprehensive MVP method that incorporates all available Z-scores into a single metric.  We have enhanced it to include selective training functions, such as training only a specific metric (absolute power, relative power, etc), or training a certain class of metrics (“all connectivity metrics”).   In addition, we have included the ability to use different upper and lower limits.  This was necessitated by the experience with a man who had excessive amplitudes overall, reaching the level of 2-3 standard deviations in the dynamic scores.  When a window of + or – 3 standard deviations was used for training, the trainee’s EEG quickly changed to a very low amplitude EEG, and overshot the goal of zero.  Therefore, we offered the ability to provide different limits, and the trainee was trained using limits of +3 and -1 standard deviations.  This allowed effective feedback, while not rewarding the trainee for going too low.

Using a comprehensive approach, it also becomes possible to address the issue of normalization training versus peak-performance or mental-fitness training.  Based upon our experience with various peak-performers, we have identified certain combinations of features that are unique to them.  We also have subjective reporting data on individuals who undergo Z-score training, and who exhibit one or more of these characteristics.  Certain characteristics are generally identifiable as “good” and which reflect optimal functioning for that individual (but not necessarily all individuals).  Other characteristics may be observed, that are concordant with “complaints,” which might include issues with attention, mood, and so on (Collura et al., 2008).

The following figure shows an example of a display used in this approach.  Despite the complexity of the underlying computations, the display and its interpretation are relatively simple.  The system derives a metric which reflects a comprehensive analysis of all of the Z-scores, or a subset thereof.  The metric becomes the training variable, thus replacing the conventional amplitude or connectivity-based metric, and is significantly more comprehensive than a single Z-score.

The interpretation of the overall success rate is identical to that in any operant conditioning paradigm, and reflects the aggregate reward being experienced by the user.  The variables that can be adjusted to control feedback are the target size and the performance score required for the derived metric.  In the example shown, the required score is 70.0 percent, and the trainee is achieving this goal 50.4 percent of the time, on average.

Figure 2 (click to enlarge): Typical indicator screen used with a Multivariate Proportional (MVP) training protocol. Top: white: MVP training parameter; green: MVP target percentage threshold (70%), red: cumulative percent time above threshold (50.4%). Middle: size of target in standard deviations (1.2), Bottom: event flag indicating the times when the MVP parameter is above threshold.

One benefit of MVP-based protocols is that they can be biased for peak performance.  For example, among the attributes that may be selected for enhancement are global alpha coherence, resting motor strip SMR, reduced low-frequency coherence, or other variables.  These protocols thus combine the concept of brain normalization with that of brain optimization.

We refer to the example case presented by Mark Smith (April issue).  In this case, we have three NeuroGuide QEEG coherence maps obtained from a full 19-channel EEG assessment.  The first map shows the trainee at an early stage in this training experience.  Considerable coherence abnormalities (hypocoherences) are evident.  The second map shows the effects of conventional targeted coherence training, using the following plan:

1. Increase coherence of beta at F4/C4 to decrease seizures. (5 sessions)
2. Increase coherence of delta at P3/T5 to decrease seizures. (5 sessions)
3. Increase coherence of delta at F7/F8 to decrease seizures. (5 sessions)
4. Increase coherence of beta at C4/F8 to decrease seizures. (5 sessions)

The effects of the training are evident.  The targeted coherences have indeed moved toward normalization.  However, many coherences that were not targeted have changed, and not for the better.  Furthermore, delta coherences have become significantly worse.  This demonstrates the potential hazards of targeting single coherence measures along single connectivity paths.  The third (right) map shows the result after several sessions of z-score targeted coherence training.  It is evident that the z-score approach is indeed capable of targeting and normalizing coherences, leading to whole-brain normalization.

Figure 3 (click to enlarge): NeuroGuide coherence maps of case of Jack (Smith, April issue) showing High Beta (top) and Delta (bottom) coherences before training (left), after a conventionally targeted coherence training regimen (middle), and after z-score training (right).

These advanced z-score training methods are implemented in software, and are applied “on top” of the basic live Z-score software that is built into the ANI DLL.  This software is itself written in the form of a library, which can become available to other system developers who wish to incorporate this new form of training.

As an example of the ability to multivariate Z-Scores to resolve complex situations, the following pre- and post-treatment QEEGs are taken from a case that required only 23 sessions to produce the changes shown by Lambos and Stark (Collura et. al. 2008).  The trainee was a 12 year-old boy with problems related to impulsivity, behavior, discipline, and hyperactivity.  In amplitudes, he had abnormally high slow frontal activity, abnormally low fast frontal activity, and occipital abnormalities in delta and alpha.  These also manifested as many significantly abnormal asymmetries.  In addition, there was hypercoherence in essentially all frequency bands, and particularly at the very low and very high frequencies.

By using an MVP protocol, the clinicians were able to remediate essentially all of these abnormalities in 23 sessions, as shown on the QEEG.  Interestingly, one small emerging abnormality appears in the form of left frontal beta and high beta.  If anything, this slightly excessive activation of the left frontal lobe might reflect a benefit, which would be a brightening effect on the trainee’s mood.  These results are taken from the eyes-open condition, which was the training condition.  A different set of changes, also related to normalization of the EEG, was observed in the eyes-closed condition, indicating that the brain was learning self-regulation for both conditions, despite being trained with eyes-open only.

Figure 4 (click to enlarge): Pre- and Post-treatment NeuroGuide QEEG maps (eyes open) showing effects of 23 sessions of 4-channel Multivariate Proportional live Z-Score training.

Summary
The use of Z-Scores in itself is an important addition to neurofeedback, but it does not provide an “automatic” solution in and of itself.  It is not necessarily applicable to every trainee, and the idea of training everyone “to the norm” is not universally applicable.  It is necessary to understand and interpret the brain dynamics of the trainee, determine which types of normalization are appropriate, and design and use protocols that are suited to the case at hand.  In general, simply using a Z-Score as a target is not sufficient to produce normalization.  In many situations, it will be important to have a whole-head QEEG type of analysis for planning and interpretation of the LZT training.  It is also important to wisely use multiple channels and multiple targets, in order to give the brain the information it needs to achieve comprehensive improvements in self-regulation.

Thomas F. Collura, Ph.D.

Members of the International Society for Neurofeedback and Research (ISNR) receive NeuroConnections as a free benefit of membership. Healthcare professionals who specialize in neurofeedback, biofeedback or QEEG are encouraged to join ISNR to receive the full edition (in a full color printed format) of NeuroConnections and other member benefits. The above article was reprinted from NeuroConnections with permission from ISNR.

References:
Collura, T.F., Thatcher, R.W., Smith, M.L., Stark, C.R., and Lambos, W.A. (2008) Real-Time EEG Z-Score Training – Realities and Prospects, in: Evans, J., Arbanel, and Budzynsky, T., and Budzynski, H., Quantitative EEG and Neurofeedback, 2^nd Edition, Elsevier, in press.

Smith, M.L., (2008) Case Study – Jack, NeuroConnections, April issue

Stark, C. R. (2008) Consistent Dynamic Z-Score Patterns Observed During Z-Score Training Sessions—Robust Among Several Clients And Through Time For Each Client, NeuroConnections, April issue.

Thatcher, R., (2008) Z Score EEG Biofeedback: Conceptual Foundations. NeuroConnections, April issue

Walker, J.E.,  Kozlowski, G.P., and Lawson, R. (2007) A Modular Activation/Coherence Approach to Evaluating Clinical/QEEG Correlation and for Guiding Neurofeedback Training: Modular Insufficiencies, Modular Excesses, Disconnections, and Hyperconnections, Journal of Neurotherapy, 11(1) 25-44.

Acknowledgment:
The author wishes to thank Michael L. Smith for helpful comments and input on this article.

Disclaimer:
The author has a financial interest in BrainMaster Technologies, Inc. The advanced multivariate targeting method described herein is patent pending in the US, Canada, and Europe

In a nutshell, it recommends that adults exercise 45 minutes every day and do muscle strengthening activities involving all muscle groups at least 2 times a week. It recommends that children exercise for at least 1 hour every day. The health benefits that they report are both numerous and extensive. Click here to listen to the National Institutes of Health’s Joe Balintfy’s summary.

The 2008 Physical Activity Guidelines for Americans is the first-ever comprehensive recommendations on exercise by the federal government. It is pre-dated by the Surgeon General’s Report On Physical Activity And Health issued in 1996, which states, “Underpinning such recommendations is a growing understanding of how physical activity affects physiologic function. The body responds to physical activity in ways that have important positive effects on musculoskeletal, cardiovascular, respiratory, and endocrine systems. These changes are consistent with a number of health benefits, including a reduced risk of premature mortality and reduced risks of coronary heart disease, hypertension, colon cancer, and diabetes mellitus. Regular participation in physical activity also appears to reduce depression and anxiety, improve mood, and enhance ability to perform daily tasks throughout the life span.” Chapter 4 of the Surgeon General’s report presents a concise explanation of the effects of exercise on health and disease as of that time.

The 2008 Guidelines go on to make clear the health advantages of adequate exercise as well as recommendations on the type and frequency of exercise for people of different ages. Its intended to serve policy makers, health care professionals, educators, and the general public in moving America toward a more active lifestyle.  The findings are possibly best summarized by this from the Secretary’s of Health and Human Services opening letter, “We know that sedentary behavior contributes to a host of chronic diseases, and regular physical activity is an important component of an overall healthy lifestyle.” And from the Guidelines summary, “All Americans should avoid inactivity. Some physical activity is better than none, and adults who participate in any amount of physical activity gain some health benefits.”

Returning to the 2008 guidelines, this correspondent was hopeful that the report would expound on the Surgeon General’s “growing understanding” of the physiological mechanisms that yield the many health benefits that accrue from regular exercise, but the recommendation is completely devoid of such information. Instead, it focuses almost exclusively on statistical outcomes that justify the exercise recommendations, which of course is necessary.

The development of the 2008 Physical Activity Guidelines was an outcome of a 2006 initiative by the DHHS to determine if there was sufficient evidence to create a such a comprehensive set of guidelines in the first place. It culminated in an October 2006 workshop of the Boards of Food and Nutrition, and Population Health and Public Health Practice, both of the Institute of Medicine, titled “Adequacy of Evidence for Physical Activity Guidelines”.

The goal of the workshop was to conduct a review of all relevant evidence relating to physical activity and the general population where (to be consistent with the FDA) the 5 areas of evidence are: efficacy, effectiveness, dose, potential adverse events, and “mechanisms of action,” recognizing that there may be more than one mechanism relating to a single health benefit. Yet in this document there are only 4 instances of the use of the term “mechanisms of action” with no supporting discussion.

In summary, the 2008 Physical Activity Guidelines present strong evidence that exercise is critical to health and well-being, and it presents equally strong recommendations for every American to engage in physical activity. It offers clear advice on what the health benefits of exercise are. It also offers recommendations on what types of exercise we might engage in to realize these benefits. But alas, in the 14 years since the Surgeon General’s report, there seems to be little knowledge either gained or published explaining “how” or “why” exercise improves health and mitigates disease.

Stephen Elliott is the principal author of The New Science of Breath and Coherent Breathing – The Definitive Method and the primary inventor of Valsalva Wave Pro, an instrument that allows observation and training of the arterial/venous blood wave that occurs in the circulatory system when breathing “coherently”.

Stephen is President of COHERENCE L.L.C. in Allen, Texas

Electroconvulsive Therapy
First developed in 1938, electroconvulsive therapy (ECT) for years had a poor reputation with many negative depictions in popular culture. However, the procedure has improved significantly since its initial use and is safe and effective. People who undergo ECT do not feel any pain or discomfort during the procedure.

Electroconvulsive Therapy (ECT)

ECT is usually considered only after a patient’s illness has not improved after other treatment options, such as antidepressant medication or psychotherapy, are tried. It is most often used to treat severe, treatment-resistant depression, but occasionally it is used to treat other mental disorders, such as bipolar disorder or schizophrenia. It also may be used in life-threatening circumstances, such as when a patient is unable to move or respond to the outside world (e.g., catatonia), is suicidal, or is malnourished as a result of severe depression. One study, the Consortium for Research in ECT study, found an 86 percent remission rate for those with severe major depression(a). The same study found it to be effective in reducing chances of relapse when the patients underwent follow-up treatments(b).

How does it work?
Before ECT is administered, a person is sedated with general anesthesia and given a medication called a muscle relaxant to prevent movement during the procedure. An anesthesiologist monitors breathing, heart rate and blood pressure during the entire procedure, which is conducted by a trained physician. Electrodes are placed at precise locations on the head. Through the electrodes, an electric current passes through the brain, causing a seizure that lasts generally less than one minute.

Scientists are unsure how the treatment works to relieve depression, but it appears to produce many changes in the chemistry and functioning of the brain. Because the patient is under anesthesia and has taken a muscle relaxant, the patient’s body shows no signs of seizure, nor does he or she feel any pain, other than the discomfort associated with inserting an IV.

Five to ten minutes after the procedure ends, the patient awakens. He or she may feel groggy at first as the anesthesia wears off. But after about an hour, the patient usually is alert and can resume normal activities.

A typical course of ECT is administered about three times a week until the patient’s depression lifts (usually within six to 12 treatments). After that, maintenance ECT treatment is sometimes needed to reduce the chance that symptoms will return. ECT maintenance treatment varies depending on the needs of the individual, and may range from one session per week to one session every few months. Frequently, a person who underwent ECT will take antidepressant medication or a mood stabilizing medication as well.

What are the side effects?
The most common side effects associated with ECT are headache, upset stomach, and muscle aches. Some people may experience memory problems, especially of memories around the time of the treatment. People may also have trouble remembering information learned shortly after the procedure, but this difficulty usually disappears over the days and weeks following the end of an ECT course. It is possible that a person may have gaps in memory over the weeks during which he or she receives treatment(c).

Research has found that memory problems seem to be more associated with the traditional type of ECT called bilateral ECT, in which the electrodes are placed on both sides of the head. Unilateral ECT, in which the electrodes are placed on just one side of the head—typically the right side because it is opposite the brain’s learning and memory areas—appears less likely to cause memory problems and therefore is preferred by many doctors. In the past, a “sine wave” was used to administer electricity in a constant, high dose. However, studies have found that a “brief pulse” of electricity administered in several short bursts is less likely to cause memory loss, and therefore is most commonly used today (d).

Vagus Nerve Stimulation
Vagus nerve stimulation (VNS) works through a device implanted under the skin that sends electrical pulses through the left vagus nerve, half of a prominent pair of nerves that run from the brainstem through the neck and down to each side of the chest and abdomen. The vagus nerves carry messages from the brain to the body’s major organs like the heart, lungs and intestines, and to areas of the brain that control mood, sleep, and other functions.

Vagus Nerve Stimulation

VNS was originally developed as a treatment for epilepsy. However, it became evident that it also had effects on mood, especially depressive symptoms. Using brain scans, scientists found that the device affected areas of the brain that are also involved in mood regulation. The pulses also appeared to alter certain neurotransmitters (brain chemicals) associated with mood, including serotonin, norepinephrine, GABA and glutamate(e).

In 2005, the U.S. Food and Drug Administration (FDA) approved VNS for use in treating major depression in certain circumstances—if the illness has lasted two years or more, if it is severe or recurrent, and if the depression has not eased after trying at least four other treatments. Despite FDA approval, VNS remains a controversial treatment for depression because results of studies testing its effectiveness in treating major depression have been mixed.

How does it work?
A device called a pulse generator, about the size of a stopwatch, is surgically implanted in the upper left side of the chest. Connected to the pulse generator is a lead wire, which is guided under the skin up to the neck, where it is attached to the left-side vagus nerve.

Typically, electrical pulses that last about 30 seconds are sent about every five minutes from the generator to the vagus nerve. The duration and frequency of the pulses may vary depending on how the generator is programmed. The vagus nerve, in turn, delivers those signals to the brain. The pulse generator, which operates continuously, is powered by a battery that lasts around 10 years, after which it must be replaced. Normally, a person does not feel any sensation in the body as the device works, but it may cause coughing or the voice may become hoarse while the nerve is being stimulated.

The device also can be temporarily deactivated by placing a magnet over the chest where the pulse generator is implanted. A person may want to deactivate it if side effects become intolerable, or before engaging in strenuous activity or exercise because it may interfere with breathing. The device reactivates when the magnet is removed.

What are the side effects?
VNS is not without risk. There may be complications such as infection from the implant surgery, or the device may come loose, move around or malfunction, which may require additional surgery to correct. Long-term side effects are unknown.

Other potential side effects include:

• Voice changes or hoarseness
• Cough or sore throat
• Neck pain
• Discomfort or tingling in the area where the device is implanted
• Breathing problems, especially during exercise
• Difficulty swallowing

Repetitive Transcranial Magnetic Stimulation
Repetitive transcranial magnetic stimulation (rTMS) uses a magnet instead of an electrical current to activate the brain. First developed in 1985, rTMS has been studied as a possible treatment for depression, psychosis and other disorders since the mid-1990′s.

Repetitive Transcranial Magnetic Stimulation

Clinical trials studying the effectiveness of rTMS reveal mixed results. When compared to a placebo or inactive (sham) treatment, some studies have found that rTMS is more effective in treating patients with major depression(f). But other studies have found no difference in response compared to inactive treatment(g).

In October 2008, rTMS was approved for use by the FDA as a treatment for major depression for patients who have not responded to at least one antidepressant medication. It is also used in countries such as in Canada and Israel as a treatment for depression for patients who have not responded to medications and who might otherwise be considered for ECT.

How does it work?
Unlike ECT, in which electrical stimulation is more generalized, rTMS can be targeted to a specific site in the brain. Scientists believe that focusing on a specific spot in the brain reduces the chance for the type of side effects that are associated with ECT. But opinions vary as to what spot is best.

A typical rTMS session lasts 30 to 60 minutes and does not require anesthesia. An electromagnetic coil is held against the forehead near an area of the brain that is thought to be involved in mood regulation. Then, short electromagnetic pulses are administered through the coil. The magnetic pulse easily passes through the skull, and causes small electrical currents that stimulate nerve cells in the targeted brain region. And because this type of pulse generally does not reach further than two inches into the brain, scientists can select which parts of the brain will be affected and which will not be. The magnetic field is about the same strength as that of a magnetic resonance imaging (MRI) scan. Generally, the person will feel a slight knocking or tapping on the head as the pulses are administered.

Not all scientists agree on the best way to position the magnet on the patient’s head or give the electromagnetic pulses. They also do not yet know if rTMS works best when given as a single treatment or combined with medication. More research, including a large NIMH-funded trial, is underway to determine the safest and most effective use of rTMS.

What are the side effects?
Sometimes a person may have discomfort at the site on the head where the magnet is placed. The muscles of the scalp, jaw or face may contract or tingle during the procedure. Mild headache or brief lightheadedness may result. It is also possible that the procedure could cause a seizure, although documented incidences of this are uncommon. A recent large-scale study on the safety of rTMS found that most side effects, such as headaches or scalp discomfort, were mild or moderate, and no seizures occurred(h). Because the treatment is new, however, long-term side effects are unknown.

Magnetic Seizure Therapy
Magnetic seizure therapy (MST) borrows certain aspects from both ECT and rTMS. Like rTMS, it uses a magnetic pulse instead of electricity to stimulate a precise target in the brain. However, unlike rTMS, MST aims to induce a seizure like ECT. So the pulse is given at a higher frequency than that used in rTMS. Therefore, like ECT, the patient must be anesthetized and given a muscle relaxant to prevent movement. The goal of MST is to retain the effectiveness of ECT while reducing the cognitive side effects usually associated with it.

MST is currently in the early stages of testing, but initial results are promising. Studies on both animals and humans have found that MST produces fewer memory side effects, shorter seizures, and allows for a shorter recovery time than ECT (i, j). However, its effect on treatment-resistant depression is not yet established. Studies are underway to determine its antidepressant effects.

Deep Brain Stimulation
Deep brain stimulation (DBS) was first developed as a treatment for Parkinson’s disease to reduce tremor, stiffness, walking problems and uncontrollable movements. In DBS, a pair of electrodes is implanted in the brain and controlled by a generator that is implanted in the chest. Stimulation is continuous and its frequency and level is customized to the individual.

Deep Brain Stimulation

DBS has only recently been studied as a treatment for depression or obsessive compulsive disorder (OCD). Currently, it is available on an experimental basis only. So far, very little research has been conducted to test DBS for depression treatment, but the few studies that have been conducted show that the treatment may be promising. One small trial involving people with severe, treatment-resistant depression found that four out of six participants showed marked improvement in their symptoms either immediately after the procedure, or soon after (k). Another study involving 10 people with OCD found continued improvement among the majority three years after the surgery.12

How does it work?
DBS requires brain surgery. The head is shaved and then attached with screws to a sturdy frame that prevents the head from moving during the surgery. Scans of the head and brain using MRI are taken. The surgeon uses these images as guides during the surgery. Patients are awake during the procedure to provide the surgeon with feedback, but they feel no pain because the head is numbed with a local anesthetic.

Once ready for surgery, two holes are drilled into the head. From there, the surgeon threads a slender tube down into the brain to place electrodes on each side of a specific part of the brain. In the case of depression, the part of the brain targeted is called Area 25. This area has been found to be overactive in depression and other mood disorders (l). In the case of OCD, the electrodes are placed in a different part of the brain believed to be associated with the disorder.

After the electrodes are implanted and the patient provides feedback about the placement of the electrodes, the patient is put under general anesthesia. The electrodes are then attached to wires that are run inside the body from the head down to the chest, where a pair of battery-operated generators are implanted. From here, electrical pulses are continuously delivered over the wires to the electrodes in the brain. Although it is unclear exactly how the device works to reduce depression or OCD, scientists believe that the pulses help to “reset” the area of the brain that is malfunctioning so that it works normally again.

What are the side effects?
DBS carries risks associated with any type of brain surgery. For example, the procedure may lead to:

• Bleeding in the brain or stroke
• Infection
• Disorientation or confusion
• Unwanted mood changes
• Movement disorders
• Lightheadedness
• Trouble sleeping

What research is underway on brain stimulation therapies?
Brain stimulation therapies hold promise for treating certain mental disorders that do not respond to more conventional treatments. Therefore, they are of high interest and are the subject of many studies. For example, researchers continue to look for ways to reduce the side effects of ECT while retaining the benefits. Studies on rTMS are ongoing and include a trial in which the procedure is being tested for safety and effectiveness for the treatment of major depression in 240 participants. Similar studies are being conducted using MST.

Other researchers are studying how the brain responds to VNS by using imaging techniques such as PET scans. Finally, although DBS as a depression treatment is still very new, researchers are beginning to conduct studies with people to determine its effectiveness and safety in treating depression, OCD and other mental disorders. Because the procedure is still experimental, other side effects that are not yet identified may be possible. Long-term benefits and side effects are unknown.

Material adapted from the National Institutes of Health (with permission) by CFisher

References:
(a) Kellner CH, Knapp RG, Petrides G, Rummans TA, Husain MM, Rasmussen K, Mueller M, Berstein HJ, O-Connor K, Smith G, Biggs M, Bailine SH, Malur C, Yim E, McClintock S, Sampson S, Fink M. Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: a multisite study from CORE. Archives of General Psychiatry. 2006 Dec;63(12):1337-1344.

(b) Fink M, Taylor MA. Electroconvulsive therapy. Evidence and challenges. Journal of the American Medical Association. 2007 Jul 18; 298(3): 330-332.

(c) Dukakis K, Tye L. Shock: The healing power of electroconvulsive therapy. New York: Avery, 2006.

(d) Sackeim HA, Prudic J, Fuller R, Keilp J, Lavori PW, Olfson M. The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology. 2007 Jan;32(1): 244-254.

(e) George MS, Sackeim HA, Rush AH, Marangell LB, Nahas Z, Husain MM, Lisanby S, Burt T, Goldman J, Ballenger JC. Vagus nerve stimulation: a new tool for brain research and therapy. Biological Psychiatry. 2000 Feb 15;47(4):287-295.

(f) Fitzgerald PB, Brown TL, Marston NA, Daskalakis ZJ, De Castella A, Kulkarni J. Transcranial magnetic stimulation in the treatment of depression: a double-blind placebo-controlled trial. Archives of General Psychiatry. 2003 Oct;60(10):1002-1008.

(g) Loo CK, Mitchell PB, Croker VM, Malhi GS, Wen W, Gandevia SC, Sachdev PS. Double-blind controlled investigation of bilateral prefrontal transcranial magnetic stimulation for the treatment of resistant major depression. Psychological Medicine. 2003 Jan;33(1):33-40.

(h) Janicak PG, O-Reardon JP, Sampson SM, Husain MM, Lisanby SH, Rado JT, Heart KL, Demitrack MA. Transcranial magnetic stimulation in the treatment of major depressive disorder: a comprehensive summary of safety experience from acute exposure, extended exposure, and during reintroduction treatment. Journal of Clinical Psychiatry. 2008 Feb;69(2):222-232.

(i) Lisanby SH, Luber B, Schaepfer TE, Sackeim HA. Safety and feasibility of magnetic seizure therapy (MST) in major depression: randomized within-subject comparison with electroconvulsive therapy. Neuropsychopharmacology. 2003 Oct; 28(10):1852-1865.

(j) Spellman T, McClintock SM, Terrace H, Luber B, Husain MM, Lisanby SH. Differential effects of high-dose magnetic seizure therapy and electroconvulsive shock on cognitive function. Biological Psychiatry.2008 Jun 15;63(12):1163-1170.

(k) Mayberg HS, Lozano AM, Voon V, McNeely HE, Seminowicz D, Hamani C, Schwalb JM, Kennedy SH. Deep brain stimulation for treatment-resistant depression. Neuron. 2005 Mar 3; 45(5):651-660.

(l) Greenberg BD, Malone DA, Friehs GM, Rezai AR, Kubu CS, Malloy PF, Salloway SP, Okun MS, Goodman WK, Rasmussen SA. Three-year outcomes in deep brain stimulation for highly resistant obsessive compulsive disorder. Neuropsychopharmacology. 2006 Nov; 31(11):2384-2393.

Introduction To Cranial Electrotherapy Stimulation
Readers not familiar with CES may want to first review “What Is Cranial Electrotherapy Stimulation?” Part 1 and Part 2 to better understand this article. The Part 1/2 series details CES’ effectiveness to treat conditions like depression and anxiety in non-TBI populations and provides important data on potential side effects and risks.

What Is Mild Traumatic Brain Inquiry and Post-Concussion Syndrome?
The Defense and Veterans Brain Injury Center Working Group’s operational definition of mBTI is: “Mild TBI in military operational settings is defined as an injury to the brain resulting from an external force and/or acceleration/deceleration mechanism from an event such as a blast, fall, direct impact, or motor vehicle accident which causes an alteration in mental status typically resulting in the temporally related onset of symptoms such as: headache, nausea, vomiting, dizziness/balance problems, fatigue, insomnia/sleep disturbances, drowsiness, sensitivity to light/ noise, blurred vision, difficulty remembering, and/or difficulty concentrating” (p. 2). This mTBI definition is noteworthy and preferred (in my opinion) because of its requirement of an “alteration” of mental status, rather than a loss of consciousness (LOC). This is consistent with current research that suggests that a LOC may not be a common symptom in mTBI, despite the common perception that it is (McCrea, 2008).

Post Concussion Syndrome may be assigned to persons that experience symptoms presumably related to a prior head injury for longer than three months. The American Psychiatric Association (APA) gives preliminary diagnostic criteria for PCS in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) under “Criteria Sets and Axes Provided for Further Study.” These include (summarized): (1) History of head trauma with a significant cerebral concussion that include loss of consciousness, post-traumatic amnesia, and less commonly, seizure onset, (2) Neuropsychological testing or objective cognitive assessment verification of attention or memory difficulties, (3) Three or more of the following symptoms temporally related to the TBI for at least 3 months: fatigue, disordered sleep, headache, dizziness, irritability or aggression, anxiety, depression, or affective lability, personality change, and apathy or loss of spontaneity (4) The symptoms cause a significant impairment in social or occupational functioning As seen above, mTBI and PCS have similar diagnostic criteria.

As can be seen, one primary distinguishing characteristic between mTBI and PCS is the length of time since injury.

Overview of Controlled CES For mTBI Studies
Smith, Tiber, & Marshall (1994) administered CES (CES Labs brand device) for 45 minutes, 4 times per week for 3 weeks, to patients with closed head injuries using a randomized design with placebo and double-blind controls (n=21). The average time since injury was 11 years (SD=8.91). They reported significant improvements on all mood measures, including tension/anxiety, depression/dejection, anger/hostility, fatigue/inertia, confusion/bewilderment, and total mood disturbance. Prior to the start of the study, 86% of the subjects were being treated for seizures with anti-seizure medication. None of the subjects in the CES treatment group experienced seizures through the time period under study, though one subject in the sham treatment group had a seizure.

Michals, Crismon, Misko, & Childs (1993) investigated CES for the treatment of posttraumatic memory impairment in individuals with head injuries using a double-blind, sham-controlled research design. The average time since injury was 4.23 years (SD=4.46). A Neurotone III CES device was used for 40 minutes per day over 4 weeks. Short-term or delayed recall measures did not evidence significant improvement. The researchers recommended that further investigation is warranted using devices with different electrical wave forms and amplitudes. Importantly, none of the subjects in this study experienced significant or long lasting side effects. It is worth mentioning that memory improvements have been found in CES single case studies with head injured patients, using Alpha-Stim, a device that uses a wave form that is different from the Neurotone III’s wave form. For example, Childs & Crismon (1988) reported improvement in immediate and delayed memory recall in a report of 2 case studies with TBI.

Conclusion
Cranial Electrotherapy Stimulation (CES) represents one promising treatment for the lingering symptoms of mTBI and PCS. The initial evidence presented here suggests that CES may be a safe treatment for mTBI/PCS and that CES may be able to significantly reduce longstanding and presumably treatment resistant symptoms. Additional large scale controlled studies are needed to better estimate CES’ safety and effectiveness with these conditions, as well as to determine if devices with different wave forms can help improve memory.

Enjoy.

CFisher

*Undifferentiated somatoform disorder is characterized by (summarized) 1 or more physical complaints (fatigue, loss of appetite, gastrointestinal, or urinary) lasting at least 6 months that cannot be explained by a medical evaluation and is not faked. See the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition (Text Revision) for a completion definition.

References:

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, D.C.

Childs, A., & Crismon, M. (1988). The use of cranial electrotherapy stimulation in post-traumatic amnesia: A report of two cases. Brain Injury, 2(3), 243-247.

Defense and Veterans Brain Injury Center Working Group on the Acute Management of Mild Traumatic Brain Injury in Military Operational Settings (2006). Clinical Practice Guideline and Recommendations. Retrieved September 15, 2008, from http://dvbic.org/public_html/pdfs/clinical_practice_guideline_recommendations.pdf.

McCrea, M. (2008). Mild Traumatic Brain Injury and Postconcussion Syndrome: The New Evidence Base for Diagnosis and Treatment. Oxford University Press (Oxford Workshop Series): New York.

Michals, M., Crismon, M., Misko, J., & Childs, A. (1993). A double-blind, sham controlled evaluation of cranial electrotherapy stimulation in posttraumatic memory impairment. Journal of Head Trauma and Rehabilitation, 8(4), 77-86.

Smith, R., Tiber, A., & Marshall, J. (1994). The use of cranial electrotherapy stimulation in the treatment of closed-head-injured patients. Brain Injury, 8(4), 357-361.

CES Mechanism of Action
Although the exact mechanism of action for CES, including Alpha-Stim, are not known, Alpha-Stim’s pulsed electrical currents are believed to affect the limbic system, the reticular activating system, and/or the hypothalamus (Gilula & Kirsch, 2005) and to stimulate regions that control pain messages, neurotransmitter creation, and hormone production via the hypothalamic-pituitary axis (Kirsch & Smith, 2004).

Alexander Bystritsky (2008) provided an excellent technical overview of the current state of knowledge in regard to CES’ mechanism of action. Readers are encouraged to read his paper. Dr. Bystrisky states that,

“Some of the signals from these afferent nerves eventually reach the ventral posteromedial nucleus of the thalamus. Animal studies indicate that 42% to 46% of CES current enters the brain, with the highest levels of current recorded in the thalamus. The thalamus is a region that seems to be important in the pathophysiology of anxiety. Evidence of this comes from positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) studies in GAD patients, which show changes in thalamic activity (as well as in other regions) with medication treatments. A single photon emission computed tomography (SPECT) study in other anxiety disorders including obsessive-compulsive disorder, post-traumatic stress disorder, and social anxiety disorder also found decreases in thalamic activity with treatment with the medication citalopram. Therefore, CES could hypothetically exert anxiolytic effects by affecting the thalamus and/or its afferent pathways. Future neuroimaging studies examining the brain regions and circuits associated with CES treatment will be needed to understand its mechanism of action” (pgs. 415-416).

Dr. Bystritsky went on to hypothesize that CES may also reset the brain to prestress homeostasis levels – this has important treatment implications for post-traumatic stress disorder (PTSD) and substance dependence, which may explain the current research interest in these areas.

CES And QEEG
Kennerly (2006) found that persons treated with CES for 20 minutes exhibited significant changes in the EEG, including increased alpha (8-12Hz) relative power and decreased relative power in the delta (0–3.5Hz) and beta (12.5-30Hz) frequencies. Increased alpha typically correlates with improved relaxation and possibly increased mental alertness or clarity (Thompson & Thompson, 2003), while decreased delta suggests reduced drowsiness. Beta reductions were exhibited mostly between 20-30Hz and this frequency band correlates with reductions in anxiety, ruminative thought, and obsessive/compulsive-like behaviors (Demos, 2005). Kennerly further reported that quantitative electroencephalography (qEEG) and low resolution electromagnetic tomography (LORETA) analyses showed that the electrical pulses generated by the Alpha-Stim reached all cortical and subcortical areas of the brain.

CES Treatment Effectiveness
Based on qualitative criteria recommended by Kirsch & Gilula (2007a), large effect sizes (i.e., >.50) are well established across a number of controlled and uncontrolled studies in the Alpha-Stim treatment of a wide variety of psychological and physical disorders (Kirsch & Smith, 2004; Kirsch & Gilula, 2007a; Kirsch & Gilula, 2007b; Kirsch & Gilula, 2007c; Kirsch & Gilula, 2007d; Matteson & Ivancevich, 1986; Moore, 1975; Rosenthal & Wulfsohn, 1970; Rosenthal, 1972; Smith & O’Neill, 1975).

Depression and Anxiety
A meta-analysis of CES for depression that included 20 studies and 975 subjects revealed a mean effect size rating of .50 (Kirsch & Gilula, 2007c; Kirsch & Gilula, 2007d). A meta-analysis of CES for anxiety which included 41 studies comprising 2049 participants found a mean effect size ratings of .57. This large effect size decreased to .53 using only double-blinded studies in the analysis (Kirsch & Gilula, 2007a; Kirsch & Gilula, 2007b). A recent uncontrolled pilot study into CES for chronic and pervasive anxiety (i.e., generalized anxiety disorder) found a 50% average reduction in self-reported anxiety by a majority of treatment completers (Bystritsky, Kerwin, & Feusner, 2008).

Insomnia
A meta-analysis of 20 studies involving 1083 participants that received CES for sleep difficulties (mostly insomnia) was recently completed. CES for insomnia achieved a mean effect size rating of .64 (Kirsch & Gilula, 2007e).

Chronic Pain
There are no known meta-analyses currently published for CES for chronic pain (i.e., headache). Soloman et al. (1989) conducted a randomized, double blind study with 100 men and women receiving outpatient care for chronic tension headache. All participants had received analgesic therapy for at least 1 year and had a minimum of 4 headaches a month for inclusion into the study. The researchers reported a statistically significant 35% reduction in pain severity scores. The percent of participants that reported statistically significant subjective headache improvement following CES treatment compared to the control group were: 12% “highly effective,” 24% “moderately effective,” 26% “minimally effective,” and 38% “not effective.”

Summary
CES for the treatment of anxiety, depression, and insomnia achieved impressive effect sizes in the studies reviewed. CES for chronic pain produced acceptable results given that participants had chronic headaches (1 year or longer) that were presumably treatment non-responsive to frontline medications.

In my experiences, CES and neurofeedback can be complementary treatments for some patients. Patients often seek treatment in a crisis and need immediate relief. Neurofeedback is not known for its immediate results and usually takes extended sessions to realize significant gains. The addition of CES provides immediate symptom relief (often the very first session), which allows neurotherapy to continue with significantly less patient stress and possibly improved outcomes (based on personal experience – not research). Kennerly’s QEEG study described above provides guidance as to who might respond to CES treatment, alone or combined with neurotherapy.

On a final note, I personally believe that Alpha-Stim, a prominent brand of CES, remains one of the most underused, cost-effective treatments on market. Alpha-Stim is a safe and effective treatment for anxiety, depression, and insomnia with mild and time-limited side effects that can be used in conjunction with most psychotropic medications (Childs & Price, 2007). I am quite frankly perplexed as to why CES is not prescribed more often, especially for persons who do not respond to front-line treatments.

Enjoy.

CFisher

References
Please see Part 1 of this series for a complete list of references.

The study, called the Biomarkers for Rapid Identification of Treatment Effectiveness in Major Depression, or BRITE-MD, measured changes in brain-wave patterns using quantitative electroencephalography (QEEG), a non-invasive, computerized measurement that recognizes specific alterations in brain-wave activity. These changes precede improvement in mood by many weeks and appear to serve as a biomarker that accurately predicts how effective a given medication will be. The study results appear in two articles published in the September issue of the journal Psychiatry Research.

Nine sites around the country collaborated on the study, which enrolled a total of 375 people who had been diagnosed with major depressive disorder (MDD). Each individual was given a baseline QEEG at the beginning of the trial and then prescribed the antidepressant escitalopram, commonly known as Lexapro, one of a class of drugs known as selective serotonin re-uptake inhibitors that are commonly prescribed for depression. After one week, a second QEEG was taken. The researchers examined a biomarker called the antidepressant treatment response (ATR) index — a specific change in brain-wave patterns from the baseline QEEG.

Subjects were then randomly assigned to continue with escitalopram or were given a different drug. A total of 73 patients who remained on escitalopram were tracked for 49 days to see if their results matched the prediction of the ATR biomarker. The ATR predicted both response and remission with an accuracy rate of 74 percent, much higher than any other method available. The researchers also found that they could predict whether subjects were more likely to respond to a different antidepressant, bupropion, also known as Wellbutrin XL.

“Until now, other than waiting, there has been no reliable method for predicting whether a medication would lead to a good response or remission,” said Dr. Andrew Leuchter, professor of psychiatry at the Semel Institute for Neuroscience and Human Behavior at UCLA and lead author of the study. “And that wait can be as long as 14 weeks. So these are very exciting findings for the patient suffering from depression. The BRITE results are a milestone in our efforts to develop clinically useful biomarkers for predicting treatment response in MDD.”

Major depressive disorder is a leading cause of disability, costing society in excess of $80 billion annually; approximately two-thirds of these costs reflect the enormous disability associated with the disorder. An estimated 15 million people in the United States experience a depressive episode each year, and nearly 17 percent of adults will experience major depression in their lifetime.

“BRITE study results suggest that the ATR biomarker could potentially provide the greatest clinical benefit for those patients who might be receiving a medication that is unlikely to help them,” Leuchter said. “Our results suggest that it may be possible to switch these patients to a more effective treatment quickly. This would help patients and their physicians avoid the frustration, risk and expense of long and ineffective medication trials.”

Leuchter noted that research has shown that depression patients who do not get better with a first treatment experience prolonged suffering, are more likely to abandon treatment altogether and may become more resistant to treatment over time.

“So the benefits to the individual and to society are enormous,” he said.

An added benefit of the biomarker test, according to Leuchter, is that it is non-invasive, painless and fast — about 15 minutes — and only involves the placement of six electrodes around the forehead and on the earlobes.

Aspect Medical Systems, which developed the ATR biomarker, provided financial support for the study. Aspect also participated in the design and conduct of the study; the collection, management, analysis and interpretation of the data; and the preparation and review of the manuscript. Final approval of the form and content of the manuscript rested with the authors.

Other UCLA authors included Dr. Ian Cook, Dr. Karl S. Burgoyne and Dr. James T. McCracken. Leuchter is chair of Aspect’s neuroscience advisory board and has provided scientific consultation to them.

The Semel Institute for Neuroscience and Human Behavior is an interdisciplinary research and education institute devoted to the understanding of complex human behavior, including the genetic, biological, behavioral and sociocultural underpinnings of normal behavior and the causes and consequences of neuropsychiatric disorders. In addition to conducting fundamental research, institute faculty seek to develop effective treatments for neurological and psychiatric disorders, improve access to mental health services and shape national health policy regarding neuropsychiatric disorders.

Adapted from the UCLA Newsroom

Enjoy.

CFisher

In order to look forward, it is instructive to look back, and to view our work in the context of our historical and anthropological development. Suppose an anthropologist visits earth from another planet, and is assigned the task of making a brief summary of human technical and cultural development, up to the current time. Something like the following graph might result.

Figure 1. (click to enlarge) Technical/Cultural Revolution

Approximately 100,000 years ago, humans were hunters and gatherers. Skills involved traveling, searching, trapping, killing, transporting, and using simple weapons and tools. Basic teamwork became essential to survival. Successful hunters were hyper-vigilant, being occupied with both finding dinner, and making sure they did not become something else’s dinner. It was essential to constantly be on the lookout, finding game, chasing it down, and catching it. Those who survived in this environment had many of the qualities we now associate with “attention deficit disorder” and “hyperactivity.” But these are useful skills, in the right context.

About 10,000 years ago, agriculture was discovered. People learned to stay in one place, watching the stars, clouds, moon, and weather. It was necessary to carefully study plants and their environment, recognize good things to eat, and recognize things that were not good to eat. It was necessary to cultivate, remove weeds, and know when planted foods were ready. Preparation of food by grinding, cooking, and preserving became important. Calendars and timekeeping, hence mathematics, now had survival value. The mind-set associated with these activities were in strong contrast to the previous 90,000 years. This mind-set now predominates in education. We are expected to sit still, study, concentrate, and be quite happy without stimulation, excitement, or adventure. If we are not happy with this, there are drugs we can take to stifle our need for novelty and exploration. We classify our more restless individuals as sick, disabled, and suffering from a disease.

We see further that there was an industrial revolution characterized by wheels, machines, factories, and cities. Following that, an information revolution was brought about through communications, computers, and automation. Many of us have seen the information revolution firsthand. From room-sized computers that could barely handle a few thousand calculations per second, we now have powerful processors in our handheld personal computers, wireless telephones, televisions, and music players. Within 5 years, these appliances will merge into one. After that, something wearable or even implantable will appear, that plays directly into the ears and eyes of the user. We will be able to communicate, do business, be entertained, and study using an implanted device that might respond to subtle muscle activity, subliminal vocalizations, direct nerve signaling, brainwaves, or other inputs.

We are all hunter/farmers, making our way in a new world that we have created, and are continuously recreating. We have within us all of these qualities, and any given individual may adopt a hunter mentality, or a farmer mentality, at any given time. Our very genes contain the seeds of both of these modes, and we can express either of them whether we know it or not. We are flexible in this regard, though some may lack certain task-switching skills. It is an insult to take those with a strong hunter inclination, and marginalize and medicate them. We are drugging our Alexanders, our Henry Fords, and our Thomas Edisons, into submission. Rather than “solving” the “problem,” we should be teaching the flexibility and appropriateness needed for specific tasks, and inculcating an adaptive style that serves a broad base of needs, not just the classroom setting.

So these hunter/farmers, who learned to make machines and then built themselves an information-based world, are now engaged in a self-created consciousness revolution. In the 1960’s and 1970’s it became common to question and look into the mental realm using a variety of techniques and agents; it became acceptable to look into new religions, belief systems, and other mentally focused pursuits. The U.S. Congress declared the 1990’s the “Decade of the Brain”, awakening interest in the brain. We have seen increased interest in meditation, spirituality, mental development, and similarly empowering pursuits. We see the widespread practice of reading, going to counselors or workshops, training classes and seminars, group processes, personal experiences (Outward Bound, survival experiences, religious retreats). An increasing number of people are aware of and accept the importance of “the inner”, as being as important, or more important, than “the outer”. We are seeing record amounts of psychoactive medications being used, as the chemical treatment of depression, anxiety, and attention problems alone represent a multi-billion dollar industry, motivated by some of the strongest advertising and lobbying forces in history.

So where are we headed? Where will today’s brain science, individual and collective consciousness, and the roots of neurofeedback, lead us during this century? What is neurofeedback? In the broadest sense, it is a means to precisely navigate inner space. What the compass, sextant, and gyroscope did for navigation and exploration of the outer world, neurofeedback can do for the inner world. Imagine systematically exploring and discovering inner lands, worlds, and dimensions that are now only fleetingly glimpsed by a select few. That flash of insight that today characterizes the occasional mental breakthrough can become something that is reached over and over, transforming individual and collective consciousness.

Let us look at some of the things we now take for granted, that would have been unthinkable only 100 years ago. Men have walked on the moon. It is routine to travel across the country, even around the world, in a single day. We have decoded the entire human genome. We know the mass of the electron to 13 decimal places. We can see and interpret events that happened 13 billion years ago. We can replace an entire human heart with a manmade device.

With this point of view, we can look forward 100 years, and envision things that are today unthinkable. Imagine that the study of consciousness enters the world of physics, and we have a true science built around the phenomena of mind. Imagine equations similar to Einstein’s field equations, but which include consciousness as a physical field. It is likely that these fields will involve other dimensions, giving rise to a sound physical basis for “other-worldly” phenomena. We may come to look upon intention as a force, similar to physical forces. We may come to understand the physical phenomena that give rise to consciousness, and may even learn to create artificial consciousness. We will understand the physical underpinnings of subjective experience, an area that is entirely mysterious to us now. 100 years ago, no one had even heard of a radio or a computer. Today, even schoolchildren can be “computer wizards” who can run circles around their parents in installing, using, even creating computer programs. So what will the “brain wizards” of the future look like?

Imagine a scientific basis for direct mind-to-mind communication. Imagine that it is possible to systematically teach clairvoyance. Imagine that we learn how to train psychokinetic ability. Imagine that we learn to develop the mind with the same zeal and specificity with which we currently develop the body. Look at a professional body builder, and ask yourself what might happen if an individual could apply the same level of determination and knowledge to the development of the brain and mind. What would a 21st century brain-builder be like? Might psychokinesis someday become as systematic and well-understood as physical exercise is today?

Imagine a world in which the cell phone is an artifact of the past. Direct mental communication is possible, for those who want to develop the ability. Instead of going to the store to pick up a cell phone, you go to a neurofeedback trainer who specializes in providing this ability. There may be some physical aspects such as implants, chemical treatments, special dietary supplements, and so on. But the individual will be trained to develop and employ abilities that today lie latent in all of us.

Imagine a system in which you put on an EEG hat (or not), and the system immediately takes over from there. It scans your brainwaves, makes analyses and comparisons, figures out what you “need”, and proceeds to configure and control the training. The feedback is based upon a complex, adaptive analysis of your brain, and does whatever is needed to move you wherever you want to go. Training involves the entire head, with global or localized training being done automatically. No more separate QEEGs, no waiting, no using separate protocols, no setting up the system, choosing settings, making changes. The system sees your response to the feedback, and adapts instantly. In a single session you might experience 2, 3, or 100 different training protocols, depending on how you respond. The displays include virtual reality, sensory immersion, abstract sights and sounds, whole head maps, real-time tomographic analyses, and statistical results, all in a comprehensive and easy to understand format.

Imagine a world in which eating medicine for psychological problems is considered obsolete. Our great grandchildren will laugh when they say “Grandma told me people used to eat serotonin uptake inhibitors to feel better.” In the future, people will be empowered to self-regulate their own mental health and stability, and it will no longer be necessary to tolerate side effects in order to deal with depression, anxiety, attention disorders, or other mental challenges.

Imagine a world in which a significant journey can be taken without physical transport, but by working with neurofeedback-guided transformation. You go into a full sensory immersion world, in which your internal state is reflected in your external world. You are free to explore, work, create, and relax in your personal reality. Feedback includes sound, sights, tactile sensations, even smells. The feedback can give rise to genuine out-of-body experiences, remote viewing, and direct mind-to-mind communication, which spring from the neurofeedback world as new dimensions in consciousness and experience. Shared experiences are even possible, giving rise to entirely new ways of being with others, transforming relationships and entire social structures.

We can envision a future in which a brainwave elite emerges. These are the individuals who have the aptitude and interest to develop mental powers well beyond those we know today. They may be called “heads,” “brainmasters,” “electric gurus,” or “cybernauts,” in reference to the emphasis they put on the use and development of the brain and mind. Not everyone will have the time, ability, or inclination to develop these skills. Building the mind in this way is sure to become controversial. New political, social, legal, and medical issues will arise. Perhaps those who are not part of this elite will continue to be relegated to eating medications, experiencing mental strife, and pursuing “old fashioned” therapies to address their mental woes.

Imagine a world in which millions, perhaps billions, of brains, are in a state of continual connectedness. A new form of consciousness emerges, in which individual brains take on the role of individual neurons, in a global brain. The next major revolution may indeed by one of “hyperconsciousness” brought on by these changes. We may find ourselves exploring other dimensions through the power of the mind, thus circumventing the anticipated challenges of space travel, supplanting it with direct travel at the level of consciousness, not merely at the level of space, time, and matter.

Scientists believe that the sun will explode billions of years in the future, and that our entire solar system will be vaporized. How will humanity persist after this cataclysm? What will happen even further into the future, when the universe meets it fate, be it eventual expansion into a black void, or compression into a “big crunch”? Will consciousness itself have the ability to persist beyond the physical reality we cling to? It is possible that, through advanced development of the mind, we will find ourselves living in an entirely different realm, one that looks back on our entire 3-dimensional universe as a distant relic of the past, much as we now look back to the Olduvai Gorge and the Mesopotamian watershed, the birthplaces of our earthbound experience.

We can now see that to consider neurofeedback solely as a means to relieve specific maladies, or to do a brain tune-up, is to ignore its true power and potential. In that view, the best that can be hoped is that some people suffer less from specific distresses, but that humanity becomes no different in the whole than it is today. To view neurofeedback strictly as a “fixer” is to say that our consciousness status quo is just fine, and all that we need to do is stamp out the aberrations. That would be like seeing the value of the automobile in running local errands, and saving a few minutes here and there. But in much the way the automobile gave rise to roads, suburbs, shipping and industry, thus transforming our world, neurofeedback will be no less a transforming agent. When neurofeedback reaches its full potential, the meaning of the human mind will have changed, and the most significant phase in human evolution will have taken place.

Hopefully, “The Decade of the Brain” will be looked upon in future years as the seed from which emerged brain mastery, consciousness exploration, and precise mental navigation. We will have learned to use that “90%” of the brain we are supposed to be ignoring, and we will use it well. These developments will have lead to a global hyperconsciousness that will be a first step toward a true supercivilization. We will reach beyond the stars into other dimensions, and beyond. We are truly poised to change the universe – one brain at a time.

Thomas F. Collura, Ph.D., P.E.

Members of the International Society for Neurofeedback and Research (ISNR) receive NeuroConnections as a free benefit of membership. All professionals who specialize in neurofeedback, biofeedback or QEEG are encouraged to join ISNR to receive the full edition (in a full color printed format) of NeuroConnections and other member benefits. The above article was reprinted from NeuroConnections with permission from ISNR.

Integrative Body-Mind Training
Integrative Body-Mind Training (IBMT) is an Eastern meditative practice shown to improve attention and self-regulation in a relatively short period of time (Tang, Ma, Wang, Fan, Feng, Lu, Yu, Sui, Rothbart, Fan, & Posner, 2007).  This training method, developed and studied in China since the 1990s, is derived from traditional Chinese medicine, as well as other forms of meditation and mindfulness practices.  Tang et al. explain that the rapid effects of IBMT training may result from its integrated mind-body components, which include relaxation, breathing, imagery, and mindfulness training.  IBMT is practiced while listening to an audio compact disc (CD) and being physically coached by an experienced IBMT mentor. 

In Tang et al.’s study, a randomly assigned group who practiced IBMT for 5 days (20 minutes per day) showed improved attention and improved stress management compared to a control group who received general relaxation training.  On specific assessment measures, the experimental (IBMT) group evidenced lower anxiety, depression, anger, and fatigue ratings, increased vigor, decreased cortisol (stress hormone), and increased immunoreactivity.  This seems remarkable considering the brief training period.

Nature Exposure
IBMT and nature exposure are both techniques that have been categorized as attention state training models (Tang & Posner, 2009).  Attention state training (AST) pertains to a change in conscious awareness that may result from meditative or nature exposure experiences.  Attention training (AT), comparatively, involves executive control mechanisms and may, for example, include mental effort and control on a working memory task.  Tang and Posner note that nature exposure is based on Kaplan’s attention restoration theory, which posits that mental fatigue may occur following a person’s sustained effort to maintain focused attention over time on cognitive tasks.  The premise of the attention restoration theory model is that a person can restore mental efficiency by decreasing directed, voluntary attention, and by increasing involuntary attention.  In other words, a person may become mentally fatigued as he or she sustains effortful attention on work-related tasks (computer, e-mail, documents, meetings, etc.), but can restore mental efficiency by increasing the involuntary attention that occurs via nature exposure.  Tang and Posner cited a recent study in which subjects assigned to an experimental group exposed to nature scenes demonstrated improved executive functioning compared to a control group exposed to urban scenes.  The main difference between IBMT and nature exposure, according to Tang and Posner, is that nature exposure is performed with one’s eyes open, whereas, IBMT practitioners practice with eyes closed and progressively use breathing and imagery techniques to accrue a set of experiences that enable the person to achieve deeper and deeper states from one session to the next.

Mindfulness
The practice of mindfulness is involved in both IBMT and nature exposure.  Mindfulness involves a divergence from conscious awareness being focused on the past or the future, thus enabling one to center awareness of thoughts, emotions, and/or actions in the present.  Studies show that mindfulness training can help reduce pain, decrease stress, improve cognition, and increase positive mood (Tang & Posner, 2009).  Other findings indicate mindfulness meditation has beneficial effects on brain and immune functioning (Davidson, Kabat-Zinn, Schumacher, Rosenkranz, Muller, Santorelli, Urbanowski, Harrington, Bonus, & Sheridan, 2003)

What’s Next?
IBMT may soon be introduced to Western culture and may be an effective method for improving attention and self-regulation that may appeal to many due to its rapid results in a brief period of time.  As such, IBMT could be a promising adjunctive technique that practitioners may wish to incorporate into multi-modal treatment plans for certain individuals.

Mark Johnson, M.A.

References
Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., Urbanowski, F., Harrington, A., Bonus, K., & Sheridan, J. F. (2003).  Alterations in brain and immune function produced by mindfulness meditation, Psychosomatic Medicine, 65, 564-570.

Tang, Y., Ma, Y., Wang, J., Fan, Y., Feng, S., Lu, Q., Yu, Q., Sui, D., Rothbart, M. K., Fan, M. & Posner, M.  (2007).  Short-term meditation training improves attention and self-regulation, PNAS, 104, 43, 17152-17156.

Tang, Y. & Posner, M.  (2009)  Attention training and attention state training, Trends in Cognitive Sciences, 13, 5, 222-227.