Introductory Clinical Neurofeedback

“One of the greatest scientific achievements imaginable would be the discovery of an explicit relationship between the waveform alphabets of quantum theory and certain states of consciousness.” Nick Herbert, Quantum Reality

We assert that Brain wave Biofeedback is at least a gross manifestation of that relationship.

– Table of Contents –
Introduction
Frequently Asked Questions
Timing Considerations
Three Concepts Underlying Successful Neurofeedback Learning
A Simplified Description of Electrical and Neurochemical Activity in the Brain
Coaching issues
Summary
Glossary
Introduction

This free online e-learning course should take about one to two hours to complete and we believe provides a solid yet brief introduction to EEG (brain wave) biofeedback or neurofeedback and the information you need to continue your learning in what many believe to be the fastest growing, most powerful category of biofeedback yet developed. Furthermore, we believe this allows you to learn in the most time and cost effective ways possible.

We can recommend many books to supplement your learning. Some of which include: An Introduction to Quantitative EEG and Neurofeedback, James Evans, and Andrew Abarbanel, Academic Press, 1999. Mindfitness Training: Neurofeedback and The Process, Adam Crane and Richard Soutar Ph.D., Writer's Club Press 2000; Biofeedback and Somatics, Eleanor Criswell, Ed.D., Freeperson Press 1995; Symphony in the Brain, Jim Robbins, Grove Atlantic, 2000. These and other relevant books can be ordered from our website or by calling our toll free number.

Having been devoted to biofeedback and applied psychophysiology for over thirty years I must confess to considerable bias. It is as difficult for me to be objective about biofeedback as it would be for an astrophysicist who deeply loved astrophysics to be objective about his work. Nonetheless we will do our best to assist you in understanding this 'technology of self knowledge' the way it actually is so that you can efficiently put it to work for you. Maybe the astrophysics analogy is fairly apt because in a sense biofeedback and especially neurofeedback, deals with the challenges of 'inner space'. In fact I and at least some of the astronauts and many scientists believe that achieving success in outer space is critically linked to our achieving major successes within our own 'inner space'.

We think that the best way to provide information and insights for you is by the use of a series of Frequently Asked Questions derived from discussions with hundreds of practitioners over decades. Some of the answers may be longer than the FAQ's you are probably used to. We invite your comments and suggestions as to how we might continue to improve this free e-learning neurofeedback course.

Frequently Asked Questions

FAQ's:

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Following are 31 FAQ's from the certification training section of our website.

  1. When and where is professional training available?
  2. What is Biofeedback, Neurofeedback and Applied Psychophysiology?
  3. Who can practice Biofeedback and Neurofeedback professionally?
  4. Is Certification necessary in order to become a practitioner?
  5. What is the minimum of training I need in order to get started?
  6. Why Biofeedback Certification Institute of America (BCIA) Certification?
  7. What Certification is available?
  8. What training does Health Training Seminars Offer?
  9. What is the content of the clinical training and certification programs?
  10. What is the National Registry of Neurofeedback Providers (NRNP)?
  11. Why choose this program?
  12. What will I learn?
  13. How well established is Biofeedback in traditional and integrative medicine?
  14. What consulting services do you offer?
  15. Why do you differentiate between traditional Biofeedback and Neurofeedback?
  16. Who is on the Health Training Seminars faculty?
  17. How do I build a successful Biofeedback practice?
  18. How do I select the right equipment for me?
  19. What do others say about Health Training Seminar's ability to help you achieve your goals?
  20. How is my timing for entering this field?
  21. Is the technology difficult to master?
  22. Do you offer internships?
  23. Do third party payor's reimburse for Biofeedback?
  24. What are the educational objectives?
  25. Do you offer online training?
  26. What are BCIA certification requirements and how do I fulfill them?
  27. What are the Qualifications for BCIA EEG Certification?
  28. How much will it cost me to get started?
  29. What is the Biofeedback Certification Institute of America?
  30. What do I do if I cannot qualify for certification?
  31. What are the benefits of Certification in EEG Biofeedback?
What is Neurofeedback? The Technology of Self Knowledge
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Neurofeedback (also known as EEG or brain wave biofeedback) is one of the most popular and scientifically interesting forms of biofeedback. Using modified EEG's (electroencephalographs) the subject's brain waves are amplified and fed back. In a rather short period of time most people can learn to substantially increase or decrease certain brain waves.

How does neurofeedback work?

The generic description of how biofeedback works applies to neurofeedback as well. However, we and many others devoted to this field feel there is an additional dimension of heuristic learning associated with neurofeedback. The most responsible leaders in the field will usually acknowledge that exactly how neurofeedback works is not absolutely known. At the same time they will state that in an impressive percentage of cases they are sure it does work. After that these same leaders are usually eager to explain their hypotheses of how neurofeedback works.

Many of these hypotheses are fascinating, and we have our own view based on our own thirty years of immersion and innovation in this field. But please keep in mind that virtually all views are hypothetical, and although useful, should not yet be categorized as proven theories.

"A hypothesis claims not rightness but usefulness." Spengler

Briefly, we will explain some of the most compelling hypotheses. In later modules we explain these hypotheses in greater detail.

The attention model is, in our view, the most important of all hypotheses. It is based on the notion that brain wave biofeedback can dramatically assist most people in learning how to increase the quality and quantity of their moment to moment attention. Our belief is that as the quality of the attention increases so does the sensitivity of the perceptions. One of the most intriguing definitions of intelligence is simply sensitivity. If that is true, increasing the quality of attention has the practical benefit of increasing usable intelligence.

If you carry this concept farther you could make the case that one of the things that a person uses increased attentiveness for, is to attend to what (s)he is thinking - the thoughts themselves. If you are comfortable with Maslow's famous actualization hierarchies we can go even further and assert that human beings actualize innate potential in proportion to our ability to watch ourselves think. If this is true and if neurofeedback can substantially assist an individual in learning how to watch him or herself think better, then it seems to us that neurofeedback is arguably one of the most valuable developments in technological, educational and philosophical history.

Another view of how neurofeedback may be working is that as the brain is brought to deep levels of quietness, unconscious and/or subconscious material comes to the surface (consciousness). Some of this material is of a creative, insightful nature and some is repressed fear material. Repressed fear material emerging from the unconscious (we prefer to use the term preconscious) often will also have a creative aspect. One of the most important modern psychological models asserts that the quality of normal consciousness is distorted and contaminated by repressed fear material. It is believed that when this material can be brought to consciousness it is 'released'.

I like the metaphor which states 'The fear is burned up in the fires of consciousness'. In fact, healthy implementation of this healing process has been one of the primary goals of meditation throughout its recorded history. The same model that has gained wide acceptance in modern psychology is also a fundamental principle in many ancient psychological systems. One of the DSM IV disorders based on this concept is known as Post Traumatic Stress Disorder (PTSD).

Another widely accepted view of the way neurofeedback may be working relates to conditioning. Over time the brain becomes heavily conditioned. Some of this conditioning is unhealthy and can lead to many disorders, unclear thinking and a general decrease in usable intelligence. By doing brain wave training in this model, the rigid, conditioned patterns in the brain are at least temporarily broken up. Practitioners sometimes refer to this as 'moving the brain out of its parking place'. This hypothesis suggests 'moving the brain out of its parking place' leads to increased flexibility and the enhancement of the brain's ability to generate new, healthier, more flexible patterns, enabling it to operate more intelligently.

This model takes on even more exciting implications when we bring Chaos and Turbulence Theory (non linear dynamics) into play. The nonlinear dynamics notion suggests that when the conditioning is temporarily broken up it allows subtle natural patterns called 'attractors' to operate more freely. These energy patterns may have substantial healing potential.

What is neurofeedback certification?

The Biofeedback Certification Institute of America is the leading certification organization for neurofeedback professionals. There are one or two competing certifications. You can get more details from our website. Certification is not presently mandated by law, but highly recommended. Many practitioners who are not certified are running successful practices.

Is this course for the interested layman as well as the professional?

We think so. Naturally, we must admit to considerable bias, but we believe that the potential for neurofeedback to bring remarkable benefits to the individual as well as profound benefits to society makes doing this kind of a seminar an extraordinarily worthwhile investment for many of those who might fit into the interested layman category. In fact, many of those who have taken our clinical EEG training seminars report receiving substantial, personal life enhancing benefits.

Is neurofeedback applicable to Peak Performance, Super Learning and Life Enhancement?

Of course. And we address these applications in this training. Going further, we have developed the Mindfitness Training program called The Process which includes among other goals the application of neurofeedback in extremely powerful ways for increasing the learning curve of those seeking to maximize application of personal growth and self-actualizing principles. Although theoretical considerations are wonderfully exciting to us, and we are deeply immersed in the odyssey of understanding consciousness from a neuroscience, quantum physics, non linear dynamics etc. perspective, we are primarily interested in strategies, principles, and insights which the ordinary person can apply in order to increase quality of life and performance. We believe that substantial numbers of human beings have the potential to be 'artists of living' and our training and research is so dedicated.

"The most invisible creators I know of are those artists whose medium is life itself. The ones who express the inexpressible - without brush, hammer, clay or guitar. They neither paint nor sculpt - their medium is being. Whatsoever their presence touches has increased life. They see and don't have to draw. They are the artists of being alive." J. Stone

What does it take to get started as a neurofeedback practitioner?

The short answer is to get proper training and quality equipment and get started. The doing is the learning. There are many details as to costs, how to get basic and advanced training, qualifications etc. available on our website. Even simpler call or email us.

What is Applied Psychophysiology?

Psychophysiology is the study of the interrelationship of physiological systems, cognition, social and environmental parameters and health. Applied psychophysiology is the application of the results of information derived from the study of psychophysiology. The equipment used in biofeedback is derived from and applicable to scientific psychophysiological studies.

How can I learn about and acquire best equipment at best values for my needs?

There is a great deal of information on our website. You can call, email or fax us your questions. Naturally, we want to be your biofeedback company, and one strategy we use to make it more comfortable for you is to handle virtually all of the equipment available that satisfies our standards. There is a wide variety of equipment available. We can usually ask you a few questions and quickly recommend the equipment that is most appropriate for your applications. Leasing and credit card financing strategies are available. Of course, the BCI Certification seminars offer the fastest way to train, as well as hands on experience with different kinds of biofeedback systems and modalities.

There are many important considerations when acquiring equipment. For example, is the equipment flexible enough? Can you set your own band widths? What is the speed of the feedback signal? What is the quality of the displays? How good is the data storage? Does the software report the clinical results in a way that makes them clear to third party payors, referral sources, the patient and, of course, the practitioner? What assessment capability does the software have ( assessments are often billed separately and can mean a great deal in terms of profitability to the practice)? Does the system use true EMG inhibit or does the manufacturer attempt to save money by using Gamma (high frequency Beta) EEG as the EMG inhibit? We believe this to be a mistake because we do not know enough about Gamma to inhibit it, which is tantamount to judging that Gamma is not only unimportant, but we are sure inhibiting it is a good thing. Has the system undergone FDA scrutiny? In the US it is a violation of federal law to use a system if it has not.

What will I learn in the next modules of this course?

The next modules are being designed to provide you with all of the competency based didactic training that we currently provide in our live seminars. This course is based on the Biofeedback Certification Institute of America's blue print for certification training.


Certification Requirements

As of 2004, all General Biofeedback BCIA Certification candidates are required to complete a minimum 92 hour training program, and BCIA EEG Certification candidates are required to complete a minimum 105 hour training program as described herein.

Blueprint for General Biofeedback

Hours

Orientation to Biofeedback 4

Stress, Coping & Illness 4

Psychophysiological Recording 8

SEMG Applications 8

Autonomic Nervous System Applications 8

EEG Applications 4

Adjunctive Intervention 8

Professional Conduct 4

Total Hours 48


Mentoring Requirements

Personal Feedback 10 sessions (minimum 20 min. each)

Patient/Client Contact 50 sessions, 25 each of EMG &
Thermal(minimum 20 min. each)

Direct Mentoring Contact 20 hours with 2 hours
face to face contact

Case Presentations 10 case Presentations

Blueprint for EEG Biofeedback

Hours

Orientation to EEG Biofeedback 4

Basic Neurophysiology and Neuroanatomy 4

Instrumentation & Electronics 8

Research 2

Psychopharmacology Considerations 2

Treatment Planning 12

Professional Conduct 4

Total Hours 36


Mentoring Requirements

Personal Feedback 10 sessions (minimum 20 min. each)

Patient/Client Contact 100 sessions
(minimum 20 min. each)

Direct Mentoring Contact 25 hours with 2 hours
face to face contact

Case Presentations 10 case Presentations


What are the clinical applications of neurofeedback?
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Biofeedback, including neurofeedback, should always be thought of as adjunctive. That is, it is always combined with other therapeutic or educational strategies. It is theoretically possible for an extremely motivated person to simply acquire instrumentation and train themselves by themselves; however, we think this would almost always be a mistake. The assistance of a properly trained professional will yield a much greater chance of success. Furthermore, the only reason to experiment by yourself would be to save money; however, assistance from a qualified professional will almost certainly yield a much better return on the total investment because of the integration with appropriate training techniques. After all, the biofeedback instrumentation is designed to assist the user in learning how to achieve the same degree of psychophysiological control without the instrumentation as they can with it. We are referring particularly to clinical neurofeedback. Biofeedback and neurofeedback applied to performance and life enhancement learning lends itself to greater flexibility and additional applications.

The major areas of adjunctive neurofeedback clinical applications include Stress Related Disorders, Substance Abuse, Learning Disorders including Attention Deficit Hyperactivity Disorder (ADHD), ADD, Post Traumatic Stress Disorder (PTSD), Epilepsy, Traumatic Brain Injury (TBI). Neurofeedback is being applied to dozens of additional disorders many of which are considered to be subsets of or otherwise related to the disorders described above. For example, Eating Disorders are a subset of Substance Abuse, Multiple Personality disorder is a subset of PTSD, some forms of Depression may be considered a sub set of Maladaptive Stress, many neuroimmune disorders are considered to be stress related, Stroke Rehabilitation (and some other forms of rehab) are a sub set of TBI, and on and on. An important notion to keep in mind is that neurofeedback influences the Central Nervous System (CNS) and the CNS influences virtually all of the body and conscious processes. Of course, Performance and Life Enhancement learning is not considered a clinical category although sub clinical symptoms must frequently be dealt with.

How can I find out about neurofeedback research?

Much of the most important research is covered in our regular training programs. We are working to bring them online so much as is possible. On our website you can acquire professional textbooks which contain thousands of research citations. We estimate that there are over 10,000 biofeedback and applied psychophysiological studies which are relevant to this field and more coming out all the time. For example, we recently read a single paper discussing brain wave synchrony which cited over three hundred studies. One of the objectives of our training is to assist you in becoming familiar with those studies that are most relevant to your needs.

How is biofeedback applied to performance and life enhancement?

All of the biofeedback instruments mentioned and more have been applied to performance enhancement. One of the reasons is that virtually all biofeedback assisted self-regulation learning leads to reduction of the maladaptive stress response and that leads to enhanced learning curves and increased energy. Currently, the most popular form of biofeedback for performance and life enhancement applications is neurofeedback (EEG). We refer you to our free e-learning MindFitness course for additional insight into EEG (brain wave) biofeedback and Life/Performance Enhancement.

Is it possible to learn enough about biofeedback to become a practitioner without coming to a professional seminar?

As they say, almost anything is possible. It is obviously easier to learn by attending live training events. However, one of our e-learning goals is to make it possible for people all over the world to learn enough about biofeedback over the Internet so they can deliver quality biofeedback training no matter how remote. The goal is also to bring the cost of biofeedback professional training down.

How do I learn more about neurofeedback online?

Take our free MindFitness course (Performance and Life Enhancement applications), our free biofeedback course (other kinds of biofeedback instruments can be useful in a neurofeedback regimen), our Biofeedback Bootcamp online, and then take advantage of our advanced e-learning neurofeedback courses when they are ready. Of course, there is no substitute for our live seminars for those who can work it out.

Do you have to know a lot about technology and computers?

No. The fact is that many of the health care professionals and educators that go through our programs are excellent therapists and teachers, and have spent their lives learning how to be 'people' people. They have not had the need to learn a lot about technology or computers. For decades we have made it our business to teach them what they need to know in order to be excellent biofeedback practitioners. Sometimes the learner is even a little techno or computer phobic. They are usually delighted to realize that learning the technical side of neurofeedback is relatively easy. It is like driving a car. It is possible to become an excellent driver without knowing everything about cars and engines, etc. Of course, there are some technical things which must be learned, but they are not that difficult. What is more difficult is to find the best ways to provide therapy and education to your clients. Most people interested in this field consider the therapy and educational part to be relatively easy because it is simply an extension of what they have been doing already. That said, many practitioners just coming in to the field have considerable concern about the technology until we have the opportunity to show them how learnable and enjoyable delivering neurofeedback services is.

Do insurance companies pay for neurofeedback services?

Of course. However, neurofeedback is subject to the same third party payment restrictions that apply to the rest of the health care system. As is true with virtually all medical and psychological modalities, biofeedback practitioners regularly use many billing strategies depending on diagnoses, credentials, insurance carriers, HMO or managed care requirements etc. As is the case with every other form of health care we can think about, the more the practitioner learns about best billing strategies for his or her situation the more profitable the practice will be.

It is also important to keep in mind that well over 50% of all moneys made in the health care business are derived from private pay and self insurance. In addition, biofeedback and especially neurofeedback attracts that class of patients defined as 'Actualizers' by the Value Added Lifestyle Survey. Many of the most successful practitioners are careful to integrate these kinds of patients into their practices because they are often the most profitable, and because they are also often the most responsible in terms of complying with the recommendations of the therapist, as well as integrating what they have learned into daily life. Beyond that, 'Actualizers' are trend setters. They are people to whom others look for advice such as who the best doctor might be etc. We devote a good deal of our training to this subject. Also, we provide consulting services for those who want to improve their biofeedback business models.

How much can I make?
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Biofeedback practitioners generally bill between $75 and $150 per therapy hour (some practitioners exceed this amount considerably). However, the same equipment which is used for biofeedback can also be used for assessments and tests which are often billed at higher rates from a time perspective. We encourage practitioners to think of their practices as small businesses (as opposed to thinking of themselves as relatively high priced labor). This can lead to additional strategies for increasing practice revenues. For example, a substantial amount of biofeedback (and neurofeedback) therapy and education can be conducted in groups. Depending on the credentials and, or licensing and management skills of the practitioner, supervision of other practitioners can lead to additional revenues.

How difficult is it to earn a living in neurofeedback?

The way I usually handle this question is as follows: First learn enough about neurofeedback to determine whether you really want to do it. If you do, especially if you love it as many of us do, then come on in. You should do fine. If you are not really attracted to it after you have learned about it in depth, but are only considering it as a way to earn a living, we do not encourage you (unless you already have a job and this is a necessary part of it) because neurofeedback takes commitment, and requires considerable artfulness. Also, we believe that our economy is so diverse that it should be possible for most of us to find work that we really like - if not love. So, we urge people to press relentlessly toward work that is loved. That said, there are some biofeedback millionaires already, and we believe biofeedback and especially neurofeedback is in its infancy.

Timing Considerations

Timing (frequency) of sessions is a bit more complex for neurofeedback than it is for traditional biofeedback. Whereas in traditional biofeedback, one session per week can work well (major exceptions for things like muscular rehabilitation etc.), neurofeedback usually works better if there are multiple sessions per week. As in traditional biofeedback, there may be two sessions per day if the patient is being treated in an inpatient setting. However, most neurofeedback practitioners recommend three or more sessions per week for those undergoing training in an outpatient environment. There are some exceptions.

At the risk of confusing you for awhile, we have to say that these timing concepts are not set in stone, but merely a general overview of the recommendations of most of the leaders in the field. There are plenty of examples of clients who were trained only once or twice per week and still received substantial benefits. However, there is considerable concern among most neurofeedback practitioners that too little training can lead to substandard outcomes. We agree with this observation. Therefore, most practitioners become skillful at persuading patients, third party payors etc. to fund as many sessions per week as are recommended depending on the therapy goals.

So, there are two major considerations:

  1. What number of sessions will most likely produce the best outcome?
  2. How will this get funded?

There have been reports of unusually successful cases in which the patient was trained for two one hour sessions per day for at least ten days. After that, the frequency and intensity of the training usually continued in a reduced manner. By far the greater challenge for most practitioners is getting clients to put in enough training time. We are not aware of any credible professionals who have reported clients over training. In fact, even after successful clients have completed their training it is generally recommended that they get five or six booster sessions once per year or so for one or two years. We think this trend will continue and be refined much further.

Obviously, the total number of sessions required to produce the best outcomes can vary tremendously. However, some rough estimates as reported by many practitioners would be about thirty to forty sessions for most substance abuse and PTSD clients; about twenty five to forty sessions for most ADHD clients, and generally thirty to forty sessions for most other clinical neurofeedback applications with the exception of rehabilitation and, of course, Performance and Life Enhancement (See MindFitness Training). Most clinical practitioners try for three to five sessions per week.

One of the peculiar characteristics of neurofeedback (and traditional biofeedback) training is that once learned it is retained, similar to some other mind/body skills like swimming or riding a bicycle etc. However, many who have continued to upgrade their personal neurofeedback training over many years report continued benefits. Perhaps this is because there may be a dynamic which increases EQ (Emotional Intelligence) along an indefinite continuum depending on the latent potential (and compatibility with neurofeedback) of the individual. There are ongoing discussions relating to hypothetical dynamics which may contribute to this phenomena.

Once we have estimated the number of sessions we think will yield clinically satisfactory results we must assist the client in evaluating how much this kind of training is worth. There are many ways to justify the therapy fees for properly screened patients (patients for whom neurofeedback is likely to yield good results). There are also ways to reduce costs to the client through multiple station training strategies and the use of home trainers etc.

Obviously, the value of this kind of learning can vary tremendously, depending on the results. We feel it is unethical to make grand claims, even though some feel (as we do) that neurofeedback in combination with the correct clinical and/or educational strategies can have exceptional potential. So, instead of making the claims, we try to explain it well enough so that those who have a propensity to learn about these kinds of things can make their own evaluation, and then take next steps accordingly.

The bottom line is that many of us believe that the results that neurofeedback training has produced in our own lives is worth far more than it cost. Furthermore, over the decades the cost in adjusted dollars of both the equipment and the professional training has steadily dropped. Our organization has innovated in a number of ways to bring those costs down while increasing the quality of both the technology and the training regimens. For example, we developed multiple station computerized systems and low cost, battery operated, personal neurofeedback instruments. This free e-learning course is another such innovation.

Three Concepts Underlying Successful Neurofeedback Learning

In the course of my life I have had a number of teachers whom I would describe as 'masters'. I noticed that they shared certain characteristics which most of us would find intriguing and extremely useful. For example, they will usually give of themselves without reservation if they perceive the student is deeply interested and committed. Another characteristic is how quickly and easily great teachers will use the term, 'I don't know'. Then they usually follow it up with something like, 'So since we don't know let's go exploring and see what we may find out'. Another intriguing strategy is simplification and the ability to point the mind of the learner to basic principles which will serve him well. They will often say something like, "You know, it is true that this subject can be incredibly complicated; however, if you will just understand these two or three basic principles and ponder them deeply you will do very well". And then these 'master class' teachers explain the principles in ways you can understand and practically apply.

It seems to us that there are three fundamental principles which when understood and applied will almost guarantee success, as well as steadily increasing understanding and growth in skillfulness. We urge you to do all you can to understand these three things to the best of your ability. They are: Attention, The Breathwork, and Sleep.

In our seminars we spend a great deal of time on these three basic concepts. However, for introductory purposes we might add the following:

Attention Most people believe at least superficially that they can change whenever they want (especially when young). But then when the time comes to institute significant change it becomes clear that it is much more difficult than was believed. This then leads to discouragement and even depression. Yet there is at least one aspect of the human mind that can be substantially changed in most of us. That is the quality of our attention. We believe that substantially enhancing the quality of one's attention is a kind of 'end point' for human beings. The reason is that high quality attention brings about profound and complex mind body benefits to all of us.

High frequency training is believed to enhance the kind of attention needed to think more clearly (especially for people who have ADD symptoms and other similar problems). Low frequency protocols are related to 'Deep States' kind of attention. In fact, we have coined the term 'Profound Attention' (as in meditation and creative states) to indicate the kind of attention that is believed to be enhanced by low frequency training protocols in most clients.

The Breathwork refers to the importance of breath retraining for most clients. Most people, especially those suffering from stress related clinical disorders, are breathing paradoxically (thoraxically - in the upper chest). Beyond that there is a strong relationship between the electronic activity of the brain and quality of breathing. In our experience, even stress management professionals overestimate their knowledge and skill at implementing healthy, 'easy breathing' strategies for themselves and their patients. Those who approach the breathwork humbly and with an open mind can usually learn how to bring about extraordinary benefits for themselves personally, as well as their clients.

Sleep is another dynamic that is poorly understood by most health care professionals and even less understood by the lay public. A great way to gain insight into the enormous opportunities for health and healing benefits that can be gained by restoring relatively normal sleep is to read William Dement's book, The Promise of Sleep. It is common for biofeedback professionals to notice that one of the least talked about benefits of learning effective self-regulation strategies is that sleep improves. Since most of the population is sleep deprived, and since that sleep deprivation is further complicated by a poor quality of sleep, even modest improvement in quality of sleep can produce disproportionately large improvements in health and mental clarity.

Biofeedback, like virtually all other scientific art forms, can be and is incredibly complex. However, I believe everyone's interests are best served by what we call in our seminars the KISSS system (Keep It Super Simple Samurai). Anyone seriously entering into the field of biofeedback and applied psychophysiology will be learning their entire lifetime. The further you go the deeper it gets. But our experience indicates that there is a relatively simple approach which works most, if not all of the time. The clinician needs to understand what we refer to as the basic high frequency protocols and the low frequency protocols. Apply the protocols as indicated according to the symptoms being addressed and WATCH THE CLIENT!. Then modify the protocols based on the client's response. Assessing client response is done in many ways, and usually utilizes a variety of assessment tools such as TOVA or IVA, Beck's Depression Inventory, MMPI, MCMI, Brain Mapping, normative data bases and other assessment tools.

The most fundamental of the low frequency protocols is Alpha/Theta reward (EMG inhibit if the instrumentation will permit). Thresholds should be set such that the client is able to achieve success (eyes closed) about 50% to 80% of the time. Above threshold means that the power (termed amplitude and measured in microvolts) must be greater than the threshold or goal set with the threshold control. Theta should be set such that the client achieves Theta bursts between 5% and 10% of the time. High frequency protocols are usually done eyes open and require at least one inhibit filter. Either Beta or SMR are rewarded and should be above threshold about 50% to 80% of the time. Theta is inhibited and should be below threshold about 40% to 80 % of the time. It is possible for some people to become so deeply relaxed that they should take extra care when reentering the challenges of normal life such as driving and walking in traffic etc.

It is important that professional equipment have EMG inhibit in high frequency protocols. High frequency electrode (sensor) placement is most often at CZ (the crown of the head) and low frequency placement should be along the occipital ridge in the back of the head (O1, OZ, O2. The art of neurofeedback lies largely in setting the training goals correctly as well as adjusting the protocols so that the client achieves best results. We emphasize that this extremely brief outline is intended for basic introductory educational purposes only and there is much more to be learned about adjusting and applying these and other protocols.

A Simplified Description of Electrical and Neurochemical Activity in the Brain

I was discussing the difficulty of explaining basic neuroelectric and neurochemistry theory to our clients with David Cascino (a talented neuroscience trained computer specialist and consultant). On the spot he began talking about it in a free flowing, story telling way which seemed to me to make it easier to understand for those clients who do not have strong psychophysiological backgrounds. I experimented with it during the seminars and found many practitioners expressed appreciation and said it helped their understanding. Therefore we are including a slightly edited version in this e-learning program.

Temporal and Spatial Summation of Post-Synaptic Potentials:

This is a look into the propagation of nerve impulses. In order for a message to be passed on from place to place, a single nerve cell must reach a threshold of excitation. The cause of excitation is inputs from surrounding nerve cells. The two factors often talked about by many neuroscientists is the concept of Temporal and Spatial Summation. When a single branch of a nerve cell receives many small inputs at a fast rate, the speed of receiving these may be enough to cause the threshold to be reached and for the cell to fire. This is called temporal summation because the nerve cell may require multiple stimulations in a given time frame to reach climax and fire. Spatial summation is when many nerve cells are stimulating the target nerve cell from different locations. The image comes to mind of a martial artist being attacked by several opponents coming from different directions and almost simultaneously. When (s)he senses things are getting critical his threshold of stimulation is reached and he explodes with energy and precise, appropriate action.

It's important to note that spatial and temporal summation are happening at the same time. One branch of the nerve cell may be getting excited multiple times in a short time frame. Another branch may get hit only once during that time. All of these are added up and the accountant of the brain cell needs to decide to fire or not to fire based on all incoming hits.

The other area we want to understand is the principle of ion flow in the nerve cell. In order for a signal to be propagated in a nerve cell, a difference in charge must exist. The first image to get set in your mind is that inside the nerve cell are gigantic proteins. The proteins are so big that they cannot move through the cell membrane or even the many channels that line the membrane. You can think of channels as valves in the membrane that let some substances pass through should they meet the size requirement. These proteins are far too big to pass through these valves. The second idea to grasp is that these giant proteins carry a strong negative charge. The inside of a nerve cell is strongly negative due to these proteins. On the outside of a nerve cell, in the surrounding media are millions of positive ions. An ion is just an atom or group of atoms with a charge. The most common are sodium and potassium ions, both with a positive charge.

Now, you have all these positive guys on the outside of the nerve cell trying to get in and connect with a large negative protein. This separation of charge is the basis for the electrical activity. So the scene is set, millions of screaming fans wait outside the gate to see the show. They can bang all they want on the door, but they can't get in. Finally the gates open and they all rush in. This mass movement of positive charges causes all kinds of electrical activity. We have no idea what is going on with much of this electrical activity. What we do know is that each gate causes the gate next to it to open and in a domino fashion, the electrical signal is passed down the length of the nerve cell until it reaches its destination.

You may be asking yourself how the first gate opens up to start this chain reaction. Well, it goes back to the spatial and temporal summation. When a nerve cell gets excited from different sources and in differing amounts per time frame, this changes the status of the nerve cell. When that threshold is reached, the first few gates are opened and the rest is automatic.

So there you have it, one small piece of a pie that keeps growing. Now, what happens after a signal is sent down a nerve cell and reaches the end of the line?

Neurotransmitter Exchange:

OK, so we can see the propagation of the electrical impulse down the body of a neuron, What now? How do brain cells communicate to each other and what in heaven are they saying?

In the very tip of the neuron is a bud-like projection called the axon terminus. It is the place where neurotransmitters are pumped out of the neuron to communicate with nearby and maybe distant neurons. What happens at this point is quite interesting, mostly because what we know is less than what is really happening. According to the most recent models, the neurotransmitters are being released into a the space between neurons called the synapse. This is the neurotransmitter superhiway. Traveling much like a drop of food coloring moves through a glass of clear water, neurotransmitters 'diffuse' to neighboring neurons. After they perform their function which we will get into in a minute, they are reabsorbed by the neuron for recycling.

Communication is a two way street. In order for a message to be conveyed, the receiver must be altered in some measurable way. On the receiving cell, a bunch of proteins are implanted in the membrane (outer skin) just waiting to be noticed. Each of these proteins (called receptors) has a beautiful unique shape and structure that is only able to fit with specific neurotransmitters. When the neurotransmitter comes in contact with its 'soul mate' receptor, the two join together and form a temporary structure called a complex. The image you have is a key going into a lock. Only certain keys fit into certain locks and it is the joining that is meaningful. A key by itself has no utility in the traditional sense nor does a lock. The action occurs when the two join together.

Through a conformational change in protein shape, the message contained from the neurotransmitter bonding to the receptor is passed along to the interior of the cell where it can then alter the entire physiology of the cell (its metabolism, interaction with other cells, etc.) It can also cause the signal to be passed to the next cell in the line or be directed to multiple lines of cells.

One of the ways brain cells communicate with each other is by affecting the receptors of their neighbors. It is just like people communicate on the gross level. When you talk with a friend, you send a signal that is picked up by his or her sensory receptors which produces a change in that persons internal representations. Brain cells, (actually all body cells) communicate by a similar means. They produce a signal, be it chemical, electrical, or mechanical. This signal alters the receptors on the target cell, (sometimes the target is the same cell that produces the signal and in this exception, the cell can act on itself) and allows that cell to change in limitless ways.

So you can easily see that cells can talk with other cells and themselves as well. Don't limit your thinking at this point to one on one interactions. Large groups of cells can 'speak' with single cells and, or other groups as you would expect.

An interesting note is the role of external drugs and their effect on brain activity when seen from the receptor perspective. Certain drugs can block the ability of neurotransmitters from binding to their reciprocal receptors. It would be like putting a piece of bubble gum in a door lock. How can the key fit in the lock with something gooing up the mechanism? Other drugs facilitate this process sort of like adding a lubricant to the lock for ease of insertion. Still other drugs block the ability of neurotransmitters from being reabsorbed when their job is done. Depression is commonly treated with drugs called something like mono-oxidase re-uptake inhibitors which prevent serotonin from being reabsorbed by the cells that secrete them allowing them to remain in synapse (neurotransmitter superhiway) for longer periods of time. Finally another class of drugs stimulate the release of neurotransmitters from the source cells much like squeezing the water out of a sponge. The sponge gets dryer with each wave of squeezing until it is virtually dried up. Caffeine works much in this way as does nicotine, cocaine and stimulants in general.

Emotions are related to the receptor model in a two step fashion. When a person experiences anywhere from a subtle almost imperceptible feeling all the way to a full blown system shocker, there is a corresponding glandular release of hormones. These, modulators are capable of traveling in the bloodstream to all parts of the body. When they arrive in the Central Nervous System, they act much like the drugs described in the above passage. One of the interesting properties of substances like hormones is their ability to travel through cell membranes and effect cellular process from the very source, the cell nucleus. First, if you can imagine a cell as being much like a basketball except the skin of the ball is full of beautiful, complex proteins protruding in multiple directions. Inside the ball is everything a cell needs to survive, all the machinery, fuel and intelligence to coordinate activity.

Neurotransmitters commonly act at just the level of the receptors on the outside skin. They interact with the beautiful proteins and pass on their message. The receptors are then responsible for getting the information to the correct location. Hormones, by contrast, are capable of bypassing this step and can travel directly through the basketball skin, (cell membrane) straight to their target. They can turn on genes inside the cell which in turn make proteins for performing limitless tasks. These proteins can then get packaged up and sent out into the bloodstream and communicate with some other part of the body. There are millions of these conversations going on at once, some locally and some over great distances when you consider the scale.

When studying any biological system, always take into account the interaction of a bunch of different systems at once. Its difficult and often impractical to isolate a single event amid a flurry of cell activity.

This is a mechanical explanation of certain neurological phenomena and still does not answer the perennial questions like...

How do EEG waves arise from these interactions and what are the relationships of the 'waves' to the environment of the brain cells and the cells themselves? What about attending neurons or groups of neurons that can watch thought? What if all cells have the capacity to watch thought and when enough of them decide to do it, the person enters a clearer consciousness where thought is allowed to perform its function and watch itself at the same time?

"Most of us live as though life is certain and death is uncertain. It's the other way around. Death is certain and life is uncertain." Jesse Jackson

So live every day as though it is infinitely precious. Because it is.

Coaching issues

In our experience most successful neurofeedback practitioners use a coaching model of training. This implies considerable personal practice on the part of the practitioner. There must be a sense of 'walking the talk'. We recommend that the practitioner train personally for at least 40 hours over the first few months during the start up period. Actually, if the practitioner realizes the performance enhancement value of neurofeedback training in his or her own life, so much the better. In that case (s)he may find that extending the training for at least 100 hours produces additional benefits and clinical insights.

Beyond that, there are many strategies for improving results with the client. One of the most important is use of imagery. We suggest that thinking about imagery from a dimensional perspective is useful, and for that reason encourage the practitioner to use what we call 'fourth dimensional' imagery whenever possible. This is imagery which assists the client in breaking out of the standard, conditioned 'three dimensional' consciousness that constitutes a kind of field which holds the unwanted behaviors and unhealthy belief systems in place. 'Fourth dimensional' imagery perceives time and space in a more functional and relatively accurate way. It tends to pull the mind into the present. Conceiving of imagery from a dimensionality perspective is not widely accepted in the neurofeedback community yet, but we predict it will be.

Another important aspect to keep in mind when considering the use of neurofeedback is that neurofeedback and especially alpha brain wave training seems to establish psychophysiological conditions which make the use of any imagery (especially well constructed visualizations) significantly more effective.

Summary

We are not aware of any successful malpractice suits relative to neurofeedback as of this writing. However, we believe the practitioner should have considerable respect for the power of this technology. Even if we think in relatively simple terms, we have to consider the consequences of deep relaxation and modification of the stress axis. For example, many kinds of drugs should be monitored because dosage requirements may change when the client deeply relaxes and reduces the fight or flight response.

When using imagery and constructed visualizations, be sensitive to clients religious beliefs and conditioning. It should be possible to assist the client in achieving the benefits of EEG biofeedback self-regulation training without creating unnecessary conflict by inadvertently imposing your philosophical or religious beliefs over his or hers. Which leads back to the invaluable strategy of focusing on the basics.

One of the most powerful of all biofeedback basics is to make sure the client understands the self regulation task and the feedback signals provided by the instrumentation. Then the practitioner should usually adopt a listen first and guide later approach. Remember, unhealthy conditioning is probably contributing to the symptoms. If you lay your conditioning over his, you may be making things worse, and losing powerful therapeutic opportunities. Deep relaxation and mind quieting can put the client in a safe, open mind state such that (s)he can bring up issues and insights which you can then turn to therapeutic advantage. We suggest that you be very careful about telling the client what to expect anymore than is absolutely necessary, because you run the risk of further conditioning him and decreasing the likelihood that his experience will be genuine and unique. One of the most important values of neurofeedback is the power it has to break old conditioned patterns and assist the client in generating original, creative concepts and thinking.

As you realize there are two other free e-learning courses on our website. You can also, sign up for our free e-newsletters and review old ones on our website. We invite you to call or email us with your questions and allow us to assist you in achieving your goals. Thank you for your attention. e-learning staff: Adam Crane BCIA Senior Fellow, BCIA EEG, NRNP Diplomate; Harry Campbell BCIA, NRNP; Marilyn Wexler, administration; Edwin Johnson, webmaster.

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"For every physiological event, conscious or unconscious, there is the appropriate and corresponding mental-emotional event, conscious or unconscious; and conversely for every mental-emotional event, conscious or unconscious, there is the appropriate and corresponding physiological event, conscious or unconscious." Elmer Green Ph.D.

MAJOR BIOFEEDBACK INSTRUMENTS

The three major nervous systems of the human being are instrumented in biofeedback, making it possible to work in a classic way - from the easy to the more difficult - from the outside in.

Voluntary Nervous System (VNS)

ELECTROMYOGRAPH (EMG) The EMG measures the electrical activity of the muscles (primarily the firing of motor neurons).

Autonomic Nervous System (ANS)

TEMPERATURE Very sensitive electronic thermometers measure temperature of the skin (usually of the hands and feet). Blood increases or decreases to these areas depending on increasing or decreasing fight or flight arousal.

SKIN CONDUCTANCE (SCR) The SCR measures relative flow of electrons across the surface of the skin (primarily the hands). This flow increases or decreases depending on the amount of conducting fluids on the surface of the skin (primarily sweat). These fluids tend to increase or decrease depending on arousal of the ANS.

BLOOD PRESSURE AND HEART RATE Blood pressure and heart rate modification strategies can be learned when the precise information from these cardiovascular activities are fed back quickly enough and in small enough increments.

Central Nervous System (CNS)

ELECTROENCEPHALOGRAPH (EEG) Probably the most glamorous of the biofeedback modalities. Measures brain waves enabling the user to modify brain electrical activity to a remarkable degree.

There are many other kinds of instruments which may be used for biofeedback (a simple bathroom scale, or mirror for example), but the instruments described above are far the most widely used both in health care and education.

Glossary

Arcane from the Latin, hidden or secrete, relating to arcanum, arcana, meaning secret, mystery; a secret remedy; elixir.

Archetype the original pattern or model after which a thing is made.

Art to join, to fit together, making or doing of things that have form and beauty. A subjective definition that makes sense to me is - putting things in their right place.

Ascetic one who practices extreme self denial, especially for religious reasons.

Attention The act of applying the mind to anything; consideration or regard for any person or thing (dictionary). We suggest attention is a condition of relative neural silence in which perception and sensitivity (intelligence) are enhanced.

Attention learning enhancing and nurturing the ability to attend deeply to what is.

Biofeedback life (bio) feedback. Information which comes back to an organism about itself.

Cohere to stick together; be united, hold fast, as parts of the same mass. In physics, to be united within a body by the action of molecular forces. To be naturally or logically connected.

Coherence the act or state of cohering. Natural or logical connection. Correspondence, harmony, agreement, rationality.

Coherence theory The theory of truth that every true statement, insofar as it is true, describes its subject in the totality of its relationship with all other things. Pragmatic theory.

Consciousness the state of being aware especially of what is happening around and within one. Having a feeling or knowledge of one's sensations, feelings, etc. Being able to feel and think, awake. Aware of oneself as a thinking being.

Dysponesis from the Greek meaning inappropriate and, or unnecessary use of energy.

Empyrean the highest heaven, among the ancients the sphere of pure light or fire, the abode of God,

Epistemology Theory or science of knowledge, treating of its origin, validity, and relation to human experience.

Heuristic the method of learning in which the student is encouraged to learn for him or herself with as little dependence on past experience or outside authority as wisdom deems appropriate.

Hypnogogic hypnopopic imagery refers to that imagery which emerges as one shifts toward sleep (hypnopopic) or comes back from sleep to consciousness (hypnogogic).

Hypothesis from the Greek hypothesis meaning groundwork, foundation, supposition. Literally 'to place under' (hypotithenai). An unproved theory, proposition, supposition, etc. tentatively accepted to explain certain facts or (working hypothesis) to provide a basis for further investigation, argument, etc.

Intelligence from the Latin intelligere - to see between the threads finely woven. therefore we suggest sensitivity is intelligence. From the dictionary - the ability to apply the mind effectively to any situation, study or problem; clear thinking plus good judgment.

Liminal a moment of equilibrium, charged with promise, when the old has not quite passed and the new is just being born. The border, or at the threshold of which, in psychology and physiology implies the least degree of stimulation that produces a response.

Meditation the art and science of evoking the highest orders of intelligence and wisdom possible for a human being.

Mutation an alteration or change. Any heritable alteration of an organism.

Mysticism the belief in a direct, intimate union of the soul with God through contemplation and love.

Profound Attention is a term (inspired by Edwards Deming's concept of profound knowledge) I coined in order to indicate there are extremely high orders of attention which are not usually recognized in traditional psychology. Also, psychology recognizes a variety of consciousness phenomena as attention (such as Molholland's 'data-capture-and-hold' type of attention. Some of these consciousness phenomena we view as orders of thinking rather than attention. Profound attention includes feelings and leads to the unfoldment of what has come to be known as emotional intelligence (EQ). There is the sense that the heart enters into the brain. I believe that neurophysiologically the brain must be extremely quiet and in this quietness it can observe thought thereby increasing the quality of thought. Such deep attention 'draws' the potential out of the moment. It might be said that this quality of attention nurtures, or causes the implicit to unfold itself becoming explicit and it does so in true real time. Meditation and love require this Profound Attention as well as evoke it. Profound attention, meditation and love may actually be the same phenomena, quality or force (similar to the space - time continuum). I believe Profound Attention can be developed, nurtured, enhanced in most human beings.

Profound Knowledge As taught by Edwards Deming it meant the capacity to see the whole (business, organization, person, a life, ecological system, etc.) system as a system. This enables the right questions to be asked. Profound Knowledge carries the notion that one must invest one's energy and resources in solving those problems which really count as opposed to wasting one's energy and resources solving problems which do not matter much or are even irrelevant. One of the best ways (perhaps the only way) to gain Profound Knowledge is through the exercise of Profound Attention.

Ontology a branch of metaphysics which studies the nature and meaning of existence.

Philosophy the serene wisdom that comes from calm contemplation of life and the universe (Webster's second definition).

Psychology the science dealing with the mind and mental processes, feelings, desires etc. learning, the acquiring of knowledge or skill.

Renaissance to be born, to be born anew, rebirth, revival.

Science from the Latin sciens, to know. The state or fact of knowing. Systematized knowledge derived from observation, study, and experimentation carried on in order to determine the nature of principles of what is being studied.

Transform to change the external form or the inner nature, to change the personality or character of.

Synchronous moving at the same rate and exactly together.

Ubiquitous being everywhere, especially at the same time.