REMOTE TRAINING OUTCOMES

As we approach the end of 2020, we felt it was prudent to objectively evaluate results of our remote, single channel neurofeedback training. As with in-person training, the neurofeedback is combined with biofeedback and metacognitive strategies. Our remote program uses Procomp2 equipment from Thought Technology. (See image below.)

This unit, along with accompanying sensors for single channel neurofeedback (brainwave training), plus heart rate (BVP) and respiration sensors, has allowed us to work remotely with clients using a virtual meeting software program that meets all privacy standards. We are excited to announce that the preliminary results are showing excellent gains on neurocognitive testing, measured using the CNS Vital Signs test battery.  

   RESULTS SHOW:

Clients who have completed 20 to 40 sessions of REMOTE ONLY training have demonstrated an average gain of 18 percentile points on  their over-all test scores on a battery of standardized neurocognitive tests (CNS Vital Signs).

(A percentile indicates the per cent of same age people who obtain a particular score; thus, if you score at the 50^th percentile rank, you are mid-average – as good, or better, than 50% of people. So a gain of 18 percentile points, if you started at the 50^th, would bring you up to the 68^th percentile rank. In other words, your score went from being better than 1/2 of the population to being better than 2/3 of the population. )

This Neurocognitive test battery includes measures of short term memory, attention, executive function, social acuity, cognitive flexibility, processing speed and reaction time.

 

         ADD Centre clients are very happy with their improvements and we are delighted that remote training is achieving the same kind of great results observed for over 25 years with in-person neurofeedback plus biofeedback interventions. We look forward to continuing to offer remote training as a part of our ADD Centre Programmes. Our clinical research, which involves tracking many measures before and after training, will continue to be updated as more clients complete their remote training and do progress testing.

         Helping people of all ages improve self-regulation of attention and emotions in order to bring out their potential continues to be the mission of the ADD Centre, whether we are seeing people in-person or working with them remotely.  

Testing Neurofeedback as a Treatment for Tourette’s

SMR training over the sensorimotor strip - has been used at the ADD Centre as a treatment for clients with symptoms of Tourette's for over 20 years with good and lasting results. 

- Dr. Lynda Thompson

- Testing Neurofeedback as a Treatment for Tourette's - Article Link

Q&A with Michelle Hampson, Ph.D.

Michelle Hampson, Ph.D.Associate Professor of Radiology and Biomedical Imaging
Director of Real-Time fMRI
Yale School of Medicine
Dana Grantee: 2009-2011

Tourette’s Syndrome is a neurodevelopmental disorder, diagnosed in children and adolescents, characterized by uncontrollable, repetitive movements or sounds, called tics. These movements might include frequent, irrepressible eye blinks, shoulder shrugs, throat clearing, grunts, or verbal outbursts. Such tics are not only socially disruptive but can be physically harmful to those diagnosed with this disorder. Unfortunately, traditional treatments for Tourette’s disorder, which include cognitive-behavioral therapy and certain antipsychotic medications, are not always effective – and can result in unpleasant, or even intolerable, side effects. The need for alternative therapies and interventions for a disorder that is more common than most realize is quite acute.

Michelle Hampson, Ph.D., an associate professor of radiology and biomedical imaging and the director of real-time functional Magnetic resonance imaging (fMRI) at the Yale School of Medicine, is interested in exploring the possibility that using neurofeedback from a brain region called the supplementary motor area (SMA), which previous studies have shown activates prior to a tic, may offer some relief, helping people diagnosed with Tourette’s Syndrome to better control their tics and reduce their frequency. Here, Hampson discusses why neurofeedback may be a good alternative treatment for this disorder and the challenges of developing the right training paradigms.

What first interested you in trying to use real-time fMRI feedback as an intervention for Tourette’s syndrome?

When I came to Yale, I discovered there was an active Tourette’s group at the Child Study Center. This condition seemed tractable from a research perspective in that it has a very clear symptom, the tic, and you know exactly when the symptom is occurring. In that sense, it’s easy to study with neuroimaging because you have a clear event-related marker to associate with brain activity. Being able to identify a symptom-related brain pattern is the first step in developing a neurofeedback intervention, so Tourette’s is a promising disorder in that respect. Also, compared to disorders like schizophrenia, for example, where people may have very different types of symptoms, there is a lot less heterogeneity. People have different types of tics, of course, but it seemed to me to be a much more solid diagnostic category and more likely that the brain circuitry involved is consistent across patients.

That said, it’s also been a challenge to study using neuroimaging. Many types of tics involve head movements, which can add a lot of noise to the imaging data.

I’d add that we also know that some people with Tourette’s are aware of a tic coming on before it occurs. It’s kind of like when you feel a cough coming on, but you are in a large auditorium and you don’t want to draw attention to yourself. So, you can suppress that cough, right? A subgroup of people with Tourette’s can do that. Not everyone, some people are completely unaware that a tic is coming on and feel like it is completely involuntary. But this subgroup is aware of a tic coming on. And these individuals feel the urge to make the movement and they report they have some ability to suppress or control the movement, at least in the short term. Like with that cough, you can prevent yourself from coughing for a certain amount of time but eventually that cough is going to happen. You are going to leave the auditorium to do it or disrupt whatever’s going on, but the cough will eventually come. It’s the same with the tics. However, the fact that some individuals do feel they can control the tics to some extent suggests that there are existing brain circuits that enable that control and that could be potentially strengthened via neurofeedback.

Why do you think it is worthwhile to develop a biofeedback intervention for this condition?

New treatments are needed – not everyone responds to the treatments that are available now. And even those that do often have troublesome residual symptoms or unbearable side effects. Our hope is that neurofeedback could help fill that gap.

This technique allows us to monitor a certain aspect of brain function using fMRI and give direct, real-time feedback back to patients, showing them how that aspect of brain function is changing. We cue them at certain times to try to increase or decrease that aspect of brain function. They get to practice controlling that aspect of brain function using the feedback we give them as a training signal. You can do this with any aspect of brain function as long as you know what aspect of brain function or activity is associated with the symptoms you are trying to control.

For example, in Tourette’s, we know that the supplementary motor area (SMA) is involved with tic behaviors. If you stimulate this area you can cause tic-like symptoms. And previous fMRI work shows that this area gets really active just before a tic movement occurs, too. That led to the idea that if we provide feedback about the SMA’s activity, we could train patients to control it, and it might result in an improvement in symptoms.

In a recent experiment, you trained study participants to both increase and decrease activity in the SMA. Why?

While it may seem to make the most sense to train them to decrease activity in the SMA, which seems like the most clinically useful direction, there’s also very interesting literature showing that when patients are very focused on a particular task, their tics will completely go away. You may know the story that Oliver Sacks told about the surgeon with Tourette’s syndrome who had tics but was able to do surgery because when he was focused on that task, the tics went away. The problem with that focus is that you can’t keep people hyper-focused all the time. They need to be able to relax and go to sleep. And being able to relax and sleep is something, like navigating social situations, that can be very difficult for people with Tourette’s. If they are a little bit stressed, they just can’t stop tic-ing and it is exhausting.

It’s sort of an odd situation. There is evidence to suggest that tics decrease when someone is very relaxed, happy, and well rested and seem to increase when people are stressed out. But the tics also decrease when they are very cognitively focused, and interestingly, cognitive focus often involves elevated SMA activity. So, in our most recent study, published in Biological Psychiatry, we tried to train the study participants to both increase and decrease activity in the SMA to see how it would affect their symptoms. We hoped, with training, there was some circuitry in the brain that we could strengthen that would allow them to better control activity in the SMA and reduce their tic urges.

What are some of the biggest challenges to designing a neurofeedback paradigm for this population?

There are many unknowns regarding how to optimize training to maximize the chances of getting clinical benefits. As you noted before, one choice we made was to train individuals to both upregulate and down regulate activity. If you upregulate by thinking of things that stress you out and make you want to tic a lot, like people making fun of you, that’s not likely to be therapeutic. So we talked with the participants about strategies that would be more helpful, like thinking about the sports they love and, if their tics tend to go away when they play those sports, imagining the movements they make and using that motor imagery to co-opt the brain circuitry involved with the tics. So, these are approaches to upregulating the SMA that we thought might have a potentially therapeutic aspect. The downregulating strategies were related to relaxing and also potentially therapeutic. In this way, we tried to maximize the therapeutic benefit of training in both the up and down directions.

I think, at the cellular level, there are probably different patterns of cells in the SMA that are active when you upregulate activity with these different strategies compared to the cells active prior to tics, but the hope was that engaging the SMA for these other purposes can suppress tics. So, it may be possible that certain types of hyperactivity in the SMA might reduce some of the tics. Unfortunately, it’s not possible see cellular level differences using fMRI – but this was our reasoning.

What did the patients think of the training?

Understanding the feedback is easy. You don’t have to understand what’s happening in the brain very deeply. We use a line graph for the feedback so, at certain points, they are trying to make the line go up and, at other times, they are trying to make the line go down. They don’t have to understand anything more complex than that. Just make the line go up or down – and they get direct feedback on whether or not they are succeeding.

That said, trying to control that line was very challenging for them. We knew that it would be before we began the study and told them they shouldn’t be discouraged – you are making changes even if you think you aren’t controlling all that well. Your brain may be picking up something even if you don’t feel like you’ve mastered control of this area.

I should add that our main measure for control, in the Biological Psychiatry paper, didn’t provide evidence that participants were actually learning effective control. It was sort of remarkable that we got the symptom change effects that we did given how noisy the learning patterns in the brain were.

How do you explain the fact that you saw sustained symptom changes?

We can’t rule out a possible placebo effect, or a learning effect that is not specific to the circuitry trained. The sham control was quite compelling, and the participants generally believed they were getting real neural feedback. But, on the other hand, an argument could be made that, at some level, during neurofeedback their brains saw a relationship between the feedback they were getting and what was happening in the brain. It’s possible that when there is a statistical relationship between the feedback and brain activity, your brain starts to rewire and build new synapses to adjust and learn. Maybe the sheer act of changing synapses in response to those statistical relationships is therapeutic. Because you don’t see the same statistical regularities in the sham treatment, that could explain why neurofeedback was associated with more symptom improvement than the sham condition.

It’s also possible that the neurofeedback did strengthen the circuitry allowing them to control their SMA, and that our measures of control over the region were just too noisy to capture that. The symptom changes are assessed across longer time frames and in a sense that provides a form of averaging that reduces noise. So, this could be a power issue, where we had better power to detect clinical changes than changes in control over the SMA. We discuss these different possibilities in detail in the Biological Psychiatry paper.

What is also interesting is that symptom changes seemed to persist and grow two weeks to a month after the neurofeedback was over. We first noticed this in another study where OCD participants who got real neurofeedback improved much more over time after the intervention, not just during the intervention. That was really surprising to us, and a similar pattern seemed to hold in the Tourette’s study. We published that finding in NeuroImage; it has some practical implications for neurofeedback studies that are discussed in that paper.

How do you plan to follow this work?

There are a lot of other conditions we are interested in studying but, in terms of Tourette’s Ssyndrome, we still have quite a bit of data to mine. We have resting state data, and we want to see which connections in the brain might have changed in response to the training. If we can identify certain functional connections that were strengthened in participants during the neurofeedback, and that are related to symptom changes, we can better understand why the participants showed the symptom improvements they did. This may help us identify other neural pathways that we should be targeting with our feedback.

That’s one of the nice things about neurofeedback: it’s kind of a closed loop in terms of basic science and clinical findings. It has an experimental medicine approach that allows us to constantly look at what’s happening in the brain and refine our targets as we learn more about what biomarkers are changing and how those changes relate to symptoms.

fMRI is, of course, quite expensive. And you’ve mentioned that there is a subset of patients, like those with tics that involve big head movements, who could not get feedback in the scanner. How do you see this type of therapy evolving?

There is a lot of interest in the neurofeedback world in eventually translating fMRI neurofeedback protocols to other modalities. There’s amazing work going on in Talma Hendler’s group in Israel which is identifying the electroencephalogram (EEG) fingerprints of fMRI activity patterns so they can train using only EEG. That’s the kind of long-term goal that the field is very interested in achieving.

Another option, in addition to the use of EEG, is functional near-infrared spectroscopy (fNIRS), which can measure blood flow activation on the outer surface of the brain. This is another promising option for measuring activity in the SMA. Developing the training paradigm using fMRI, which has good spatial resolution where you can target exactly where you want in the brain, is a good place to start. Then once you’ve found the right targets to train people to control, that result in symptom improvement, you can work on ways to translate those biomarkers to a different modality.

References

Time course of clinical change following neurofeedback. Rance M, Walsh C, Sukhodolsky DG, Pittman B, Qiu M, Kichuk SA, Wasylink S, Koller WN, Bloch M, Gruner P, Scheinost D, Pittenger C, Hampson M. Time course of clinical change following neurofeedback. NeuroImage 2018, 181:807-813. doi: /10.1016/j.neuroimage.2018.05.001

Orbitofrontal cortex neurofeedback produces lasting changes in contamination anxiety and resting-state connectivity. Scheinost D, Stoica T, Saksa J, Papademetris X, Constable RT, Pittenger C, Hampson M. Orbitofrontal cortex neurofeedback produces lasting changes in contamination anxiety and resting-state connectivity. Translational Psychiatry 2013, 3:e250. doi: 10.1038/tp.2013.24

Remote Training Options

In addition to counselling sessions that can be provided by telephone by Dr. Lynda Thompson and Andrea Reid-Chung (both hold registration with College of Psychologists of Ontario) and Lena Santhirasegaram (registration with College of Psychotherapists of Ontario), the following at-home options are available through the ADD Centre.

The following may be a lot of material in one posting. Please call if you have questions and we will call you back as soon as possible.

1. eVu TPS Home Biofeedback Training:

The eVu TPS is a portable sensor for at-home biofeedback training with a smartphone or tablet. The sensor is designed for users who do not necessarily have high level of experience with biofeedback equipment. The sensor is applied to a single finger with a fabric strap and detects and transmits highly researched measurements of psycho-physiological health, including heart rate variability. The TPS measures Temperature, Pulse and Skin conductance. By resting the sensor over your diaphragm, you can practice synchrony between breathing and heart rate changes, thus training heart rate variability.

DeStress Solution Training Program

The eVu TPS sensor can be used for a stress-reduction training program administered remotely via online conference.

This program provides:

• a method for assessing and reporting stress,
• training screens for self-regulation (biofeedback)
• relaxation therapy exercises

The program begins with an initial stress test and analysis. The user’s physiological stress-response provides guidance for the at-home biofeedback training screens. Ultimately, the user learns to become aware of their negative physiological stress responses, such as noticing that your hands are getting cold when you are stressed. You then practice how to voluntarily shift to a more desirable response, such as warming your hands.

Systems will be available to rent for a small fee and then online training sessions billed per session. Sessions would be done with our staff and may include Biofeedback plus Metacognitive strategies as requested. This program runs on an Android phone or tablet.

2. Audio-Visual Entrainment (AVE)

Audio-Visual Entrainment (AVE) is a technique that utilizes pulses of light and sound at specific frequencies to gently and safely guide the brain into various brain wave patterns.

Through the process of entrainment (the tendency of physiological processes to mirror environmental stimuli) you have the ability to alter your brain wave frequencies to improve mental performance.

It is an effective, inexpensive alternative therapy for many symptoms such as anxiety, inattention Deficit Disorder, Seasonal Affective Disorder (SAD), PTSD, and chronic pain. AVE may also increase brain health by increasing cerebral blood flow and stimulating beneficial neurotransmitters, such as serotonin, norepinephrine, and endorphins. AVE devices have been used successfully to boost physical performance for athletes, academic performance for students and cognitive performance for seniors.

Recommended AVE Program examples:

A1- Sensory Motor Rhythm (SMR) - Use to achieve relaxed attention.

A2- SMR for Sleep - Use to improve sleep for those with insomnia due to a “racing” mind but relaxed body.

A4- ADD and Learning - This session has rapid transitions for mental stimulation to

help keep the user “engaged” in the session. Used in the ADD study published in the

Journal of Neurotherapy.

This system is available for rent and will include a recommendation as to which session(s) would be best for you.

3. Cogmed Working Memory Training Program:

Cogmed Working Memory Training is an evidence-based program for helping children, adolescents, and adults sustainably improve attention by training their working memory.  It does so through web-based training programs that are age and ability appropriate. It was originally developed in Sweden and has considerable research behind it. It is only available through accredited psychology service providers, such as the ADD Centre.

The research-based program, clinically proven to increase working memory capacity, is delivered under the supervision of a qualified Cogmed Provider—a “Coach”. The training consists of a specific set of working memory tasks that are performed on a computer or tablet in the convenience of the trainee’s home, school, or designated health care facility.

These Programs are “built around three easy-to-use and age-specific applications, the Cogmed program guides the trainees through multiple working memory exercises, automatically adjusting them in real-time to a level that is challenging but not so difficult that it becomes intimidating. It adapts to the trainee’s ability. Each application shares the same underlying design and algorithms – the differences are in the user interface.

This program involves an initial interview and then weekly coach calls to check on progress. The program runs for 5 weeks, 5 days per week. We are offering this at a special discount due to the COVID-19 epidemic. As many children are home from school over the next few weeks this program can be a productive way to use this time off.

www.cogmed.com for more information.

4. iLS Listening Safe and Sound Protocol (SSP):

WHAT IS THE SSP?

Developed by Dr. Stephen Porges, the Safe and Sound Protocol (SSP) is a five-day auditory intervention designed to reduce stress and auditory sensitivity while enhancing social engagement and resilience. Based on Dr. Porges’ Polyvagal Theory, by calming the physiological and emotional state, the door is opened for improved communication and more successful therapy.

The SSP is a research-based therapy showing significant results in just five days in the following areas:

• Social and emotional difficulties
• Auditory sensitivities
• Anxiety and trauma related challenges
• Inattention
• Stressors that impact social engagement

More recently this has been recommended for Concussion. 

At the ADD Centre we are involved in a joint research project with the University of North Carolina (on hold due to COVID-19) concerning this intervention and feel this is a helpful approach.

5. ProComp2 Home Neurofeedback Training

This program allows you to do regular single channel neurofeedback sessions from home. For the most part, you would be continuing your program as done at the ADD Centre. One of our neurofeedback trainers would login remotely at regular times to help you run your sessions. This can include metacognitive strategies. 

We would arrange an initial session to put the software on your computer. It is helpful if you have EXCEL already installed in order to graph your learning curve.

PLEASE SEND AN EMAIL TO addcentre@gmail.com to ask questions and/or inquire about pricing.

Dr. Lynda Thompson and her husband have written the basic textbooks in this field, The Neurofeedback Book and The Functional Neuroanatomy book, that describe why and how biofeedback and neurofeedback works. These books include the background behind the methods described above. They have done over 150 presentations as invited teachers to large professional groups in 25 countries on 5 continents.

Biofeedback Training Options and COVID-19 Update

Dear Clients and Parents,

The health of our clients is our top priority; thus, to reduce the chance of any community spread of COVID-19, the ADD Centre will be postponing all in-person training sessions as of March 18 for 2 weeks. The regular schedule for training sessions and assessment bookings will resume April 1. If this schedule should change, you will be notified by email or phone.

The ADD Centre staff are committed to keeping your training and progress going forward without long pauses. To this end, we wish to be regularly in touch with you by phone and on-line. For those of you who wish to continue some training at home we are investigating the best methods to help us continue training with you but in your own home. We recognize that this presents some disruption and new learning and hope to make this as simple as possible.

While we are not able to meet with you in person, we can provide the following options for you:

1. Phone consults/counselling sessions will be available:
   1. Those who have regular counselling sessions with Lynda can do these by phone. We will be connecting with you by email to confirm these appointments will move forward as planned.
   2. Clients who wish to have counselling, consultations or online trainings with Andrea can book these via email.
   3. Online counselling sessions for clients or parents can also be booked with Lena, a registered psychotherapist.
   4. We offer an online working memory training program called Cogmed www.cogmed.com. If you are interested in working through this program while you are social distancing at home, please let us know. We would arrange an intake interview with Lena to set up the program. This program is entirely remote. It is a 5-week program involving 5-days-a-week on-line exercises. (See the attached BODES hand-out for details.)
   5. Our full time training staff may provide metacognitive training sessions by phone or using Gotomeeting software by request. If you wish to book this type of appointment, please indicate what you would like your child to learn about from the following list and we can arrange for a phone meeting between your child and one of our full time staff members/trainers (Erik, Maya, Zifeng). These would be 30 minute meetings:
      1. Homework strategies
      2. Test taking strategies
      3. Math, Reading, Writing Strategies
      4. Organizational skills

6. We are working on some further remote training options that may include iLS listening, neurofeedback, Heart Rate Variability & Biofeedback, and light and sound. We will inform you when these services become available and how to access them.

In the meantime, try some of the interventions outlined in the attached BODES hand-out that some of you will already have received at the time of your assessment. The helpful tips include details about taking fish oil supplements, doing effortless diaphragmatic breathing and keeping to a regular sleep schedule. You can download a free-for-a-month breathing app called “EZ Air” from www.bfe.org to help your practice of effortless diaphragmatic breathing.

Helping you be your best is always our goal, whether we do that in person or in other ways. This crisis presents an opportunity to be flexible and show resilience. We are grateful for your understanding. Wishing you and your families good health, we remain,

Sincerely yours,

Lynda Thompson, Ph.D., C.Psych. Andrea Reid-Chung, M.A., C. Psych. Assoc.

Executive Director Clinical Director

Gamma Training Part 2

Gamma has been an unexpected journey.

It is easy to wrap one’s head around the need to address brain functionality, to enhance memory, to decrease anxiety, to improve reading comprehension, to develop good organizational  skills or to fine tune executive functioning for your child or yourself. We  can all appreciate the need to overcome traumatic or acquired brain injury, current or generational trauma.

Gamma has helped to revisit deeper aspects of brain injuries, refine healing and add more dimension to processing information. It has also been an exploration, not easy to describe.

 Gamma brain waves have a small amplitude and a fast oscillatory range. Gamma allows  the brain to process multiple sensations at  the same time. It allows us to experience the five senses altogether. It efficiently absorbs information and change in one’s environment to fine tune instinct. It speeds up mental processing and perception by linking information from all parts of the brain. Gamma deepens REM sleep. There is  a sense of euphoria, our own natural anti-depressant.

The foundational Neurobiofeedback  prepares you for the intense work that it takes to target the gamma range. At one point I described the Neurobiofeedback effects as changing knob and tube wiring for well insulated copper wire. Adding gamma is  like creating a fibre-optic cable connected to a vast network. Often more sleep is needed and good quality nutrition is always necessary to support the development of the new connections the training stimulates.

Like the initial Neurobiofeedback training gamma also needed the first 20 hours just  to build a template for the new function. There was one immediate sensation that made the initial development of gamma more enjoyable. Euphoria!

 It was overwhelming at first when gamma brought all the other brainwaves and senses on-line at the same time to process information. It was like experiencing  multiple dimensions, sensory overload and information coming at me from all directions all at once. The sense of expanded reality equalized quickly to a comfortable level for which I was quite grateful. I learned to relax into the volume of co-ordinated information. What used to be a mentally crowded jumble of lists, chores, responsibilities etc. went the other direction. I felt as if there was endless, open room to fill or organize as I wanted. My days had “free time”. Previously so much effort had gone into sorting through unsynthesized information.

 The training settled into a week of euphoria then a week of building capacity which, frankly, was often unpleasant. There were memories that had threads to current circumstances that had never come to full awareness in therapy, including EMDR and Brainspotting which both access the left and right hemispheres of the brain. I suspect that the more integrated function of gamma helps the brain co-ordinate a lifetime of imprints and influences much more efficiently than memory or willingness alone can account for.

One of these moments, I think, is worth mentioning.

I had come to many layers of understanding and resolution over two incidents that, although separated by 35 years, were similar in one critical element. I had became responsible for the safety and the life of someone who should have been cared for by an adult in the first circumstance and then for someone whose  safety and needs were dismissed by a medical professional in the second circumstance. Both times I was in a vulnerable state myself.  I had resolved what I thought were all the  nuances of my responses to these events. But one morning, the day after a gamma training, I woke up light headed, dizzy and trembling. It was a completely  familiar  sensation. This was the same post trauma, full body response, linked also by the scent memory of hospitals and drugs that I had experienced first at 15 years and then again at 50 years of age. Gamma had brought together  everything from all the senses. It brought up the deepest of survival and empathic instincts.  I realized that even the smallest element of similarity in other situations would heighten perceptions and cause my body to gear up for battle by ever so slightly initiating an internal trembling.

Another layer of exhausting conditioning resolved. Another opening for deeper resolution of other injuries. My dream world was a  marathon for a couple of weeks.

 Sometimes we, well certainly I, have in some circumstances never downgraded other conditioned responses that while useful at the time have just become  automatic in the nervous system especially those events that are long gone from current necessity but still play their part in shaping current or future behaviour. The best example I have for this is the attentive sleeping that parents or  palliative caregivers maintain long after the children have moved out or the caregiving is over. I was with my Mother when she was in hospital with pancreatic cancer. I listened for her breath for weeks. I woke up at 4:22 every morning for years after she died. My nervous system was deeply imprinted.

There may not be any fault or negligence in how many events are dealt with but who can know how or why  events configure as they do in unique and individual ways that may be influenced by biochemistry, DNA, personality, environment, nutrition etc.  I have found that with gamma training there has been a deeper cohesion, consolidation and understanding of previous events. I think that this is in large part because gamma links all the senses with more of the brain and nervous system. There has been a  deep relaxation, an emotional resilience and a very profound sense of well being that is easing into everyday life. This is a gift of unexpected magnitude for me. I am very much an introvert who as a child was deeply affected by things that would be inconsequential to most people. It would take me days and sometimes weeks to recover from an incident. On the upside I developed a lot of empathy.

 The euphoria is not as pronounced any more but a quite ordinary, garden variety of consistent kindness and calmness is there in everyday use. The type of kindness that  allows enough sleep every night rather than one day of collapse, the kindness that doesn’t wait for bells to ring to acknowledge a job well done but celebrates daily effort. Internalized kindness has made it easier to review, catalogue and archive experiences, available if needed but otherwise comfortably stored. I had wanted to enhance gamma to make me a better therapist. I wasn’t expecting so much personal benefit. Silly I know, but I did have a Grande Canyon deep groove of expectations geared to care of others at all costs.

I will have done 40 hours of gamma training by November 2015. I hope that the speeding up of mental processing and perception develops a whole lot more! The first piece that I wrote for the blog was relatively easy to write as it was well remembered historical information and well used resources. Writing about the unfamiliar path  that gamma has taken me on, linking and reworking memories, emotions and information has been much more of a process than simply reporting the events. I feel differently about many things. I am not sure yet if I am expressing myself in a way that does justice to the altered perceptions.  Finding that voice has been curious and a little unclear.

A good friend made an observation about the first piece and gave me some advice for this post. She said,” The only thing I would say is missing is the answer to the question - - Why?  Why would they want to know your story and why would this help them?” It is a good question and a valued observation as I have not written anything for anyone else before these posts. Certainly my clinical practise in manual therapies is centred around what will help someone else. Writing is a whole other world and use of the brain. Perhaps that then is part of the answer to “why”,  the chance to use your brain in ways that you hadn’t contemplated before.

For myself, I would say that the experience of having more of one’s brain available more of the time is pretty heady stuff.  I would definitely have to say that using the brain’s capacity, freer of constraints or injuries  is inspiring. Personal sovereignty is a good goal. Compassion is a good foundation. A finely tuned instinct creates certainty and  security. And not least, but very refreshing, sleep is sweet and deep.

Biofeedback at the APA Convention - August 6-9, 2015

Biofeedback at the APA Convention in Toronto

 The Biofeedback Federation of Europe provides professionals worldwide with a greater understanding of biofeedback. We're continually inspired by work that is being done in the field. But for every health professional using biofeedback in practice, hundreds are not. We were pleased to see that the upcoming APA Convention will feature a symposium on biofeedback with speakers covering topics such as ADHD, anxiety, depression, chronic pain, stress and peak performance.

Biofeedback and Neurofeedback

Biofeedback is a learning process in which people are taught to improve their health and performance by observing signals generated by their own bodies such as heart rate, temperature and skin conductance.  This information is fed back to the person in real time, allowing them to learn to control their response to different stressors.

One of the presenters taking part in the symposium on "The Evolution of Psychotherapy---Can Biofeedback Advance the Practice of Psychotherapy?" at the APA Convention is Dr. Lynda Thompson. Dr. Thompson is best known for her work in the field of neurofeedback, a type of biofeedback that measures brain activity. Together with her husband, Dr. Michael Thompson, she runs the ADD Centre at the Biofeedback Institute of Toronto. Dr. Michael Thompson describes neurofeedback as, "a non-invasive learning procedure that allows the client to train their own brain, practicing healthy patterns and normalizing functions. This learning is vastly accelerated because we are able to specifically target the learning to the area(s) and the neural networks of the brain that are not functioning appropriately. It is always combined with Heart Rate Variability (plus other peripheral biofeedback measures as necessary for a particular patient).

"Some of the symptoms that can be worked on in training include: anxiety and depression; ADHD; learning difficulties such as dyslexia and math problems; migraine; memory difficulties;  sleep disorders; anger control; and difficulties interpreting social cues such as is found in Asperger’s syndrome and autism."

APA Convention - Toronto, ON - August 6-9, 2015

If you're planning to attend the APA Convention in Toronto, we encourage you to take a moment to see how you can incorporate biofeedback into your practice. In addition to Lynda Thompson, the presenters in the symposium include: Carol S. Austad, Cosima Hoetger, Paul Lehrer, Donald Moss, and Patrick Steffan.

Session Title: 2316

The Evolution of Psychotherapy---Can Biofeedback Advance the Practice of Psychotherapy?

Session Type: Symposium

Date: Fri 08/07 4:00PM - 5:50PM

Division/Sponsor: 42-Psychologists in Independent Practice

Building/Room: Convention Centre/Room 206D North Building-Level 200

Read the full abstracts here:

http://www.apa.org/convention/program-search.aspx?title=biofeedback

More About Dr. Lynda Thompson and the ADD Centre

Over the last 23 years Dr. Lynda Thompson with her staff at this Centre have carried out over 150 invited workshops and lectures in 23 countries on 5 continents and have professional publications that include: 8 book chapters, 25 journal articles, and 4 books including the basic textbook in the Neurofeedback field, The Neurofeedback Book:  An Introduction to Basic Concepts in Applied Psychophysiology (2003, 2015), and Functional Neuroanatomy Organized with Reference to Networks, Lobes of the Brain, 10-20 Sites, and Brodmann Areas (2015).

Drs. Lynda and Michael Thompson teach two annual neurofeedback workshops at the Viamede Resort, Stoney Lake, Ontario near Peterborough and 1 3/4 hour coach ride from Pearson International Airport Toronto. The upcoming workshop dates are:

September 21 to 25, 2015 or

May 30  to  June 4, 2016

More information is available from www.addcentre.com or by a telephone call to the ADD Centre, Biofeedback Institute of Toronto (905-803-8066).

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The Biofeedback Federation of Europe is approved by the American Psychological Association to sponsor continuing education for psychologists. The Biofeedback Federation of Europe maintains responsibility for this program and its content.

Gamma Brainwave Training Part 1

Part 1: A brief history of what came before Gamma Training 

(for this training Gamma is defined as 38 to 42Hz)

Part 2: To come later, Description of Gamma Training Sessions

Ten years ago  I found myself  in the   Emergency  Room at Toronto General Hospital  with an appendix that had perforated about three weeks  earlier. I have a strong immune system . I was not experiencing any pain or nausea. It was only the possibility of  having contracted a stomach virus that sent me to a walk-in clinic just to check it out.  It took a CT scan to verify that I was well on the way to not surviving the infection. While I was waiting for the antibiotics to get me in good enough condition for surgery I contracted a Clostridium Dificil infection as well. In the normal way of things C.Dificil  stays in the digestive system but with about a third of the peritoneum filled with everything that had nowhere else to go when the appendix perforated the C.Dificil  affected many other cells. I was on intravenous and oral antibiotics for several weeks. I also used a probiotic that is very useful for C.Dificil (Saccharomyces Boulardii) and Shakya Dorje a Tibetan Medicine Emchi (Doctor) here in Toronto brought me three herbal preparations to help mend a very injured digestive system. All of this worked well enough to heal my appendix which I still have to this day.

The next ten years were not without problems though. I was exhausted, food did not give me any energy. My memory was deteriorating. Words got lost when I was trying to carry on a conversation. I could not focus my attention. Sleep was not restorative.  As if  all that wasn’t enough I had a radial head fracture 3 months after getting out of hospital. This happened on a Tuesday and I went back to work on Friday of the same week, again, with the aid of Tibetan Medicine. Financial stress was a big factor. My father also died quite unexpectedly just as I thought that nothing else could possibly happen.

I was increasingly frustrated and frightened by the loss of mental capacity, creeping weight gain and rapid bone loss. I’ve come to understand that these things are in-fact very inter-related. I decided to tackle the brain function first by getting an assessment at Arrowsmith School. I did a part-time program, 2 hours, twice a week  at Arrowsmith for 2 years until the exhaustion became so intense I would fall asleep 20 minutes into working on the Clock Exercise. The exercises that Barbara Arrowsmith has designed strengthen 19 different cognitive functions. I just did not have the health or stamina to manage the demands of class and work. It was at Barbara’s book launch (The Woman Who Changed Her Brain) that I had a conversation with Norman Doidge, author of The Brain that Changes Itself and How the Brain Heals, about Neurobiofeedback. It sounded like this might be the next step for me. I went for an assessment at the ADD Centre and started the single channel training the next week. Here was something that could also repair the brain.  Each training session was one hour, once a week, on my day off, which seemed much more do-able. The foundational repair work addresses the function and relationships of Alpha, Theta, Beta and Delta brainwaves. I can tell you I had a  fair amount of emotional relief when sleep became restorative. I started remembering dreams. Many of them were invaluable in letting me know that my brain was once again sorting through the leftovers of the day with more purpose and efficiency. I was refreshed by sleep in a way that I had not been for years. Memory for simple things like a grocery list  became easy.  I didn’t have to stumble around in my mind for words or explain about Acquired Brain Injury part way through a conversation. The insidious slide into ADD was reversed.

 Lynda Thompson, at the 40 hour re-assessment, was delighted to tell me that I had improved to the point where I could end the training or set up a maintenance schedule.      I had other ideas.

I had noticed that the Gamma brainwaves were not included in the training. Lena, my Neurobiofeedback trainer, told me that only one other person had done any work with gamma. I told Lynda and Lena that I wanted to be the second person. I had read that gamma was well developed by Tibetan Buddhist Meditators. Richard Davidson has done research with Tibetan monks and brain imaging. I had also seen a demonstration of Tibetan healing chants, practices and instruction at Massey Hall many years before I was in the hospital. I met with Lho Thul Tenzin Nimya Rinpoche who is both a monk and Emchi. He gave me some instruction and assistance that was very useful. I was  working with several cancer patients at that time. The gift of practical tools, the generosity he showed me, his deep calmness and acceptance has not faded in my memory. It continues to inspire me. I also knew that gamma increases conscious attention, compassion, calmness, instinct, REM sleep and neural synchrony.

 I am an Osteopath and a Massage Therapist. I’ve been in practice for 25 years so far. I’ve always had a hope, a wish to be in practice for 50 years just to see what my hands would know after that many years of people, their bodies, their unspoken expression of life communicating to my hands. Compassion, for me, is expressed in my hands. I said to Lynda in that conversation that while I could add techniques to my therapeutic tool kit it was the expression of well developed gamma/compassion that I really wanted to experience  over the next 25 years.