Is brain-behavior behavior? If so, it can be conditioned just ...

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  • It started with Epilepsy. But these patients had other problems, and it lead to Sleep, then ADD, and now . . .
  • Too much slow wave activity stops the brain from functioning wel..
  • This is a record of every client on whom I have had the opportunity to do a TOVA retest.
    15 of the 20 showed significant improvement on two or more TOVA subscales and also showed significant improvements in focus, impulsiveness and socialisation.
    Of The five that did not show improvement, 4 came from families which had significant family/marital conflicts, three were highly oppositional/obsessive, and one was a chronic marijuana smoker.
    Liam toohey, Michael Ritchi, Connor, Annelise, Richard Moore
  • ADHD illustrates many important issues, even though you may be primarily interested in other disorders. ADHD is important for these reasons:
    As a disorder, does it really exist? If it does, how can we clearly define it. Can modern brain scanning techniques tell us anything?
    ADHD is a disorder of attention and focus, involving three major dimensions: Inattention, Impulsiveness, overactivity.
    It is diagnosed behaviourally, if a person shows any of these three symptoms to a degree that interferes with their ability to function, in more than one setting.
    In the past it has been thought that some sort of neurological problem underlies ADHD, and now we know that this is true
  • Is brain-behavior behavior? If so, it can be conditioned just ...

    1. 1. Is brain-behavior behavior?Is brain-behavior behavior?  If so, it can beIf so, it can be conditioned justconditioned just like otherlike other behaviorsbehaviors  In 1960s, certainIn 1960s, certain rhythms could berhythms could be “trained”“trained”  Led toLed to Neurotherapy andNeurotherapy and Brain-ComputerBrain-Computer interfaces (BCI)interfaces (BCI)
    2. 2. When you become aware of your own brain activity –you can change it also.
    3. 3. Electrical stimulation of brains (ESB)Electrical stimulation of brains (ESB)  Electrical stimulation of brains of ratsElectrical stimulation of brains of rats - James Olds in 1950s;- James Olds in 1950s; • Jacobsen and Torkildsen replicatedJacobsen and Torkildsen replicated work in humans;work in humans; • some epileptics stimulatedsome epileptics stimulated themselves into convulsionsthemselves into convulsions 
    4. 4. INTRA-CRANIAL SELF-INTRA-CRANIAL SELF- STIMULATIONSTIMULATION  Rodent wireheadsRodent wireheads • 0.0005 amps whenever rat pushed lever0.0005 amps whenever rat pushed lever • Up to 10,000 bar-presses an hour recordedUp to 10,000 bar-presses an hour recorded • Animals self-stimulate > 24 hrs continuously withoutAnimals self-stimulate > 24 hrs continuously without rest, and cross electrified grid to gain access to leverrest, and cross electrified grid to gain access to lever • Reward center: Medial forebrain bundle passing throughReward center: Medial forebrain bundle passing through lateral hypothalamus and ventral tegmentumlateral hypothalamus and ventral tegmentum • Other brain centers are aversive, such asOther brain centers are aversive, such as periaqueductalperiaqueductal grey matter (PAG)grey matter (PAG) • Ventral tegmental area (Ventral tegmental area (VTAVTA) neurons manufacture) neurons manufacture dopaminedopamine and they are under continuous inhibition byand they are under continuous inhibition by gamma-aminobutyric acid (gamma-aminobutyric acid (GABAGABA) system, an important) system, an important component of the ”final common pathway" of reward,component of the ”final common pathway" of reward, implicated in addiction, mood, and learning.implicated in addiction, mood, and learning.
    5. 5. Delgado, Primate wireheads, andDelgado, Primate wireheads, and Circuitry manCircuitry man
    6. 6. Electrical stimulation of brainsElectrical stimulation of brains (intracranial stimulation)(intracranial stimulation)  Pavlov conditioning experimentsPavlov conditioning experiments • Tone for food, buzzer for shock –Tone for food, buzzer for shock – • Moved them closer together in timeMoved them closer together in time • confounded dog fell asleepconfounded dog fell asleep  Termed “internal inhibition”Termed “internal inhibition”  Animal can close down ownAnimal can close down own systems to avoid stresssystems to avoid stress  Neal E Miller trained autonomic functionsNeal E Miller trained autonomic functions • Dogs salivate to get foodDogs salivate to get food • Rats control heartrate to get waterRats control heartrate to get water
    7. 7. History of BiofeedbackHistory of Biofeedback  JH Bair, 1901, instrument used to teach ear wigglingJH Bair, 1901, instrument used to teach ear wiggling  In early 20th century, J.H. Schultz in Germany developed aIn early 20th century, J.H. Schultz in Germany developed a technique calledtechnique called Autogenic TrainingAutogenic Training. Verbal instructions are. Verbal instructions are used to guide a person to a more relaxed and controlledused to guide a person to a more relaxed and controlled physiological state.physiological state. • The method flourished, and the results were reported upon byThe method flourished, and the results were reported upon by Wolfgang Luthe in 1969 in the United States.Wolfgang Luthe in 1969 in the United States.  Increased awareness in Western world of yogic ability toIncreased awareness in Western world of yogic ability to alter physiology volitionally. E.g., a yogi could survive in aalter physiology volitionally. E.g., a yogi could survive in a sealed box by voluntarily reducing his metabolic ratesealed box by voluntarily reducing his metabolic rate significantly, surviving hours with a limited supply ofsignificantly, surviving hours with a limited supply of oxygen.oxygen.  Peripheral biofeedback techniques includePeripheral biofeedback techniques include • GSR, thermal, breathing, cardiacGSR, thermal, breathing, cardiac
    8. 8. History of EEG biofeedbackHistory of EEG biofeedback  1934, Adrian watched his EEG in front of1934, Adrian watched his EEG in front of oscillograph and created alpha at willoscillograph and created alpha at will  Alpha biofeedback or deep statesAlpha biofeedback or deep states • Joe Kamiya at Univ of Chicago,Joe Kamiya at Univ of Chicago, 1958+1958+  Kamiya 1958Kamiya 1958 • 1st subject - 60 tones and 601st subject - 60 tones and 60 guesses, half rightguesses, half right • 2nd trial, 65 % correct2nd trial, 65 % correct • 3rd 85% correct3rd 85% correct • 4th, after a few mistakes, 400 correct4th, after a few mistakes, 400 correct in a rowin a row  1968 first congress in Aspen Colorado,1968 first congress in Aspen Colorado, called biofeedbackcalled biofeedback  ““Alpha training” adopted by flowerAlpha training” adopted by flower culture of late 1960s, and practitionersculture of late 1960s, and practitioners oversold its claimsoversold its claims 1978 Science paper1978 Science paper
    9. 9. History of SMR biofeedbackHistory of SMR biofeedback  In 1960s Mercury astronautsIn 1960s Mercury astronauts claimed they saw nativesclaimed they saw natives waving at them when the flewwaving at them when the flew over the Pacific.(i.e., theyover the Pacific.(i.e., they hallucinated)hallucinated)  In 1967, Gordon Allies,In 1967, Gordon Allies, inventor of amphetamine, wasinventor of amphetamine, was contracted to test toxicity ofcontracted to test toxicity of the Mercury capsule rocketthe Mercury capsule rocket fuel with David Fairchildfuel with David Fairchild  However Allies tested anotherHowever Allies tested another chemical compound onchemical compound on himself and shortly died,himself and shortly died, before contract over. Fairchildbefore contract over. Fairchild asked Sterman to help finishasked Sterman to help finish work.work. MB StermanMB Sterman
    10. 10. Sterman was studying EEG-Sterman was studying EEG- behavioral correlates in catsbehavioral correlates in cats
    11. 11. If EEG behavior is like any other behavior, itIf EEG behavior is like any other behavior, it could be shaped with operant conditioningcould be shaped with operant conditioning  Two prominent rhythms in cat EEG – SMR and PRSTwo prominent rhythms in cat EEG – SMR and PRS • Couldn’t train PRS, but could train SMRCouldn’t train PRS, but could train SMR • More on the PRS laterMore on the PRS later
    12. 12. Cat Wireheads: cortical electrodes, not brainCat Wireheads: cortical electrodes, not brain stem or hypothalamicstem or hypothalamic  Cats often used inCats often used in electrophysiologyelectrophysiology because head sizebecause head size the samethe same regardless ofregardless of breed, unlikebreed, unlike dogsdogs
    13. 13. 10 cats trained to produce SMR (sensorimotor10 cats trained to produce SMR (sensorimotor activity over motor strip) for chicken broth & milkactivity over motor strip) for chicken broth & milk
    14. 14. Acquisition resembles normalAcquisition resembles normal behavior under O.C. trainingbehavior under O.C. training
    15. 15. Classic abundance response atClassic abundance response at extinctionextinction
    16. 16. History of SMR biofeedbackHistory of SMR biofeedback  Then Sterman and Fairchild went on to another study,Then Sterman and Fairchild went on to another study, testing rocket fuel on 50 cats, 10 from Sterman’s previoustesting rocket fuel on 50 cats, 10 from Sterman’s previous SMR training study.SMR training study.  Inject 100 mg/kg or so of fuel into each catInject 100 mg/kg or so of fuel into each cat • After one hour, all usually go into grand malAfter one hour, all usually go into grand mal  but not all - 7 delayed, 3 not at all.but not all - 7 delayed, 3 not at all. • seizure thresholds changed in these 10seizure thresholds changed in these 10 • Not explainable by placebo (“i shall please” in Latin) asNot explainable by placebo (“i shall please” in Latin) as cats didn’t know what to expect, and experimenter blindcats didn’t know what to expect, and experimenter blind because effect was entirely unexpectedbecause effect was entirely unexpected
    17. 17. Sterman et al (1967) showing usual toxicSterman et al (1967) showing usual toxic prodrome and resistance to MMH-prodrome and resistance to MMH- induced seizures in a subgroupinduced seizures in a subgroup NASA Rocket fuel Avg 2 hours+ for seizures with EEG trained cats vs. 1 hour for normal cats Time
    18. 18. History of SMR biofeedbackHistory of SMR biofeedback  Replicated findings in monkeys, then moved to humans atReplicated findings in monkeys, then moved to humans at colleagues urging.colleagues urging.  Human epilepticsHuman epileptics • First case study published in EEG & Clin NeurophysiologyFirst case study published in EEG & Clin Neurophysiology • N=4 study, 65% seizure reduction, in Epilepsia 1976N=4 study, 65% seizure reduction, in Epilepsia 1976 • Then n=8, ABA three-year study, Epilepsia 1978Then n=8, ABA three-year study, Epilepsia 1978 • Finally, full blown study funded by NIHFinally, full blown study funded by NIH  Sham control, n=24, three yearsSham control, n=24, three years  Double yoked n=8, n=8 NF, n=8 log booksDouble yoked n=8, n=8 NF, n=8 log books  many went seizure freemany went seizure free  controls after study received NFcontrols after study received NF  Reliable increase in sleep spindle density andReliable increase in sleep spindle density and decreased awakeningsdecreased awakenings
    19. 19. A major study showed 60% reductionA major study showed 60% reduction in seizures 12 months after trainingin seizures 12 months after training
    20. 20. Turf war with medicineTurf war with medicine  In 1982 Sterman’s NIH grant for 3 y wasIn 1982 Sterman’s NIH grant for 3 y was funded, but then they demanded doublefunded, but then they demanded double blind after approving the initial design,blind after approving the initial design, then they pulled funding saying goalsthen they pulled funding saying goals already reachedalready reached  Cost of temporal lobe resection forCost of temporal lobe resection for epilepsy = $200,000epilepsy = $200,000 • Money lost if patient undergoes neurotherapyMoney lost if patient undergoes neurotherapy successfullysuccessfully
    21. 21. Review of 19 studies with EEGReview of 19 studies with EEG Biofeedback for Epilepsy*Biofeedback for Epilepsy* Medical Journal, Jan 2000Medical Journal, Jan 2000  82% of studies demonstrated82% of studies demonstrated significant seizure reductionsignificant seizure reduction  Average reduction exceeded 50%.Average reduction exceeded 50%.  Studies reportedStudies reported reduction inreduction in seizure severityseizure severity..  About 5% had complete control forAbout 5% had complete control for up to one yearup to one year * Sterman, MB (2000). Basic Concepts and Clinical Findings in the* Sterman, MB (2000). Basic Concepts and Clinical Findings in the Treatment of Seizure Disorders with EEG Operant Conditioning.Treatment of Seizure Disorders with EEG Operant Conditioning. Clinical EEG, 31(1Clinical EEG, 31(1), 45-55.), 45-55.
    22. 22. SMR attenuated (compared to cat subdural recordings) butSMR attenuated (compared to cat subdural recordings) but also present at the scalp in humansalso present at the scalp in humans
    23. 23. Mechanisms of SMR trainingMechanisms of SMR training  EnhancingEnhancing GABAGABA circuitrycircuitry involved ininvolved in motormotor regulation,regulation, dampeningdampening excitability toexcitability to sensorimotorsensorimotor excitationexcitation
    24. 24. 10-20 International System of Electrode Placement10-20 International System of Electrode Placement
    25. 25. History of Motoric HyperexcitabilityHistory of Motoric Hyperexcitability  1905: Hyperkinetic syndrome1905: Hyperkinetic syndrome (George Frederic Still, Lancet)(George Frederic Still, Lancet) • ““wanton destructiveness and a deficit inwanton destructiveness and a deficit in moral behavior”moral behavior”  Now known to be due to slowed maturationNow known to be due to slowed maturation • only partly related to will power, if at allonly partly related to will power, if at all  Lubar (1975) ABA study, n=4Lubar (1975) ABA study, n=4 • Cz theta/beta ratioCz theta/beta ratio
    26. 26. Patterns of behavior indicative of ADHDPatterns of behavior indicative of ADHD  InattentiveInattentive • Easily distractedEasily distracted • Fails to pay attention to detailsFails to pay attention to details  makes careless mistakesmakes careless mistakes  rarely follows directions completely or properlyrarely follows directions completely or properly • Forgets things needed to complete tasks (e.g., pencils)Forgets things needed to complete tasks (e.g., pencils)  HyperactiveHyperactive • Unable to sit stillUnable to sit still  Leaves seat when sitting expected or instructedLeaves seat when sitting expected or instructed • Talks non-stopTalks non-stop  ImpulsiveImpulsive • Unable to suppress impulsesUnable to suppress impulses  inappropriate comments or shouts out answers earlyinappropriate comments or shouts out answers early • HitsHits • Often puts oneself in danger, such as dashes into streetOften puts oneself in danger, such as dashes into street
    27. 27. Attention Deficit Hyperactivity DisorderAttention Deficit Hyperactivity Disorder  ADHD affects 2 million children in USAADHD affects 2 million children in USA • 5% of all boys5% of all boys • 2% of all girls2% of all girls  ~ 60% will remain symptomatic as adults~ 60% will remain symptomatic as adults  1 M children take Rx to control hyperactivity.1 M children take Rx to control hyperactivity.  Genetic component: MZ concordance is 75-91%Genetic component: MZ concordance is 75-91%  EEG frontal slowing due to immature frontal lobeEEG frontal slowing due to immature frontal lobe in impulsive subtypein impulsive subtype
    28. 28. RitalinRitalin  ControversyControversy  CCommonly prescribed drug for childrenommonly prescribed drug for children • Worries about long-term effects.Worries about long-term effects. • No studies on children who have takenNo studies on children who have taken Ritalin > 14 months.Ritalin > 14 months. • Very similar to cocaine in compositionVery similar to cocaine in composition and effectand effect
    29. 29. Monastra study – ADHD and biofeedbackMonastra study – ADHD and biofeedback vs. stimulant therapyvs. stimulant therapy  100 ADHD children, ages 6-19, inattentive or combined types100 ADHD children, ages 6-19, inattentive or combined types  1-year multimodal outpatient program1-year multimodal outpatient program • included Ritalin, parent counseling, academic supportincluded Ritalin, parent counseling, academic support  51 with EEG biofeedback51 with EEG biofeedback  RESULTSRESULTS • Post Tx assessments with and without stimulant therapy.Post Tx assessments with and without stimulant therapy.  Ritalin produced significant improvement on TOVA and ADDESRitalin produced significant improvement on TOVA and ADDES • Did not sustain when Ritalin removedDid not sustain when Ritalin removed  EEG biofeedback group sustained gains when Ritalin removed.EEG biofeedback group sustained gains when Ritalin removed.
    30. 30. First Year of specificFirst Year of specific Neurofeedback ApplicationNeurofeedback Application  1967 SMR conditioning in general1967 SMR conditioning in general  1973 Epilepsy1973 Epilepsy  1975 Peak Performance1975 Peak Performance  1976 ADHD1976 ADHD  1977 Addiction1977 Addiction  1978 Anxiety disorders1978 Anxiety disorders  1978 Learning disabilities1978 Learning disabilities  1980 Sleep Disorders1980 Sleep Disorders  1995 Brain Injury1995 Brain Injury  1995 Lyme's Disease1995 Lyme's Disease  1996 CFS1996 CFS  1997 Mood disorders1997 Mood disorders
    31. 31. Neurotherapy -startNeurotherapy -start  Revives Hess’ CNSRevives Hess’ CNS model of 1950smodel of 1950s • overarousedoveraroused • underarousedunderaroused  Added by OthmersAdded by Othmers • instabilityinstability  Related issue ofRelated issue of plasticityplasticity • Cajal thoughtCajal thought adult brain fixedadult brain fixed • finally counteredfinally countered by Peter Erikssonby Peter Eriksson 19981998
    32. 32. Most important figure in behavioralMost important figure in behavioral neuroscience (i.e., psychology)neuroscience (i.e., psychology)
    33. 33. Elegant design to counter anyElegant design to counter any intrinsic (non-contextual) rewardintrinsic (non-contextual) reward
    34. 34. Earned PRSEarned PRS
    35. 35. PRS and learningPRS and learning
    36. 36. PRS characteristicsPRS characteristics  Reward-based inhibition of MRFReward-based inhibition of MRF • Mesencephalic Reticular Formation (originally called ARF) –Mesencephalic Reticular Formation (originally called ARF) – turns off the DC, i.e., volitional aspect of mindturns off the DC, i.e., volitional aspect of mind  PRS does not occur initiallyPRS does not occur initially • animal must be fully habituated to environmentanimal must be fully habituated to environment • any novelty or change will disrupt it.any novelty or change will disrupt it. • Light must also be on for PRS to emerge, evenLight must also be on for PRS to emerge, even when “light off” is a signal of food delivery trials.when “light off” is a signal of food delivery trials.  3-5 s burst indistinguishable from sleep onset or SWS3-5 s burst indistinguishable from sleep onset or SWS  Signal transmission in thalamus (LGN) and cortex isSignal transmission in thalamus (LGN) and cortex is suppressed by PRS (similar to SWS)suppressed by PRS (similar to SWS)
    37. 37. Unresponsive during PRS, like sleepUnresponsive during PRS, like sleep
    38. 38. PRS (6-9 Hz in cats, 8-13 Hz in humans)PRS (6-9 Hz in cats, 8-13 Hz in humans)
    39. 39. Alpha burst reflect preparationAlpha burst reflect preparation
    40. 40. Impact human learningImpact human learning
    41. 41. Field of NeuroregulationField of Neuroregulation  Clinical aspectsClinical aspects • Thalamocortical dysrhythmiasThalamocortical dysrhythmias  CognitionCognition • Time bindingTime binding • Information processing, recruitmentInformation processing, recruitment  ERD and ERSERD and ERS
    42. 42. Feedback Screen Therapist Monitor EEG Sensors NF PracticeNF Practice Therapist and client/game screenTherapist and client/game screen
    43. 43. Game provides client feedbackGame provides client feedback Mazes
    44. 44. Space RaceSpace Race
    45. 45. Reward The Therapist Screen Raw Inhibit Inhibit
    46. 46. Scoring Charts Provide Periodic Feedback
    47. 47. A normal looking EEG is small in heightA normal looking EEG is small in height Small EEG
    48. 48. ReducingReducing excessive (tall) slow brainexcessive (tall) slow brain waveswaves helps the brain function betterhelps the brain function better Examples of excessive slow brainwaves
    49. 49. Example of EEG Brain MapExample of EEG Brain Map Courtesy of Q-Metrx
    50. 50. This man has way too much alpha withThis man has way too much alpha with his eyes open. He’s got problems withhis eyes open. He’s got problems with obsessive thinking – getting “stuck”obsessive thinking – getting “stuck” Slow alpha increased with eyes open. That’s not normal.
    51. 51. PRE/POST ASSESSMENTSPRE/POST ASSESSMENTS Male, age 9. Drawing beforeMale, age 9. Drawing before Neurofeedback trainingNeurofeedback training
    52. 52. Male, age 9.Male, age 9. Drawing after 4Drawing after 4 months ofmonths of NeurofeedbackNeurofeedback training, 5/2/95training, 5/2/95
    53. 53. Child’s Family Drawing atChild’s Family Drawing at Beginning of NF - 8/3/94Beginning of NF - 8/3/94
    54. 54. Drawing after Twenty Sessions -Drawing after Twenty Sessions - 9/8/949/8/94
    55. 55. Drawing after forty sessionsDrawing after forty sessions -11/25/94-11/25/94
    56. 56. Neurofeedback Outcome 2003 Courtesy of Moshe Perl, Ph.D. 89 102 89 8586 100 86 80 70 86 82 68 Inattention Impulsivity Response Time Variability 40 50 60 70 80 90 100 110 120 StandardScore Pretreatment 20 sessions 20 or more sessions neurofeedback TOVA Summary - 53 Subjects
    57. 57. One year follow-upOne year follow-up Courtesy of Moshe Perl, Ph.D. 103 106 94 9799 105 92 92 80 88 84 74 Inattention Impulsivity Response Time Variability 40 50 60 70 80 90 100 110 120 StandardScore Pretreatment Post Treatment 14 Months Followup TOVA Follow-up Summary - (n=16)

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