Trina Doerfler, ND, DC
Discussion of the brain is everywhere these days … it’s on the cover of leading news magazines; public television has a series entitled “The Brain Fitness Program”; and more than a few books are being written on how to better understand and work with this most complex and central of our systems.
In part, this interest has occurred because there are new ways of imaging the brain, informing us of its functioning in different states of mind. Traditional ways of imaging the brain – CAT scans, MRIs and the now-ancient X-ray – were all breakthroughs in their time and allowed us to see ever-finer resolutions of the structures of the brain, each a huge step forward from previous techniques, like dissection of preserved specimens. Examination of Albert Einstein’s brain revealed an increased proportion of glial cells relative to neurons in the left posterior parietal lobule, indicating greater associative interaction in an area of the brain that works with visuospatial information. This difference in the left parietal lobe is seen in the autopsy specimens of other gifted mathematicians and may well indicate a lifelong development of concepts in mathematics that can be best manipulated by a visual/spatial cognition, but whether this difference is inborn or was a product of a life of usage in this manner is under much debate.
The frontal lobes, temporal lobes, overall weight and proportion of grey matter to ventricle space of Einstein’s brain was not different than the control brains in the study by Lancet in 1999. These relatively superficial measures do nothing to show the myriad functions carried out by this benign-looking, grey and lumpy organ that generates our thoughts, carries on innumerable processes of chemical regulation and balance, and creates the ineffable quality of who we are, distinct from anyone else. This was the state of brain science until the last few years, when everything changed. We have begun to be able to see how the brain functions inside its own structures (i.e., the left or right anterior cingulated gyrus, the orbitofrontal cortex, etc.) while alive and at work.
The advent of several new tools has enabled us to see inside the brain as it works and considers. Imaging techniques such as the functional MRI and the PET scan have given us a look at how the brain operates under varying circumstances, bringing to light some of the most optimistic findings about human life that have been published since the dawn of neurology.
It was long thought that the brain had a single critical time frame for its decisive and formative period, after which no more major remodeling could occur. For example, critical periods for skills such as language have a time frame of 0-5 years. Emotional tone was thought to be set by age 5. Different skill sets have been studied and thought to be unchangeable after the first three years (Balbernie, 2001). Work was also done by Karr-Morse and Wiley (1997) on early exposure to domestic violence that set the period of neuroplasticity at the first three years.
That meant that if you were unlucky enough to be born into circumstances that didn’t best support healthy development, you were doomed for the rest of your life. No more neurons would be created, and the pathways that were established during the critical period would just be run over and over again. It was believed that your neurology was irreversibly established at the conclusion of this period. If there was a major injury, a process of rehabilitation might bring back some of the functions to a very limited degree, but there would be no significant structural recovery.
Plasticity and Neurofacilitation
New imaging techniques tell us that this bleak scenario is similar to many other assumptions about our biology that have been debunked, having turned out to be driven more by our perspective at the time than by any accurate functional knowledge of the brain itself. A number of books have been written on this topic. The book Train Your Brain, Change Your Life has some extremely valuable approaches to learning to retrain your brain from this newly informed standpoint. Daniel Siegel, MD (who sat on the dais with the Dalai Lama last spring at the Seeds of Compassion conference in Seattle) has a book, The Mindful Brain, which talks about what happens inside a brain that is practicing awareness in the moment, a discipline called “mindfulness” in the Buddhist tradition. The tone of these books is starkly different than that of the standard texts we studied in school. It is frankly optimistic and informedly so, as is the information that is being brought to light about what is possible. Children past the critical period, adults with neurobiological disorders like obsessive-compulsive disorder (OCD), and even elders have been documented doing exactly what we always thought was impossible: making new neurons, creating new pathways, remodeling whole structures by processes largely related to the brain’s perceptual experience. The remodeling of the brain in response to what it perceives is called neuroplasticity. This new concept is substantiated by new imaging techniques, documenting this unplumbed treasure of restoration in the deepest part of our anatomy. It operates by feedback.
It is an intuitive truth that the brain builds itself based on what it perceives; it is also a physiological fact. Our experiences teach us what is predictable, making future events navigable based on similar situations in our past. As we learn, we do the neurological equivalent of laying down a pathway that then becomes more easily traversed the next time. Each time we run that pathway, it takes less and less electrical energy to run it and it becomes a habit, something like a rut in a road. The rut may not be the most efficient or effective approach to the goal, but that no longer figures into the navigation; it’s just a lower energy option, so it gets run preferentially. This is called neurofacilitation, and accounts for much of our habitual patterning in both cognitive and emotional functioning.
Facilitation occurs as a major determinant until the brain is “informed” of what it has chosen as its path. This self-awareness brings a kind of reckoning, driven entirely from the inside. If the chosen pathway is one that is dysfunctional or does not best meet the task at hand, then from within one’s own self there is an inherent (preconscious) shift to a brain wave pattern that is more responsive to the demands of whatever activity is happening, whether it is of an escalatory or de-escalatory nature. Patients do well in life when they can pay attention when they need to pay attention, relax when it is time to relax, get aroused when stimulated and be able to return to baseline after the activity is done. This sounds simple, but when it doesn’t happen the increasingly common ills of modern life occur: anxiety, inattention, insomnia, post-traumatic stress, substance abuse, chronic fatigue, OCD and so forth.
Neurofeedback is a relatively new field, and the non-entrainment side of it even newer. Neurofeedback was born out of an experimental accident, 20 years ago in a lab run by Barry Sterman, PhD. Findings from the study – which used operant conditioning on epileptic cats – meant that operant conditioning, a behavioral training technique, could prevent a neurotoxin from producing seizures.
Sterman was struck by this and went on to work with adult epileptic subjects and then children with great results in reducing seizure activity. Thus, neurofeedback was born. He also found that these techniques worked with neurocognitive problems such as the Attention Deficit/Hyperactivity Spectrum and is still involved with the public school system in Yonkers, N.Y.
Add human studies info here …
Most commonly, neurofeedback is practiced by quantitative analysis of an EEG that attempts to determine optimal levels of different brain waves, with some schools of thought placing emphasis on one or another of the brain waves or the relationship between two different ones. Alpha/theta training is quite popular, and there is much benefit to be gained for most people from working this way. This method is known as entrainment, because there is a change to the patterns prescribed by the practitioner or program of analysis chosen to analyze the EEG. The system I chose to work with is a non-entrainment system that functions on a principle that I find to be more in accord with the principles of naturopathic medicine. It operates by the Vis Medicatrix Naturae being activated within the person to design the course of changes in brain wave patterns that are the best route for optimal functioning for that person at that time. There is nothing in this system that pushes the brain wave patterns in any direction from the outside; it is an entirely internally driven system. It relies on the wisdom of nature within the person to navigate the course and destination.
To my amazement and delight, I have found this to be unerring. Perhaps because the basis for this work emerges out of a model of non-dual psychology, there is a quality of seamlessness to the progress I see in people. Patterns of dysfunctional behavior fall away without any conscious effort. Often, what is reported to me in the office is the sense of just having forgotten to have a drink after work, to get enraged at the traffic, or to feel anxious in social situations. All of these are habits, neurologically learned at some point and repeated like a reflex over and over again once the synaptic pattern is laid down.
How does this seemingly magical shift occur? The neurofeedback software can tell mathematically when a brain wave pattern is dysfunctional. The baseline created before a session is used to affix a dynamic live-time reference box that moves with each of the brain wave frequencies, and if any particular brain wave either shoots past or does not meet the reference box, feedback is produced. The feedback comes in the form of an interruption in the music playing; a subtle, almost subliminal break. This alerts the brain to “notice” that something has happened, as the brain is wired to notice change. When this occurs, there is an awakening on a neurological level and a review of its own brain wave pattern production. This “mindfulness” on a neurological level is what creates the shift. The dysfunctional patterns, when interrupted, thus fall away, and there is an internal mechanism that kicks in (the Vis, I would call it) to produce a pattern of brain waves that is more suited to the task at hand. Different tasks during the day sometimes require diametrically opposed states in order to be successful. The brain waves that succeed at the task of focus and alertness are the opposite of those that ease one into relaxation and sleep. A brain that is flexible and resilient can move from one demand to the other without friction, substance (i.e., caffeine, alcohol, etc.) or other means of strenuous adaptation. Neurofeedback training of this sort has that flexibility and resilience as the only goal. It is used for a number of challenges, from a peak performance tool before a high-stakes performance to a nontoxic, safe and effective approach any time the brain is not able to meet the task at hand.
Work like this is at its heart a true demonstration of the principles of naturopathic medicine, and I predict will become a major modality in the treatment of so many cognitive/emotional problems. Work with the brain on so many levels has gained tremendous attention lately, both on the diagnostic side with new imaging techniques and on the therapeutic side. We are just at the beginning of understanding how to intervene with these types of diagnoses, beyond the psychiatric medicines that we have had to rely on until recently. Using neurofeedback is tremendously efficient, safe and inexpensive, and has produced some of the most remarkable results I have ever seen in my 19 years of practice (see the accompanying box for examples).
These results are simply what a well-functioning brain will do in response to the task at hand, without hesitation. It is the dysfunctional patterns that we have accumulated over time that divert the brain from optimal operation. By simply interrupting the dysfunctional patterns as they occur, the brain learns by its own feedback and can create new patterns that can flex and change (and, dare I say, dance) with the demands of our complex days. Just as a driver who is becoming drowsy on the road will respond to a gentle nudge and reflexively pull the car back onto the driving surface, so will an awakened brain instinctively know the optimal brain wave pattern in order to meet the task of the moment. This seems to be the Vis Medicatrix Naturae at work in a fashion that we are just beginning to be able to access. The work of neurofeedback is in its infancy and there is much to be studied about outcomes and the different ways of working, but the ability of this noninvasive technique holds a promise of help for suffering that we have not had an effective way to intervene with as yet.
Neurofeedback training is designed to be a short-term program, with sessions held on a regular basis for a short time, then less regularly and ending when one’s system has changed. Depending on the length of time the maladaptive programming has been “working,” treatment or training time can vary from 3 to 12 weeks in general. Refresher sessions are sometimes needed if life situations are stressful, but usually occur at long intervals, such as once every few months.
It is a wonderful adjunct to psychotherapy, as it restores flexibility and resilience to a cognitive/emotional system and enhances any progress. Anxiety, depression and insomnia are often medicated, but there are a myriad of side effects accompanying their long-term usage. Post-traumatic stress disorder is mainly treated with antidepressants and/or anxiolytics, neither of which addresses the root of the problem. Traumatic brain injury and the post-chemo brain have so little to be offered in the therapeutic realm, yet this offers a new and truly naturopathic modality that deals directly with the brain in a noninvasive, gentle and effective way.
Case Study Synopses
A 23-year-old man from Nigeria was kidnapped by the Lord’s Resistance Army and forced to fight with children. When he escaped and came to the U.S. as a refugee, he was taking daily doses of tranquilizers in the daytime and sleep medications at night. He reported nonetheless being tremendously anxious and unable to sleep. After 12 weeks of neurofeedback training, he was off all medication and sleeping at night.
There is also the physician who was a lifelong insomniac and, in fact, came from a multigenerational family of insomniacs, some of whom died of drug addiction in their attempts to sleep at night. After several months of somewhat irregular training, this physician could read a book in bed without getting escalated, then turn out the light and go to sleep without waking during the night.
Another man had recovered from metastatic testicular cancer that had spread to his brain, but after the chemo and radiation he had lost his mental focus and creative drive and had not worked in six years, nor had he played the guitar, a former passion of his. Six weeks into neurofeedback training, he picked up his guitar again, and 12 weeks into it he began to look for a job.
I would be more than delighted to hear from anyone with questions about this work!
Trina Doerfler, ND, DC has been in practice for 19 years performing general naturopathic and manual medicine, and has taught a number of courses at Bastyr University as an adjunct faculty member. Two years ago she discovered neurofeedback and gave away her practice to devote herself to working with people in this compelling new way, finding that working directly with the brain in this manner enables Tolle Causam in an extraordinary and profound way, representing the deepest demonstration of naturopathic principles she has found so far. She has offices in Seattle and Bellingham, Wash.
Balbernie RR: Circuits and circumstances: the neurobiological consequences of early relationship experiences and how they shape later behavior, The Journal of Child Psychiatry27(3):237-255, 2001.
Karr-Morse R and Wiley MS: Ghosts from the Nursery. New York, 1997, Atlantic Monthly Press.