What's New in Neurofeedback
A Monthly Summary of News and Events

Vol. 7 No. 9 - September 2004

This newsletter is sponsored by EEG Spectrum Intl, Inc.,
a leader in providing clinical service and training professionals.
Past issues available at http://start.eegspectrum.com/Newsletter/
To subscribe or cancel, see newsletter's end. Opinions related in
this newsletter reflect the author's only. Copyright (C) 2004
by EEG Spectrum Intl, Inc. or David Kaiser. All rights reserved.
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Announcements - News
In the Spotlight - Take Two Placebos and Call Me in the Morning, revised
News & Reviews - Books & journal papers
Events & Locations - Conferences, Courses
Last Word - Faulty Foresight

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Announcements - News

Learning languages 'boosts brain'
Scanners 'improve brain surgery'
Walking a Good Workout for Your Brain
Stroke victim robbed of her dreams
Brain scans show hypnosis at work
New theory on cause of dyslexia
Single gene removes sex differences in mice brains
Brain may produce its own antipsychotic drug

All links at:
http://news.yahoo.com/fc?tmpl=fc&cid=34&in=science&cat=brain_research


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In the Spotlight

Take Two Placebos and Call Me in the Morning, revised

As we learn more about the biological underpinnings of psychological
disorders and how conditions such as depression and anxiety rewire
our neural circuitry, skewing our reward systems and cognitive
apparatus, we will probably need to rethink the distinction between
neurological disorders and psychiatric ones and develop a new
category, such as psychoneurological disorders; or perhaps
pneurological disorders. Although neurofeedback has proven
anticonvulsant properties, some critics claim that evidence for
treating psychological disorders is lacking, either due to design
problems or placebo effects. That anticonvulsants are now regularly
used for numerous psychiatric conditions (e.g., bipolar disorder,
OCD, PTSD, social phobia, alcohol withdrawal and dependence) makes
the neurology/psychiatry distinction tenuous at best. That impact in
psychiatric functioning can be so readily prescribed to the placebo
effect indicates how layperson knowledge colors scientific
understanding about this phenomenon. This is no placebo effect, per
se. We are misguided when we ignore the role mental processes play
in neurological and psychiatric symptoms, and the history of placebo
research is fraught with misconceptions.

When Freud gave a name to our darkness, the unconscious, he set
loose a process of distrust in ourselves and our self- knowledge
that may never end. From this infernal creation descends a minion
known as the placebo effect, the idea that the mind can make itself
better if only each of us allow it. Healing through distraction, or
concentration, or surrender. It's a interesting idea, if it works.

But does it.

Henry K. Beecher's influential 1955 paper "The Powerful Placebo,"
published in the Journal of the American Medical Association, was
the first study to quantify the magnitude of the placebo effect and
it is this paper which is the source of our layperson knowledge.
Beecher claimed that about a third (35%) of 1082 patients were
"satisfactorily relieved" by a placebo alone. This value was not
carved in stone but merely a mathematical average of 15 clinical
trials for a variety of diseases. Improvements ranged from 21 to 58
percent, so the reliability of the one-third number (or 35%) should
have been questioned from the very start.

Forty years later, it was questioned. In the Journal of Clinical
Epidemiology, Kienle and Kiene (1997) examined all of Beecher's
studies and determined that "no evidence was found of any placebo
effect in any of the studies cited by (Beecher)." One hundred
percent off the mark! Impressive. Instead of a placebo effect,
Kienle and Kiene (1997) concluded that the improvements reported in
these groups of studies could be accounted for by the following:
spontaneous improvement also known as recovery, symptom fluctuation,
regression to the mean, concomitant treatments, scaling bias,
obliging reports by patients, irrelevant response variables,
experimental subordination, conditioned answers, psychosomatic
phenomena, and other factors including an "active placebo" also
known as an (active) treatment. No room for anything to do with the
spooky unconscious (that is, psychological anticipation).

In a related paper the same authors wonder whether the placebo
effect was largely illusory and may not exist at all. It would be a
vestige of Freudian thought clinging to our post-modern thought (my
words, not theirs). Gotzsche (1995) argued that the concept of
placebo should be discarded altogether, but most disagree and
continue to argue that psychological mechanisms underlay nonspecific
effects (e.g., Kirsch, 1997). Freud, once unloosed, can never die.

As any physicist can tell you, studying a phenomenon, even one that
doesn't have in basis in reality, can be interesting and even
fruitful. For a placebo effect to exist, what neurobiological
mechanisms must control it, what neuroanatomical or functional
systems must be involved? What are the duration and dosage curves
like and why? Levine volunteered endorphins to answer some of these
questions. Others have gone so far to say that the placebo effect
may occasionally be toxic! (cf. Shapiro & Shapiro, 1997; Freud
kills). While important questions have yet to be addressed, some
researchers in mental health began to sling the term around like mud
at anything they did not have patent rights to. Perhaps with
hindsight, Kienle and Kiene (1997) warned that "the placebo topic
seems to invite sloppy methodological thinking." And sloppy thinking
is the hurdle facing any treatment modality which competes
(effectively) against the current standard.

The Ethics of Placebo Controls

In 1992, Russell Barkley argued that neurofeedback must be compared
to the placebo condition before he would take any claim seriously.
He suggested using sham feedback in his report (CHADDer Box). Human
protection committees and researchers recognize how the "option" of
false feedback may be unethical, as well as impractical -- another
example of sloppy thinking. False feedback often "breaks the blind"
of the patient. Children are particularly quick to detect when
information on the monitor is not associated with their EEG. (An
interesting finding in and of itself.) This means that a
double-blind is unlikely to hold, and remains a fiction as it also
exists in much of clinical research. (e.g., if clinicians and
researchers involved in a double- blind cannot recognize which
patient received the active treatment and which the sugar pill after
awhile, then the treatment isn't very effective, is it?)

The Nuremberg Code formulated shortly after World War II in response
to Nazi atrocities limits the extent of future human experimentation
and was the precursor to the Declaration of Helsinki accepted by the
World Health Organization in 1964, a declaration to which our
governmental and regulatory bodies prescribe. The Declaration of
Helsinki elevates concern for the health and rights of individual
subjects over concern for society, for future patients, or for
science.. "In any medical study," it asserts "every patient --
including those of a control group, if any -- should be assured of
the best proven diagnostic and therapeutic method." Re-read that
statement. It ends the use of placebo controls when a proven
therapeutic method exists. A study that violates this provision
should not be accepted for publication and any application to a
regulatory body for a treatment which unnecessarily involved placebo
-controlled trials ought be rejected.

Ought to be.

The Code of Federal Regulations under which the FDA operates
includes mention of the use of placebo controls, thus deeming them
acceptable for US biomedical research. Some researchers complain (in
letter to BMJ, etc.) that without a placebo control, their grant
proposals will never be funded. Even when alternative treatments are
available, a placebo control is an implicit requirement in
competitive funding situations. This de facto requirement includes
disorders of moderate severity and pain, clearly in violation of the
Declaration of Helsinki. Recently, non-inferiority trials have
arisen as an alternative to placebo controls; trials in which an
experimental treatment may not be superior to an already known
active agent but is also not clinically or statistically inferior to
that agent in its effectiveness. In this way, a researcher can
fulfill their ethical obligation to all patients in a trial. In a
sense, both the experimental group and non-experimental group are
being providing the best treatment available.

Why are placebos used at all ?

I can think of three reasons why placebo controls are desirable:

To evaluate absolute efficacy: Placebo controls supposedly determine
whether a new treatment is better than nothing.
To avoid difficult decisions about treatment effectiveness:
Differences in cost, unintended (side) effects, drug interactions,
and other factors may make comparisons between treatments of similar
efficacy inexact and subjective.
To bolster statistical significance: As any psych grad student
knows, it is much easier to detect statistical significance between
a placebo and an active treatment than between two active
treatments. (And it is less expensive to use a placebo condition
than to increase the n, the other method of bolstering one's stats.)

Ignoring the ethics of requiring placebo controls, or even the
phenomenological argument of whether placebo effects exist at all, I
think we can distinguish a placebo from an active treatment by the
following criteria:

Specificity: A single symptomalogical or functional domain is
impacted by a treatment compared to nonspecific or multiple domains
(This one will be difficult with neurofeedback as the functional
improvement is regulatory, not focal.)
Toxicity: Use of the treatment can cause worsening of symptoms in
some individuals. (Good thoughts rarely kill, though nocebos do
exist.)
Long Duration: Changes associated with the treatment endure for
weeks, months, or years.
Dose-dependence: Extent of changes reflect an accumulation of doses
(cumulation and carry-over effects)
Time-dependence: Changes occur in response to a manipulated
time-line. Symptom changes do not emerge before or long after
treatment is complete, for instance. (time-effect curves)

Neurofeedback meets each of the above criteria for ADHD and epilepsy
and other disorders, but most of this information -- such as long
duration and dose dependence -- is in the clinical record only,
unpublished, and therefore unavailable to our critics. I can see a
research program, or a dozen, focused on these five criteria.

One day, I see myself sitting down for a neurofeedback training
session, strapping on the electrodes, and saying, "I hope the
placebo effect is strong today" -- and be mocking our rocky past.

-DK
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News & Reviews

NEW BOOKS

The Mind and the Brain : Neuroplasticity and the Power of Mental Force
by Jeffrey M. Schwartz, Sharon Begley;
Schwartz pioneered the use of PET in studying OCD.
--www.amazon.com/exec/obidos/ASIN/0060393556/top100

Principles and Practice of Sleep Medicine
by Meir H. Kryger, et al
Encompasses pathophysiology, diagnosis, and treatment of disorders
resulting from disruptions of sleep-wake cycles and circadian
rhythm. --www.amazon.com/exec/obidos/ASIN/0721676707/top100

The Body Remembers: The Psychophysiology of Trauma and Trauma
Treatment
by Babette Rothschild
Somatic memory of trauma experienced is discussed with case studies.
--www.amazon.com/exec/obidos/ASIN/0393703274/ top100

Wider than the Sky: The Phenomenal Gift of Consciousness
by Gerald M. Edelman
How do neurons give rise to subjectivity? From Nobel Laureate.
Pertinent findings of modern neuroscience --
www.amazon.com/exec/obidos/ASIN/0300102291/top100

Drugs, Behavior, and Modern Society
by Charles F. Levinthal
Controversies surrounding drug use and abuse with a focus on health
and prevention. --www.amazon.com/exec/obidos/ASIN/ 0205323669/top100

The Epidemic: The Rot of American Culture, Absentee and Permissive
Parenting...
by Robert Shaw
Definitely the author doesn't pull any punches: "(Spoiled) children
are not an aberration. They are the natural outcome of the way we
have been raising them,"
--www.amazon.com/exec/obidos/ASIN/0060011831/top100

Adult Children of Alcoholics: Expanded Edition
by Janet Woititz
Advice and information for adult children of dysfunctional families
--www.amazon.com/exec/obidos/ASIN/1558741127/ top100

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JOURNAL PAPERS

Stimulant treatment over five years: adherence, effectiveness, and
adverse effects. : Psychostimulants improve ADHD symptoms but
adverse effects persist.
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15100562

Use of the Calmset 3 biofeedback/relaxation system in nocturnal
bruxism. : Single patient exhibited fewer bruxing episodes following
treatment, which were sustained at 6 month followup.
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15208977

The medial temporal lobe : Reviews function of MTL. No simple
dichotomies for it versus hippocampus were found (e.g., and
associative versus nonassociative memory, episodic versus semantic
memory)
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15217334

Low emotional intelligence as a predictor of substance-use problems.
: Poorer coping predicted drug-related problems, but not
alcohol-related problems.
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15237864

Neuropsychology of adults with ADHD: a meta-analytic review. : ADHD
adults exhibit europsychological deficits in attention, behavioral
inhibition, and memory
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15291727

Efficacy of treatment for child and adolescent traumatic stress. :
Meta-analysis of 8 studies found treatment for traumatic stress led
to greater improvement than either no treatment or routine community
care.
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15289252

128-Channel EEG Source Imaging in Epilepsy: Clinical Yield and
Localization Precision. : Evaluated feasibility, clinical yield, and
localization precision of high-resolution EEG source imaging of
interictal epileptic activity. Foci was localized in 93% of
patients, 79% exactly.
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15284597

Abnormal EEG synchronisation in heavily drinking students. : Heavily
drinking students had more synchronisation in theta and gamma bands
during eyes closed, both with and without a task, interpreted as
changes in hippocampal-neocortical connectivity.
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15294207

Concept of psychical trauma: A bridge in interdisciplinary space. :
Recent neuroscience findings in emotion and memory are integrated
with psychoanalysis and the concept of trauma.
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15310427

Perspectives on the estimation of effective connectivity from
neuroimaging data. : Discusses model in use with event- related fMRI
to estimate connectivity across the brain.
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15319514

Does sleep or sleep deprivation increase epileptiform discharges? :
Sleep deprivation does not increase the yield of epileptic discharge
in pediatric EEGs.
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15342836

Neuroscience research on the addictions : Advances in neuroimaging
will eventually allow pre-onset addiction and other frightening
invasions of privacy.
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15345277
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Upcoming Courses

A Pathway to Brain Regulation - Neurofeedback helps improve
neuroregulation. It's used by health care professionals for ADHD,
depression, anxiety disorders, LD, mood disorders, and behavioral
problems. This 4-day course, Neurofeedback in a Clinical Practice,
provides the basis for using Neurofeedback clinically. - *28 CEs

4-Day Comprehensive Course Dates

Raleigh NC Nov 11-14
Los Angeles CA Dec 9-12
Dallas TX Jan 13-16
Orlando FL Feb 24-27
Phoenix AZ Mar 10-13
Boston MA Apr 7-10

Our course is a hands-on experience right from the start. Attendees
consistently say this format is a very good way to learn
Neurofeedback.

"Neurofeedback should be viewed as one of the three essential or
primary forms of intervention - psychotherapy, psychopharmacology,
and Neurofeedback. In my experience, neurofeedback is every bit as
important and powerful as the other two forms of treatment." - Dr.
Laurence Hirshberg of Brown University Medical School, a
psychologist specializing in Developmental Disorders and Autism.

Contact Karie Kramer, our training coordinator, for more information
818-789-3456 ext 847 or see www.eegspectrum.com/Training

*EEG Spectrum International, Inc. is approved by the APA to offer
continuing education to psychologists. ESII maintains responsibility
for the program.


Conferences for Neurofeedback Clinicians & Researchers
CONFERENCE LOCATION DATES

AAPB - http://www.aapb.org Austin TX Apr 1-4
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Last Word

Faulty Foresight

The political season is nearly over, thank goodness: only 15 polling
days left! The debates were filled with predictions, as they are
every election year. I'm reminded of George W Bush's comment in the
2000 debates "I would be very careful about using our troops as
nation builders." (Oct 3, 2000). Or Cheney's "My belief is we will
in fact be greeted as liberators (by the Iraqi people)." (3/16/03)
or Secretary of Defense Donald Rumsfeld's "We know where (the
weapons) are. They're in the area around Tikrit and Baghdad and
East, West, North and South somewhat." (3/3/03) or his "It is not
knowable how long that conflict would last. It could last, you know,
six days, six weeks, I doubt six months." (2/7/03). Politicians are
poor prognosticators -- but scientists and business people aren't
much better.

Ironically, those well-situated in scientific or cultural fields are
often the last to recognize change. Ripples must become swells
before makers and shakers of the previous paradigm take notice, and
by then, it is usually too late to respond or assist.

Here are a number of erroneous predictions, preceded by a few
comments about prognostication itself:

"There are two kinds of forecasters: those who don't know, and those
who don't know they don't know." - J K Galbraith, economist.

"The future is already here - it's just unevenly distributed." -
William Gibson.

Life can only be understood backwards, but it must be lived
forwards. - Soren Kierkegaard, philosopher.

"The past resembles the future more than one drop of water resembles
another." - Ibn Khaldun.

"I think there is a world market for maybe five computers." - Thomas
Watson, chairman of IBM, 1943.

"There is no reason anyone would want a computer in their home." -
Ken Olson, founder of Digital Equipment Corp., 1977.

"This 'telephone' has too many shortcomings to be seriously
considered as a means of communication. The device is inherently of
no value to us." - Western Union internal memo, 1876.

"The telephone may be appropriate for our American cousins, but not
here, because we have an adequate supply of messenger boys." - group
of British experts, c.1900.

"One day there will be a telephone in every major city in America" -
Alexander Graham Bell, c.1880.

"Good enough for our transatlantic friends... but (Edison's
incandescent lamp is) unworthy of the attention of practical or
scientific men" - British Parliament

"When the Paris Exhibition closes, electric light will close with it
and no more be heard of." -- Erasmus Wilson, Oxford professor, 1878.

"Everything that can be invented has been invented." - Commissioner
US Office of Patents, 1899.

"I will ignore all ideas for new works on engines of war, the
invention of which has reached its limits" - Sextus Julius
Frontinus, 1st century A.D.

"The bomb will never go off. I speak as an expert in explosives." -
Admiral William Leahy, US Atomic Bomb Project.

"As far as sinking a ship with a bomb is concerned, you just can't
do it." - Rear-Admiral Clark Woodward, 1939

"Stocks have reached what looks like a permanently high plateau." -
Irving Fisher, Yale Professor of Economics, 1929.

"1930 will be a splendid employment year." -U.S. Department of
Labor, 1929.

"A physicist who professed such heresies is unworthy to teach
science." - German Minister of Education in response to Ohm
publishing his ideas on electricity, now know as Ohm's law

"The horse is here to stay, but the automobile is only a novelty." -
Bank president, 1903, advising Henry Ford's lawyer not to invest in
the Ford Motor Company.

"By the turn of this century, we will live in a paperless society."
Roger Smith, chairman of General Motors, 1986

"The abdomen, the chest, and the brain will forever be shut from the
intrusion of the wise and humane surgeon." - JE Ericksen, Surgeon
Extraordinary to Queen Victoria, 1873.

"Law will be simplified [over the next 100 years]. Lawyers will have
diminished, and their fees will have been vastly curtailed." -Junius
Henri Browne, Journalist, 1893.

"It would appear we have reached the limits of what it is possible
to achieve with computer technology, although one should be careful
with such statements; they tend to sound pretty silly in five
years." -John von Neumann, computer scientist, 1949.

"Jupiter's moons are invisible to the naked eye, and therefore can
have no influence on the earth, and therefore would be useless, and
therefore do not exist." - contemporary professor on Galileo's
pronouncement concerning his discovery.

"Well-informed people know it is impossible to transmit the voice
over wires and that were it possible to do so, the thing would be of
no practical value. Editorial in Boston Post, 1865.

"Before the twentieth century closes, the earth will be purged of
its foulest shame, the killing of men in battle under the name of
war." - Andrew Carnegie.

Recently, an adolescent with uncontrolled seizures had his corpus
callosum partially severed to stop the seizures. Unfortunately, the
procedure did not have the intended result. A vagal stimulator was
then implanted. Again, the seizures continued. Since the
neurologists and surgeons had no other remedy in mind, the mother
asked whether neurofeedback might be tried. The neurologist was not
caught at a loss for words: "Too experimental," he said.

Not exactly a prediction, but short-sighted nonetheless.

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