An Overview of the Development and Evolution of NeurOptimal®: A Personal Reflection
Susan Cheshire Brown Ph.D.
I entered the neurofeedback field in the early 90s. At that time, the field was represented by two disparate training methods. One was SMR/beta training (all single channel of course) for basically ADD, and the other was alpha-theta training. This was generally practiced as an abreactive approach to personal transformation. Those who offered the former did not offer the latter--and there was no model of neurofeedback that attempted to integrate these disparate approaches.
Enter Val Brown. Val had integrated the two types of training into what he called the Five Phase Model. Whatever their diagnosis, clients were taken methodically through eyes-open SMR then beta training and then shifting to eyes closed alpha-theta training – all utilizing CZ as the training site – ending with Global Synchrony training using a four channel setup, if that were available. Otherwise, the Synchrony was allowed to emerge naturalistically, still using the single site, CZ based training format. The advantage of this model was both its ease of administration (no diagnosis, single site) and completeness (symptoms not only resolved-- the training was also personally transformative). Moreover, working at CZ was also remarkably safe, so side effects were relatively few. Safety was also greatly enhanced by Val's observation that pulsing at 3Hz was highly significant in trauma victims, followed by his insistence on suppressing 3 Hz throughout training, regardless of what other targets might also be used as augments or inhibits. This observation – the significance of 3Hz an essential attribute in disorder – was one of his most important contributions to the field, in my personal view. It permitted trauma victims the possibility of release of symptoms without re-visiting the trauma. Surprisingly this has raised, and still raises, a good deal of antipathy among "feel it to heal it" therapists. After Val and I became a couple, I continued to work with the Five Phase Model but started to experiment with ways I could enhance and speed up training. I felt comfortable doing this because the Five Phase Model was a relatively safe model to experiment with, but I also felt some concern in that I knew I would shift to what I found working best, whether it was part of the Five Phase Model or not! This was an intensive period for me clinically, and resulted in routine suppression of 23-38, routine use of 40 Hz, and the discovery of the benefits of 21 Hz or the "Aura frequency" as we called it. But training was still single channel. I had found I could speed training up by lateralizing (training left and right brain C3 and C4 instead of CZ), but this came at an increased cost of side effects. So much of the clinical hour was spent moving from right to left brain, and closely noting how the client was feeling, and adjusting training based on client self-report. This was particularly difficult for immune-suppressed folks, who would not know for hours and sometimes days, the actual impact of the training. If they felt good when they left they would collapse later, and if they felt not so good after their session they would start to feel good later. How well a therapist could manage these clients clearly distinguished the more experienced from the less. Much effort was expended by therapists to become adept in managing these side effects. As I was exploring clinically, Val was evolving his theoretical thinking more towards a non-linear dynamical model. Val had originally included lateralizing away from CZ – to enhance SMR or Beta training – but then to return to CZ to establish that the training had actually accomplished the intended training. However, this more dynamic approach was only a beginning for further exploration of the dynamical structure of neurofeedback training as a comprehensive process. As he further developed and articulated this emerging model, it became clear that what Val was talking about theoretically and mathematically actually described the very practical ways I had developed by working with clients. Where I had moved away from the original linear Five Phase Model with my two years of explorations, suddenly overarching theory and the clinical practice of neurofeedback came together again. Some other specific events also occurred that were to change forever the way we work. At a FutureHealth meeting I was sitting at the Thought Technology booth where their ProComp encoder was being demonstrated. On a whim I suggested that Val hook me up and see if we could train two sides at once. This was a very odd suggestion at the time as we were used to training "SMR" on the right and "Beta" on the left, as these two frequency bandwidths are two very different states. However, as we discovered while sitting at that booth, you could indeed train both SMR and Beta at the same time. Of course, many colleagues protested that such concurrent training was “too much for the CNS to handle”. In retrospect it seems silly but, at that time, there was a widespread assumption that the CNS could ONLY train in one specific “augment” target at a time! We, of course, didn’t listen to the naysayers and continued to explore the use of multiple, concurrent targets. What a change that made! Since the ProComp gave us two separate real-time channels of EEG – which we could train simultaneously – we were now able to get double the training in a session, all in one swoop.
Another event occurred at the same meeting and it too was to have a profound effect on our development. Val was presenting on thresholding and discussed some of the ideas for a live demonstration of these new ideas with Tom Allen, one of the developers of the Biograph system. As a demonstration, I was hooked up facing towards the audience – facing away from the screen – so I had no visual feedback, just auditory. The demonstration showed how you could manually bracket a signal moving rapidly above and below, above below and so on for about six iterations. The signal would try to seek the threshold limit by increasing in amplitude, then suddenly drop and settle at a new desired lower level, if the target involved an augment frequency such as SMR or Beta. However, if the target involved an inhibit frequency, like 2-6 Hz, then the signal would try to seek the threshold limit by decreasing in amplitude, then suddenly shoot upwards to settle at a new desired higher level – all using the same “bracketing” process. Although Tom described this phenomenon in terms of learning theory, Val described it in non-linear terms as dynamical thresholding. Coupled with our bilateral training at 21 and 40, and alpha-theta – the Period Three Approach was born.
Period Three was a three-tiered training, with a more complex organization and implementation. Unlike the Five Phase Model, which required a systematic progression through stages as the client became increasingly stable, in the Period Three Approach all three of the different “Periods” of training were often used within one session. Val by this time was writing our own interface to the neurofeedback software we were using, and the three periods were represented by sets of different Display Screens, which we would later come to call Portals. We had also chosen a very visual interface with which to work with thresholds and observe brain activity.
A consequence of this approach was that we began to approximate the Matrix Mirror of NeuroCARE Pro in which we could observe shifts in brain activity long before the client experienced unwanted side effects FROM those shifts. The learning challenge for trainers then became spotting the Matrix Mirror patterns that would be triggered in some clients by feeding back certain frequencies, and adjusting training to avoid those pitfalls. A skilled trainer could then largely avoid unwanted side effects while still providing an integrated training process that was independent of diagnosis. At this point, we decided we would design a truly "Comprehensive" Portal which contained all the frequency bandwidths we worked with. The intriguing possibilities offered by this, was that you could shift from one period to another (particularly Period One and Period Three) by pulling out one set of boxes and bringing in others, without the client consciously knowing you had changed the contingencies – and without having to interrupt the training to load a different configuration. This, we thought, would require some increased flexibility on the part of the client to negotiate training. Interestingly, the Comprehensive Portal was originally intended as a means of working with all frequencies sequentially as a “mix and match” version of the Period Three Approach all available in one interface. But we quickly discovered that, of course, you could train all the frequencies at once. How had we ever thought you couldn't? And very much to the point – training all the frequencies at once assured that any unwanted effects triggered by one frequency would be immediately offset by another frequency before they had even occurred. Voila! Essentially side-effect free neurofeedback within one integrated, easy to use, training environment. And once we had effectively eliminated the trigger of most side effects – low beta – and added a softening band to the energizing Comprehensive mix, we now have a one-size adapts to all Comprehensive Portal. Currently, we work with real-time JTFA on the fly, feeding back the brain's progression into increased resilience and flexibility. We no longer train different states – or different ways to access to various states. We also no longer use a distinct approach for “alpha-theta” or other forms of extended eyes closed training. Instead we have clients train while dynamically shifting between eyes open and eyes closed – or not – without any specific regard to using one of other for a particular training effect. All target boxes are now set automatically and do not require individual adjustment. A click up or down on the multiplier makes training easier or harder as necessary or desired, relieving the trainer of all but minimal attention on the software. A complete session can be conducted now by automatically moving a series of steps (Zen 1-4) that provide powerful and safe transformation for any client. And if trainers would like to work in their own distinctive way, a mass of alternative mathematical, operational and theoretical options are available on the fly. The history and evolution of the CARE approach itself, truly reflects the transformational possibilities it offers to its users!