Neurofeedback: The First Fifty Years

By James R. Evans

Neurofeedback: The First Fifty Years features broadly recognized pioneers in the field sharing their views and contributions on the history of neurofeedback. With some of the pioneers of neurofeedback already passed on or aging, this book brings together the monumental contributions of renowned researchers and practitioners in an unprecedented, comprehensive volume. With the rapid and exciting advances in this dynamic field, this information is critical for neuroscientists, neurologists, neurophysiologists, cognitive and developmental psychologists and other practitioners, providing a clear presentation of the frontiers of this exciting and medically important area of physiology.

• Contains chapters that are individually authored by pioneers or well-known persons presently active in the neurofeedback field
• Provides personal and historical perspectives regarding important past and present developments and future needs
• Enables each author to discuss his or her unique contributions to the field
• Includes chapters noting the contributions of deceased neurofeedback pioneers

• Language: English
• Publisher: Academic Press
• Release date: Nov 8, 2019
• ISBN: 9780128176603

Book preview

Neurofeedback

The First Fifty Years

Edited by

James R. Evans

Mary Blair Dellinger

Harold L. Russell

Table of Contents

Cover image

Title page

Copyright

Dedication

Memoriam(Written in Memory of Harold L. Russell, Co-editor)

Contributors

Preface

Acknowledgements

Supplementary recognitions

Chapter 1. Some call me the father of clinical neurofeedback

Other researchers also began to explore this new field

Other early contributors to the field

Possible future directions

Chapter 2. My personal neurofeedback journey

Chapter 3. The legacy of Margaret Ayers

Chapter 4. Connecting the isomorphic dots: From Bioenergetics and character structure to EEG neurofeedback

Founding Quietmind

Shining new light on dementia

The daily mail delivers a surprise

Chapter 5. My neurofeedback story

How I got started in neurofeedback

Chapter 6. On the road with a maverick

Chapter 7. My unique journey to neurofeedback

Important early historical developments in NFB

More recent historical developments

My research

My hopes and expectations for the future

Some conclusions

Chapter 8. Our neurofeedback journeys

Early beginnings and landmark developments

Personal contributions

Some general conclusions and hopes

Chapter 9. In tribute to Thomas Budzynski and Helen Budzynski

Chapter 10. Learning: extracting experiences in the space-time continuum

Chapter 11. My neurofeedback story

Biofeedback epiphany

Beginning neurofeedback

Bright times, dark times

Onward

Neurofeedback stories

Conclusions

Chapter 12. My place in neurofeedback – The last 50years

Chapter 13. My neurofeedback journey of discovery

The development of my interests

Key developments in neurofeedback

My most valuable contributions

The future of neurofeedback

Chapter 14. A technology of self knowledge science, art, evolution and spirit

Introduction

Chapter 15. A neuropsychologist's experience of neurofeedback

Chapter 16. My QEEG and neurofeedback story: in pursuit of the neuro-cognitive origins of learning disabilities

Background

History

Learning about learning disabilities

Connecting with disconnection

Conclusion

Chapter 17. Origins of NeuroField

Chapter 18. My fifty-year association with neurofeedback training

Roots, highways and byways

Major developments (my opinions)

Conclusions/hopes/expectations

Chapter 19. Highlights of our neurofeedback experiences

Les Fehmi

Susan Shor

Les and susan

Chapter 20. Neurofeedback and developmental trauma: a personal story

Beginnings

Major contributions to the field

Obstacles in the field

The Author's contributions

Chapter 21. Finding neurofeedback from a Neurologist's point of view

Key developments in the 50-year evolution of neurofeedback (1968–2018)

My own contributions to the field are evolving

Predicting the future if the field of neurofeedback

Chapter 22. A neurofeedback journey

The challenges before us

Chapter 23. My neurofeedback-related adventures

From N. Dakota to California

A major change of professional life

European and international connections

Society activities

Emphasis on the raw EEG signal

Professional companies

The endophenotype concept

Some views on current status of the field

Chapter 24. Contributions of Elmer and Alyce Green to Neurofeedback and the Science of Human Consciousness

Background

Psychophysiological Principle

Mind-body dichotomy and volition

Autogenic training

Exploring human potentiality

Development of clinical biofeedback

Alpha-theta brainwave training

Neurofeedback and creativity

Visualization and passive volition

State of presence

The states of consciousness model: a map of intrapersonal, extrapersonal, and tranpersonal

Testing the states of consciousness model: physical fields and states of consciousness research

The later years

Chapter 25. Personal perspectives on neurofeedback

Beginnings

Personal contributions

LENS and me

Simpler May Be better

Concluding remarks

Chapter 26. Neurofeedback contributions of Joseph J. Horvat

Chapter 27. Neurofeedback and me: the history

The early years

Developments in the middle years

Recent developments and some comments on the field

Chapter 28. Neurofeedback and me: the parting of the Red Sea

Special acknowledgments

Chapter 29. QEEG and neurofeedback, a Neurologist's perspective

Beginnings

Early neurofeedback practice

The inspiring case of Brian

Development and incorporation of QEEG

Our concussionology work

Concluding remarks

Chapter 30. A neurofeedback story

Chapter 31. A brief history of my contributions in the field of neurofeedback

Background

Research

Neurofeedback research

Chapter 32. My neurofeedback narrative

Background: My First 30 Years

Neurofeedback research begins: USA and Norwegian connections

International collaboration on ADHD research

Interest in infra-low EEG frequencies

Chapter 33. The self-liberating power of the introverted mind

The background

My introduction to biofeedback

LENS matters

The present and beyond

Chapter 34. A social worker's neurofeedback story

Beginnings

Some basic concepts

Importance of psychosocial variables

Some newer developments

My present neurofeedback practice

Future expectations

Final comments and recommended readings

Chapter 35. My journey into neurofeedback

Getting started in neurofeedback

The most important developments and consequences

My most valuable contributions to the field

The future of neurofeedback

Chapter 36. 50 years of neurofeedback: my contribution

Chapter 37. Neurofeedback from the Heart of a Clinician

Chapter 38. My life with neurofeedback

Chapter 39. My neurofeedback story

Developing interest in integrative medicine, biofeedback and neurofeedback

Major historical contributions to the fields of biofeedback and neurofeedback

Personal professional contributions to the field

Conclusion

Chapter 40. My intrigue with the brain

Chapter 41. My 50years of history in the field

Biofeedback

Neurofeedback

Operant conditioning-based neurofeedback

The LENS (Low Energy neurofeedback system)

A LENS Session's raw EEG

The Chrysalis

Chapter 42. Milestones in development of the Othmer method

Early Foundations

The Sterman-Ayers-Othmer triad

Affordable QEEG analysis arrives

Optimal Response Frequency and Infra-Low Frequency Training

Emergence of a new theoretical model

An overview

Concluding Observations

Key to the Literature

Chapter 43. History of the Othmer Method: an evolving clinical model and process

Beginnings

The arousal model

The brain instability model

Discovery of the frequency rules

Emerging primary categories of dysregulation

Entering the infra-low frequency range: 2006

Key modes of dysregulation

Basic sites

Current applications

Summary and conclusion

Guide to the literature

Chapter 44. My biofeedback/ neurofeedback story: 1970s to transition

Sources and motives

Research contributions and professional contacts

Conclusions/hopes/expectations

Chapter 45. Highlights and summary of my neurofeedback journey

Beginnings

My unique contributions continue

Miscellaneous comments on the EB field

Wishes, plans and recognitions

Chapter 46. Neurofeedback: A scarce resource at the mental market

Chapter 47. My deliverance: neurofeedback

Chapter 48. The way starting from the Aldine Biofeedback and Self-Control books toward the new neurofeedback avenue

Beginnings

Major historical developments

Personal contributions

Chapter 49. Neurofeedback: my journey and contributions

Beginnings and early influences

Chapter 50. Neurofeedback: the first fifty years—my story

Overview

Beginnings

The medical school days

Anna

Colleagues react

My world turned upside down

Re-emergence

From here to the future

Chapter 51. Show me the data

Introduction

How did I get here?

The cold-pressor study

The search starts

The basal forebrain area

The SMR story

SMR and sleep spindles

SMR and seizures

Current activity

Thoughts about the current status of neurofeedback

Chapter 52. My academic life with neurofeedback

Most outstanding positive developments

Most negative developments

My most valuable past Contribution(s) to the field; future directions

Examples of my research contributions

Chapter 53. Highlights of my neurofeedback journey

The early Switzerland days

Neurofeedback training begins

My professional neurofeedback role begins

Executives, heart smart and sustainability

Practice in the recent past and present

Miscellaneous comments

What next? What of the future of neurofeedback?

Chapter 54. My career in QEEG and neurofeedback

Beginnings

Choices for most important developments in the field of neurofeedback

Author's major contributions

Chapter 55. Do you think we can get the brain back into neurotherapy?

Clinical versus normative databases

Symptom down research methodologies and treatment

One-size-fits-all

Conclusions

Chapter 56. Neurofeedback's first fifty years: my story

Why and how I was initially motivated to enter the neurofeedback field

Opinion of the most important and landmark developments in the field over the fifty-year time span

Author's most important personal contributions to the evolution of the field—past, present and future

List of contributions to the field of EEG neurofeedback

Chapter 57. A quarter century immersed in neurofeedback

Introduction

Being recruited into the field

Milestones and comrades

Advancements in the field: a personal perspective

Our contributions

Hopes for the future of combined neurofeedback and biofeedback

Chapter 58. My years with neurofeedback

Chapter 59. Waking up from the matrix: realization of neurofeedback-based health care in a neurology practice

How I first became interested and involved in neurofeedback

Positive developments faciliating the evolution of neurofeedback

Chapter 60. My odyssey in QEEG-guided and symptom-based neurofeedback

Introduction

Introduction to quantitative EEG (QEEG)

Symptom-based protocols

Studies in dyslexia

Studies in closed head injury (CHI)

Study on anxiety associated with post-traumatic stress disorder (Walker, 2009)

Study on anger control disorder (Walker, 2013)

Study on recurrent migraine headaches (Walker, 2011)

Study on dysgraphia (Walker, 2012a, 2012b)

Studies in epilepsy (Walker, 2008)

Conclusion

Chapter 61. How I ended up in neurofeedback

Adventures along the way

Major developments, future promise

Some things I have accomplished

Chapter 62. My neurofeedback life experiences

Entry into the field

Landmark developments in the field

Index

Copyright

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Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

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Dedication

We dedicate this book to:

Those 1960s visionaries, living and dead, who pursued inner space, thus laying the foundation for the field of neurofeedback.

And, to the young persons world-wide currently practicing or researching neurofeedback. May you grow the field—and, in the spirit of 1969, perhaps hurry the Dawning of the Age of Aquarius!

Memoriam(Written in Memory of Harold L. Russell, Co-editor)

Rather than giving someone his undivided attention, Harold, who passed away April 12, 2019 at age 92, had the unique ability to attend to someone with broad attention. He heard deeply what a person was communicating to him in multiple ways. Harold was an avid reader, keeping up with a vast number of journal articles while simultaneously scanning his knowledge base to find additional characteristics that he had already checked out and found adequate. His ever-increasing fund of knowledge allowed him to give realistic encouragement to those who turned to him for help. He was generous with his time and knowledge, and gave encouragement and support to many.

Harold's primary objective in life was to learn as much as he could about what was effective for people, whether individuals or groups; whether children or octogenarians. Being informed allowed Harold to encourage and support people to go beyond what they had seen as their personal limits. He was so accepting of where people were, that he gave them a number of options as ways to increase their health: physically, mentally and intellectually. Since Harold practiced what he preached he was intimately attuned to the human condition. It wasn't unusual to hear him say, JTC, a streamlined way of saying Join the Club (of the human condition).

In addition to working with individuals, Harold was attuned to processes from which large groups of people of every age could benefit. More than a quarter of a century ago he derived a rhythmic auditory-visual stimulation system that let children develop to higher intellectual levels than before using his repeatable techniques. And his dream of providing inexpensive units to children so that many more could develop intellectually can still become a reality. Serving as an ardent co-editor of this book on neurofeedback was among his last professional contributions.

Harold's thoughtfulness, generosity and creativity will be greatly missed by his wife and colleague Vicki, his family, and his many former clients, as well as by those in the field of neurofeedback.

Contributors

Martijn Arns

Research Institute Brainclinics, Nijmegen, The Netherlands

Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands

neuroCare Group, Munich, Germany

Marvin H. Berman,     Quietind Foundation, Elkins Park, PA, United States

Eugenia (Genie) Bodenhamer-Davis,     University of North Texas, Neurotherapy Lab, Denton, United States

Valdeane W. Brown,     Zengar Institute, Inc., Victoria, BC, Canada

Linda Brownback,     Mason and Associates, Group Psychological Private Practice and Biofeedback Center, Allentown, PA, United States

Thomas S. Brownback,     Mason and Associates, Group Psychological Private Practice and Biofeedback Center, Allentown, PA, United States

Thomas G. Browne,     Neurenics Psychology, Inc., Private Practice, San Francisco, California, United States

David S. Cantor,     QEEG-D, IBQE-D, BCN/Mind and Motion Developmental Centers, Johns Creek, GA, United States

Dan Chartier NA,     Licensed Psychologist and Health Service Provider, Life Quality Resources, North Carolina, United states

Thomas F. Collura,     BrainMaster Technologies, Inc. Bedford, Ohio, United States

Jonathan Cowan,     Peak Achievement Training, Goshen, KY, United States

R. Adam Crane,     BCIA Senior Fellow, BCIAEEG, NRNP Diplomate. Director of BioMonitoring International and BioTec Corporations

John Davis,     Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada

Scott L. Decker,     Department of Psychology, University of South Carolina, Columbia, SC, United States

Nicholas Dogris,     CEO and Co-founder of NeuroField, Inc., Santa Barbara, CA, United States

Jim Evans,     Sterlingworth Center, Greenville, SC, United States

Les Fehmi,     Research Director, Princeton Biofeedback Centre, Princeton, NJ, United States

Sebern F. Fisher,     Private Practice, Northampton, Massachusetts, United States

Lauren Frey,     University of Colorado, Anschutz Medical Campus, Aurora, Colorado, United States

Gerald Gluck,     Brain Healing Center, Coral Springs, FL, United States

Jay Gunkelman,     Brain Science International, San Ramon, CA, United States

D. Corydon Hammond,     Physical Medicine & Rehabilitation, University of Utah School of Medicine, Private Practice, South Jordan Utah, United States

Ann Marie Horvat,     Corpus Christi, Texas, TX, United States

Merlyn Hurd,     New York, NY, United States

Victoria L. Ibric,     Neurofeedback and NeuroRehab Institute, Inc, Pasadena, CA, United States

Joe Kamiya,     University of California, Berkley, San Francisco, CA, United States

Harry Kerasidis,     Center for Neuroscience, CalvertHealth, Prince Frederick, MD, United States

Cynthia Kerson,     Department of Applied Psychophysiology/Saybrook University/Pasadena, California, United States

J. Lucas Koberda,     Neurology, PL, Brain Enhancement, Inc., Kerry Forest Parkway, Tallahassee, FL, United States

Juri D. Kropotov

N.P. Bechtereva Institute of the Human Brain, Russian Academy of Sciences, St. Petersburg, Russia

Department of Neuropsychology, Andrzej Frycz-Modrzewski Krakow University, Krakow, Poland

Stephen Larsen,     Director at Stone Mountain Center, New York, NY, United States

Lea Leonard

Licensed Clinical Social Worker in Florida

Board Certified in Neurofeedback through BCIA, holds a Technician Certificate in QEEG through QEEG Certification, Private Practice, Wings of Change, Naples, Florida

Member National Association of Social Workers

Member International Society for Neurofeedback Research

Robert E. Longo,     Private Practice, Serendipity Neurofeedback, Lexington, NC, United States

Joel F. Lubar,     University of Tennessee, Knoxville, TN, United States; International Society for Neurofeedback and Research, Miami, FL, United States

Joy Lunt,     Brain Potential, Inc., Burbank, CA, United States

Randall R. Lyle,     Marriage and Family Therapy Department, Mt. Mercy University, Cedar Rapids, IA, United States

Robert E. McCarthy,     McCarthy Counseling Associates, Oleander Drive, Myrtle Beach, SC, United States

Penny S. Montgomery,     New Hope For The Brain, A private practice in Lakewood, Colorado

John K. Nash,     Licensed Psychologist

Jeff Nichols,     The Elmer E. and Alyce M. Green Foundation, Topeka, KS, United States

Len Ochs,     Private Practice, Sebastopol, CA, United States

Siegfried Othmer,     The EEG Institute, DBA of EEG Info, Los Angeles, CA, United States

Susan FitzGerald Othmer,     The EEG Institute, DBA of EEG Info, Los Angeles, CA, United States

Peter A. Parks,     Synergy Systems Consulting, P.A., The Elmer E. and Alyce M. Green Foundation, Topeka, KS, United States

Sarah Bremer Parks,     Synergy Systems Consulting, P.A., The Elmer E. and Alyce M. Green Foundation, Topeka, KS, United States

Harold L. Russell † ,     Harold Russell passed away on April 12, 2019 before he could complete this chapter. It has been lightly edited by his wife, Vicki, and Jim Evans

William John Scott,     BrainPaint, Inc., 310-573-9901, Malibu, CA, United States

Susan B. Shor,     Clinical Director, Princeton Biofeedback Centre, Princeton, NJ, United States

Mark B. Shtark,     Research Institute of Molecular Biology and Biophysics, and Novosibirsk State University, Novosibirsk, Russia

Mark Llewellyn Smith,     Neurofeedback Services Of New York, New York, NY, United States

Tato Sokhadze,     Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, SC, United States

Richard Soutar,     New Mind Technologies, Roswell, GA, United States

Fred S. Starr,     Myneurva Datasystems, Amesbury, MA, United States

M. Barry Sterman,     University of California at Los Angeles, United States

Ute Strehl,     Institute for Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Tuebingen, Germany

John Styffe,     Brain Care, Zurich, Switzerland

Tanju Sürmeli,     BCN, IBQED Living Health Center for Research and Education, Sisli, Istanbul, Turkey

Paul G. Swingle,     Swingle Clinic, Vancouver, BC, Canada

Hsin-Yi (Jean) Tang,     School of Nursing, University of Washington Health Sciences Center, Seattle, WA, United States

Robert W. Thatcher,     Applied Neuroscience Research Institute and Applied Neuroscience, Inc

Lynda Thompson,     The ADD Centre© and Biofeedback Institute, 50 Village Centre Pl, Mississauga, ON, Canada

Michael Thompson,     The ADD Centre© and Biofeedback Institute, 50 Village Centre Pl, Mississauga, ON, Canada

David Trudeau

Retired. Department of Psychiatry, Addictive Disorders Section, Veterans’ Affairs Medical Center, Minneapolis, MN, United States

Department of Family Practice and Community Health University of Minnesota, Academic Health Center, Minneapolis, MN, United States

Robert P. Turner

Network Neurology, Charleston, SC, United States

Associate Professor of Clinical Pediatrics & Neurology, University of South Carolina School of Medicine & Palmetto Health Richland Children's Hospital, Columbia, SC, United States

Department of Pediatrics Community Faculty, Bon Secours Roper-St Francis Hospital System, Charleston, SC, United States

Associate Researcher, MIND Research Institute, Irvine, CA, United States

Jonathan Walker,     Neurotherapy Center of Dallas, Dallas, TX, United States

Nancy E. White,     Unique Mind Care, Houston, TX, United States

Nancy L. Wigton

Applied Neurotherapy Center LLC, Tempe, AZ, United States

AZ Good Health Center, Tempe, AZ, United States

---

†  Deceased.

Preface

It was the 1960s in America--a time of cultural, social and sexual revolution. It was a time of contentious politics, tragic assassinations and inter-generational conflict, but also of creative thinking, exploration, hope, and setting of lofty goals. While the latter most famously involved exploration of outer space and the moon landing, there also was much exploration of inner space, consciousness, via meditation and chemicals such as LSD, mushrooms, and marijuana. And then, as the decade was coming to a close a psychologist named Joe Kamiya discovered that biofeedback of brain electrical activity also can impact inner space---in retrospect, not so surprising given the electro-chemical nature of brain function. This discovery added EEG biofeedback to the already existing more general field of clinical biofeedback established by pioneers such as Barbara Brown, and Elmer and Alyce Geeen. With its exciting promise not only for expanded mindfulness, but also for control of abnormal brain electrical activity in epilepsy and other clinical conditions, EEG biofeedback became a dominant and often independent procedure within the more general field, and was assigned the new term neurofeedback. During the 1970s and 1980s a relatively small number of early pioneers including Barry Sterman, Margaret Ayers, Siegfried and Sue Othmer and Joel Lubar continued to demonstrate the clinical value of neurofeedback, often struggling to keep the field alive and growing despite resistance from various sources. This book contains their neurofeedback stories as well as those of most other early pioneers, and a large number of others who have followed and made important contributions to the field.

Undoubtedly, there will be readers who will question the editors' choices of chapter authors, especially of those other than the early pioneers. Briefly, the process was as follows: after the proposal for the book was accepted by Elsevier and a contract signed, the editors presented to each other lists of names of persons he or she considered to have made especially valuable, unique, and/or well known contributions to the field. Following some discussion, each of about ninety nominees was contacted via e-mail, and provided a short description of the proposed book and an invitation to submit a chapter. In cases where a nominee no longer was living, former close associates were contacted and invited to submit a chapter describing that person's neurofeedback journey. Invitees were requested to include in the chapter some details of how they initially became interested in the field, briefly list a few of their candidates for most important developments during the fifty year evolution of the field, mention what they believe were their own most important contributions, and discuss their hopes and expectations for the future of the field. Given a popular science rather than scientific writing style desired for the book, potential chapter authors were asked not to include figures, or tables unless absolutely necessary, and to keep references to a minimum. Invitees were asked to refrain from making strongly negative or inflammatory comments about any person or his or her work. Page count was to be limited to no more than ten to accommodate publisher's total page limit. (However, the latter proved difficult due to variation in font sizes used. Actual page counts of submitted manuscripts ranged from three to sixteen.) Sixty-two persons submitted first drafts which were edited and returned to authors, who then made acceptable modifications prior to final submission to the publisher. Nearly all authors adhered, more or less, to the original request regarding content.

In the following pages readers will learn that there were multiple recurring themes among the chapters. Examples include: (1) authors' interests in the field very often originated from a search for help for a medically-related condition of a child, a client or themselves which had not responded to traditional treatment; (2) strong agreement regarding the landmark nature of developments such as Barry Sterman's cat research, Eugene Peniston's success with substance abuse, Joel and Judith Lubars' theta/beta ratio correlation with ADHD, alpha-theta training for trauma, Bob Thatcher's scientific research involving a normative date base, LORETA analysis, production of efficient and affordable equipment by Lexicor Corp., and establishment of professional associations such as AAPB and ISNR; (3) while operant conditioning was accepted by the majority as the mechanism accounting for positive neurofeedback training results, some authors disagreed. For example, some argued for a sort of body wisdom explanation whereby the brain, if provided appropriately detailed feedback, naturally reorganizes itself; (4) the question of how and why a large number of often very different neurofeedback approaches lead to positive training results. Authors unanimously rejected placebo as the main mechanism of neurofeedback efficacy; but the question was addressed directly by only one author who postulated that all approaches facilitate organization of rhythms of the brain; (5) most, but not all, authors appeared to accept that neurofeedback training is a very safe procedure with few, or no, enduring negative side effects; (6) general agreement that the field is expanding rapidly, but disagreement over why it remains out of the mainstream of medicine. Authors suggested such causal factors as lack of consistent scientific research support for its efficacy, extravagant claims for cures of multiple ills, lack of enforceable training standards for practitioners, and competition from a myriad of alternative medicine practitioners; (7) considerable controversy over the clinical and practical value of normative database and qeeg-guided, 19 channel versus simpler and less expensive one or two channel, symptom-based neurofeedback; (8) frequent mention that the history of the field is replete with disagreements, often quite contentious, regarding ownership of patents and ideas, and relative usefulness/uselessness of specific neurofeedback procedures and equipment; (9) disagreement over the question of need for research support for efficacy of neurofeedback. Some advocated randomized, double blind, placebo controlled studies, others were in favor of use of more appropriate, yet rigorous designs, while others implied the field already is clinically proven, and minimized or rejected need of research; and (10) high on author wish lists for the future of the field were enforceable standards for practice of clinical neurofeedback, and greater coverage of neurofeedback treatment by medical insurance providers.

Throughout development of this book the editors attempted to remain neutral and apolitical. With one exception, all chapters are in alphabetical order. That exception was Chapter 1 by Joe Kamiya in recognition of the fact that he often is considered the father of clinical neurofeedback (and, incidentally, was the lead editor's first biofeedback mentor at the University of California, SF). We, the editors, naturally had opinions regarding favorite personalities, and most valuable and likely-to-be enduring developments in the field. However, we believed that only time will reveal the true facts of such matters. So, for purposes of this book, we took the stance that all authors and neurofeedback methods are created equal until history proves otherwise. Some present readers should be around in 2069 to read a 100 year history sequel to this book. Perhaps they then will learn truths concerning relative validity and value of first 50 year developments. In the meantime, we hope present readers enjoy the neurofeedback stories in this book, and will use the information to help speed the field's evolution toward becoming a major part of the mainstreams of medicine and education, as well as an effective, and safe, tool for exploration and self-mastery of inner space.

The Editors

Acknowledgements

When one's neurofeedback journey spans fifty years it is inevitable that many will have contributed significantly to its beginnings and progress. Here I recognize and thank the following persons as especially significant for this book:

• My maternal grandmother, Ida V. (McGinnis) Rogers, whose Christian Science-related beliefs regarding mind over matter planted early seeds of interest

• My sister Marjorie Evans Starrs for constantly urging me toward ever-higher educational goals

• Dr. Frank I. Varva, supervisor, and Joanne M. Borger, fellow psychologist, at Polk (PA) Center for their encouragement and support as I pursued interests in neuropsychology and neuromodulation

• Professor H. Carl Haywood, Ph.D. at Peabody College of Vanderbilt University whose demands for onward and upward of his students included the study of neuropsychology of learning disorders.

• Dr. Bob Thatcher, whose support and many contributions to the field continue to sustain my interests

• Dr. Fred Medway, former director of the School Psychology Training Program at the University of S.C. for his support of my qEEG research interests while a faculty member

• John Gilbert, and former USC graduate student, Peggy Tindal, for providing encouragement and inspiration to publish the first of the several neurofeedback books I subsequently edited or co-edited.

• Heather Gill, Ann Guyer, Susan Hendley, Karren Peterson, Jane Price and Lavena Wilkes, staff members at the Sterlingworth Center for their consistent encouragement of my editing efforts

• Mary Blair Dellinger, MA, BCN, co-worker and indispensable co-editor of this volume whose energy, talent and computer skills made it possible

• My wife, Martha Young-Evans, for her patience and understanding over the past year as I worked in my basement office, temporarily sacrificing family time for book time

• Natalie Farra, Rebecca Henry, and Samantha Allard of Elsevier Publishing for their encouragement, patience and assistance during planning and/or preparation of this book

All those whose creative genius and efforts over the past fifty years gave rise to and sustained the field now known as neurofeedback, and made possible a book such as this.

Jim Evans

I wish to recognize and thank the following persons:

• My son, Collin McEwen, for being supportive of my work editing this book and my neurofeedback practice

• My neurofeedback clients, who continue to inspire and teach me about the potential of neurofeedback

• Senior editor on this book, Dr. James Evans, thank you for his wise guidance and mentorship, and unyielding belief in me

• My parents, Leigh Ann Reedy and Auby Dellinger, for their continuing support and encouragement

• Robert (Rusty) Turner, M.D. for being an amazing example of a compassionate health care professional, often offering advice regarding my clients, while providing quality neurofeedback services in his own clinic, Network Neurology

• Dr. Scott Decker, for introducing me to neurofeedback back when I was a clueless undergraduate and taking me on as an assistant in his research Applied Cognitive Neuropsychology Lab at the University of South Carolina

• Dr. Harold Russell and his wife Vick foor their editing assistance prior to and following Harold's passing

• The professionals working together to further the field of neurofeedback through research and clinical practice, many of whom contributed to this book

• Rebeka Henry, Natalie Farra, and Samantha Allard from Elsevier for their assistance and cooperation throughout the production of this book

Mary Blair Dellinger

Supplementary recognitions

The chapters of this book describe highlights of the neurofeedback journeys of a large percentage of the early pioneers, and those of a representative sample of important, more recent contributors. Of course, there are many more persons whose journeys have been of much significance to the field. Some were, in fact, invited to contribute a chapter, but declined for various reasons such as time pressures or illness. And, due to page limitations, a great many others who have made, and/or are making, important contributions could not be invited. A large number of names come to mind of persons whose contributions the editors consider of special significance to the history of the first 50 years of neurofeedback. One hundred of these are listed below in alphabetical order. Given the continuing rapid growth of the field of neurofeedback, hundreds more names obviously would qualify for this list, but were unknown to or not recalled by editors at the time the list was prepared. No names were intentionally omitted.

1. Richard Abbey

2. Andrew Abarbanel

3. Alarik Alexander

4. Susan Alvarez

5. Richard Alford

6. John Anderson

7. Valerie Anderson

8. Guy Annunziata

9. Elsa Baehr

10. Rufus Baehr

11. Salvatore Barba

12. Rebecca Bassham

13. Alexei Berd

14. Grant Bright

15. Steven Brotman

16. Leslie Burgess

17. Rex Cannon

18. Jeffrey Carmen

19. Wes Center

20. Theodore Chapin

21. Lori Russell-Chapin

22. Rob Coben

23. Mike Cohen

24. Terri Collura

25. Marco Congedo

26. Charles H. Davis

27. Roger deBeus

28. Mary Blair Dellinger

29. John Demos

30. Dirk de Ridder

31. Karen Dodge

32. Mario Dollschnieder

33. Stuart Donaldson

34. Carolyn Earnest

35. Rick Ellis

36. Susan Ford

37. Jon Frederick

38. Kathleen Friend

39. Jay Gattis

40. John Gilbert

41. Mike Gizmondi

42. Penijean Gracefire

43. John Gruzelier

44. Bob Gurnee

45. Ann Guyer

46. Ed Hamlin

47. Barbara Hammer

48. Michael Hickey

49. Betty Jarusiewicz

50. David Joffe

51. Jack Johnstone

52. Phil Jones

53. Vickie Jones

54. David Kaiser

55. Lynda Kirk

56. Paul Kulkosky

57. Rima Laibow

58. Karen Lake

59. William Lambos

60. Robert Lawson

61. Sanjay Manchanda

62. George Martin

63. Mike Metzig

64. Barbara Minton

65. Vince Monastra

66. Don Moss

67. Louise Norris

68. Georges Otto

69. Eugene Peniston

70. Jane Price

71. Rob Reiner

72. Leonard Richards

73. Jim Robbins

74. Peter Rosenfeld

75. George Rozelle

76. Martha Maldonado Rubi

77. Vicki Jones Russell

78. Marvin Sams

79. Terry Semple

80. Leslie Sherlin

81. Deb Simkin

82. Michael Sitar

83. Peter Smith

84. Emily Stevens

85. Steve Stockdale

86. Diane Stoler

87. Sebastian Striefel

88. Gabriel Tan

89. Yvonne Tate

90. J. Lawrence Thomas

91. Tiff Thompson

92. Kirt Thornton

93. Tim Tinius

94. Hershel Toomim

95. Dan Tuttle

96. Werner Van den Bergh

97. Bessel Van Der Kolk

98. Paul Wand

99. Sarah Wyckoff

100. Marci Zinn

Chapter 1

Some call me the father of clinical neurofeedback

Joe Kamiya     University of California, Berkley, San Francisco, CA, United States

My first contact with the EEG occurred when I was a new instructor in the Department of Psychology at the University of Chicago. My office was near the sleep laboratory of Professor Nathaniel Kleitman of the Department of Physiology at the University. He was just retiring from a distinguished research career and kindly allowed me to use his laboratory for my own research. He asked William Dement, then a medical student and an assistant of Professor Kleitman, to teach me about the EEG. Dement was very helpful, showing me the attachment of scalp electrodes, how to prepare the equipment for the inked-pen tracings of each EEG recording site, and to identify the tracings in terms of the different stages of the sleep-wake cycle and dreaming activity. I started studying the various physiological indicators of sleep and dreaming, with the EEG and eye movements being among the most interesting.

As I watched the EEG's fluctuations emerge on the continuously moving graph paper during all-night recording sessions, I became interested in another aspect of the EEG in the awake subjects. I noticed the irregularly repeated alternations of the occipital EEG alpha rhythm with a lower voltage mixed frequency pattern in awake subjects who sat quietly with eyes closed. I also observed the occurrence of alpha activity in the occipital region of awake subjects.

My Department of Psychology at the time (the mid 50's) was among the most important ones to follow the traditions of B.F. Skinner in the use of a kind of training called operant discrimination training. Howard F. Hunt, who became chairman following James G. Miller, helped shape my thinking in the following way: I wondered whether people might learn to discriminate their own state of EEG, as to whether they were in alpha or non-alpha, using discrimination training. Might the difference between the presence of alpha rhythm activity and its absence be associated with a difference in some subjective experience, state of mind, feeling, mood, or other mental quality?

With the help of a small grant from NIMH, I began experimenting to see.

Choosing college students who had clear trains of alpha about one-third to one-half of the time, they were told: This will be an experiment to see if you can learn the difference in feel between two different brain wave patterns as they appear in your EEG tracings. I had them sit alone with eyes closed in a darkened room. The EEG equipment was in a separate room, so the subject would have no audible feedback from the recording equipment as to whether the alpha rhythm was present. I proceeded to run trials three or four times a minute. The training sessions were run for approximately 1   h with a 5-min break at 30   min. I instructed them to sit quietly, listening for a single ding of a bell that I would ring about two or three times each minute. Outside the subject's room I watched the subject's EEG emerging on the paper trace. I decided to designate the presence of alpha state A and the absence of Alpha, state B. About half the time I would ring the bell when they were showing EEG pattern A, and the other times when they were showing EEG pattern B. Each ding of the bell would be a prompt for them to report their guess as to whether they were showing pattern A or B, and I would immediately indicate if their guess was right or wrong; A was correct for alpha present, and B was correct for alpha absent.

Most subjects learned to make significant progress within one or two sessions. One remarkable subject made over 200 correct responses in a row. Intrigued, I kept running him beyond the normal session's time. When he finally made a wrong response and I said wrong, he was stunned. He told me he had deliberately made a wrong response, because he thought I was pulling his leg, just saying correct to whatever he said!

At first, he was unable to describe why he was so accurate, but as further training continued with him making perfectly correct judgments, he thought it seemed as though he was looking at something in his mind's eye when B was the correct answer, and A the correct answer when he was not so visually occupied. Others were unclear, stating simply sometimes it feels like I should say A, and sometimes like I should say B. During breaks in the training sessions they were encouraged to talk about what they had been trying. I think this helped them to code their successes and failures in their cognitive maps, helping them to recall from memory an essentially non-verbal task.

It was interesting to note that as subjects became more accurate in their judgements, they would seem to regularize their alternations from state A to State B. They would seem to begin to hold one particular pattern and then release it into the other pattern on their own, apparently to better judge which state they were holding at the time of the bell, so that they could be more accurate in their judgments. That is, they began to anticipate what they should say depending on what state of mind they had maintained at the time of the bell ding. This was interesting because my intention of training was not to train them to achieve control of their alterations of alpha and non-alpha, but merely to discern if there was any subjective difference between them. The subject who achieved the most accurate discrimination of alpha presence from its absence was able, without any further training, to produce at my command nearly continuous streams of alpha for several pages of records. The more accurate subjects were at discriminating alpha, the more adept they seemed to be at controlling it.

Clearly, learning to discriminate alpha from its absence seemed to contribute to the ability to control its presence. The apparent control unintentionally brought on by discrimination training led me to wonder if it would not be interesting to see if I could start with control training without any discrimination training at all. In 1956 I tried testing this idea by what I believe to be the first experiment to train the control of alpha abundance using feedback of alpha amplitude as an aid. With some circuitry including a voltage detector, I arranged a tone to be sounded in the subjects’ room whenever their alpha amplitude exceeded a threshold that I set. I asked the subjects to try whatever mental state that would work to increase the total duration of the tone. The tone would stop when the alpha rhythm disappeared. The subjects were now instructed to maintain the tone for as long as possible for a 5-min period, and then to prevent the tone from happening for the next 5-min period. A third 5-min period required them to increase the tone, and the fourth to decrease the tone. It was very clear that nearly all subjects could achieve some measure of control over whether they could produce alpha or non-alpha.

Initially, nearly all subjects showed a drop in alpha production that would last for a few moments. It seemed due to their attention to performing what was being asked of them. As expected, individuals previously trained in alpha discrimination learned more quickly to increase alpha than individuals who had not been so trained.

When asked to describe the difference in subjective quality between A and B, or tone on from tone off, even the most accurate performers did not have clear descriptions. This problem may suggest ways of mapping for each person the principal components underlying his or her judgments of the similarity of several EEG and other trained physiological variables to each other and to all the others. I would expect the wide individual differences in verbal descriptions could be greatly reduced. Your alpha is most likely not all that different from mine, given we are both of the same species.

The subjective reports of many subjects, after several sessions of training, began clearly to involve some kind of visual imagery as being the primary condition in which the alpha was not present. Some subjects were unable to achieve control, but they were a small minority, perhaps less than ten percent over 5 training sessions. The most successful subjects felt that the alpha state was more pleasant a state than the non-alpha state. The latter seemed to be more busy, and several subjects specifically identified visual imagery activity as useful for suppressing alpha. As for the subjective state of alpha, other than that it was a rather relaxed state, not much further was said. But one subject rather enjoyed putting himself in the alpha state. He asked at the end of his last training session if he could return for further training sessions so he could stay in an alpha state for as long as an entire session. In one of the first publications of this work, I mentioned this person's response. The result, unfortunately, was a widespread and oversimplified belief that alpha was a very pleasant state to be in-a thesis for which, as discussed above, there was limited subjective support. The cultural context of the 1960's contributed largely to that oversimplified response. There was much popular writing about the happiness that neurofeedback could magically bring, much to my regret.

Other researchers also began to explore this new field

While I was working at University of Chicago, Barry Sterman at UCLA was experimenting with operant conditioning of the sensory motor rhythm (SMR), first with cats, then applying what he was observing to his pioneering work with humans using SMR feedback for epileptic seizure disorders.

Elmer Green, who was in the engineering department at Chicago, came to a talk I gave on discrimination of EEG alpha. Later when he was at the Mayo Clinic, he began with his colleagues Alyce Green and Dale Walters to establish similar work in what they termed Voluntary Controls.

The following scientists were presenters at the first Biofeedback Research Society meeting in 1969 in Santa Monica, CA.:

• Tom Mulholland spoke of his early alpha studies with Eric Peper from the V.A. in Bedford, Massachusetts.

• Johann Stoyva spoke of developing early clinical biofeedback in collaboration with Tom Budzynski at the University of Colorado.

• Les Fehmi, then at UCLA, began learning how EEG alpha related to states of consciousness, later developing the Open Focus approach to mindfulness.

• Barbara Brown at the Los Angeles V.A. Hospital became, in 1969, the first president of the Biofeedback Research society.

• Leo DiCara spoke of using feedback techniques in experimental animals.

• And, I reported on EEG Alpha Biofeedback.

• John Basmajian described applying operant conditioning methods to EMG, predating others' work in EEG.

Other early contributors to the field

Notable EEG feedback researchers and cognitive scientists outside the US were Antoine Rémond from France and Niels Birbaumer from Germany.

Mention must also be made of E. Roy John, a wide-ranging neuroscientist, engineer and theoretician. Among his many contributions to our knowledge of the brain, he pioneered the early development of qEEG. As a fellow former University of Chicago researcher and valued friend, I always admired both the scope and depth of his views.

Looking back at the history of this field following these first experiments with the EEG, it was clear that many measures other than EEG alpha wave presence could be brought under control with the same methods used for alpha training. The development of biofeedback, as it came to be called, expanded its use for the control of such activity as the galvanic skin response, muscle tension, blood flow, stomach acid and motility, and other measures. The overwhelming thought among researchers, clinicians, and the public was that this method was primarily a useful clinical tool. Migraine headaches, persisting muscle pains, ADHD-ADD, anxiety, insomnia, epilepsy and other common disorders became candidates for treatment by biofeedback. The field has primarily been identified ever since for the treatment of clinical disorders. Other applications now focus on enhancing optimal performance, such as training professional athletes and Olympic contenders, or corporate executives to be more effective.

The field of neurofeedback has expanded and combined with new ways of looking at brain activity, with qEEG and LORETA, as well as fMRI. As computers have become vastly more powerful, and equipment and knowledge have become more sophisticated, the field has blossomed into some remarkably beneficial applications. They are too many to list here, but for two useful bibliographies: see one on neurofeedback compiled by Cynthia Kerson http://www.aped.training/s/NFB-Biblio-Aug-2016.pdf. This online publication is complete with abstracts. The 2017 ISNR bibliography is another useful recent reference.

Possible future directions

Reviewing the work done in the field, which is by now occupied by scores, if not thousands, of biofeedback-neurofeedback clinicians, my view is that there is a tendency to forget that training people to achieve discernment and control of a physiologic function might be an important basic research tool in the field of psychophysiology. This would be true regardless of whether there were any practical medical applications. The basic science of mind-brain and mind-body relations is a field where much serious mapping of the relations can be done, and it is hoped that a number of publications in the future will be devoted primarily to simply describing the relationships between mind and body functions. I regard Neurofeedback as a basic science tool that is sorely needed, and that should be pursued regardless of what practical applications it may have. It is through advancement of basic knowledge in this area that novel future applications can follow.

A change in scientific algorithms has been on the horizon for some time.

Johann Stoyva and I published in 1968 an article in the Psychological Review in which we examined the logic of indicators of dreaming sleep. The central concept of the article is that all indicators of private experience like dreaming, including the verbal reports of the dreamer, coordinated eye movements, accelerated heart rate, etc. are less than perfect individually, but together they converge in strong support of this presumed event in nature. Identifying physiological indicators of special mental states makes use of a scientist's own subjective observation. Using neurofeedback for themselves may enable scientists to include their own first-person observations in the service of hypothesis generation.

I believe that a major challenge facing all of us in biofeedback and neurofeedback is being able to comprehend the relationship of the specific feedback program that we are using in relation to the entire biological system. Now I think it is time for considering the use of complex computer models of the entire body-brain system. Our approach to both the central nervous system as well as the autonomic nervous system has so far been piecemeal and fragmentary. It also is capable of continuous evolution. Technical and theoretical advances are making a more holistic approach possible. A whole development in thinking that is based on the concept of neuro-plasticity points us in expanding new directions. More complete computer models of the entire organism-in-its-environment need development. This will require considerably more computer power than is currently available.

The ideas behind so-called deep learning or recurrent neural networks could be useful in this arena, not to create an artificial intelligence but to be used as computational tools to further our understanding of the brain-body-social system. Specifically, deep learning is based on using a massive computing power to build layers of abstractions over complex data with a very high number of variables. Those model-building techniques potentially could be harnessed to provide novel forms of feedback and understanding.

Algorithms that have superordinate-subordinate systems that match the hierarchical biological systems of the human being are what we need to try to develop. For this we may need some experts outside of those we have worked with, including especially mathematicians who can help us conceptualize the entire system of brain and body so that a particular biofeedback system can be described as a very specific part of the total system. As far as I know, no one has attempted an abstract mathematical characterization of the relationship of the entire brain-body system. We can, as workers in the field, well afford to seek the advice of mathematicians and others whose areas of concern have been the abstract relationships of each part to the total system. It can be said that this is pie in the sky thinking, but I believe that it is going to be important for our field to encourage investigating the essential mathematical relationships constituting the human system.

Complicating matters further, I believe such a system needs to recognize that the human organism is part of a social system from birth to death, and that the functions of the organism are, to a great extent, dependent upon the complexities of the social system. Examples of what I mean are the authoritarianism that pervaded much of human interrelationships, being enmeshed in such matters as conquests of territory, compliance with dictatorial regimes, and active protests against them. The newborn baby is a part of a historical system which we tend to overlook in our biological models. The fact that the human being is a part of a social system at all times cannot be overlooked.

It is sometimes said that scientists have been understandably averse to dealing with subjective mental phenomena which are not susceptible to the same type of hypothesis confirmation that blood pressure or metastasizing cells are. Yet scientific models that are supposedly comprehensive representations of the human species that overlook such things as the role of human happiness, are quite incomplete. It is very clear to me that we need new conceptual systems and approaches to studying mental states like happiness and their relationship to biological systems.

Thus, in closing, the study of the human organism in its totality as a biological, social, subjective and historical entity is a tremendous challenge, one that will require all of our scientific and humanistic skills, including knowledge of our history as an evolving social system. To meet this challenge a wide range of thinkers should be enlisted to help fashion a more comprehensive model of understanding of the human species. Conferences dedicated to these ideas should be encouraged. Scholarship and knowledge can only benefit.

Chapter 2

My personal neurofeedback journey

Martijn Arns a , b , c       a Research Institute Brainclinics, Nijmegen, The Netherlands      b Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands      c neuroCare Group, Munich, Germany

Abstract

My personal neurofeedback journey, from Martijn Arns

Keywords

ADHD; Biography; Brainclinics; Martijn Arns; Neurofeedback

In 1994 I started my master's in psychology and decided to study in Nijmegen (The Netherlands). During my first year, two experiences shaped my specific interest in Biological Psychology. During the early 90's the new antidepressant drug Prozac, part of the SSRI-family, became in use in the Netherlands. At that time, I observed the effects of this drug in my close surrounding having life changing effects. Concurrently at the university, we were dealing with the topic of ‘Biological Psychology’, where I started to realize - and understand - how just a few milligrams of a specific compound could have tremendous effects on someone's functioning after being impaired for a long time. But, as we know from neural plasticity, what-fires-together-wires-together. This serendipitous coinciding of biological and psychological aspects, in real-life and in my studies, made me decide to choose as a specialty ‘comparative and psychophysiological psychology’, or, in brief, biological psychology. During and after I graduated as MSc in biological psychology at Radboud University in Nijmegen in 1998, I conducted several projects in the field of applied neuroscience in Sydney (Westmead Hospital), Munich (Max Planck Institute for Psychiatry) and Glasgow (Organon Research in Newhouse). In 2011, I obtained my PhD on the topic of ‘EEG-based personalized medicine for ADHD and depression' at Utrecht University, where I'm still affiliated as a researcher.

In 2001, I founded what is now known as Research Institute Brainclinics as an independent research institute. At Brainclinics, we specialize in applied neuroscience, advancing the understanding of psychiatric disorders through brain imaging (QEEG, ERPs), chronobiology and sleep, and Research Domain Criteria (RDoC). We expect knowledge attained will aid in a future of personalized medicine in mental health. More specifically, today we focus on the development and application of neuromodulation techniques such as neurofeedback in the treatment of ADHD, and magnetic brain stimulation (rTMS) in the treatment of depression and OCD. It was in 2004, after my first encounters with my main inspirators in the field of neurofeedback, Barry Sterman and Jay Gunkelman, when we started treating our first patients with neurofeedback.

In 2006 when I founded Psychology Practice Brainclinics we specifically applied, and further investigated new innovative treatments such as Neurofeedback and rTMS. At that time, we were the first outpatient setting in Europe where rTMS was offered for the treatment of depression. Eventually, in 2015 this psychology practice was acquired by the neuroCare Group in Munich. Protocols and assessments developed at Psychology Practice Brainclinics now form the basis of neuroCare Clinics worldwide. I still serve there as scientific adviser.

In addition, I was founding director of Brainquiry (until 2007; where we developed the world's first Bluetooth based portable neurofeedback equipment), and I served as editor of various scientific journals and books, organized many international conferences and served on the board of several international professional organizations. Recently, together with Barry Sterman, we published a book about the history of neurofeedback and EEG that contains many new and interesting insights featuring pioneers such as Alfred Lee Loomis, Barry Sterman, Joe Kamiya and Niels Birbaumer (Arns & Sterman, 2019).

The last 50   years have been a very exciting time for the field of neurofeedback. Many controlled studies have been published, we understand much more about the mechanism of some neurofeedback protocols, and much scientific discussion about the efficacy of neurofeedback has been initiated. What has struck me over the last two decades, is that the biggest obstacle in our field preventing neurofeedback to become mainstream, is actually the majority of people that practice neurofeedback or are involved as vendors. On one hand we see the careful, diligent work of applied researchers who try to investigate the real effects of neurofeedback with well-considered control groups and designs investigating incremental improvements and innovations of existing protocols. On the other hand, we see a market dominated by commercial companies and clinic chains that are over-shouting each other about the newest, most advanced, most effective innovation in neurofeedback, for the widest array of indications without conducting (any) required research. Examples of these are the many hyped applications such as Z-Score neurofeedback, Infraslow neurofeedback, Neuroptimal etc. (see Coben, Hammond, & Arns, 2019 for a systematic review), and the wide range of clinical claims people make on clinic websites, ranging from Schizophrenia, Pre-Menstrual Syndrome, to auto-immune disorders. What many people forget, is the ‘outside-looking-in’ effect of such an approach. This effect is illustrated by the following example.

When I explain to colleagues in the field of rTMS, and substitute a rTMS-analogy for what the neurofeedback field looks like, I say ‘With depressed patient A this morning, I applied Theta- burst rTMS stimulation to the right- and left-temporal cortex because I thought that was the best given he had some traumatic experiences. With depressed patient B this afternoon, I did a 1   Hz TMS protocol occipital because she had some excess high beta activity occipital’ and ‘rTMS works for everything. We have seen great success with Alzheimer's and cancer, and it also helps as anti-ageing agent. When you stimulate wrinkles, they disappear’. Many don't believe nor understand such claims, and immediately consider it snake oil. Therefore, we should pay careful attention to how other neuromodulation treatments have succeeded to make it as a mainstream treatment in half the time neurofeedback has been in existence.

Illustrating how people that practice neurofeedback are an obstacle to neurofeedback moving forward, are various ‘failed studies’, that were simply investigating what is out in our field. That is, the first Ohio State University study simply investigated the available ‘SmartBrain’ approach, while the Nijmegen studies simply investigated a specific neurofeedback approach from a large clinic-chain in the Netherlands (for overview see Arns, Heinrich, & Strehl, 2014). The fact that such studies turn up negative, is only reflecting the state of our field. Altogether, I see it as the biggest challenge for neurofeedback to overcome in the decade to come, that is, to develop, use, and enforce standards in our field.

On the other hand, we now see so many well-controlled and adequately powered studies, that the signal starts to emerge from the background-noise, and meta-analyses are finding more consistency. Personally, I think the latest meta-analysis on long-term effects is one of the most promising pieces of evidence we have thus far (Van Doren et al., 2018). Here was found that across studies, clinical benefit from neurofeedback tended to improve further with time – without any sessions during the follow-up period. And, clinical benefit was similar for neurofeedback, when compared to active treatments including medication (where medication was continued during the follow-up period).

Finally, for specific neurofeedback protocols we have come to understand much better how they work, especially SMR Neurofeedback. Sterman already observed in his early cat studies that after SMR neurofeedback, sleep spindles were – and remained - enhanced during sleep, and cats exhibited more uninterrupted sleep. This finding combined with the most frequently reported ‘side effect’ of neurofeedback, that people sleep much better, led us to investigate the role of sleep and the circadian system in ADHD in more detail. This has resulted in exciting new insights into the etiology of ADHD, e.g. circadian rhythm problems being central in a large group of ADHD patients as evidenced by peculiar geographical differences in ADHD prevalence with low prevalence in regions with strong sunlight intensity such as California, Phoenix, Arizona, Spain and Italy relative to areas with low sunlight intensity (see Arns, van der Heijden, Arnold, & Kenemans, 2013). But in addition, it was also shown that the clinical benefit of SMR neurofeedback is mediated by sleep normalization in ADHD, which in turn drives improved attention in ADHD (Arns, Feddema, & Kenemans, 2014). These results, that emanated from the original work by Sterman, have provided exciting new insights on the role of sleep in the etiology of ADHD, that can even benefit clinicians that do not intend to use neurofeedback, thereby also closing the loop from 50   years ago to now. From that angle, in my view, the field of neurofeedback has had huge indirect impact on the field of psychiatry. I hope that in the next 50   years the treatment will make it as a mainstream treatment and will thus have direct effect, at least for ADHD, and maybe for other applications– if demonstrated by research …

References

Arns M, Feddema I, Kenemans J.L. Differential effects of theta/beta and SMR neurofeedback in ADHD on sleep onset latency.  Frontiers in Human Neuroscience . 2014;8:1019. doi: 10.3389/fnhum.2014.01019.

Arns M, Heinrich H, Strehl U. Evaluation of neurofeedback in ADHD: The long and winding road.  Biological Psychology . 2014;95:108–115. doi: 10.1016/j.biopsycho.2013.11.013.

Arns M, van der Heijden K.B, Arnold L.E, Kenemans J.L. Geographic variation in the prevalence of attention-deficit/hyperactivity disorder: The sunny perspective.  Biological Psychiatry . 2013 doi: 10.1016/j.biopsych.2013.02.010.

Arns M, Sterman M.B.  Neurofeedback: How it all started . Nijmegen, The Netherlands: Brainclinics Insights; 2019.

Coben R, Hammond D.C, Arns M. 19 channel z-score and_ LORETA neurofeedback: Does the_ evidence support the hype?  Applied Psychophysiology and Biofeedback . 2019;44(1):1–8. doi: 10.1007/s10484-018-9420-6.

Van Doren J, Arns M, Heinrich H, Vollebregt M.A, Strehl U, K Loo S. Sustained effects of neurofeedback in ADHD: A systematic review and meta-analysis.  European Child & Adolescent Psychiatry . 2018 doi: 10.1007/s00787-018-1121-4.

Chapter 3

The legacy of Margaret Ayers

Penny S. Montgomery     New Hope For The Brain, A private practice in Lakewood, Colorado

Abstract

Margaret Ayers was a visionary clearly ahead of her time. She was the first to establish a neurofeedback practice in the United States to manage symptoms of traumatic brain injury. She was the first to use inhibition protocols. She was first to teach others to rely on neurophysiology to determine electrode site placement, and she was first to recognize and teach the information found in the morphology of the EEG using raw brainwave patterns.

Keywords

Coma; Inhibition; Morphology; Traumatic brain injury