2. Is brain-behavior behavior? If so, it can be conditioned just like other behaviors If so, it can be conditioned just like other behaviors In 1960s, certain rhythms could be trained In 1960s, certain rhythms could be trained Led to Neurotherapy and Brain-Computer interfaces (BCI) Led to Neurotherapy and Brain-Computer interfaces (BCI)

3. When you become aware of your own brain activity –you can change it also.

4. Electrical stimulation of brains (ESB) Electrical stimulation of brains of rats - James Olds in 1950s; Electrical stimulation of brains of rats - James Olds in 1950s; Jacobsen and Torkildsen replicated work in humans;Jacobsen and Torkildsen replicated work in humans; some epileptics stimulated themselves into convulsionssome epileptics stimulated themselves into convulsions

5. INTRA-CRANIAL SELF- STIMULATION Rodent wireheads Rodent wireheads 0.0005 amps whenever rat pushed lever0.0005 amps whenever rat pushed lever Up to 10,000 bar-presses an hour recordedUp to 10,000 bar-presses an hour recorded Animals self-stimulate > 24 hrs continuously without rest, and cross electrified grid to gain access to leverAnimals self-stimulate > 24 hrs continuously without rest, and cross electrified grid to gain access to lever Reward center: Medial forebrain bundle passing through lateral hypothalamus and ventral tegmentumReward center: Medial forebrain bundle passing through lateral hypothalamus and ventral tegmentum Other brain centers are aversive, such as periaqueductal grey matter (PAG)Other brain centers are aversive, such as periaqueductal grey matter (PAG)periaqueductal Ventral tegmental area (VTA) neurons manufacture dopamine and they are under continuous inhibition by gamma-aminobutyric acid (GABA) system, an important component of the final common pathway" of reward, implicated in addiction, mood, and learning.Ventral tegmental area (VTA) neurons manufacture dopamine and they are under continuous inhibition by gamma-aminobutyric acid (GABA) system, an important component of the final common pathway" of reward, implicated in addiction, mood, and learning.VTA dopamineGABAVTA dopamineGABA

6. Delgado, Primate wireheads, and Circuitry man

7. Electrical stimulation of brains (intracranial stimulation) Pavlov conditioning experiments Pavlov conditioning experiments Tone for food, buzzer for shock –Tone for food, buzzer for shock – Moved them closer together in timeMoved them closer together in time confounded dog fell asleepconfounded dog fell asleep Termed internal inhibition Termed internal inhibition Animal can close down own systems to avoid stress Animal can close down own systems to avoid stress Neal E Miller trained autonomic functions Neal E Miller trained autonomic functions Dogs salivate to get foodDogs salivate to get food Rats control heartrate to get waterRats control heartrate to get water

8. History of Biofeedback JH Bair, 1901, instrument used to teach ear wiggling JH Bair, 1901, instrument used to teach ear wiggling In early 20th century, J.H. Schultz in Germany developed a technique called Autogenic Training. Verbal instructions are used to guide a person to a more relaxed and controlled physiological state. In early 20th century, J.H. Schultz in Germany developed a technique called Autogenic Training. Verbal instructions are used to guide a person to a more relaxed and controlled physiological state. The method flourished, and the results were reported upon by Wolfgang Luthe in 1969 in the United States.The method flourished, and the results were reported upon by Wolfgang Luthe in 1969 in the United States. Increased awareness in Western world of yogic ability to alter physiology volitionally. E.g., a yogi could survive in a sealed box by voluntarily reducing his metabolic rate significantly, surviving hours with a limited supply of oxygen. Increased awareness in Western world of yogic ability to alter physiology volitionally. E.g., a yogi could survive in a sealed box by voluntarily reducing his metabolic rate significantly, surviving hours with a limited supply of oxygen. Peripheral biofeedback techniques include Peripheral biofeedback techniques include GSR, thermal, breathing, cardiacGSR, thermal, breathing, cardiac

9. History of EEG biofeedback 1934, Adrian watched his EEG in front of oscillograph and created alpha at will 1934, Adrian watched his EEG in front of oscillograph and created alpha at will Alpha biofeedback or deep states Alpha biofeedback or deep states Joe Kamiya at Univ of Chicago, 1958+Joe Kamiya at Univ of Chicago, 1958+ Kamiya 1958 Kamiya 1958 1st subject - 60 tones and 60 guesses, half right1st subject - 60 tones and 60 guesses, half right 2nd trial, 65 % correct2nd trial, 65 % correct 3rd 85% correct3rd 85% correct 4th, after a few mistakes, 400 correct in a row4th, after a few mistakes, 400 correct in a row 1968 first congress in Aspen Colorado, called biofeedback 1968 first congress in Aspen Colorado, called biofeedback Alpha training adopted by flower culture of late 1960s, and practitioners oversold its claims Alpha training adopted by flower culture of late 1960s, and practitioners oversold its claims 1978 Science paper

10. History of SMR biofeedback In 1960s Mercury astronauts claimed they saw natives waving at them when the flew over the Pacific.(i.e., they hallucinated) In 1960s Mercury astronauts claimed they saw natives waving at them when the flew over the Pacific.(i.e., they hallucinated) In 1967, Gordon Allies, inventor of amphetamine, was contracted to test toxicity of the Mercury capsule rocket fuel with David Fairchild In 1967, Gordon Allies, inventor of amphetamine, was contracted to test toxicity of the Mercury capsule rocket fuel with David Fairchild However Allies tested another chemical compound on himself and shortly died, before contract over. Fairchild asked Sterman to help finish work. However Allies tested another chemical compound on himself and shortly died, before contract over. Fairchild asked Sterman to help finish work. MB Sterman

11. Sterman was studying EEG- behavioral correlates in cats

12. If EEG behavior is like any other behavior, it could be shaped with operant conditioning Two prominent rhythms in cat EEG – SMR and PRS Two prominent rhythms in cat EEG – SMR and PRS Couldnt train PRS, but could train SMRCouldnt train PRS, but could train SMR More on the PRS laterMore on the PRS later

13. Cat Wireheads: cortical electrodes, not brain stem or hypothalamic Cats often used in electrophysiology because head size the same regardless of breed, unlike dogs Cats often used in electrophysiology because head size the same regardless of breed, unlike dogs

14. 10 cats trained to produce SMR (sensorimotor activity over motor strip) for chicken broth & milk

15. Acquisition resembles normal behavior under O.C. training

16. Classic abundance response at extinction

17. History of SMR biofeedback Then Sterman and Fairchild went on to another study, testing rocket fuel on 50 cats, 10 from Stermans previous SMR training study. Then Sterman and Fairchild went on to another study, testing rocket fuel on 50 cats, 10 from Stermans previous SMR training study. Inject 100 mg/kg or so of fuel into each cat Inject 100 mg/kg or so of fuel into each cat After one hour, all usually go into grand malAfter one hour, all usually go into grand mal but not all - 7 delayed, 3 not at all. but not all - 7 delayed, 3 not at all. seizure thresholds changed in these 10seizure thresholds changed in these 10 Not explainable by placebo (i shall please in Latin) as cats didnt know what to expect, and experimenter blind because effect was entirely unexpectedNot explainable by placebo (i shall please in Latin) as cats didnt know what to expect, and experimenter blind because effect was entirely unexpected

18. Sterman et al (1967) showing usual toxic prodrome and resistance to MMH- induced seizures in a subgroup NASA Rocket fuel Avg 2 hours+ for seizures with EEG trained cats vs. 1 hour for normal cats Time

19. History of SMR biofeedback Replicated findings in monkeys, then moved to humans at colleagues urging. Replicated findings in monkeys, then moved to humans at colleagues urging. Human epileptics Human epileptics First case study published in EEG & Clin NeurophysiologyFirst case study published in EEG & Clin Neurophysiology N=4 study, 65% seizure reduction, in Epilepsia 1976N=4 study, 65% seizure reduction, in Epilepsia 1976 Then n=8, ABA three-year study, Epilepsia 1978Then n=8, ABA three-year study, Epilepsia 1978 Finally, full blown study funded by NIHFinally, full blown study funded by NIH Sham control, n=24, three years Sham control, n=24, three years Double yoked n=8, n=8 NF, n=8 log books Double yoked n=8, n=8 NF, n=8 log books many went seizure free many went seizure free controls after study received NF controls after study received NF Reliable increase in sleep spindle density and decreased awakenings Reliable increase in sleep spindle density and decreased awakenings

20. A major study showed 60% reduction in seizures 12 months after training

21. Turf war with medicine In 1982 Stermans NIH grant for 3 y was funded, but then they demanded double blind after approving the initial design, then they pulled funding saying goals already reached In 1982 Stermans NIH grant for 3 y was funded, but then they demanded double blind after approving the initial design, then they pulled funding saying goals already reached Cost of temporal lobe resection for epilepsy = $200,000 Cost of temporal lobe resection for epilepsy = $200,000 Money lost if patient undergoes neurotherapy successfullyMoney lost if patient undergoes neurotherapy successfully

22. Review of 19 studies with EEG Biofeedback for Epilepsy* Medical Journal, Jan 2000 82% of studies demonstrated significant seizure reduction 82% of studies demonstrated significant seizure reduction Average reduction exceeded 50%. Average reduction exceeded 50%. Studies reported reduction in seizure severity. Studies reported reduction in seizure severity. About 5% had complete control for up to one year About 5% had complete control for up to one year * Sterman, MB (2000). Basic Concepts and Clinical Findings in the Treatment of Seizure Disorders with EEG Operant Conditioning. Clinical EEG, 31(1), 45-55.

24. SMR attenuated (compared to cat subdural recordings) but also present at the scalp in humans

25. Mechanisms of SMR training Enhancing GABA circuitry involved in motor regulation, dampening excitability to sensorimotor excitation Enhancing GABA circuitry involved in motor regulation, dampening excitability to sensorimotor excitation

26. 10-20 International System of Electrode Placement

27. History of Motoric Hyperexcitability 1905: Hyperkinetic syndrome 1905: Hyperkinetic syndrome (George Frederic Still, Lancet) wanton destructiveness and a deficit in moral behaviorwanton destructiveness and a deficit in moral behavior Now known to be due to slowed maturation Now known to be due to slowed maturation only partly related to will power, if at allonly partly related to will power, if at all Lubar (1975) ABA study, n=4 Lubar (1975) ABA study, n=4 Cz theta/beta ratioCz theta/beta ratio

28. Patterns of behavior indicative of ADHD Inattentive Inattentive Easily distractedEasily distracted Fails to pay attention to detailsFails to pay attention to details makes careless mistakes makes careless mistakes rarely follows directions completely or properly rarely follows directions completely or properly Forgets things needed to complete tasks (e.g., pencils)Forgets things needed to complete tasks (e.g., pencils) Hyperactive Hyperactive Unable to sit stillUnable to sit still Leaves seat when sitting expected or instructed Leaves seat when sitting expected or instructed Talks non-stopTalks non-stop Impulsive Impulsive Unable to suppress impulsesUnable to suppress impulses inappropriate comments or shouts out answers early inappropriate comments or shouts out answers early HitsHits Often puts oneself in danger, such as dashes into streetOften puts oneself in danger, such as dashes into street

29. Attention Deficit Hyperactivity Disorder ADHD affects 2 million children in USA ADHD affects 2 million children in USA 5% of all boys5% of all boys 2% of all girls2% of all girls ~ 60% will remain symptomatic as adults ~ 60% will remain symptomatic as adults 1 M children take Rx to control hyperactivity. 1 M children take Rx to control hyperactivity. Genetic component: MZ concordance is 75-91% Genetic component: MZ concordance is 75-91% EEG frontal slowing due to immature frontal lobe in impulsive subtype EEG frontal slowing due to immature frontal lobe in impulsive subtype

30. Ritalin Controversy Controversy Commonly prescribed drug for children Commonly prescribed drug for childrenommonly prescribed drug for childrenommonly prescribed drug for children Worries about long-term effects.Worries about long-term effects. No studies on children who have taken Ritalin > 14 months.No studies on children who have taken Ritalin > 14 months. Very similar to cocaine in composition and effectVery similar to cocaine in composition and effect

31. Monastra study – ADHD and biofeedback vs. stimulant therapy 100 ADHD children, ages 6-19, inattentive or combined types 100 ADHD children, ages 6-19, inattentive or combined types 1-year multimodal outpatient program 1-year multimodal outpatient program included Ritalin, parent counseling, academic supportincluded Ritalin, parent counseling, academic support 51 with EEG biofeedback 51 with EEG biofeedback RESULTS RESULTS Post Tx assessments with and without stimulant therapy.Post Tx assessments with and without stimulant therapy. Ritalin produced significant improvement on TOVA and ADDES Ritalin produced significant improvement on TOVA and ADDES Did not sustain when Ritalin removedDid not sustain when Ritalin removed EEG biofeedback group sustained gains when Ritalin removed. EEG biofeedback group sustained gains when Ritalin removed.

33. First Year of specific Neurofeedback Application 1967 SMR conditioning in general 1967 SMR conditioning in general 1973 Epilepsy 1973 Epilepsy 1975 Peak Performance 1975 Peak Performance 1976 ADHD 1976 ADHD 1977 Addiction 1977 Addiction 1978 Anxiety disorders 1978 Anxiety disorders 1978 Learning disabilities 1978 Learning disabilities 1980 Sleep Disorders 1980 Sleep Disorders 1995 Brain Injury 1995 Brain Injury 1995 Lyme's Disease 1995 Lyme's Disease 1996 CFS 1996 CFS 1997 Mood disorders 1997 Mood disorders

34. Neurotherapy -start Revives Hess CNS model of 1950s Revives Hess CNS model of 1950s overarousedoveraroused underarousedunderaroused Added by Othmers Added by Othmers instabilityinstability Related issue of plasticity Related issue of plasticity Cajal thought adult brain fixedCajal thought adult brain fixed finally countered by Peter Eriksson 1998finally countered by Peter Eriksson 1998

35. Most important figure in behavioral neuroscience (i.e., psychology)

36. Elegant design to counter any intrinsic (non-contextual) reward

37. Earned PRS

38. PRS and learning

39. PRS characteristics Reward-based inhibition of MRF Reward-based inhibition of MRF Mesencephalic Reticular Formation (originally called ARF) – turns off the DC, i.e., volitional aspect of mindMesencephalic Reticular Formation (originally called ARF) – turns off the DC, i.e., volitional aspect of mind PRS does not occur initially PRS does not occur initially animal must be fully habituated to environmentanimal must be fully habituated to environment any novelty or change will disrupt it.any novelty or change will disrupt it. Light must also be on for PRS to emerge, even when light off is a signal of food delivery trials.Light must also be on for PRS to emerge, even when light off is a signal of food delivery trials. 3-5 s burst indistinguishable from sleep onset or SWS 3-5 s burst indistinguishable from sleep onset or SWS Signal transmission in thalamus (LGN) and cortex is suppressed by PRS (similar to SWS) Signal transmission in thalamus (LGN) and cortex is suppressed by PRS (similar to SWS)

41. Unresponsive during PRS, like sleep

42. PRS (6-9 Hz in cats, 8-13 Hz in humans)

43. Alpha burst reflect preparation

44. Impact human learning

45. Field of Neuroregulation Clinical aspects Clinical aspects Thalamocortical dysrhythmiasThalamocortical dysrhythmias Cognition Cognition Time bindingTime binding Information processing, recruitmentInformation processing, recruitment ERD and ERS ERD and ERS

47. Feedback Screen Therapist Monitor EEG Sensors NF Practice Therapist and client/game screen

48. Game provides client feedback Mazes

49. Space Race So how do you do it?

50. Reward The Therapist Screen Raw Inhibit

51. Scoring Charts Provide Periodic Feedback Operant Conditioning

52. A normal looking EEG is small in height Small EEG

53. Reducing excessive (tall) slow brain waves helps the brain function better Examples of excessive slow brainwaves

54. Example of EEG Brain Map Courtesy of Q-Metrx

55. This man has way too much alpha with his eyes open. Hes got problems with obsessive thinking – getting stuck Slow alpha increased with eyes open. Thats not normal.

56. PRE/POST ASSESSMENTS Male, age 9. Drawing before Neurofeedback training

57. Male, age 9. Drawing after 4 months of Neurofeedback training, 5/2/95

58. Childs Family Drawing at Beginning of NF - 8/3/94

59. Drawing after Twenty Sessions - 9/8/94

60. Drawing after forty sessions - 11/25/94

61. Neurofeedback Outcome 2003 Courtesy of Moshe Perl, Ph.D.

62. One year follow-up Courtesy of Moshe Perl, Ph.D.