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Integrating neurofeedback and psychoanalytic psychotherapy: A nonlinear dynamical systems approach to mind and brain
... Participants reported paying attention to how they are showing up in the room with clients and trying to create an environment where they feel safe enough. Leddick (2015) addressed the importance of creating a sense of safety in order to open the possibility for change, "the patient's CNS [central nervous system] must actually assess the present context and itself as safe enough and requiring fewer of said constraints in order for change to occur" (p. 121). ...
... 141-142). Leddick (2015) called the computer a "third" in the relationship and expressed this presence "requires attention and holds therapeutic potential" (p. 132). ...
... 101). Leddick (2015) also wrote about the potential for touch to have nurturing qualities. ...
Introduction. Trauma has been found to have a significant impact on the brain, particularly when it occurs during developmental years. Some studies have found neurofeedback to be effective for treating symptoms of complex/ developmental trauma. There is minimal guidance on integrating neurofeedback into therapy with this population. In this qualitative study, the researcher used interpretative phenomenological analysis to gain an understanding of trauma therapists’ experiences with integrating neurofeedback into their clinical work with complex/developmental trauma and how this impacts the therapeutic relationship. Methods. Sixteen mental health professionals who self-identified as specializing in complex/developmental trauma and used neurofeedback as part of their therapeutic approach participated in this study. Data collection consisted of a demographic survey and semistructured interviews. Results. Analysis revealed five superordinate themes: the process of learning neurofeedback; integrating neurofeedback into trauma therapy; grounded in neuroscience and focused on context; building awareness; and shift in dynamics. Conclusion. The results of this study offer practical suggestions for getting started with neurofeedback and integrating it into trauma therapy. Additionally, special considerations when practicing neurofeedback with complex/developmental trauma were identified, including shifts in the therapeutic relationship that occur with the addition of this modality.
A positive view is taken of integrative analytic and bio-psychological Somatic Experiencing (SE) therapy for trauma. Levit’s case report is viewed as reflecting an early stage of the analyst’s development as an integrative clinician. A risk of integrative treatments is splitting between modalities of analytic functions including affect regulation. The present case is read closely. Commentary focuses on enactment and missed opportunities for analytic reflection, including (transference) meanings of SE interventions. Increased analytic attention to therapeutic process aims to open reflective space to discuss a wide range of experiences in treatment, including disappointments and other (more negative) aspects of transference, deepening the therapeutic experience, and reaching more broadly into sequelae of the patient’s developmental trauma than SE intervention alone. Integrated bio-psychological interventions are compared and contrasted with use of psychotropic medications in analytic therapy. Bio-psychological interventions such as SE have the advantage of adding resources for the analyst’s self-regulation as well.
Unlabelled:
BACKGROUND AND HYPOTHESES: Postcancer cognitive impairment (PCCI) is observed in a substantial number of breast cancer survivors, persisting for as long as 20 years in some subgroups. Although compensatory strategies are frequently suggested, no restorative interventions have yet been identified. This study examined the feasibility of EEG biofeedback ("neurofeedback") and its potential effectiveness in reducing PCCI as well as the fatigue, sleep disturbance, and psychological symptoms that frequently accompany PCCI.
Study design:
This was a 6-month prospective study with a waitlist control period followed by an active intervention. Participants were female breast cancer survivors (n = 23), 6 to 60 months postchemotherapy, with self-reported cognitive impairment.
Methods:
Four self-report outcome measures (Functional Assessment of Cancer Therapy-Cognitive Function [FACT-Cog], Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-Fatigue], Pittsburgh Sleep Quality Index [PSQI], and Brief Symptom Inventory [BSI]-18) were administered 3 times during a 10-week waitlist control period, 3 times during a 10-week (20-session) neurofeedback training regimen, and once at 4 weeks postneurofeedback.
Results:
All 23 participants completed the study, demonstrating the feasibility of EEG biofeedback in this population. Initially, the sample demonstrated significant dysfunction on all measures compared with general population norms. Repeated-measures ANOVAs revealed strongly significant improvements (P < .001) on all 4 cognitive measures (perceived cognitive impairment, comments from others, perceived cognitive abilities, and impact on quality of life [QOL]), the fatigue scale, and the 4 psychological scales (somatization, depression, anxiety and global severity index) as well as on 3 of 8 sleep scales (quality, daytime dysfunction, and global). Two of the other sleep scales (latency and disturbance) were significant at P < .01, and 1 (use of medication) at P < .05; 2 were not significant. Improvements were generally linear across the course of training, and were maintained at the follow-up testing. At the follow-up testing, the sample no longer differed significantly from normative populations on 3 of the 4 FACT-Cog measures (impairment, impact on QOL, and comments), FACIT-Fatigue, PSQI sleep quality and habitual efficiency, or any of the BSI-18 measures of psychological disturbance.
Conclusions:
Data from this limited study suggest that EEG biofeedback has potential for reducing the negative cognitive and emotional sequelae of cancer treatment as well as improving fatigue and sleep patterns.
When psychoanalysis is conceived intersubjectively, full engagement between therapist and patient
creates an emergent, indivisible whole. The coupled therapist/patient system takes on a life of its own
to operate beyond reductive analysis. This paper offers a detailed clinical case in order to illustrate
five key principles from the perspective of nonlinear dynamics: (a) A nonlinear relationship exists
between diagnosis and treatment, when symptoms shift with treatment and diagnosis emerges out of
it; (b) the intersubjective field is a complex web of feedback loops continually operating on multiple
time scales and descriptive levels; (c) the coupled therapist/patient system self-organizes implicitly
toward the edge of chaos; (d) at the fertile edge of chaos, novelty and greater system complexity
emerge spontaneously; and (e) core therapist/patient dynamics are expressed as recursive, fractal
pattern.
Despite important recent progress in understanding disorganized attachment, we still lack a full understanding of the mechanisms of disorganized attachment formation and transmission prior to 12 months. In this paper we lay out our recommendations for the study of the 4-month origins of disorganized attachment. In our subsequent Paper II we report on the results of a large empirical study that was conducted along the lines we recommend in Paper I. Both Papers I and II are based on Beebe et al. (2010)8.
Beebe , B. , Jaffe , J. , Markese , S. , Buck , K. , Chen , H. , Cohen , P. … and Feldstein , S. 2010 . The origins of 12-month attachment: A microanalysis of 4-month mother–infant interaction . Attachment & Human Development , 12 : 1 – 135 . [Taylor & Francis Online], [PubMed], [Web of Science ®]View all references. In Paper I we describe our proposal that a detailed microanalysis of 4-month mother–infant face-to-face communication would further inform our understanding of the process of disorganized attachment formation between mother and infant. Such a microanalysis would allow us to characterize the nature of the 4-month infant's procedural representations, or emerging “internal working models” of attachment.
Nonlinear dynamic systems theories offer useful approaches for understanding psychoanalyses: One of the most distinctive and appealing features of psychoanalytic thinking is its focus on mental processes that defy categorization and linear explanation. Analytic therapists tolerate uncertainty, find meaning in apparently disordered communication, and embrace the unexpected twists and turns that emerge from intimate attention to the ordinary complexities of everyday life. These are hallmarks of a psychoanalytic sensibility that spans various theoretical persuasions. Non-linear dynamic systems theory embodies the same sensibilities: It emphasizes such descriptors as pattern, complexity, flux and flow, the interplay of ambiguity and order, stability and instability, and the natural value of uncertainty and generative chaos. Although systems theory may appear esoteric and overly intricate, it can be approached in an intuitive, experience-near way so as to offer a language and an imagery that underlie everyday clinical thinking. Its metaphors and aesthetics can help analysts become more precise, spacious, and immediate about basic assumptions that tend to be taken for granted. In addition to tracing this conceptual path, this paper provides a brief account of the history of nonlinear thinking in psychoanalytic theorizing and offers clinical examples.
Neurofeedback (NFB) involves a brain–computer interface that allows users to learn to voluntarily control their cortical oscillations, reflected in the electroencephalogram (EEG). Although NFB is being pioneered as a noninvasive tool for treating brain disorders, there is insufficient evidence on the mechanism of its impact on brain function. Furthermore, the dominant rhythm of the human brain is the alpha oscillation (8–12 Hz), yet its behavioral significance remains multifaceted and largely correlative. In this study with 34 healthy participants, we examined whether during the performance of an attentional task, the functional connectivity of distinct fMRI networks would be plastically altered after a 30-min session of voluntary reduction of alpha rhythm (n = 17) versus a sham-feedback condition (n = 17). We reveal that compared to sham-feedback, NFB induced an increase of connectivity within regions of the salience network involved in intrinsic alertness (dorsal anterior cingulate), which was detectable 30 min after termination of training. The increase in salience network (default-mode network) connectivity was negatively (positively) correlated with changes in ‘on task’ mind-wandering as well as resting state alpha rhythm. Crucially, we observed a causal dependence between alpha rhythm synchronization during NFB and its subsequent change at resting state, not exhibited by the SHAM group. Our findings provide neurobehavioral evidence for the brain's exquisite functional plasticity, and for a temporally direct impact of NFB on a key cognitive control network, suggesting a promising basis for its use to treat cognitive disorders under physiological conditions.
This review paper deals with methodological and technical foundations of the Operational Architectonics framework of brain and mind functioning. This theory provides a framework for mapping and understanding important aspects of the brain mechanisms that constitute perception, cognition, and eventually consciousness. The methods utilized within Operational Architectonics framework allow analyzing with an incredible detail the operational behavior of local neuronal assemblies and their joint activity in the form of unified and metastable operational modules, which constitute the whole hierarchy of brain operations, operations of cognition and phenomenal consciousness.
Self-organized criticality is an attractive model for human brain dynamics, but there has been little direct evidence for its existence in large-scale systems measured by neuroimaging. In general, critical systems are associated with fractal or power law scaling, long-range correlations in space and time, and rapid reconfiguration in response to external inputs. Here, we consider two measures of phase synchronization: the phase-lock interval, or duration of coupling between a pair of (neurophysiological) processes, and the lability of global synchronization of a (brain functional) network. Using computational simulations of two mechanistically distinct systems displaying complex dynamics, the Ising model and the Kuramoto model, we show that both synchronization metrics have power law probability distributions specifically when these systems are in a critical state. We then demonstrate power law scaling of both pairwise and global synchronization metrics in functional MRI and magnetoencephalographic data recorded from normal volunteers under resting conditions. These results strongly suggest that human brain functional systems exist in an endogenous state of dynamical criticality, characterized by a greater than random probability of both prolonged periods of phase-locking and occurrence of large rapid changes in the state of global synchronization, analogous to the neuronal "avalanches" previously described in cellular systems. Moreover, evidence for critical dynamics was identified consistently in neurophysiological systems operating at frequency intervals ranging from 0.05-0.11 to 62.5-125 Hz, confirming that criticality is a property of human brain functional network organization at all frequency intervals in the brain's physiological bandwidth.
Dissociative attunement is a profound rhythmic encounter in therapeutic treatment. Attunement is a synchronized awareness of implicit knowing that is nonlinear and bidirectional. Empathically attuned clinicians are like microtonal tuning forks. They resonate with a variety of emotional pitches and will resonate with nuanced shifting of emotional tone. This resonance is the basis of dissociative attunement. Concepts such as empathic attunement, affect attunement, "the unthought known," "implicit relational knowing," and "a two-person unconscious" help us to understand unique aspects of projective identification, transference, and countertransference within the dissociative frame. However, "dissociative" attunements are systemically self-emergent moments in which multiple self-states are shared by means other than projection. Using clinical vignettes, I demonstrate how dissociative attunement can paradoxically appear to be misattunement. By synthesizing scientific and theoretical concepts applied to these clinical moments, we can understand dissociative attunement as a therapeutic tool as well as a pathway to vicarious traumatization.
A robust body of neurophysiologic research is reviewed on functional brain abnormalities associated with depression, anxiety, and obsessive-compulsive disorder. A review of more recent research finds that pharmacologic treatment may not be as effective as previously believed. A more recent neuroscience technology, electroencephalographic (EEG) biofeedback (neurofeedback), seems to hold promise as a methodology for retraining abnormal brain wave patterns. It has been associated with minimal side effects and is less invasive than other methods for addressing biologic brain disorders. Literature is reviewed on the use of neurofeedback with anxiety disorders, including posttraumatic stress disorder and obsessive-compulsive disorder, and with depression. Case examples are provided.
I argue that because psychoanalysis and psychotherapy are emergent processes and the expression of values, a hermeneutic perspective is necessary to study them. I present some basic aspects of one significant perspective of this kind, that of Hans-Georg Gadamer. We have no choice but to recognize that objectivism is the dominant mode of thought in our culture and the means by which the public is liable to judge our claims for psychoanalysis and psychotherapy. Nevertheless, it is crucial for us not to privilege quantitative empirical research in the study, and especially in the formulation, of these activities.
According to behavioural theories deriving from pragmatism, gestalt psychology, existentialism, and ecopsychology, knowledge about the world is gained by intentional action followed by learning. In terms of the neurodynamics described here, if the intending of an act comes to awareness through reafference, it is perceived as a cause. If the consequences of an act come to awareness through proprioception and exteroception, they are perceived as an effect. A sequence of such states of awareness comprises consciousness, which can grow in complexity to include self-awareness. Intentional acts do not require awareness, whereas voluntary acts require self-awareness. Awareness of the action/perception cycle provides the cognitive metaphor of linear causality as an agency. Humans apply this metaphor to objects and events in the world to predict and control them, and to assign social responsibility. Thus, linear causality is the bedrock of technology and social contracts.Complex material systems with distributed non-linear feedback, such as brains and their neural and behavioural activities, cannot be explained by linear causality. They can be said to operate by circular causality without agency. The nature of self-control is described by breaking the circle into a forward limb, the intentional self, and a feedback limb, awareness of the self and its actions. The two limbs are realized through hierarchically stratified kinds of neural activity. Intentional acts are produced by the self-organized microscopic neural activity of cortical and subcortical components in the brain. Awareness supervenes as a macroscopic ordering state, that defers action until the self-organizing microscopic process has reached closure in reflective prediction. Agency, which is removed from the causal hierarchy by the appeal to circularity, re-appears as a metaphor by which events in the world are anthropomorphized, making them appear subject to human control.
In this brief survey, I discuss some examples of the fascinating phenomenon of universality in complex systems, in which universal macroscopic laws of nature emerge from a variety of different microscopic dynamics. This phenomenon is widely observed empirically, but the rigorous mathematical foundation for universality is not yet satisfactory in all cases.
Infant development research has proposed links between early development and adult personality and psychopathology. Although clinicians have long taken these for granted, these research approaches raise a number of methodological and clinical issues worth exploring. Analysts have relied on varied formulations of “psychic structure,” but these are sometimes elusive and have not lent themselves to the precision, specificity, and validation that some analysts and many developmentalists prefer. New models have emerged over the last decades, including conceptions of internal working models of attachment, implicit relational knowing, and the like. Attachment research has shown strong correlations between infant attachment classification and adult personality. Recent research such as that of Beebe, Jaffe, and their colleagues has extended the correlations between early mother–infant interaction patterns and adulthood. All of this supports clinicians' interest in attention to the details of analyst–patient interaction, emotion regulation, inersubjective meaning-making, and other markers that can be observed in both infancy and adult analysis.
Certain tasks, including many that involve an interaction with another person, require individual mastery of some technical skill and require that this skill be incorporated within relational spontaneity—a fact that has provided psychoanalytic support for the classical concept of technique because it is well understood that technique alone is not enough and that the human relationship matters equally. I offer an Interpersonal/Relational viewpoint that in the psychoanalytic relationship, the skill that an analyst must bring to it is not acquired through learned technique, nor is it applied. The process of self growth in psychoanalysis is inherently relational and not brought about through the relationship between patient and analyst; rather, it embodies the relationship and takes place within it. I describe a treatment context in which the analyst's professional role is subsumed within a shared personal field, and that what is meant by “a royal road to the unconscious” is the joint creation of a relational unconscious that is mediated by state-sharing—a process in which analyst and patient gradually are able to invite increased permeability between their respective self-state boundaries. I submit that to continue labeling what we do as technique slows the natural evolution of psychoanalysis, both clinically and as a body of theory.
Recent findings regarding the neurobiological and developmental substrates of complex trauma and complex traumatic stress disorders are introduced in Chapter 2. Developmentally adverse interpersonal traumas in early childhood (or developmental trauma) include sexual, physical, and emotional abuse, abandonment by caregiver(s), chronic and severe neglect, domestic violence, or death or gruesome injuries as a result of community violence, terrorism, or war. Psychological traumas are developmentally adverse if they block or interrupt the normal progression of psychological development in periods when a child (usually in infancy and early childhood) is acquiring the fundamental psychological and biological foundations necessary for all subsequent development: (1) attention and learning; (2) working (short-term), declarative (verbal), and narrative (autobiographical) memory; (3) emotion regulation; (4) personality formation and integration; and (5) relationships (attachment). This chapter provides an overview for the clinician and clinical researcher of the current knowledge base concerning the biological and psychological underpinnings of healthy child development and the potentially adverse impact of traumatic stressors and stress reactions. Self-regulation serves as the organizing framework for this overview and discussion of the implications for the assessment and treatment of complex traumatic stress disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Previous studies of a 12-14 c/sec slow wave rhythm localized to sensorimotor cortex in the cat indicated its functional relationship to thalamo-cortical inhibitory discharge, suppression of phasic motor behavior and suppression of drug-induced convulsions. Investigations in man showed the presence of a similar rhythm in rolandic cortex. Biofeedback techniques for the operant conditioning of this rhythm developed in studies of the cat provided a basis for similar EEG feedback training in man. The functional characteristics mentioned above suggested that this training could be of some benefit in the treatment of epilepsy. This communication reports preliminary findings from such a study in a 23-year-old female subject with moderately controlled major motor seizures of frontoparietal origin. Biofeedback training of this sensorimotor rhythm resulted in a striking enhancement of the rhythm's occurrence, differentiation from simultaneously recorded alpha rhythm activity, and a marked suppression of seizures. Changes in sleep patterns and personality were noted also.
To explain spontaneous EEG through measurements of spatiotemporal patterns of phase among beta-gamma oscillations.
High-density 8 x 8 intracranial arrays were fixed over sensory cortices of rabbits. EEGs were spatially low pass filtered, temporally bandpass filtered and segmented in overlapping windows stepped at 2 ms. Phase was measured with the cosine as the temporal basis function, using both Fourier and Hilbert transforms to compensate for their respective limitations. Spatial patterns in 2D phase surfaces were measured with the geometric form of the cone as the spatial basis function.
Two fundamental state variables were measured at each digitizing step in the 64 EEGs: the rate of change in phase with time (frequency) and the rate of change in phase with distance (gradient). The parameters of location, diameter, duration, and phase velocity of the cone of phase were derived from these two state variables. Parameter distributions including recurrence intervals extending into the low theta range were fractal; the mean values varied with window duration and interelectrode distance.
The formation of spatial amplitude patterns began with state transitions that were documented by phase discontinuities and phase cones. The multiplicity of overlapping cones indicated that sensory neocortices maintained a scale-free state of self-organized criticality (SOC) in each hemisphere as the basis for its rapid integration of sensory input with prior learning stored in cortical synaptic webs. Further evidence came from the fractal properties of the phase parameters and the self-similarity of phase patterns in the ms/mm to m/s ranges.
These EEG data suggest that neocortical dynamics is analogous to the dynamics of self-stabilizing systems, such as a sand pile that maintains its critical angle by avalanches, and a pan of boiling water that maintains its critical temperature by bubbles that release heat. Beta-gamma oscillations stem from the ability of neocortex to maintain its stability under continuous sensory bombardment. Modeling implies that the critical parameter of neocortex (analogous to angle of repose or temperature) is the mean firing rates of neurons that are homeostatically regulated by refractory periods everywhere at all times in cortex. The advantage of SOC in perception may be the ability it gives neocortex to generate instantaneous global state transitions (avalanches, bubbles) large enough to include the multiple sensory areas that are necessary to form gestalts (multisensory percepts).