دانلود کتاب Neurofeedback in the Treatment of Developmental Trauma. Calming the Fear-Driven Brain

Foreword by Bessel van der Kolk, MD:

How often is an experienced clinician-researcher confronted with a new paradigm
that profoundly changes his understanding of what he has done all his professional
life? How often does a remarkably novel way of understanding the mind, brain, and
body come along, one that has been around for at least three decades yet remains at
the periphery of clinical practice and neuroscience?
A few years ago I served on a medical panel in which we all were asked to name
the greatest advance we were then involved in. One person mentioned mosquito
netting to combat malaria, another that she had found a gene for anorexia (huh?, I
thought), and I mentioned that we were working on ways to reconfigure electrical
communication patterns in the brain in order to help people feel more fully alive in
the present. The audience stared in disbelief, but I had no chance to elaborate on my
statement. In her book, Sebern Fisher does so eloquently.
One way in which we judge credibility of new treatment techniques is by the way
the bearer of the tidings behaves. If a skittish, intense person pushes me hard into
taking an interest in their amazing new therapy that will solve most of mankind’s ills,
I usually squirm away. However, when a calm, curious, confident, and humorous
individual engages me into looking at familiar things from an intriguing new angle,
my curiosity is piqued.
I had the good fortune of meeting Sebern Fisher at an attachment conference in
Providence, Rhode Island in the fall of 2007. She showed me a series of family
drawings sketched by a very impaired 10-year-old boy who had been treated with
neurofeedback (see Figure 4.1). The first drawing consisted of a stick figure, which a
3-year-old could have produced. Twenty sessions later his family portrait had taken on
complexity, nuance, and character. Another twenty sessions later the drawing looked
like the work of a full-fledged young artist. I was intrigued. I had never encountered a
treatment approach that could shift the perceptual system of a human being so
dramatically in such a short period of time.
My intrigue, combined with Sebern’s thoughtfulness, gentleness, and sharp
analytical skills, prompted me to eagerly accept her invitation to spend a weekend
with her in Northampton, Massachusetts to become more familiar with whatneurofeedback could do, specifically with regard to patients suffering from
developmental trauma. Sebern explained that she could show me all the
electroencephalograms and statistical analyses 1 that had been collected on
neurofeedback, but none would be as eloquent as the patients she had treated, and she
wanted me to meet them.
One snowy afternoon Sebern hooked me up to a small computer in her home
office to display an electroencephalogram (EEG) of my brain waves on the screen in
front of me, an EEG that was more sophisticated than what one million dollars worth
of equipment could produce in the EEG laboratory in which I had worked in medical
school. Nice to see how technological advances had democratized access to brain
wave activity.
Subsequently, I interviewed three of Sebern’s patients, all of whom had suffered
from developmental trauma. One was a woman who had been plagued with
intractable epileptic seizures and confined to her apartment in a housing project,
waiting for her next seizure to occur, hoping that this would not happen at a time
when she was to pick up her baby from daycare. She told me that neurofeedback had
cured her seizures after numerous medications had failed to do so, and had helped her
to become sufficiently focused to attend college and get a degree in journalism.
The next young woman had been chronically isolated and out of touch with her
environment. After neurofeedback training, she came across as vivacious and
inquisitive.
The third patient was most familiar: A young woman who had grown up shuttled
between residential treatment programs, hospitals, and foster care placements and
who, a few years prior to our meeting, had matured out of Child Protective Services,
suffering from dissociative identity disorder and chronic self injurious behavior,
without any identifiable skills. Young people like her tend to be too confused,
frightened, and dysregulated to benefit from most therapy programs, and, lacking
more effective interventions, are often managed on mood stabilizing medications,
which make them less impulsive but also less able to learn and engage deeply in
school, work, or relationships.
A bright woman, she described what it was like to have been plagued by chronic
noises in her head and an inability to focus on schoolwork, therapy, or consistent
relationships because of a disastrous combination of a chronic state of terror and
extreme mental confusion. During our two lengthy interviews she gave me the most
lucid description anybody has ever given me of what it was like to have been a
chronically dissociated, self-destructive, terrified adolescent.
Of the many memorable things she told me, one in particular stands out: “Yes, I
slowly became an attached person. When you are not afraid and confused you can
know people differently.” When I asked her to summarize what neurofeedback haddone for her she said,
It calmed me down. It stopped the dissociation. I can now use my feelings; I’m not running away from
them; I’m not held hostage by them. I can’t turn them off and on, but I can put them away. I may be sad
about the abuse I went through, but I can put it away. I can call a friend and not talk about it if I don’t
want to talk about it, or I can do homework, or clean my apartment. I’m not anxious all the time, and
when I am anxious I can reflect on it. If the anxiety is coming from the past I can find it there, or I can
look at how it relates to my life now. And it’s not just negative emotions, like anger and anxiety—I can
reflect on love and intimacy or sexual attraction. Neurofeedback freed me up to live my life the way I
want to because I’m not always in the thrall of how I was hurt and what it did to me. I’m not in fight or
flight physically all the time.
She appeared completely cured, and three years after our interview she graduated
near the top of her class in nursing school. Sebern’s patients are the sorts of patients
who utilize enormous public health resources, usually with very little to show for it.
They barely function. These are the treatment-resistant people we know so well, and
who have inspired us at the Trauma Center in Boston to explore a whole range of
unconventional treatments. What Sebern’s patients told me was the sort of anecdotal
evidence that we need to inspire us to begin a serious exploration of how—and for
whom—these treatments work. I felt in my element: I love to study promising new
treatments that have not been tested before, like, over the years, Prozac, EMDR,
sensory integration, and yoga for PTSD.
Probably the greatest challenge in mental health is how we can help patients with
severe affect regulation problems, like those I interviewed at Sebern’s office. This
usually results from severe childhood abuse and neglect—otherwise known as
developmental trauma—in which lack of synchronicity in the primary caregiver
relationship leads to abnormal rhythms of brain, mind, and body. These patients are so
chronically hyperaroused or shut down, and unable to filter out irrelevant information,
that they have trouble engaging in whatever they are doing in a focused manner
(except when they are involved in re-enacting their traumas). Our field has struggled
to come up with treatments that can help them to be fully alive in the present, without
being hijacked by fear, confusion, or distraction, and thus far we have been painfully
unsuccessful.
As Sebern says in this book: “Stress never lies with the events that we identify as
stressful—it lies in our reaction to them.” Neurofeedback raises the brain threshold
and generally increases stress resiliency as it increases stability. We are supposed to
learn affect regulation during the first few years of life. However, if the system that
regulates emotional arousal does not become hardwired in the brain early in life there
is little chance that subsequent experience can engage neuroplasticity to such a degree
that it can override the critical periods of development. Research on monkeys and
infants raised with sensory and emotional deprivation in orphanages has shown that it
is virtually impossible for the brain to acquire such capacities outside of these criticalperiods. My meetings with Sebern’s patients held out the promise that neurofeedback
might be able to accomplish what we had thus far failed to do.
Upon my return to Boston we at the Trauma Center arranged to get ourselves
trained in neurofeedback, and to start a regular clinical and research program. We
were interested in brain function and physiology, and, somewhat surprisingly, one of
the strongest groups of supportive colleagues came from Boston University’s
Department of Sports Medicine. One application of neurofeedback’s capacity to
change focus and attention has been in the area of performance enhancement. 2
Neurofeedback training has been shown to improve cognitive flexibility, creativity,
athletic control, and inner awareness. 3 I do not know of any other psychiatric
treatment that can do that.
In Italy, Bruno Demichelis, the head psychologist of MilanLab, a research center
established by soccer club AC Milan, taught his players to maintain a state of
relaxation while watching video recordings of their errors, which led to increased
mental and physiological control. In 2006, several of these players were members of
the Italian team that won the World Cup. The following year, AC Milan won the
European championship.
Chris Kaman of the Los Angeles Clippers, the 7-foot NBA center, is a poster child
for neurofeedback training. In his early years in the NBA he had trouble concentrating
and often lost track of what he was doing. After a series of neurofeedback sessions
under the supervision of psychologist Tim Royer he averaged a career-high 17.9
points, 13.7 rebounds, and three blocks per game, and became a dominant center in
the NBA. Kaman attributes his athletic improvements to neurofeedback. 4
Some of the best work in the area of neurofeedback and performance
enhancement has been done by John Gruzellier in London, who studied the effects of
10 sessions of neurofeedback on a group of music students. A panel of judges from
the Royal College of Music evaluated their performance of a piece of music before
and after neurofeedback training. When compared with five alternative treatment
groups, only the neurofeedback group improved their real-life musical performance
by approximately 10%, a huge difference in such a competitive field.
These studies on performance enhancement fit in well with the effects of
neurofeedback on traumatized individuals: It helps to stabilize and focus attentional
systems in the brain. Neurofeedback truly is a different paradigm from what we are
accustomed to. Communication patterns in the brain are mediated by chemical and
electrical signals. Because of the enormous clinical and commercial potential of
psychiatric medications thus far, only the chemical paradigm has received significant
interest from the scientific community. The electrical patterns in the brain have been
almost entirely ignored. Even brilliant neuroscientists like Antonio Damasio and JaakPanksepp invariably express the hope that the abnormal brain patterns that they find
in their research studies will some day be rectified when somebody discovers the right
chemical intervention. Neurofeedback offers an alternative to drugs and seems to be
able do things that medications up to now have failed to deliver.
When neuroimaging techniques became available they allowed us to observe
metabolic patterns in the brain and localize particular mental activities. However,
localization does not necessarily lead to effective intervention—it just gives us a
better idea of where things take place. In contrast, sophisticated EEGs allow us to
measure shifting communication patterns in real time and can assist us to alter
specific brain wave configurations by finding the right locations and frequencies for
neurofeedback intervention. By providing brains with feedback we can change brain
wave patterns and help people’s minds to become more alert, attentive, focused, and
organized.
As Sebern says about her patients suffering from developmental trauma, and
indeed all those who engage in neurofeedback training,
When we provide feedback to the brain we are, essentially, providing it with a mirror of its own function
and inviting it to make more of some frequencies and less of others, that is, to oscillate differently. In
neurofeedback, we seem to be nudging the brain to set up new oscillatory patterns that enhance both its
natural complexity and its inherent and necessary bias toward self-regulation. In effect, we may be
freeing up innate but stuck oscillatory properties in the brain and allowing new ones to propagate. In
neurofeedback, you see an evolving presence and dimensionality of the person who is training. They
expand their focus, think new thoughts about old problems, and typically their vocabulary grows and
becomes more nuanced. They are able to escape the ruts of their narrative.
It amazes me that this powerful approach has been available as long as it has
without yet finding widespread acceptance. Neurofeedback is applied neuroscience—
it is a new frontier in helping innumerable people who up until now have been
condemned to just make the best of feeling chronically fearful, unfocused and
disengaged. Sebern Fisher, a sensitive clinician and immensely experienced
neurofeedback practitioner, is the right person to teach us how to integrate it into
clinical practice.
—Bessel A. van der Kolk, MD
Medical Director, The Trauma Center at JRI
Professor of Psychiatry, Boston University School of Medicine