Apr 10, 2006, 09:02

Part Two
By: Sebern Fisher, MA, BCIA

In Part One of this series, I discussed the discovery of neurofeedback and the new paradigm of brain function revealed by it. Neurofeedback training reinforces the conditioning of the brain by rewarding it for making certain frequencies and not making others. The rewards provide feedback to the trainee or perhaps more accurately, to the trainee's brain, by telling it that it is accomplishing the requested training task. This training appeals to the brain's electrical circuitry and probably its chemical properties as well, because they are dependent on each other.

Part One also reviewed how different brain frequencies represent different emotional states in the person. If a person's EEG is looked at when they are relaxed, it will exhibit high amplitude (big) Alpha waves, something that would be unlikely to see if the person were under stress. Neurofeedback can teach the brain to make the Alpha waves, which in turn create a feeling of relaxation in the brain's owner.

When a person is feeling high-strung, the brain is creating too many high Beta waves or fast wave activity. In residential populations when we encounter too many slow brain waves, it is highly likely that the person's brain is struggling with a trauma, injury or neglect. In other populations, this slow brain wave activity can indicate dysthymia or ADD without hyperactivity. It may seem counterintuitive to suggest that too much slow brain wave activity can be either over or under arousal. However, when this slow brain wave or Theta activity occurs, particularly in the right hemisphere, it suggests a developmental injury. This type of activity makes it difficult for that part of the brain to function properly, yet it must do so in order to regulate affect. Theta activity in the left hemisphere can make it difficult to properly activate attention, as seen in ADD. Some brains swing wildly between over arousal and under arousal, and this instability in the firing of the brain could manifest as bipolar illness. The message here is that the brain encodes all of these states within its frequency domain. When over aroused, under aroused or unstably aroused, the proper feedback can teach the brain to make different frequencies as needed.

No child who needs or is in residential care will be described as relaxed, and few, if any, will be under aroused. Quite the opposite is true. These children, and without treatment, the adults they become, are invariably highly aroused individuals. For some, this history began while still in the uterus, and the mother describes them as a somersaulting and restless fetus. This baby is colicky, difficult to soothe and sleeps poorly. For others, the difficulty of affect regulation surfaces later, in extended tantrums, oppositional and defiant behavior, lack of empathy and remorse, and for some, no apparent conscience at all. In all of these clinical presentations and the possible diagnoses that come with them, from ADHD to bipolar disorder to reactive attachment disorder, there is a common thread. This child's brain cannot regulate his or her arousal states and they lack the vital capacity for affect regulation. They lack the ability to regulate feelings and behaviors, which is perhaps the best single definition of emotional disturbance.

Affect Regulation:

Children who experience difficulty with affect regulation may have genetic factors that predispose them to bipolar illness, schizophrenia, autism and Aspergers. Anyone suffering from any of these disorders is dealing with hyper-arousal, which may have developed in the fetal brain because of exposure to toxins or other injury in utero. Such exposure will commonly manifest in the child as affect regulation problems.

However, the most common affect regulation problems develop within the relationship between mother and baby. This is often very difficult for many parents to accept if they feel blamed for their child's difficulty. One of the important advantages of looking at emotional disturbance through the lens of neurofeedback is that it is the misfiring brain that drives the problem, not the character of the person. No one can be better than his or her brain. This is as true for the struggling parent as it is for the struggling child. With this insight, we can see that there is no one to blame. This does not mean no one is responsible because everyone must be responsible for his or her actions. However, people are more capable of being responsible when they recognize what drives their behaviors, particularly those that are not helpful to anyone. Once it is evident how the brain's frequencies influence emotional states, it is clear that "badness" is not the motivator behind bad behavior. It is a disruption in the firing of the brain's circuitry, particularly the circuitry in the right hemisphere and pre-frontal lobe area that, to a great extent, determines ones ability to control feelings and actions.

The recent work of psychologists, Allan Schore, Affect Regulation and the Origin of Self; Affect Disregulation and Disorders of the Self, and Affect Regulation and the Repair of Self, and Daniel Siegel, The Developing Mind, and Parenting From the Inside Out, reorients therapists to the importance of the primary attachment between mother and baby and its implications for brain development. They both maintain that the attentive, well-attuned mother builds the baby's capacity for affect regulation. The attuned mother is well regulated so she is capable of both soothing herself and her baby during times of distress. When she does this predictably and reliably, she not only helps her baby to develop psychologically, she actually promotes brain growth in the baby's right hemisphere. This occurs particularly in the right pre-frontal lobe or the right orbito-frontal cortex (ROC), the area right beneath the right side of the forehead.

The right hemisphere is the first to develop and does so, preferentially over the left, for the first 18 months of life. As discussed earlier, this part of the brain is primarily responsible for the regulation of affect. The amygdala of the right hemisphere comes "online" during the fifth month in utero. This part of the "limbic brain" is devoted to the organism's survival through the encoding of fear memory. When the ROC is working correctly, it governs the brain's fear center and quiets fear and rage. When the ROC fails to develop normally, the amygdala dominates the brain's responses, and fear and rage can flood the circuits and direct everything the individual does. Fear and rage arise as the first response to many situations, but for those with adequate ROC development it would not evoke either feeling. The fear-based and aggressive behaviors that may seem inevitable, or even natural, to a person with poor ROC development, will appear uncalled for at best, and at worst, either dangerous or bizarre, to someone with adequate ROC development.

Schore argues that the critical development of the ROC depends on a "good-enough" attachment between mother and baby. This mother regulates her baby's affect by cradling him in her attunement, which she expresses through eye contact, facial expression, holding, vocal tone and the song of normal speech. The mother's capacity to regulate herself builds her baby's brain structure and circuitry, particularly the ROC, and with it, her baby's ability to internalize her. All of these mothering functions depend on the mother's capacity to regulate her own emotional state. With these capacities intact, she is attuned to her baby; she quiets the storms of distress, amplifies the experiences of delight and allows periods of rest, relaxation and quietude. Schore convincingly argues that through these interactions, the mother is developing the baby's right pre-frontal cortex, making it increasingly possible for him to regulate the full spectrum of affect as he grows and matures.

Perfect attunement is of course, impossible. Life gets in the way. However, the mother who is able to regulate herself can and does make the emotional repairs necessary to allow her baby to regain his regulation.

I believe fear and reactivity, the imperative of the amygdala, are the core issues in most psychopathology. It is fair to assume that most children in residential care and all in juvenile detention, lack the ability to regulate their amygdalas because the development of the right hemisphere and specifically the ROC is impaired. A healthy ROC enables the ability of cause and effect thinking. It is very difficult for those without it to learn from experience. They routinely fail to generalize from one situation to the next. Without cause and effect thinking, learning at all levels - emotional, relational and academic - is at best, a challenge. In Part Three of this series, I will illustrate through cases studies, that when these impairments are severe, not even the best psychotherapy, behavior modification program or therapeutic milieu will work. We must appeal directly to the brain beneath the disorder. In my experience to date, the best way to do that is with neurofeedback.

About the Author:
Sebern F. Fisher, MA, practices psychodynamic psychotherapy and neurofeedback in Northampton, MA. She trains professionals nationally and internationally on neurofeedback, neurofeedback and attachment disorder, and the integration of neurofeedback with psychotherapy. Fisher was also the Clinical Director of a Residential Treatment Center for 10 years. She is presently consulting with the Sandhill Center in Los Lunas, NM, on the integration of neurofeedback into their treatment milieu.


Yet another "blame it on the mother" approach. I was very interested in this series of articles up to the point this bias was revealed. How does the author explain cases of siblings, raised by the same mother, with very different results? There are thousands of families in which several children turn out fine and one has ADHD or other disturbances. Also, what about the enormous increase in ADHD and similar diagnoses in the US? Has there suddenly developed a wave of awful mothering and brain injury? Not very helpful.


I agree with Vogt's comment "another blame it on the mother". I believe we all respond to our whole environment and that Dad's have to play a part in this. My second son was equally loved and cared by me although his father played a larger part in his life than my first child just because there were now two children. Our second son showed signs of ADD from the time he could crawl. But more importantly focusing on blame is unproductive. If you have a solution that works, and this does sound promising that is what we need to focus on. I think neurofeedback is facinating and showing itself as a safe and reliable therapy. There are too many dangerous drugs being persribed to our ADHD, ODD.......children. Keep up the good work.


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