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Electroencaphalographic Driven Stimulation (EDS)

A survey and overview of the EDS program, its benefits, risks, areas of applicability, observations which make EDS interesting, research plans, hypotheses about how it works, its relationship with EEG biofeedback, commercial sound and light stimulation devices, milestone and signs of progress during EDS treatment, references, a letter to someone close to the head injured, and suggestions for the use of EDS.

Electroencephalographic Driven Stimulation (EDS)

[Note: This paper is included for historical purposes and represents the state of the art as of February of 1994. It is not necessarily representative of theoretical and practical considerations as in 1995.]

EDS Treatment Contents

I. Abstract

II. Electroencephalographic-driven stimulation (EDS) Program

III. Benefits of EDS

IV. Method and Research Plans

V. Electroencephalographic-driven stimulation

VI. EDS: A Summary

VII. EDS: A More Detailed Look

VIII.Signs of Progress

Appendices
A. To the Person Close to Someone Who Has Had a Head Injury

B. Suggestions for EDS Training

ABSTRACT
Electroencephalographic DISENTRAINMENT Feedback (EDS)

What it is:
EDS is a new form of brain wave biofeedback. Like the usual brain wave biofeedback, the person's brain waves are measured and translated into feedback that is seen or heard by the person. EDS is different from brain wave biofeedback in a number of ways, however. They are:

1. The feedback presented to the person is in the form of lights that pulsate at the same frequency, more or less, as the strongest brain wave. These lights are very bright, and rest inside goggles that the person wears over the eyes.
   
   
2. Unlike traditional biofeedback, EDS is a passive process and the person does not have to try to understand the feedback, or learn how to regulate his or her own brain waves. Without the need to take time to learn how to control one's own brain waves, the process of change begins immediately.
   
   
3. Unlike traditional biofeedback, the changes have come much more rapidly and are more significant to patients and their families. Thirty-six patients have been worked with: head injured patients, patients suffering from post-traumatic stress, patients suffering from depression, and from stroke.

• No one was hurt,
• Nine of the ten head-injured patients were back to their pre-injury emotional, energy, and fine-motor coordination states within an average of 6, 20-minute sessions. There were some subtle skill losses which did not clear up within the six sessions, however, the patients recovered their patience, energy, concentration, and ability to do more than one thing at a time.
• The post-traumatic stress patients calmed down so that they no longer had their former fears and did not lapse into temper tantrums.
• Improvements in efficiency, effectiveness, stamina, and fine-motor coordination were noticed in nearly everybody.
• Three stroke victims, five-to-seven years after their strokes, began to move again and to recover sensation after six sessions.

4. All sessions are given on a daily basis. Each session lasts approximately 45 minutes, and involves actual connection to the EDS system for 20 minutes.
   
   
5. The EDS system involves equipment readily available to professionals: a computerized brain wave biofeedback system, a special board that rests inside the computer that generates the flashing lights, and a software disk the joins the system together and gives it the intelligence to obtain the above results.
   
   The EDS system is unusual because all of these patients had given up hope. While there are other treatments for post-traumatic stress, each of these patients had many years of psychotherapy, biofeedback, and even other forms of brain wave biofeedback; and there are no other effective treatments for brain injury and stroke that offer these kinds of results. One patient said that he could not have obtained the results he got in a week anywhere in the world at any price.
   
   While the final determination on how EDS works must rest with a great deal of research, we believe that EDS works to break up the rigid, self-protective way the brain has of responding after social (stress) or physical trauma. There is evidence that during any kind of trauma, mental or physical, the brain protects itself from seizures and overloads by releasing chemicals that protect it from these dangers. Unfortunately, the protection also interferes with normal functioning and makes the person lose abilities. Long after the trauma is over and the danger is past, the protection still remains in place and there are few comfortable or rapid ways of getting the brain to relax: the person becomes stuck in various kinds of disabilities.
   
   The EDS system is usable by mature, very intelligent therapists who are extraordinarily attuned to the needs and skills of their patients. While there is no necessity for the therapist to be licensed, accredited, or degreed, there is a very definite need for the therapist to be well-trained and competent as a therapist, and to work under the supervision of someone who is legally responsible for treatment and who is entitled to bill for service.
   
   

The EDS Program

Comparison With Other Modalities
The use of the combined technologies of photic stimulation (EEG entrainment) and EEG biofeedback with head injury, PTSD, and depression patients has been clinically shown to produce the beginnings of demonstrable improvement in a matter of three or four sessions. More pervasive changes are seen in perhaps another five or six sessions. These marked behavioral changes appear to hold a least ten months, judging from those who terminated treatment that long ago. The potential clinical effectiveness and cost savings of using these two technologies conjointly make further study a necessity at this time. The two modalities are discussed below.

Entrainment

• In the consumer field: Entrainment devices are becoming more popular in the consumer market both as relaxation induction and scholastic and athletic performance enhancement tools. One of the manufacturers in Seattle said that his sales have doubled every year for the past three years. These devices are often offered for sale through the large catalog houses such as Sharper Image and Nieman Marcus. These devices are not considered by the FDA as medical devices as long as their labeling excludes mention of medical uses and claims, and no mention is made that these devices influence EEG activity.
  
  
• In clinical neurology: EEG entrainment, i.e., photic driving is a well-known tool for studying seizure activity and is a routine part of many EEG evaluations, and has been in general practice for many years.
  
  The net effect of the use of entrainment is that it is not a new technology and its effects are well known. Curiously, however, there are literature gaps in both basic sciences research on photic driving, and on clinical applications of photic driving.

EEG feedback
EEG biofeedback was used in the form of dominant frequency feedback in the late 'sixties with a typical goal of enhancing "Alpha" rhythm as a way of managing stress. "Alpha" became synonymous with the human-potential movement and as a cure-all, after which EEG feedback soon lost the respect of any serious clinicians and academicians. When computer-based FFT waveform analysis became more commonplace, a new generation of EEG equipment began to be sold to the clinical biofeedback market, and soon found use in the treatment of addictions and PTSD. The publication of a series of controlled studies with both psychometric and biochemical tests, with up to three years of follow-up started a rash of new interest in EEG feedback as a clinical tool. Further, its application to epilepsy and attention-deficit disorders broadened its clinical applicability. While these applications are still controversial, growing numbers of clinicians have become involved in the clinical use of EEG feedback.

The current work links photic and auditory stimulation and EEG biofeedback, an idea which came about while I resisted a request to develop some specialized entrainment techniques and instead defaulted to a feedback loop system based on many years' experience with EEG biofeedback. The results observed and treatment >protocols developed herein were completely unexpected.

ADVERSE EFFECTS
Adverse Effects: Since the discovery of seizure activity is a goal of the use of photic driving by neurologists, seizure activity cannot truly be considered a side effect of this kind of stimulation. However, seizure activity can be a side effect of being in a shopping mall, as well as a side effect of helicopter noise, television and video game raster, fluorescent light flicker, as well as commercially-available consumer entrainment devices. While there have been no published reports of adverse effects of popular commercial entrainment devices, there is current litigation concerning one alleged case.

The issue here is whether unexpected seizure activity can be a plausible outcome of EEG-driven entrainment devices, a technology which will be described below. When one considers that medical photic stimulation usually persists a particular frequencies for some determinate length of time in the effort to evoke seizures ­p; at least a few seconds ­p; and considering that the length of time that live EEG-driven stimulation persists at any one frequency is rarely more than a half-second, the probability is smaller that EEG-disentrainment devices will cause seizure. This is not to say that the chance of seizure induction is impossible. Such a possibility should be screened for, and acknowledged in any informed consent procedure.

Photohypersensitivity:
Experience using photic driving has evoked photosensitive reactions in approximately 80 per cent of patients referred with post-concussive problems, normal, neurotic, and borderline diagnoses when the treatment was administered properly.

These reactions have almost always been accompanied by observable jumps or other sharp movements, exclamations of discomfort, and alterations in breathing rate and motility. These reactions have almost always been accompanied by visible or audible expressions of discomfort although it is conceivable that a patient could have a reaction and not express it at the time.

Duration of adverse reactions:
All reactions have been observed to be transient, with the nearly none lasting more than thirty-six hours, and better than 90% lasting no longer than 30 minutes.

Types of photosensitive reactions:
The following types photosensitive reactions have been observed:

1. Feelings of Irritability
2. Feelings of Confusion
3. Feelings of anger
4. Feelings of fear
5. Feelings of lightheadedness
6. Headaches
7. Anxiety
8. Muscle control problems post head injury
9. Speech interruption problems post head injury
10. Sleep interruption
11. Episodes of increased hypertension

Photosensitive Characteristics of the light stimulus:

1. Brightly strobing lights may evoke adverse reactions at any frequency, but have been observed to most frequently evoke disruptive reactions at lower frequencies (below 15 Hz), when the duty cycle of the lights is longest, and the lights are their brightest, and secondarily at higher frequencies (above 20 Hz).
   
   
2. Flashing bright lights varying in frequencies have been more disruptive than lights at a constant or near constant frequency if the frequency is not in itself a problem.

Characteristics of patients showing photosensitive reactions
Head injury patients frequently complain that the lights are too intense, or much less frequently that they feel evocations of anger, fear, and rage; these can be very brief reactions lasting less than a minute. These photosensitivity reactions have always been deconditionable 80% of the time within three, 20 minute sessions, and nearly all the time with another 15 sessions.

Borderline patients without head injury tend to react with the above-mentioned hypersensitivity reactions and fearfulness about returning to treatment. Such reactions have always been present, and may be desensitized in perhaps ten-to-fifteen sessions, in contrast to the three which may be needed with the head injured.

Normals who use muscular tension, vasoconstriction, and awareness constriction to manage their emotions may suffer brief but strong reactions and disruptions, and find that their sense of control is interfered with if stimulation is not begun carefully. With continued treatment they later discover that these controls are unnecessary. The sudden loosening of controls can be quite alarming to them and result in strong somatic reactions, but is avoidable when this possibility is assessed in advance, and initial exposure is minimal in time and intensity, perhaps to as short an exposure as 2-to-4 minutes.

Psychotics have not been exposed by me to photic stimulation. Caution needs to be exercised with them by reducing light intensity minimal, for this reason.

Components of the EDS system
Equipment: The current equipment consists of a commercially available J&J computerized single channel bipolar EEG feedback recording system, a Synetic Systems Synergizer PC board, and the two subsystems wedded together by software written specifically for that purpose. The software specifically permits control of the intensity (duty-cycle length) of the light stimuli, their flash frequency, a leading percent, and the sequencing of different exposure configurations, as well as maintaining a patient data base, session statistics, and options for auditory stimulation.

Theory of operation: An ad-hoc theory of operation has evolved based on the following typical observation with a reasonably wide set of non-psychotic patients.

Observations that make EDS interesting:

1. Of ten unselected heterogeneous head injured patients accepted in sequence, 9 were returned to their pre-injury affective status in an average of seven, 20-minute sessions. This means that all the patients were able to sleep through the night, and showed sudden, marked drops in irritability and depression along with increases in their patience and return of sense of humor. Some reported improvement in recent memory and ability to multitask. However in large part, no marked changes were seen in intellectual performance within the six-session average.

2. PTSD patients (without head injury) who had high levels of functioning prior to their trauma; litigation pending; and even workers compensation willing to support them have attained enough clinical relief from their symptoms that they have returned to work in a matter of weeks, or found major relief of symptoms within a week of daily brief (20-40 minutes) sessions.

3. Cases of PTSD, some with rages lasting 20 years, complicated with cocaine and alcohol abuse, have found relief within weeks of weekly sessions, after decades of group and individual counseling, neural feedback retraining, and chemotherapy. The cessation of rage reactions has lasted 9 months post termination of treatment and follow-up continues.

4. These therapeutic procedures themselves have been extremely simple, i.e., entraining, or driving, the dominant frequency upward and downward in a reiterative fashion, desensitizing the patient to frequencies and light brightnesses they dislike when necessary, individualizing the protocol for each individual, and managing abreactions when they rarely occur.

5. It was necessary to discard procedures that worked with less efficacy, such as single-direction leading, and lead the dominant frequency up or down for periods of 10 or 20 minutes at a time. Likewise, it was necessary to individualize many components of the treatment.

6. Some of the head-injured patients (13 %) have encountered severe problems becoming desensitized to the mid or lower frequencies. They have forced the redesign of the pulse width of the strobe's duty cycle short enough to allow desensitization. At times these problems have led to brief abreactive reactions similar to those encountered by Peniston, or brief exacerbation of the symptoms that occurred as a result of their head injury.

7. Patients with tremor from active pathophysiology (Parkinson's, for instance), show decreases in tremor and more of a sense of control. This can also be stated as an observed significant increase in both eye-hand, gross and fine motor coordination, as well as more energy to devote to the task involving motor activity. The results from those with active pathophysiology do not hold as well as those with trauma that has occurred in the past.

8. Symptom remission is often accompanied by both desensitization to the strobe lights (if there has been a problem of hypersensitivity), and more close following of the dominant frequency of the directional pattern of the leading per cent. In other words, if the leading per cent moves upward, the dominant frequency is expected to follow.

9. Two patients who have been five and seven years post stroke, respectively, within 6 days (two, 20-minute sessions per day) began to more freely move previously paralyzed limbs with much less spasticity to the extent that one, for the first time since the stroke, could walk up steps and flex her left knee and pick up objects with her left hand without the usual death grip; or in the other case, roll over in bed at night to snuggle with her husband, and raise a formerly totally paralyzed leg from a supine position and cross it over her better leg; right facial tone also was seen to recover completely. The handwriting of yet a third individual, seven years after a mild stroke, recovered completely to its pre-stoke legibility after two, 30 minute sessions.

10. A patient with a bruise on his lower spine, confined to a wheelchair for the past fifteen years unable to move his legs, was able within the first 20 minutes to show reduced spasticity in his left ankle, and within seven sessions, show articulated lifting of his left (worst) leg, and talked of markedly increased sensation in both feet.

11. Approximately 20% of the non-head injury patients have proven extremely hypersensitive to the lights to brief EDS and have required us to adapt the equipment to reduce the intensity of the lights to less than 1/200 of that tolerated by other patients. Systematic ways of assessing the effects of EDS needs to be undertaken; the effects of longer treatment times will be explored.

12. Significant for its absence was any sign of seizure activity from any of the patients receiving EDS, even from the one patient who did have seizures for a period after her injury.

13. Theta/High-Beta (19-30 Hz) ratios move upward from .13, and downward from above six (even from 47:1), to the neighborhood of 1:1, +/- .3. Memory problems have almost always been accompanied by wide disparities between High-Beta and Theta, in which High-Beta is maximized and Theta is minimized, or the reverse. We may be seeing defects in the emotional tagging of memory, making recall problematic. Such defects may include splitting and dissociation, on one hand, and flooding, on the other.

14. Two of three patients referred as borderline have been ultrasensitive to one or the another aspect of the strobe lights. They desensitize with great difficulty, which suggests that these borderlines patients have a biologically-based irritable brain. If this holds true with further research, it could shed a great deal of light on why borderline patients have such difficult lives, are so difficult to work with, and why they take so long to treat using conventional psychotherapy. The third patient ­p; who showed clear and marked improvements with a week, and desensitized to the light stimulus within three sessions ­p; admitted to having had a series of head injuries when she was in her teens.

BENEFITS OF EDS
For Head Injury Patients:

1. Decreased feelings of irritability
   
2. Decreased feelings of anger
   
3. Decreased feelings of fatigue
4. Decreased feelings of anxiety
5. Decreased feelings of depression
6. Improved sleep
7. More energy
8. Improved concentration and attention, formerly interfered with by affective activity
9. Improved memory, formerly interfered with by affective activity

Tangible, palpable, visible improvements are typically noted within 3 to 6 sessions. Ninety per cent of the patients demonstrate hypersensitivity to the strobing of the lights, and need some at least three to four sessions to desensitize themselves. However once the desensitization process starts, and it does start slowly, the remainder of the desensitization proceeds rapidly.

Adverse effects are heightened occurrences of their symptoms for brief periods during the light desensitization period.
Method and Research Plans

Method: EDS proceeds according to the following general algorithm. The stimulation frequencies have special relationships with the EEG.

As the target frequency of the strobe sweeps downward, patients may show hypersensitivity to the lengthening duty cycle of the strobe light. Desensitization to the strobe is often accomplished by either dimming the lights to an acceptable level and slowly increasing their brightness, or restricting the range of the target frequency sweep, and gradually extending it as tolerance builds to the offending frequencies.

On-going Research
Two studies are in the advanced stages of design to assess safety and efficacy considerations. The two studies are concerned with depression and post-concussive affective and cognitive problems. Steps are also under way to meet FDA guidelines for experimental procedures. Additional studies with post-traumatic stress and chemical addiction are under consideration at this time.

ELECTROENCEPHALOGRAPHIC-DRIVEN STIMULATION
Background
Those who rely on medication to treat psychopathology know the futility of trying to change some behaviors exclusively through words, imagery, and movement. Electroencephalographic-driven stimulation (EDS) is a behavioral tool to influence brain electrical and chemical activity without medication and may reset the brain to its natural homeostasis so that self regulation can be learned much more easily without attempting to fight chemical pathology with words. It is the goal of this paper to describe EDS and a variety of ways it can be used to treat clinical conditions which require specific interventions.

Hypothesis on Mechanism
Since symptomatology improves rapidly when:

1. the symptoms are disrupted by alternations in leading direction (which means influencing the brain to alternately produce slightly faster and slower EEG activity),
   
   
2. desensitization occurs to higher intensity stimulation as well as a broadened frequency spectrum of frequency stimulation, and
   
   
3. there is a history of high functioning prior to trauma.

These observations have led me to view long lasting dysfunctions, ones refractory to behavioral interventions and other rehabilitation techniques, as possible neurochemical impairments, and specifically rigidification of neurochemical response systems.

It may be that social and physical trauma evoke such a flood of neurochemical activity in the brain that the brain secretes more inhibitory neurotransmitters to protect itself against seizure. In doing so, the protective inhibition also leads to loss of function. It may further be that these inhibitory neurotransmitters do not dissipate easily, or that their production mechanism does not reset itself. The disruptive effects of the EDS stimulation prompt their discharge and allow the brain its normal homeostatic functioning.

It has been widely observed that rigidity of response sets accompany most pathology, and leave individual stuck in their pathology. The alternating push-pull of the photic driving may be responsible for inducing more functional flexibility.

EDS: A SUMMARY
EDS is a tool used to produce relatively rapid resolution of difficult emotional reactions, whether the reactions appear to have been induced by physical or social trauma. It appears to be a tool that can and must be used artfully and skillfully. The tool does not do the work alone: the proper use of the tool is necessary.

EDS is a combination of procedures that have been used and researched. The combination of EEG as a guide to the disentrainment stimulus, while not new, has been used infrequently and as a combination is not well researched. The phenomena seen during the use of EDS is indistinguishable in form to that seen doing EEG biofeedback, hypnosis, or even other psychotherapies, except in speed of effect. The pace of the progress using EDS can be much faster than with EEG feedback alone. EDS is particularly useful when a patient is either refractory to psychotherapy or the pace of psychotherapy seems inordinately slow, and has been functioning well prior to trauma.

This is a very powerful tool, and when not used properly can very rapidly cause great discomfort and disorganization of consciousness. It has been necessary to take a history for physical and emotional trauma, and if present, proceed with caution in your treatment. The use of EDS requires a high degree of skill, experience, and sensitivity as a therapist. EDS is not for any therapist without these qualities.

It is hypothesized that EDS rapidly brings electrical and chemical changes to a person's brain, and in doing so:

• breaks a biochemical pattern's location and type, that developed either suddenly during shock, or gradually over a longer period of time, under prolonged stress.
  
  
• allows new information (psychotherapy, counseling, education) to be recognized, taken in, and used much more easily without the interference of a person's own brain-chemistry problem. It is further hypothesized that the rapidity of the changes observed occur so because EDS works so rapidly to evoke changes in a person's brain chemical and electrical activity.
  
  EDS has been successfully used in cases of:
• trauma caused by work and war stress
• depression
• obsessive-compulsive disorder
• alcohol and cocaine addiction

EDS differs from ordinarily-available consumer (or professional) entrainment devices in that its pulsating lights and sounds are controlled by the person's brain wave activity. This customizes the pulsation frequency to the person's own activity, rather than delivering a theoretically- or arbitrarily-selected light and sound signal.

EDS does not require twelve-to-eighteen sessions in which the patient tries to understand the meaning of the feedback signals, and so differs from EEG biofeedback that is now becoming used to treat attention deficit and chemical dependency problems.

Normal individuals will either have no reaction, or even a clearly positive reaction to this procedure, whereas those with emotional problems will find themselves facing their problems in a very gentle, bearable way.

As the patient proceeds through therapy using EDS, he or she rapidly finds that problem reactions become progressively harder to evoke in real life. This means that the problems are less frequently bothersome.

The equipment used consists of:

• a brain wave measurement device,
• a computer fitted with a device that controls the lights and sounds,
• goggles or glasses, and earphones, and
• software to link the brain waves with the lights and sounds.

To use the equipment, the individual is fitted with the EEG electrodes, the goggles, and earphones. The psychologist monitors the computer screen and controls the feedback and the person's mood so that the person experiences the emotional problems but remains comfortable at the same time. At other times the psychologist changes the feedback to strengthen and clarify the person's consciousness so that the problems can be faced more easily outside the session.

EDS is a modality that can be used in many different ways to fit the condition of the patient. This paper will outline these ways as they are known at this time. These procedures and equipment have evoked no serious problems to date. No patient has reported being any more disrupted from EDS than from any other kind of therapeutic procedure, having now treated three dozen patients successfully with EDS.

Corollary EEG biofeedback work has preceded EDS work in the areas of:

• epilepsy treatment,
• treatment of multiple personality disorders,
• attention-deficit disorders with and without hyperactivity, and
• mild, closed head injury.

It remains to be seen whether EDS treatment will find application in these disorders. Only a great deal of future research and controlled studies will support the place of EDS treatment. At the moment it is a treatment that is in a very early stage of development.

This is the Decade of the Brain in modern psychiatry. Modern medicine, with its use of medication, shows the importance of biological change in producing psychological changes. Yet psychiatry also knows that medicine produces effects only briefly. EDS has the potential of showing how changing the brain's internal functioning can leave much longer-lasting effects.

EDS FEEDBACK, A MORE DETAILED LOOK

For many years people have been interested in using EEG biofeedback to explore states of consciousness, to relax, to manage seizures, and to control hyperactivity in children. EEG Disentrainment Feedback (EDS) is a new form of feedback that lets a patient's EEG control intense feedback directly into the central nervous system through the eyes and ears for the purpose of influencing the electrochemical activity of the brain, and thus mood and cognitive integrity (the quality of attention, concentration, and memory).

This paper explores a technology that has been startling to use clinically in the rapidity with which dramatic clinical phenomena are surfaced to become ready for psychotherapeutic processing. It is hypothesized that this technology directly changes the neurochemical activity of the brain in ways that can directly ameliorate some forms of psychopathology.

It is important to note that nothing in this paper is meant to suggest that a mechanical method of changing psychopathology is being offered. Instead, as mentioned later, clinical skill in a therapeutic relationship is felt to be as necessary as the technology and complementary to it. Further, since this particular technology has been used clinically for only 10 months and few have completed a course of treatment with it, what is being written here consists of treatment observations made against a context of experience with traditional EEG feedback, experiences reported in the EEG feedback literature, and a familiarity with other modalities of treatment that bear on what happens to people psychologically as they change physically.

EEG BIOFEEDBACK

Lately EEG biofeedback is finding prominence in the fields of alcohol and cocaine addiction (Peniston & Kulkosky), in the treatment of post-traumatic stress disorder (Peniston & Kulkosky), and in the treatment of attention-deficit disorders (Lubar & Shouse). Unfortunately, the commercially-available equipment that monitored EEG for biofeedback use in the 1960s and 1970s was much less accurate than it is today, and inflexible in its ability to both select bands to respond to and feedback contingencies for providing biofeedback. Further, the oversimplified way in which EEG feedback was used gave its use a bad name, and attached ridicule to its use especially when it was used to promote "alpha" as a cure-all. The EEG feedback and monitoring available to practitioners today is very much more sophisticated in its signal processing and analysis capabilities than was previous equipment.

But while today's improved equipment makes it possible to do a variety of more sophisticated applications and keep better records, important for both research and practice, the treatment duration involved in such courses of treatments is often 30, 60, or more sessions, and is therefore very time- and dollar-consuming, commodities that are increasingly rare in these days of managed care and cutbacks in employer-sponsored medical care.

ABOUT EEG FREQUENCIES AND STATES OF CONSCIOUSNESS
Early work with EEG biofeedback focused on the benefits and working of particular EEG states in contrast to others. Alpha was initially said to be good for relaxation; SMR for epilepsy and attention deficit with hyperactivity; Beta for attention deficit without hyperactivity; and Theta for alcoholism. The majority of researchers and clinicians emphasized what one frequency band could do, rather than paying particular attention to patterns of brain wave activity, how they correlated with treatment outcome, or the implications they had for defining the patient's state of mind. Some early clinical research is suggesting that in addition to the amplitude of a particular frequency or range of frequencies, it is also advisable to notice the per cent of the time that frequency is active, and the relationship among the activities of the different bands. For instance, initial interest in Alpha-Theta EEG training with alcoholics soon became modified when it became clear that a significant proportion of them lost memory, attention, and concentration facility when the lower frequencies were overemphasized in relation to Beta activity. There soon needed to be ways to make Theta evocation contingent on adequate amounts of Beta activity. The idea of ratios sprang up and we now see "high" (5:1 to 2:1) ratios of Theta to Beta power activity signs of loosening of cognitive controls. There is, however, some good rationale for using methods other than simple ratios for looking at relationships among different EEG bands (especially when the band have different widths) which still talk about the effects of relationships among band activity on consciousness. Further, recent information suggests that the more narrowly the band can be defined, down to one Hz, the clearer will be the relationship to consciousness. Much more research is needed to validate, clarify, and extend these concepts.

EEG-DISENTRAINMENT
On the other hand EEG stimulation is found in the popularized entrainment devices which are used from relaxation, to concentration enhancement, and to exploration of beyond-life experiences. The advertising for the use of these devices often promises a competitive edge in academics, sports, and in the business worlds.

Entrainment is done by flashing intense lights in front of a person's eyes, and/or sending intense sound waves into a person's ears. The purpose of entrainment is to passively induce brainwaves with a particular set of frequencies into the person's brain by the use of flashing lights and/or sounds, and therefore induce a particular state of mind. These devices are advertised in many modern executive/high-end catalogs and are available to lay people.

One of the problem with these devices from my point of view is that the entrainment frequency is chosen on an arbitrary or stereotyped basis, and may bear no relation to particular individual's EEG activity or the particular person's ability to entrain. That is, a fixed and arbitrary entrainment frequency ignores the possibility that different individuals brains may entrain at different rates.

Additionally, entrainment is an established procedure for eliciting seizure activity in some medical EEG examinations. In recognition of this, all consumer entrainment device manufacturers warn customers and potential customers of the potential of seizure induction if an individual susceptible to seizures uses an entrainment device that stimulates or evokes seizures ­p; even though seizures may have never manifested themselves. It remains questionable whether such disclaimers will actually protect the manufacturers against damage litigation if a customer has a seizure after commencing the use of an entrainment device, with or without a history of seizures.

ELECTROENCEPHALOGRAPHIC-DRIVEN STIMULATION
EDS is a cross between traditional biofeedback for EEG activity, and visual and/or auditory entrainment of the EEG. In practice, a summary of the EEG frequencies is used as a reference against which the strobe frequency is set.

Sessions usually last 4 minutes initially to evaluate and acclimate the person, however they may go as long as 20 or 30 minutes of connect time.

In an EEG feedback therapy program, between 12 and 16 of the perhaps 30 - to - 40 sessions are typically devoted to finding meaning in the visual and auditory signals. The patient has to discern patterns in the feedback signals as well as in his or her conscious experience that correlate with the feedback. Further, the EEG feedback patient must also become aware of his or her tendencies and efforts to control, manage, block, or otherwise direct inner experience. I am suggesting that the balance of the EEG training program is dedicated to allowing the dropping of the patient's tendency to direct and guard his own flow of experience to permit the patient's neurochemistry to return to some kind of healthy normalcy.

THE ISSUE OF "IS IT LEARNING JUST BECAUSE IT IS NOT A CONSCIOUS, DELIBERATE PROCESS?"
The use of EEG disentrainment has been criticized as inducing passive change in the patient, which has little chance of promoting either a sense of empowerment or long-term change in the patient's psychological status. It is here hypothesized that EEG disentrainment, instead, eliminates a major portion of the time-consuming feedback discrimination process, clarifies the patient's tendencies to control the inner flow of conscious experience, and still permits as long as needed the chance to desensitize, drop defenses, and allow neurochemistry the opportunity to return to its normal homeostasis. Further, the EEG disentrainment supports, but does not force, the patient to experience unfamiliar states of consciousness that enhance the chances of recognizing these states with further treatment. While the person receiving EDS treatment may feel as if they are "not doing anything" or not involved in a conscious learning process, they have nonetheless brought themselves to a setting that is structured to allow the individual's brain to adapt and learn at a neurological level.

The phase of the EEG therapy process devoted to feedback and consciousness pattern discrimination undoubtedly contributes to the acquisition of self-regulatory skills. However, the elimination of the feedback discrimination task in the EDS treatment still seems to allow acute patient awareness of the operation of the his or her defensive structure and process; the acquisition of a state of passive-allowing of experience seems facilitated by the EDS as it increases the patient's awareness of being drawn into different states of consciousness ­p; in a matter similar to the way the patient's own needs can draw him or her in particular states.

EDS still allows the patient the needed time to practice responding to his or her own conscious experience without directing or packaging it, as the strobe frequency changes from 105% or 95% of the dominant frequency to 100%, meaning the therapist has stopped trying to change the patient's EEG, and the flashing lights and pulsating sounds merely reflect the patient's EEG without biasing it in any way. In fact, people not infrequently report being able to control the color of the lights and the pitch of the sounds, even with non-zero leading percents.

HOW EDS APPEARS TO WORK

The Desensitization Paradigm:
EDS interventions appear to be similar to other forms of desensitization which, in this case appears to work with centrally-mediated relaxation ­p; in contrast to the peripherally-mediated relaxation of many other forms of biofeedback. There appear to be two kinds of problems that are amenable to EDS desensitization. The first is a conditioned reaction to an aversive situation. EDS re-creates that reaction without any of the patient's self-initiated cognitive stimulation. Stimulating the reaction with the EDS driving evokes an unintegrated emotional reaction which is noticeably less upsetting than exposure to an integrated internal or external stimulus. The individual usually tends to have only a fraction of the former autonomic, visceral, motoric, and experiential response set and identifies the reaction as "not all that unpleasant."

The second kind of problems appears to be a neurochemical and electrical reaction to the first kind of problem. This can be identified by potentially strong autonomic, visceral, or motoric responses with no experiential content or memories. These tend to be sharp and uncomfortable, and need to be pursued with care.

However once exposed to either of these sets of problems, successive brief re-experiences tend to be progressively less intense, especially when the driving stimulation follow reasonable desensitization paradigms.

The Chaos Paradigm
Some degree of biochemical fluctuation, variability, and randomness is likely to occur and be tied to specific cognitive activity at any brain site. Behavioral pathology has often been looked at as rigidification of response sets. It is quite possible that behavioral, cognitive, and affective problems have attached to them rigidity of neurotransmitter responses at any given site or sites. The approach of using EDS to reiteratively increase and decrease EEG dominant frequency may disrupt biochemical rigidity. This change in biochemical responsiveness may account for the apparent contentless physical, emotional, and even cognitive changes patient undergo, not only using EDS, but other EEG, hypnotic, and most certainly chemotherapeutic interventions. The rapidity of the changes is also suggestive of biochemically-induced change.

Disentrainment refers to the disruption of entrained patterns, patterns which have become in some way locked. "This phenomenon, in which one regular cycle lock into another, is now called entrainment, or mode locking." (Gleick, 1987, p. 293) Disentrainment is more a process which leads to the re-establishment of biological systems flexibilty. As critical as the ability of a system in its ability to withstand shocks is "how well a system can function over a range of frequencies. A locking-in to a single mode can be enslavement, preventing a system from adapting to change....(N)o heartbeat or respiratory rhythm can be locked into the strict periodicities of the simplest physical models, and the same is true of the subtler rhythms of the rest of the body." (Gleick, 1987, p. 293, italics author's) The EDS system is designed to make more flexible a range of neurological and neurochemical systems from the largest to the scale, and consequently improve conditions of patients once thought to be largely hopeless. The success of this system rests on the integrity and ingenuity of the research toward this end.

The above two paradigms are complementary and are not to be thought of as mutually-contradictory and separate.

It may be that the freedom from biochemical rigidity may allow the body's naturally-occurring homeostatic mechanisms to be in force, and further permit success at many self-regulatory strategies. This becomes more significant as we consider how long it takes for some people with some problems to change using psychotherapy and even biofeedback. These may be perfect examples of neurochemical rigidity. It is felt that these early attempts at EEG-driven auditory and photic feedback are quite crude, but represent, nevertheless, the threshold of a new era in which behavioral interventions are directly aimed at neurochemical change ­p; perhaps a more direct behavioral medicine than has been previously conceived. Only good, controlled research will prove the significance of this line of thinking. CLINICAL QUESTIONS ABOUT EDS
There are several important clinical questions that need to be answered about EDS:

1. Can it shorten the length of time for EEG treatment?
2. Is it efficacious with the above mentioned disorders?
3. How robust are the treatment effects in terms of their completeness and longevity?
4. What are the risks, short and long term with its use for both clinical and non-clinical problems (enhancement)?
5. Will its course of maturation (if, indeed, there really is some merit to this procedure) be something like that of ethical drugs-turned-over-the-counter medication?
6. Does EDS in fact influence the electrochemical activity of the brain in a way that is clinically meaningful in therapy?
7. Does EDS affect the dispersion of the EEG activity, and if so, how?

Signs of Progress
The following signs will alert the therapist about functional neurochemical changes in the patient. Patients will take comfort from your observations of these events.

1. After an initial period of days the lights will appear to reduce in intensity and lose their colorfulness. This reduction in light intensity will also be seen in increasing tolerance to photic stimulation in those who are photohypersensitive or photo-ultrasensitive after the intensity of the stimulation has been reduced. It would serve the therapist and patient well to continue to elicit comments about the patient's degree of comfort/discomfort with the intensity of the stimulation. In the absence of such queries the patient often becomes quiet and more comfortable as time progresses.

Desensitization to stimulation appears to accompany the return of function. Whether desensitization to the intensity and/or frequency components of the stimulation is one of the factors that promotes recovery remains to be determined. In any case, it seems of critical importance to understand the neural mechanisms that promote neural desensitization as a reflection of the adaptive mechanisms of the brain, especially in the presence of the sequelae of social or mechanical trauma, or long-term dysfunction of varying degrees and kinds.

2. Two kinds of changes take place in the look of the flashing lights: First, changes that accompany frequency changes, and the second hypothetically with internal changes in the neural activity of the brain.

What the person sees, eyes closed, remember, varies with the frequency of the stimulation. Lower frequencies will be accompanied by larger geometric designs and reticulations, while higher ones will be accompanied by smaller ones, and even the blending of the visual field into subtle patterns or simply a gray or white field. Colors may be more easily seen at the lower frequencies, with the colors perceived changing with continued exposure.

Colored, kaleidoscopic patterns will be perceived that will vary in their meaningfulness, from the most abstract geometric patterns to meaningful precepts (a slowly turning golden globe, for example).

The lights always have a kaleidoscopic quality about how they are perceived as the patient rests eyes closed. As noted above, one of the observable changes over time is the decreasing intensity of the lights, and along with that decrease, changes in the intensity and quality of the color. Note that the actual color of the lights in use at this time is always red, regardless of the color perceived by the patient, and always fixed in the way they are physically embedded in the glasses. Be prepared for some patients to have a hard time accepting that the changes in perception are occurring inside their heads. Also, do not be surprised about comments about comparisons with the psychedelic experiences from the 1960s.

In addition to intensity and color differences, the lights may appear to move in different directions from time to time. They may appear to hang in front of the eyes at one time, then move from left-to-right for a while, and then from right to left. They may then appear to move toward the person, then away. At times patients have mentioned that they are in the lights. Some of these changes may be temporarily uncomfortable for a patient: that is, a few may not like the perceptions of the lights coming at them. It is rather like movie scenes of moving through asteroid fields.

If the therapist will cheer the patient's perceptions, explaining them as having to do with frequency, chemical changes in the brain, or habituation and desensitization to the lights as signs of progress, decreasing brain irritability, the patient will feel more relaxed and confident.
REFERENCES
Gleick, James: Chaos: Making of a New Science. 1987, Penguin Books, New York.
Lubar, J. F. & Shouse, M.N. EEG and Behavioral Changes in a Hyperactive Child Concurrent With Training of the Sensorimotor Rhythm (SMR). A Preliminary Report. Biofeedback and Self-Regulation, 1976, 1, 293-309.
Peniston, E. G. & Kulkosky, P. J. (1989, March/April). Alpha-Theta Brainwave Training and ß-Endorphin Levels in Alcoholics. Alcoholism: Clinical and Experimental Research 13 (2), pp. 271-279.
Peniston, E. G. & Kulkosky, F. (1990). Alcoholic Personality and Alpha-Theta Brainwave Training. Medical Psychotherapy 3, pp. 37-55.
Tansey, M.A. EEG Sensorimotor Rhythm Biofeedback Training; Some Effects on the Neurologic Pressures of Learning Disabilities. International Journal of Psychophysiology, 1984, 1, 163-177.

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Appendices

Len Ochs, Ph.D.
California Psychologist License Number PSY 12119
October 6, 1995

To the person close to someone who has had a head injury:

This information has been prepared for you to bring you some comfort. Someone special to you has had a head injury. This injury causes the person's brain function to change and have the following effects on him or her:

• The person may become more vulnerable and emotionally sensitive (irritable, sad).
• The person may become more distractible.
• The person may become more depressed.
• The person may become more forgetful.
• The person may have increased problems sleeping.
• The person may lose attention and focus.

There may be an unavoidable temptation for you to view the person as irritating, less competent, less dependable, and less fun to be with. Your confidence in the person may drop, and he or she may become increasingly disappointing to you. You may probably not be able to understand why the person doesn't stop acting that way and get back to normal. Finally, you may be tempted to think about psychological reasons for the person's behavior, and find it hard to look at the person as if there is something biological going on. Finally, it may seem to you as if the person may never recover from the problem, and that you won't be able to wait forever.

Fortunately, we are finding at noticeable improvement in most head injured patients within a week's time using a new and experimental treatment. The treatment involves one brief session a day Even more improvement has been observed with another week's time in patients who were well functioning before their head injury. Your feedback on changes -- or lack of changes -- in your favorite person's behavior is very important to us. The treatment consists of changing the rigid ways the brain wave frequencies of the patient's brain have come to respond by alternately speeding and slowing the brain waves, creating the flexibility of response the person once had.

This is done by recording his or her brain waves, and using the frequencies measured to control the speed of lights flashing in front of the eyes of the individual. Often the lights are too bright for the person at the start of therapy; so the first part of the therapy is devoted to desensitizing the individual to the brightness of the lights. The second goal is to be able to speed and slow the brain of the person without creating discomfort. At this point the person is usually ready for discharge, and is showing noticeable signs of improvement. At this stage of development of this technique. the results appear to hold.

Please keep us informed and feel free to call us with questions.

Yours truly,

Len Ochs, Ph.D.

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Suggestions for the use of Electroencephalographic-driven stimulation:

1. Test for short durations in each direction first to assess the patient's reactions.
   
   
2. First start with whatever feels good for the patient. Limit the brightness levels and frequencies of the stimulation to those well tolerated by the patient.
   
   
3. As they continue, increase the stress from the stimulation on them as gently as possible so that they become desensitized to the stimulation. Increases in stress can be brought about by:
   
   a. lowering the lower limit, or raising the upper limit one Hz every few minutes and let the person adapt before another change.
   b. lengthen the session from 4 minutes on upward to 30 or 40 minutes.
   c. increase the discrepancy between their EEG summary frequency and the stimulation frequency.
   
   
4. Keep the person as comfortable as you can. The natural changes in their dominant frequency will often be enough to provide for feedback that is disruptive. Let them adapt and be generous with the time for them to adapt.
   
   
5. Teach comfort. Be comfortable yourself.
   
   
6. Build on strength. This is no place for "no pain, no gain." Even the shadow of distress is ample ­p; and preferable ­p; for desensitization.
   
   
7. If you have tried your best to stir up trouble, lengthened the sessions to 40 minutes, for four days, discharge the patient from this part of the treatment. They are finished except for environmental or other counseling.
   
   
8. See the person daily if you can. The more closely spaced the sessions, the faster the person will move. In other words, you may need 15 sessions of daily sessions, but 30 of weeklies.
   

16.05.2008. 09:34

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