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Thoughts About EDS

EEG Site Location, Hypersensitivity: Alternating the Leading Polarity, What's In a Name, Hypersensitivity: Management by Brightness and Stimulation Intensity, Hypersensitivity, Brain Irritability, and Functioning Level, Cortical Permeability, Desensitization and Functioning Level, Pace of Desensitization, Decreases in Low Frequency Amplitudes and Variability, The Need to Lower the Brightness of the Lights after Desensitization, The Meaning of Band-Related EEG, Diagnostic Considerations, Electrode Site Selection, Part 2, The Potential Central Locus of "Peripheral" Problems, The Corrected Technical Inadequacy Uncorrected, Consciousness Optional, Frequency of Treatments, Duration of Treatment and Factors that Determine Treatment Length, Sensitivity, Its Acknowledgment, Management, and Benefits, EDS in the Social/Scientific/Clinical Context, Conclusions to Date

Thoughts about EEG-Driven Stimulation
After Three Years of Its Use:
Ramifications for Concepts of Pathology, Recovery, and Brain Function.

Len Ochs, Ph.D.

Outline

Introduction
Little did I know what I was in for when, more than three years ago, I declined the request of Harold L. Russell, Ph.D. for me to develop a low-cost cassette-tape-driven home trainer device to generate light and sound stimulation to enhance the performance of school children, as he had done in a previous study (Carter & Russell, 199x). This paper will explore what seems especially significant to be had from what I did discover in response to Russell's request. I will present what others and I have observed, comment on these observations, make some suggestions as to questions for research and practice, and point to some of the scientific, therapeutic, and economic issues that arise.
I will be thinking aloud and sharing my reasoning and ways of approaching the use of EEG-driven stimulation (EDS), and my assessments and hypotheses about why I saw what I saw. These judgments are offered for their heuristic value, and without any need on my part to believe I am right on any score. I hope the reader will recognize that I have reversed my thinking on some matters as I continue to explore the use of EDS, and ask the reader not to blindly follow or believe anything I write just because it has been committed to paper. Whatever is here may be shown to be untrue tomorrow. Note that I do not believe that EDS provides a successful method of treating all problems, especially important since people have approached me to treat more medical problems than I knew existed.

The major implication of this chapter is that both the physically and psychologically traumatized brain has demonstrated vastly greater capacity for recovery that has previously been appreciated. Secondarily, EDS appears to help the traumatized human person achieve clearly increased performance in relatively short periods of time. On the other hand, traditional EEG biofeedback may be just as effective as EDS under some conditions. Last, there appears to me to be no basic science to help understand the phenomena described here, which means that there appears now opened a new field for inquiry.

My objections to Russell's invitation were that:

  1. I thought fixed-frequency stimulation might be inefficient way to entrain the EEG because it had only accidental relevance to the momentary peak EEG energy of the particular individual with whom it was being used. People seem to entrain to different degrees and at different rates, the kind and intensity of the stimulation aside. One of the factors that might bear on entrainability might be the distance, at any moment, of the stimulation frequency from the predominant energy of the EEG. With that as a supposition, I suggested to Russell that he, instead, tie the stimulation frequency to some percentage of the momentary dominant, or peak, EEG frequency.

    Further, setting the stimulation frequency to some positive percentage of the dominant EEG could satisfy those EEG biofeedback investigators advocating increasing EEG frequencies for enhanced cognitive control, on one hand, while a negative percentage of the dominant frequency, on the other, could satisfy the EEG investigators advocating decreasing EEG frequencies for enhancing emotional integrity and decreasing chemical dependence, on the other hand.

  2. I had seen similar treatment responses to EEG biofeedback using different protocols, and divergent responses to EEG biofeedback using ostensibly similar protocols. Having seen this, I felt that current treatment protocols needed to be much more extensively developed. I felt that I might be closing off options and precluding results by adopting the current approaches to brain wave training.
With agreement, then, from Russell to sponsor the programming of the software as I originally conceived it, I designed the software and sent it off to the programmer.

The original software was originally designed to link together the J&J I-330 EEG module 201, and the Synetic Systems Synergizer, a light and sound generation device which fit inside an IBM-clone computer. As I originally conceived, the software was to allow the Synergizer card to set the flash frequency of the lights inside some ski goggles, and to continuously reset their speed as the dominant EEG frequency of the person's brain changed on a moment-to-moment basis. The software also set and reset the frequency of auditory tones coming through ear phones, in the same way it set the light frequency.

It is important to note that there were many technical inadequacies of the first generation system. Yet the results from this technically inadequate system appeared unmatched by any other treatment in existence for closed traumatic head injury. Yet our results were not quite as good when the technically much more sophisticated second generation system was introduced, leading us to try to duplicate some of the inadequacies of the original system. We discovered that preconceived technical exactness was not identical to clinical efficacy.

In summary, this software was to take another approach to stimulate the brain toward the ends set by Peniston and Kulkosky, on the one hand, and by Lubar, on the other hand.

The effects of the use of the software have frequently surprised me and continue to do so. The Russell-Carter studies with stimulation evoked interesting improvements in performance, IQ measurements, and behavior (198x, 199x). The effects observed in the use of EDS, however, evoked beneficial and relatively rapid changes which shocked me, stunned and delighted patients and those close to them, and drew the interest of physicians and neuroscientists.

Here, in the order and context in which I observed them, is a description of how I developed some instrumentation, the means of measurement, the means of controlling the stimulation, the problems and benefits I observed in the development of this system, how I managed the problems as they evolved, especially with experience with heterogeneous populations, and some of the ramifications of these observations. It must be said that I have done nearly everything wrong from the point of views of those experienced in recording the EEG, as well as those experienced in providing EEG biofeedback, especially in relation to their concerns about shaping reinforcement contingencies, those using photic (or auditory) stimulation, managing high and low frequency EEG production in relation to under-and over-arousal phenomena, maximizing the amplitudes of some EEG frequencies while inhibiting the amplitudes of other frequencies in relation to particular problems, locating sensor sites for recording, setting the brightness intensity in relation to re-existing stimulation standards and out of consideration for evoking seizures.

There we no clues in the literature for guidance in the preliminary work with EDS, so my rules were first to try it on myself, and to always strive to maintain patient comfort; accepting no deviation from the complete comfort standard if I could help it.

The reader is cautioned that the purpose of this chapter is to enumerate some of the phenomena, issues, and concerns I encountered, and not to provide a decision tree about which settings, options, conditions, and choices are to be made in any particular clinical instance. The elucidation of such a decision tree, while interesting, is beyond the scope of this chapter. While I present some information about settings, conditions, and treatment options, they are too numerous to mention completely in a brief chapter. Further, there is still not enough concrete research-based information about the particular benefits or drawbacks of any particular setting or settings, or even whether such settings are in themselves useful or necessary. There needs to be a component analysis to determine which conditions are necessary and useful.

In summary, as they say on the news broadcasts, don't try this at home without adequate consultation, or without allowing yourselves a few years to slowly explore these phenomena and to train yourselves.

This is, I hope, an introduction to some fascinating phenomena:

EEG Site Location, Part 1
I tried monitoring the EEG at each of the usual historical site alternatives of occipital locations of O1 and O2, the top of the scalp at CZ, or the site of insult or its contra coup, and found no clear differences in either the way the light stimulation was tolerated or the speed of treatment. I also tried the central forehead site FPZ, and because the light tolerance and results were as good here as at the other sites, and because there was less practical difficulty of asking patients to deal with residual 10-20 paste wax in their hair, I stuck with the frontal site at the commencement of treatment. The frontal site has indeed always been more prone to artifact from extraorbital activity, jaw movement, facial expression changes, swallowing, etc., however since the artifact, itself, decreased as a function of treatment progression, I accepted the artifact decrease as one of the global indicators of improvement and persisted on the selection of FPZ as an initial starting site.

There was one other consideration bearing on forehead location. This pertains to the work of Davidson (199x) and his observation that one hemisphere or another is more activated in depression. I tried lateralizing the forehead site to left and right, and found, again, no differences in the reaction of those showing depressive features. This is not to say that lateralizing EDS or even EEG stimulation might not, with a change in protocol, make a difference in the success of the management of depression; however, under the current circumstances, the clinical efficacy and practicality of using FPZ overrode all the other considerations pertaining to the selection and use of the more standard electrode sites.

More will be written about changes in electrode site as the chapter progresses. I believe that the initial site-specific insensitivity of the treatment results are important when it comes to formulating a tentative picture of the traumatized and otherwise dysfunctional brain. Just as the patients are less permeable or impermeable to information, and just as the are stuck in their dysfunctional cognitive, emotional, anxiety, response, movement, and attentional patterns, their dysfunctional brains may be globally locked into rigid neuronal response patterns. This raises the question about the efficacy of choosing any specific site over another at the start of the treatment: one site may be as good as the next when using EDS.

Hypersensitivity: Alternating the Leading Polarity
The first clear reaction I encountered in the use of EDS was hypersensitivity to the stimulation. You will note that the way I first managed the stimulation to counter their reaction led me to procedures and hypothesizing, both of which I now challenge.

I first started working with a couple of individuals with post-traumatic stress symptoms. Neither were treatable with psychotherapy and relaxation training, or with biofeedback (including EEG biofeedback). One of the individuals reacted strongly to the visual and auditory stimulation. She jumped in her seat, and complained of headache and back ache. Other patients later complained about one aspect of the stimulation or another. Some expressed dislike of the "flicker." Others complained about the color, or the brightness. Some could not verbalize the quality they didn't like, but reacted physically, or just said that they didn't like it. Others exclaimed using a variety of verbal and non-verbal startle responses. One individual became explosive, and frightened staff members in other rooms with the volume of his outbursts and cries.

In each of these cases, I responded by changing the direction of the leading, which means if the lights were set to flash at five per cent faster than the dominant frequency, I changed the polarity to let them flash at five per cent more slowly. In nearly all instances of this problem, the reactions of the patients initially subsided. Further polarity changes at the occurrence of these reactions continued to manage and minimize the reactions.

I continued to use polarity of leading as the way to minimize these reactions, although brightness control was available to me, because the software permitted fast and easy changes of polarity, while brightness was controllable with considerably more difficulty and less speed.

Two questions arose: how rapidly to make the polarity changes, and the optimal size of the leading percent. In other words, would I get less aversive reaction if I changes polarity rapidly or slowly? Would I get less upset if I varied the size of the leading percent in any particular way?

In answer to the above questions, there appeared to be little clinical difference which alternatives I chose: the major differences showed in whether or not I chose to alternate polarities, which I began to do with such regularity that I modified the program design to allow me to specify sequences of pre-programmed polarity alternation, which later became added to the patent application.

The successful use of alternating polarity also led me to think of the process as a disruptive, deconstructionist form of therapy, which later became recast in the form of an applied chaos theory model.


What's In a Name?
The change from either speeding or slowing the EEG through unipolar leading, to both speeding and slowing the EEG through bipolar leading (plus and minus leading percents) also influenced what I called the process. I originally called the process EEF, for EEG Entrainment Feedback. Once I changed from unipolar to bipolar leading I kept the EEF name, despite the urging of Jon Cowan, who persisted in his argument that more than entrainment was being done. I was stuck in my own rigidity of the way I looked at the process until I read Chaos: The making of a science, by Glueck (p. 293). He used the word "disentrainment" referring to the unlocking of a system. I then was able to see the system as a disentrainment system, and changed the name of the process from EEF to EDF, EEG Disentrainment Feedback, also satisfying Cowan on this score at the same time.

As I further loosened my grip on the process, the name changed to Neurophotic Stimulation, and finally to EEG-Driven Stimulation, a theoretically unencumbered and more descriptive name.

I want to emphasize that the treatment effects observed were not due to training to increase some components of the EEG band or inhibit others, even though the observable changes in the EEG activity across the 0 - 30 Hz band were identical to that obtained from the traditional EEG biofeedback training to do so. I have observed experienced EEG clinicians and researchers attempt to truncate the EEG band activity at one end or the other, or at a selected frequency, either based on some theoretical basis, or previous experience with traditional EEG feedback. In fact, I, myself, did this when I first started using EDS. I no longer find this necessary, and prefer, instead, to control frequency-specific abreactions with decreases in stimulus intensity (light brightness).

In fact, the entire polarity alternation strategy for controlling leading may be unnecessary. I adopted that strategy before I knew about the importance of managing the stimulation intensity.

I became aware of many patients' sensitivity to the brightness of the photic stimulation while working with some of the patients of neuropsychiatrist-head-injury-specialist Herbert Gross, M.D. in Los Angeles. The patients' brightness sensitivity became apparent to me when I could not reduce the brightness of the lights to permit their comfort. I had been successfully using red LEDs, among the most irritating colors one could employ, and still achieve good results. When the red LEDs annoyed the head injured population I changed to green LEDs, much less irritating than the red ones. These worked well for the group of head injured patients who had been functioning extremely well prior to their head injuries.


· Hypersensitivity: Management by Brightness and Stimulation Intensity

An informal survey of those using light stimulation devices available to consumers showed that they, in contrast to those with symptoms, enjoyed lights at full brightness. So I was still operating under the presumption that the brighter the lights, the better the results. Once I had grasped the idea that the red lights were too bright and had shifted to the more tolerable green ones, I began to slowly desensitize the patients to the brightness of the lights. This desensitization process allowed them to maintain their comfort with lights of increasing brightness. After desensitizing them to the red lights, I was able to again use the glasses with the red LEDs, and eventually with continued desensitization, at full brightness, as well.

While the green LEDs, with their decreased brightness, worked well for those who had performed well prior to their head injuries, they were inadequate to meet the sensitivities of a second group of patients with heterogeneous diagnoses prior to their exposure to EDS, including a the diagnoses of borderline and various anxiety problems.

These patients required green LEDs with tissue paper folded over them, or with masking from manila folder material, and even partial covering from vinyl black electrical tape. Only with such masking could these ultrahypersensitive patients be comfortable, even with the lights at their lowest intensities.

· Hypersensitivity, Brain Irritability, and Functioning Level

As I continued to work with both head injury and non-head injury patients, it soon became apparent that the greater incidence of behavioral and physical pathology seemed to correspond with increasingly prominent hypersensitivity to the stimulation. In other words, patients with depression, energy problems, irritability, explosiveness, violence, distractibility, recent memory problems, difficulty in organization, problems following conversation, and difficulty reading all may have had irritable brains, as evidenced by relatively large amplitude low frequency activity, with relatively high standard deviations. This is an entirely testable hypothesis, and it, to the extent it is true, becomes a rather remarkable statement about human functioning and functional impairment.

· Cortical Permeability

Ordinarily the brightness of the lights is frequently varied during a treatment session. During one session, by accident, a protocol was loaded that held the light brightness constant during the stimulation periods, revealing EEG activity which was initially seen when the patient's complaints were prominent.

A young woman in her thirties, otherwise high functioning, complained of a post-puberty history of premenstrual fatigue, irritability, racing thoughts, and sleeping problems, leaving her with severely restricted professional job functioning fifty per cent of the time each month. She left her job to avoid the continuous extreme effort needed to fulfill her professional duties two weeks of each month. For two cycles after desensitization had been completed, her sleeping problems ceased, as had her racing thoughts, irritability, and diurnal fatigue. During the third cycle premenstrually, however, her fatigue returned and was ever present. Examination of her EEG spectrum recorded under moderately bright light stimulation (25% out of a maximum of 50 % brightness) showed relatively large amounts of high amplitude, low frequency activity when the brightness was held consistently at 25 % across all four stimulation periods.

The session was constructed of a one-minute no-stimulation pre-baseline, four, 18-second stimulation recording periods, repeated 17 times, and a one-minute no-stimulation post-baseline. All recording was done eyes closed. Electrode sites were left ear lobe ground and a CZ the active site.

The high amplitude, low frequency activity was not present when the light brightness was reduced to 10 % during the first and third 18-second recording periods. It may be that the more continuous, brighter stimulation overloaded the cortex enough to penetrate it to be recorded at the scalp. Yet the intermittent stimulation may have permitted the cortex to recover its integrative and impermeable properties to prevent the light-evoked potentials from appearing at the scalp.

The treatment plan is to examine the reliability of the differential effect of continuous brightness, vs. varying brightness, as well as the brightness/consistency threshold, and to see if the cortical permeability will be responsive to gradually increasing the proportion of time spent at higher levels of brightness. If she can show increasingly long stretches of low frequency inhibition under more persistent brighter stimulation, there is greater chance that she will also be free from her hormonally-loaded pre-menstrual fatigue.

· Desensitization and Functioning Level

Another observation, equally testable, was that the level of patient functioning consistently increased as their comfort increased with progressively brighter light stimulation. This means that depression, irritability, impatience, and explosiveness lifted, violence ceased, distractibility, anxiety reactions, organizational problems, problems following conversation, and difficulty reading were all markedly ameliorated ­p; without any claim that they were totally erased. The problems were improved enough that friends, spouses, distant relatives, employers, and last, the patients, themselves, were delighted and surprised at the improvement. Academic grade improvements were noticed as well. These observations were echoed as well by physicians and neuroscientists not involved in this treatment (although no attempt was made to keep them blind to who was involved in the treatment).

The linking of desensitiztion to the stimulation with functional improvements, to the extent that it is experimentally confirmed, is another important assertion.

Note that there has been no chance to treat those with violence attached to obvious character disorders, and no implication is here drawn that EDS has been or is effective with violence in that context.

· Pace of desensitization

There is a characteristic desensitization curve, even though the entire desensitization process can take anywhere from five minutes to five months. Indeed, there need not even be a need for desensitization at the frontal location; it may exist at another site, or in another form rather than as a comfort problem to some characteristic of the light stimulation.

The initial pace of desensitization is always relatively slow, relative to its much higher rate of change at the end of the process. The desensitization curve appears to be a hyperbolic function in which the slope of the rate of change of the light intensity is often imperceptible initially, but its rate of change, is geometric at the end. Put another way, the initial brightness changes may be 1 % at a time, but increase in units to 20 % at a clip in the final minutes of the process.

During a long desensitization process, lasting months, the final 80 % of the brightness changes may occur in one treatment session. This pattern is consistent across all patients whenever the need for desensitization is present.

· Decreases in Low Frequency Amplitudes and Variability

There were and are decreases in signal amplitude and variability accompanying the desensitization process. These decreases appeared across the entire 1 - 30 Hz spectrum, but especially in the low frequency 1 - 12 Hz EEG range, including that activity which was clearly and even probably attributable to artifact.

These amplitude and variability differences may document on a neuronal level organic events which parallel the recovery of energy, mood, and cognitive skills. These organic events may represent the quieting of the brain when not engaged in a directed process. The recovery of skill was apparent in both those who had clear mechanical and physical trauma, and those who suffered lifelong energy, emotional, anxiety, and cognitive functional problems.

This lowering of the EEG's amplitude using EDS stands in contrast to the attempts to increase parts of the EEG in the use of traditional EEG biofeedback. Whether it is the desensitization process, the alternate polarity leading, or some other element of the procedure that automatically effects the amplitude and variability decrease, the important point is that these decreases occur in the EDS process without the careful treatment directing so characteristic of traditional EEG biofeedback. This implies that some element or elements of the EDS treatment trigger a natural homeostatic mechanism of the brain to return essentially normal function.

· The Need to Lower the Brightness of the Lights after Desensitization

One of the patients, early in the exploration of EDS, again suffered workplace abuse trauma and re-experienced symptoms formerly minimized by EDS. She remained free from her former dislike of the brighter lights, however. There was, to me, the implication that she had not relapsed into photosensitivity, and therefore did not need a lowering of the light brightness. Continued treatment with EDS at high levels of brightness, however, did not lead to a decrease in her new trauma symptoms, which showed themselves prominently as depression, anxiety, and anger. High amplitude and variability of low frequency activity again showed itself in her EEG record. And following her EEG, of course, the light stimulation was itself bright, low frequency stimulation.

It occurred to me that the brightness and frequency at this time might be re-stimulating her pathology, adding to the effects of the retraumatization. As a test of this hypothesis I drastically lowered the intensity of the lights and almost immediately saw her depression again begin to decrease.

At the same time I was doing this work, Harold Russell was using the EDS system in Galveston with a few patients who had experienced cerebral vascular accidents. I gave him the information about the value of lowering the brightness of the lights, which he applied to the therapy he was doing. He subsequently found that motoric and cognitive rehabilitation progress was stimulated and accelerated by lowering the brightness of the lights.

Interestingly many users of pre-programmed frequency commercially-available sound and light systems run their systems at full brightness. The colors and patterns are most visually interesting at full brightness. The patients most often will seek full brightness, partly for aesthetic reasons, and partly, upon questioning, because they think that brighter is inherently better, and that all treatments inherently involve the struggle to tolerate discomfort ­p; which they feel they should do if they really want to improve.

However it is apparently not the case that brightness is always better, and not the case that discomfort with bright lights will bring them accelerated recovery. In fact, when comfort is used as a cue for brightness settings, and the light brightness in minimized, improvement across the board in energy, mood, cognitive integrity, etc., is re-instituted.

The sense I make of this is that brain at the end of treatment may be in a very different state than it was at the start of treatment. The large amplitude, low frequency activity acted to block function in those suffering major symptoms and performance decrements. When the patients had been desensitized, however, and the resting eyes-closed amplitude across the spectrum was consistently flat, the patients were now responsive to external stimuli, but not hypersensitive or hyperreactive. Their responses were more flexible, as it were. Is it any wonder, then, why high amplitude strobic stimulation would act as if it was overloading the cortex of these individuals and in a sense duplicating the internally-produce pathology that once was there? Decreasing the stimulation after the desensitization process might be more effective because the brain may be more responsive to the stimulation at this stage.

It may be that the pathology of the brain may require a major change or reorganization at the start of therapy, and to try to work at locally at the site of damage futile because of other problems extant at the start of treatment. Once the brain has been globally reorganized by the desensitization process, and the patient is comfortable at full brightness, to continue with that level of intensity in a more flexibly-functioning brain may be to overwhelm the cortex. In other words, we may be able to experimentally approach duplicating trauma and recovery from trauma in safe ways. After desensitization, by lowering in the intensity of the stimulation, we may be more able to locally stimulate the cortex ­p; something that we were unable to do at the start of treatment. At this stage I do see behavioral changes more closely tied to what is commonly thought of as local cortical neuropsychological functions. In other words, local site stimulation and local site recovery may be addressable only after global stimulation and reorganization has taken place.

· The Meaning of Band-Related EEG

When one uses EDS and looks at the EEG spectrum activity, the meaning of what one sees may be very different from what one examines when watching the EEG from eyes-closed monitoring without stimulation. Traditional EEG feedback treatment often strives to maximize Alpha and Theta for chemical

dependence and PTSD problems (Peniston and Kulkosky, 199x). Traditional EEG feedback treatment also often strives to maximize SMR and/or Beta band activity for underarousal problems (Lubar, 199x; Othmer, 199x).

If the aim in chemical dependency and PTSD treatment is to maximize Theta and Alpha activity, then it is puzzling that those entering treatment with physical and emotional trauma, depression, and fatigue show Alpha, Theta, (and Delta) activity most prominently when their activity is measured eyes closed with stimulation. Much of the early research linked the presence of Alpha with comfort, relaxation, and meditative states. More pointedly, the amplitude of Delta and Theta activity has been observed to rise as patients experience anger, sadness, and hurt; while the amplitude of Alpha activity has been observed to rise when patients have talked about anxiety and fearfulness.

As treatment progresses, the EEG activity across the spectrum decreases and diminishes in variability. If the EEG spectrum were monitored as they sit with their eyes closed and without stimulation, their EEG activity decreases, but not nearly as fast as it does with stimulation. Further, while the EEG activity drops rapidly under stimulation, it drops much faster using stimulation that alternates 180 degrees out of phase in front of the left and right eyes than it does when the lights strobe simultaneously.

Two ideas seem important here. The first is that the eyes closed resting EEG activity diminishes as the number and intensity of symptoms decrease, leading me to question both the meaning of attempting to increase the high frequency activity relative to low frequency activity to increase attention and activation, and the meaning of attempting to increase the low frequency activity in chemical dependency situations. What would happen if traditional EEG feedback were to be used to inhibit the activity across the spectrum, regardless of the problem?

Second, high amplitude Delta and Theta seem to parallel the active influence of a past filled with anger, sadness, hurt, depression, or head injury. High amplitude Alpha activity seems to parallel the presence of anxiety. The meanings of activity in these bands is very different from those usually attached to these bands.

· Diagnostic Considerations: Cortical Permeability Syndromes

EDS has been successfully and reliably used with post-concussive disorders, depressive disorders, post-traumatic stress disorders, attention-deficit disorders with and without hyperactivity, chronic fatigue syndrome, and spastic paresis following cerebral vascular accidents and spinal cord bruising. Post-stroke aphasia has also reliably improved. The size and quality of the improvements have been so significant that they have made differences in the lives of patients both at home and at work. The contributions have been so noteworthy over a wide range of diagnoses that the results seem improbable under most conditions.

If all the above disorders are indicated by high amplitude, low frequency activity, then we may be talking about a number of manifestations of a single disorder, functional cortical permeability or insufficiency, in which the cortex is inadequate to the task of integrating and inhibiting the low frequency activity. All of these problems may reflect a problem of cortical permeability to brain stem/limbic/thalamic activity, permeability which decreases with EDS and results in higher functioning.

· Electrode Site Selection, Part 2

It has been clear that performance can be impaired even though the EEG activity at one site is low and smooth across the spectrum. It is because local site recording and therefore stimulation is possible after the desensitization stage that it becomes worthwhile to move away from the forehead and situate the sensor at sites around the scalp, following the 10-20 international placements, but, again, feeling free to use intermediate placements when pathology and results warrant it. The next stage is to look at each site for evidences of focal high amplitude/variability activity, and stimulating at that site until the EEG activity is low and stable. The activity at each site is assessed and worked with until no high amplitude/ variability activity is observed.

· The Potential Central Locus of "Peripheral" Problems

Most pathology is treated peripherally, even when there are known central nervous system mechanisms involved. To date peripheral treatment has been attempted though exercise, diet, medication, etc., except where frank neuroleptic or neurosurgical intervention has been involved.

EDS provides a behavioral way to directly influence central mechanisms, vs. the indirect means of traditional EEG feedback, whose feedback signals are interpreted cortically. With EDS, the signals picked up from the brain are ultimately fed back to the brain through the eyes, extensions of the brain. The information EDS feeds back to the brain has no graphic or symbolic meaning, as the information from traditional EEG feedback has, so there is nothing to interpret. However, while the information is fed back directly into the brain, it is also undirected, i.e., certain frequencies are not associated with particular functions.

The extent of the promise of this approach can only be imagined.

· The Corrected Technical Inadequacy Uncorrected: Alternating Hempispheric Stimulation


One of the more interesting sides of exploring EDS has been the extent to which preconceptions about accuracy have been unnecessarily attached to efficacy. There were clear inaccuracy problems in first generation software, causing the left and lights to strobe 180 degrees out of phase. I had assumed that they had been flashing in phase synchrony. When the lights flashed at lower frequencies, however, they were observed to flash together only inconsistently. I called the dyssynchronously flashing lights to the attention of the programmer with the intention of emphasizing how remarkable it was to obtain good results with such unplanned sloppiness. When he offered to correct the asynchrony of the lights, the best I could do was to permit him to offer synchrony as an option, holding out the possibility that it was precisely the occasional dyssynchrony that was one of the factors that permitted the remarkable results to occur.

As the second generation software was developed, left-right phase synchrony was the only option at first. However while the desensitization process seemed identical, the results seemed to hold less well until the programmer was persuaded to supply an option for permitting the lights to strobe 180 degrees out of phase.

Additionally, the effect of alternating hemispheric stimulation is to instantly inhibit high voltage activity across the spectrum. The use of alternating stimulation is especially useful after the amplitude of the activity has already substantially lowered. Using alternating stimulation as the first element of treatment prevents treatment from having the carry-over between sessions that it does when it is used later in treatment, when it seems to deepen the treatment effects and strengthen carry-over.

This may be an example, subject to experimental verification, of the power of accidental digressions from pre-planned designs. The potential is clarification of the ramification of left-right phase dyssynchrony for the chaos model of optimal brain functioning, and its converse of entrainment-locked pathology.

· Consciousness Optional

Psychologists and traditional biofeedback therapists tend to hold to the model of therapy as a conscious process. Yet an unknown per cent of patients receive therapy that is primarily conversational for long periods of time with minimal concrete results (even though they may report that they feel better). Non-psychotherapeutic psychiatrists, on the other hand, tend to see medication as the primary component in the recovery and symptom management process, relegating the conscious participation and learning on the part of the patient to a secondary role.

EDS seems to provide a behavioral non-medicinal, non-surgical, yet non-psychotherapeutic, and probably a neurochemical, way to change behavior, thought, and feeling, especially the symptoms of mechanical and psychological post-traumatic influences.

Patients show no conscious learning as a result of EDS. It therefore complements both chemotherapeutic and psychotherapeutic techniques, especially since both conscious human involvement and clear change are desirable, and it seems quite implausible that any single treatment, such as EDS, can address all symptoms.

Conscious self-development is necessary, but can proceed with greater efficiency once the patient's conscious is clearer.

· Frequency of Treatments

Treatments appear most effective when delivered on a daily basis. Further, even twice daily treatments of 20 minutes in duration, separated by at least a 20-minute rest period, appear to accelerate treatment. Treatment effects appear to need a critical mass of treatments to overcome the rigidity of the system that perpetuates the symptom systems and pathology. To dilute the time density of treatments appears to increase the total number of treatments needed, as well as to delay the onset of the successful management of the symptoms.

On the other hand, it is possible to leave the patient spacy, slightly disoriented, fatigued, and even headachy, with sessions that are too long, stimulation too bright, and sessions too frequent. While each patient is different, these factors generally hold.

· Duration of Treatment and Factors that Determine Treatment Length

The degree of sensitivity to the light stimulation, how rapid the rate of desensitization, and the duration of the existence of the symptoms and efforts to compensate for them are the best determiners of the duration of treatment. For example, the average duration of treatment for a formerly high functioning, multitasking patient who had a head injury 2.5 years prior to treatment, is approximately 6 sessions with 20-minutes of stimulation during each session. If the person had lifelong problems prior to the trauma, the treatment time ranges 40 to 70 sessions. If the problem is post-stroke or spinal cord bruising paresis, the course of treatment may number into the hundreds of sessions. Finally, there are those whose desensitization period can span months because of the slow rate of desensitization.

A number of relatively highly functioning individuals have approached me to enhance their performance, to improve their memory, etc. These individuals have been very difficult to work with. First, much of the initial improvement occurs within the domain of greater energy, sleeping, mood, and to the extent that fatigue and mood have interfered, with attention and memory. The more subtle neuropsychological function such as primary short-term memory and sequencing may take five times as long as mood to show discernible improvement. Thus I discourage the more high functioning for looking for incremental and subtle improvements unless they are motivated enough to expend relatively long times and larger amounts of money in their pursuit of improvement.

The linking of photosensitivity with treatment duration and psychological symptom severity is a provocative one.

· Sensitivity, Its Acknowledgment, Management, and Benefits

The phenomenon of sensitivity to stimulation is one of the most intriguing of those encountered using EDS. The observation of the parallel between dysfunction and sensitivity to strobing lights, whether this sensitivity is expressed verbally, motorically, or both, or whether it is visible as increasing delta, theta, or alpha activity without a return to baseline within five minutes, leads me to consider heuristically some treatment approaches, get a glimpse of some brain mechanisms, and generally propose models of brain trauma and its resolution. The apparent plasticity of the dysfunction under the stimulation of EDS, itself, leaves me to doubt that much post-trauma dysfunction is attributable to the trauma, but instead that it is more attributable to the interference from the brain's own protective mechanisms as they interfere with function not damaged by the trauma. Rather than working with trauma induced brain damage, in the case of brain injury, we may be working with protective neurochemical systems which he have previously been unable to influence with any specificity.

However of all that I might say about sensitivity, what to me is most important is that we apparently are far more sensitive than we have ever expected, at least when injured or dysfunctional. The medical establishment, and to a certain extent the psychological establishment, has taken a bully-exercise gain-through-pain approach to rehabilitation, which I, too, almost began to apply to EDS work until I saw that the opposite worked was the only approach that worked. It has turned out that the more sensitivity is favored, and the treatment made as gentle as possible in ways I couldn't not even begin to imagine, the neuronal strength of the patients has been supported, and recovery follows far more often than not. This often means that the stimulation intensity may be kept at barely visible, that during the desensitization period the therapist needs to know how to be content to sit quietly until the patient, in congruent word and deed, gives the ascent to increase the brightness, and that the therapist have a wide range of tools available to accurately assess and cross check the patient's readiness to have the brightens increased. For example, the therapist may need to ask "May I increase the brightness a notch?" or "Have the lights gotten a little duller and stayed that way?", "Could you take this level of brightness for another few hours?", or watch the relative ease or difficulty with which the patient answers these questions, neither too fast, nor too slow.

It has only been when maximum advantage of the patient's sensitivity has been exploited, that maximum speed of treatment is achieved. Otherwise much treatment time is spent recovering from treatment-induced relapses.

· EDS in the Social/Scientific/Clinical Context

These are issues of concern expressed by other professionals:

1. Invasiveness: In contrast to traditional EEG feedback, EDS is considered invasive. Yet invasive in the traditional medical sense means the cutting of a natural boundary, such as using electrostimulation, or surgery. In contrast, EDS makes use of light being shined in the eyes of the patient, the eye being made for photic stimulation within certain intensities (which are well within the range delivered by the EDS system).

2. Other-directed (Therapist-regulation), vs. self-regulation: Two attitudes are interwoven in this controversy. First, there are those who equate self-regulation with conscious, intentional self-regulation. If the regulation that occurs is not conscious and intentional, it is not self-regulation. Yet the spinal cord and lower brain centers are not only responsible for many of our life-support systems, but they also can learn and adapt quite nicely. In other words, we may be just as smart subcortically (and unconsciously) as we are consciously; so it seems wasteful to devalue non-conscious self-regulation and to throw away resources that can be mobilized for learning and life enhancement.

The second controversy is the locus of control issue, or who is in control, therapist or patient? This issue seems to be grounded in the belief that traditional biofeedback places the patient in charge, and that he or she is truly engaged in self-regulation. There is, of course, the implication that when a therapist is using strobing lights that the process is controlled by the therapist.

In fact, the design of the treatment protocol used in traditional biofeedback is under therapist control, i.e., whether to enhance a particular high frequency activity and inhibit low frequency activity. Further, the operation of the threshold, which determines which EEG activity gets which kinds of reinforcement, is under therapist control in traditional EEG biofeedback.

Similarly, the therapist is clearly in control of the structure of the EDS session, but is guided by the patient's subjective sense of what is comfortable and uncomfortable. In contrast, when using EDS the way I advocate, however, the goal of EDS is flexibility of neural functioning, and there is no unilateral influence of the brain to either produce more fast-wave activity, or more slow-wave activity. The patient is trained to do both, which provides greater choice of which may be most effective in any situation.

Hopefully both procedures will maximize the ability of the patient to self-regulate. However I see the premise as naive to hold that traditional EEG biofeedback places the patient is in charge.

3. Harm (Physical and Psychological) Long and Short-term

The Thalidomide tragedy has made everyone aware of the importance of looking at long-term effects of a prospective treatment, and rightly so. It is always worth reviewing the probability that wherever there is change there is disruption. And whether good or bad, there will always be unpleasant as well as beneficial effects, even if the treatment is entirely "natural". So the issue here is not whether there are unpleasant "side effects", but to identify what they are. Once identified, the prospective recipient of the treatment can weigh the benefits against the risks of treatment.

The unpleasant side effects of treatment discovered to date echo the unpleasant effects of any other kind of change process, whether it is hypnosis, psychotherapy, biofeedback, yoga, etc. No patient over the last three years has ever reported a new symptom, one that has never been experienced by that patient. However, any current symptom, physical or psychological, can be temporarily exacerbated.

4. One rumor about is that EDS is so powerful that it eliminates abreactions, and therefore the chance to grow from learning to manage abreactions. Whether the unpleasant effects are called abreactions or side effects, these problems are part of life, including the EDS process. How abreactions are treated seems more a function of therapist orientation and knowledge than a function of the treatment process.

5. Ignorance and lack of literature. There is neither prior literature nor a basic science of using EDS. We know so little about variable-frequency stimulation on EEG activity. However we do now have a reliable set of previous experience with a number of kinds of diagnoses; and ignorance becomes one more risk for people facing a life of major functional impairment. The risks of entering the unknown must be weighed against a life of almost certain continued pain and loss of function. This has been a risk that some patients are willing to take.

6. There is a frequently-expressed concern about EDS producing therapist unemployment because it is too effective. It is true that EDS reduces treatment time, makes for a more rapid turnover, and places new demands on a therapist's marketing skills. However, it also increases a therapist's effectiveness, and makes for a more enjoyable therapy process. Further, it increases the number of patients a therapist can help in shorter lengths of time. Last, there is an endless fountain of human suffering to which we can address our efforts. We won't run out of patients unless we don't keep up with new treatment and marketing technologies.

· Conclusions to Date

1. With stimulation directed by one's own brain, tied to it's own ever-changing energy peak, and somewhat distorted in how it is fed back to the person, mood, energy, cognitive functioning, attention, movement, confidence, sleep, and attention stands a reasonable chance to be improved even long after physical and psychological trauma, and even if the person has been medically declared doomed to disability the rest of one's life.

2. The treatment process that can bring about this rehabilitation requires a relatively low level of technology, and moderately high levels of education on the part of the therapist.

3. The exact importance of each of the elements of the treatment is unknown and needs to be clarified by research. However a phased introduction of some of the elements is important: such as desensitization, local stimulation at relatively low levels of brightness, and alternating stimulation, in sequence.

4. The observations of the safety and efficacy of this treatment need to be certified by independent, controlled research, and can be done so.

5. Rather than being seen as treating a myriad of disparate disorders, EDS seems to treat a cortical permeability syndrome,with symptoms specific to the particular parts of the brian effected.

6. The most important conclusion that I draw is that the performance deficits frequently seen after physical and psychological trauma can be less from any physical or emotional damage, and more from the individual being neurochemically stuck in a maladaptive compensatory neurochemical reaction system, which might be corrected with relative ease. The impact of such a treatment system on medical and psychological rehabilitation may be enormous, and result in significant reduction in human suffering and loss, involving relatively little expense, time, and rehabilitative resources.

16.05.2008. 09:51

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