By Richard Soutar, Ph.D.
The concern about possibly overtraining a client began to circulate in the late 1990s when qEEG became more broadly available. At the time most people in the field were learning about training dynamics, how long to train a client in a session, what types of protocols worked best at what locations for different disorders and the role of symptom observation during and after the training process.
At that time Susan Othmer was a premier innovator who was pioneering the use of protocols and who developed a wide following in the field. Her techniques were broadly based on Sterman’s research as well as her astute clinical observations in applying those in the clinical setting. Much of Sterman’s research focused on arousal theory as he was a sleep researcher dealing with the mysteries of the thalamus and its role in arousal and sleep.
Sue noted that she could have a major effect on the baseline level of arousal in the nervous system by differentially training on the left or right side of the brain. At the time she was limited to single channel amplifiers and so trained different frequencies sequentially in each hemisphere to finely tune the arousal level of her clients. She might train beta at C3 in the left hemisphere for 10 minutes to increase arousal and then train SMR up in the right hemisphere for 5 minutes to finely tune the effect by reducing the arousal a little based on the client’s self-report. In each protocol she typically trained theta down as well as high beta down. In a sense she was tuning the gating system of arousal via the thalamus. It was quite an effective technique. Eventually she went on to train the DC component of the brain to achieve the same effect more directly.
In developing her method, she gauged the effect of her training in real time by assessing changes in her client in terms of their symptoms and fine shifts in their clinical presentation. In discussing her technique with her students, she spoke in terms of adjusting the subtle effects of overtraining or under training in the session as well as between sessions. Other clinicians attending her workshop or hearing about her technique began to generalize her perspective and describe their own client’s response in terms of overarousal and underarousal, even if they were not using her methods. It was a useful concept at the time and grounded in solid theory.
Probably at the peak of her influence in this area, brain mapping became more affordable and accessible. Those clinicians who used maps began to observe different training effects and dynamics with respect to the brain that could not be seen in a typical training screen or in terms of symptoms. You could not measure phase, coherence and symmetry with a single channel approach. In addition you did not have the luxury of seeing the effect at all locations of the brain as a result of your training. Granted it was not in real time, but it was a powerful new tool for overall assessment in depth in terms of neocortical dynamics and pioneers like Joel Luber were all over it.
There were disturbing paradoxes to this new tool however. There was so much information that it was difficult to analyze and make clinical decisions. At the time, most clinicians did not know what all the pages of complex statistical bivariate analyses meant. Clinicians were not trained in neurophysics, signal processing and advanced statistical analysis. It was fine for those with research degrees but even for them there was yet little know how the brain functioned and what correlated with all these newly available measures.
One thing they did know was the normative range of EEG activity in a healthy human being and they could tell from the map how deviant the activity was in any given individual. The conundrum was where to train to move their clients back into a normative range because it was expected that if they could do that then the clients symptoms would abate. But that in fact is not what always happened. Clients did not immediately improve on symptoms or they got worse. Frequently the clinician would remap out of concern and note that areas they down trained that were two standard deviations too high in amplitude were suddenly one standard deviation too low. Other areas they did not train at all and that were in normal range suddenly went too low in amplitude as well. Someone with high amplitude delta would suddenly have delta amplitude too low and their beta went from normal to one standard deviation too low. They would assume they had over trained the person and overshot their mark as if the brain was a passive linear process. Most busy clinicians were not reading deep into the research about the emerging findings of the time, or they might have interpreted this paradox differently.
As it turns out, the brain is not linear in growth or process. It engages in a nonlinear dynamical process. It is also a living reactive system that pushes back. Drugs give the illusion of linearity in their effect because they force the brain to change its process, especially if you ignore some critical factors such as side effects. Drugs produce side effects and the more we force the brain the more side effects it produces. Neurofeedback does not force the brain but rather invites it to change through learning. In that process the brain reorganizes and we don’t have the science to predict how it will specifically do that reorganization in each instance because it is a monumentally complex non-linear system. Most clinicians have a very hard time grasping that concept.
So looking at it from this perspective we can expect the brain to move in many unpredictable ways as it attempts to accommodate new learning. Many times, it looks as if it is adapting in a non-normative direction but if clinicians take a deep breath and continue to apply the appropriate protocol to move the brain into the range of normality, they will see the brain returning to its old profile with improvements. The journey can be long and tortuous at times but the brain has its own healing wisdom and the incredibly ancient allostatic drive toward homeostasis that all living things pursue underlies the whole process.
This has deep implications for protocol selection. If we cannot predict where the brain will go, like so many things in life, we can still learn to assist it on its journey. There will be a large number of protocols that will assist the brain in its nonlinear process of sorting out all of its own options and the maps will guide us if we allow the brain to take the lead. No one can say which protocol option is best, but probability analysis can aid us in picking a good one. At NewMind we have a reliable statistical method to do that and it has worked extremely well for over two decades. We also have qualitative and quantitative methods to assess that process and maintain it on a sure path.
As the brain changes, so will the individual. This is not a comfortable process for most. Change is often difficult and painful. Physical healing is often painful and uncomfortable as well as nonlinear. Some days you feel better and some days you don’t, but you are still moving toward your healing goal. Just because a protocol results in temporary discomfort, does not mean it is the wrong protocol. It also does not always mean you have to change the protocol. Using your clinical skills and patience can go a long way towards relieving discomfort and reaching your clinical goals. Good counselors with extensive experience know this well. Helping your client integrate with appropriate clinical skills will help your client stay on the path to healing and lessen needless dropouts and frantic changes of protocol after protocol.