LENS AND NEURAL REGULATION BRAIN AND BODY. Ulrich Lanius Ph.D.

Transcription

1 LENS AND NEURAL REGULATION BRAIN AND BODY Ulrich Lanius Ph.D.

2 INTEGRATING THERAPIES BRAIN AND BODY Series of case studies Standalone intervention vs. adjunctive LENS and EMDR: synergistic effects Overlap in functional mechanisms? Theory and practice Adaptation of LENS applications Brain and body

3 DEVELOPMENTAL TRAUMA INFORMATION PROCESSING THERAPIES Neglect and abuse produce dysregulated brain activity Interferes with effective Adaptive Information Processing (AIP) AIP theory as well as recent research support the notion of EMDR Therapy intervening at a neurobiological level Similarly LENS neurofeedback can be considered to be a neurobiologically based intervention Both forge adaptive associations among neural networks in the brain

4 HYPOTHESES NEUROFEEDBACK & EMDR The addition of LENS neurofeedback during all three trauma treatment phases can increase Adaptive Information Processing by directly intervening at the level of the electrical or frequency level domain of brain and body LENS will facilitate EMDR treatment effects of PTSD, mood and anxiety as well as symptoms in clients with concurrent attachment disorder.

5 CASE STUDY INCLUSION CRITERIA LENS & EMDR No response to treatment as usual Pharmaceutical intervention Body psychotherapy (eg Sensorimotor, Somatic Experiencing) Conventional neurofeedback EMDR Can t identify target Blank when processing Can t tolerate body activation when processing No change or lasting change in SUD level

6 ADDITION OF LENS NEUROFEEDBACK TYPES OF INTERVENTIONS Delivering LENS neurofeedback prior to starting EMDR Therapy Delivering LENS neurofeedback and EMDR in the same treatment session Delivering LENS neurofeedback between EMDR sessions Delivering LENS to the body during EMDR in the same treatment session Providing alternating bilateral stimulation directly to the brain through LENS neurofeedback

7 WHAT IS THE LENS? BRIEF HISTORY Developed in 1990 by Dr. Len Ochs, Ph.D. Dr. Ochs recognized that using a normative database may not be the best approach, and decides I ll never tell the brain what to do Disruptive stimulus LENS No need for client to focus on task Dr. Ochs discovered that patients responded dramatically faster to interventions

8 PASSIVE NEUROFEEDBACK THE LENS Limited or no awareness Hum activity from Digital Signal Processor all NFB Low energy stimulus e.g. watch battery Little effect unless signal feeds back information Based on dominant frequency Statistical means of extracting the power of EEG e.g. highest amplitude Feedback about frequency at offset Break up existing neuronal pattern - brain not trained to specific frequency Disruptive stimulus move brain from its parking spot Removing the auto-protective mechanisms of the brain Brain reorganizes itself

9 THE LENS HOW THE LENS WORKS Traditional biofeedback: uses a normative database to teach, or train, the brain using operant conditioning to emit pre-determined optimal frequencies at each of the 10/20 sites. The LENS: Using real-time Dominant Frequency (DF) calculations, it is believed the LENS s paradoxical feedback TM interrupts maladaptive patterns acquired in response to head trauma, physical or emotional trauma, genetic factors, environmental influences, anoxic events, chemotherapy treatment, medications, etc. It is thought that the paradoxical feedback disrupts the timing of the thalamico-cortical signals, disrupting the brain defensive neurochemistry that cuts connectivity. It is much easier to trip someone than to teach them how to fall. L. Ochs

10 TREATING WITH THE LENS LENS SESSION Three sensors are attached to the patient, and the LENS session is administered. The average length of a LENS session is 1-8 minutes.

11 CREATING A MAP 10/20 SITES The LENS utilizes the standard international 10/20 sites, which are nothing more than evenly distributed over the scalp, and gathers information at each of 21 sites as it provides treatment.

12 10-20 SYSTEM

13 TREATING WITH THE LENS STANDARD MAP The LENS Map, which reflects the EEG information gathered at each of the 21 sites, guides patient treatment by providing the order in which to treat the 21 sites.

14 TREATING WITH THE LENS STANDARD MAP Amplitude plus standard deviation Dominant frequency plus standard deviation Target in sequence from lowest amplitude to highest amplitude

15 STANDARD MAP SURVIVOR PATTERN

16 TREATING WITH THE LENS SUPPRESSION MAP Coeffcient of variability SD/amplitude SD/dominant frequency Target in sequence Most suppressed to least suppressed Faster, more efficient than standard map

17 SUPPRESSION MAP SURVIVOR PATTERN

18 SUPPRESSION EEG EFFECTS

19 SUPPRESSION EFFECTS Related to notion of burst suppression Stress related release of endogenous opioids Opioids do not create burst suppression Decreased amplitudes Inactivated brain states, eg. anesthesia, coma, hypothermia Decrease in cerebral metabolic rate Absence of higher level brain activity Brain inactivation Pattern of high activity and no activity Spikes and flatlines

20 DISSOCIATION INHIBITORY NEUROTRANSMITTERS Endogenous opioids & cannabinoids Opioid blockade facilitates cognitive processing and cortico-thalamocortical processing of visual stimuli (Lensing 1995) Naltrexone: alpha blocking Increased visual pursuit behavior Increased visual contact in social situations 8/26/2018

21 BRAIN ACTIVATION DISSOCIATIVE RESPONSE

22 SUPPRESSION EEG EFFECTS

23 LENS THE NOTION OF SUPPRESSION Survivor pattern Lack of variability/flexibility Lack of adaptive response of the brain to environmental input Amplitude suppression Dominant frequency suppression Suppression of specific frequencies Coefficient of variability

24 SUPPRESSION EEG EFFECTS

25 SUPPRESSION EEG EFFECTS

26 SUPPRESSION VS SLOW WAVE ACTIVITY DIFFERENCES Slow wave faster than suppression No burst suppression in normal sleep Delta activity Associated with slow wave sleep Increased declarative memory

27 SUPPRESSION REMOVAL Increase in functioning Increased amplitudes Increased slow wave activity Increased definition on regular map Regular map will look more dysfunctional Rapid removal of suppression may be issue in Dissociative Disorders

28 LENS EEG & SUPPRESSION In fact, the EEG at the end of a successful LENS treatment can look more typical of what accompanies impairment of functioning than it did at the beginning from the traditional qeeg point of view. Len Ochs

29 TREATING WITH THE LENS Increased amplitude Greater variability Increased level of functioning Severe DD do not tolerate removal of supression REMOVAL OF SUPPRESSION Increased access to mnemonic material Desensitization going slow

30 EEG ACTIVITY EFFECTS OF PTSD Beta (Cohen et al. 2012; Huang et al. 2014) Gamma (Cohen et al. 2012; Huang et al. 2014) Alpha (Begic 2003; Huang et al. 2014) Theta (Todder et al. 2012; Huang et al. 2014) Alpha/theta ratio (Veltmayer et al. 2006) 8/26/2018

31 ALPHA ABNORMALITIES HUANG ET AL 2014 Decreased alpha-band activity in PTSD Bilateral FPs Bilateral dlpfc (more R than L) Bilateral anterior aspects of superior temporal gyri (more R than L) Bilateral precuneous cortices Bilateral sensorimotor cortices (more R than L) 8/26/2018

32 EFFECTS OF PTSD ALPHA ABNORMALITIES Huang et al /26/2018

33 NEUROFEEDBACK AND PTSD KLUETSCH ET AL Childhood abuse PTSD Pz only default network - reducing alpha Decreased alpha amplitude followed by alpha rebound removal of suppression? Increased salience network connectivity with right insula Increased default network connectivity with bilateral posterior cingulate, right middle frontal gyrus and left mpfc

34 NEUROFEEDBACK AND PTSD NICHOLSON ET AL Childhood abuse PTSD Pz only default network - reducing alpha Decreased alpha amplitude followed by alpha rebound Decreased PTSD Sx and reduced arousal Shift in amygdala complex connectivity From areas implicated in defensive, emotional and fear processing/memory retrieval to prefrontal areas implicated in emotion regulation/modulation

35 NEUROFEEDBACK AND PTSD NICHOLSON ET AL. 2016

36 THE ROLE OF ALPHA DOMINANT FREQUENCY Dominant frequency in brain and body Increased alpha frequency associated with increased memory and cognitive functioning Decrease of alpha frequency in Alzheimer s Involvement of theta Alpha: attentional suppression in visual cortex Faster rhythms modulated by slower ones Alpha inhibits slower oscillations Gamma rhythm nested in alpha rhythm 8/26/2018

37 DOMINANT FREQUENCY ALPHA Alpha dominant frequency in normal adults Infants and toddlers: delta and theta Alpha dominant frequency in the body Mind-body connection? Lowered dominant frequency in trauma survivors Excessive low frequency band amplitudes

38 ALPHA WAVES FUNCTION Alpha suppression with gaze orientation Alpha and beta gating mechanism for gamma, especially after initiation of saccades. Decreased alpha: exteroceptive Increased alpha: interoceptive Alpha inhibits information processing (Klimesch, 2012) 8/26/2018

39 DISSOCIATION INHIBITORY NEUROTRANSMITTERS Endogenous opioids & cannabinoids Opioid blockade facilitates cognitive processing and cortico-thalamocortical processing of visual stimuli (Lensing 1995) Naltrexone: alpha blocking Increased visual pursuit behavior Increased visual contact in social situations 8/26/2018

40 LENS A HYBRID APPROACH Integrates findings from traditional NFB Kluetsch et al. (2014), Nicholson et al. (2016) Focus on alpha band Apply to LENS NFB Use of LENS maps PTSD and Traumatic Stress Syndromes Maybe applicable to other populations

41 LENS ALPHA FEEDBACK Applications include 8-12hz band filter alpha filter 100 percent duty cycle Longer duration Smaller offset Increased use of narrow band More easily tolerated Decreased alpha with strong alpha rebound Theta crossover

42 THE LENS ALPHA-THETA

43 LENS & EMDR AN INTEGRATED APPROACH Prior to EMDR processing Client unable to proceed to trauma processing In addition to other stabilization activities More rapid stabilization General symptom improvement Decreased anxiety Improved mood Greater effects than stabilization as usual

44 NEUROAFFECTIVE PSYCHOTHERAPIES LENS & EMDR Standalone vs. Integration w/ EMDR Use in stabilization Increase in cognitive capacity Increase in self-regulation Ego state communication Improved trauma processing EMDR and SP Mopping up Integration

45 THE LENS EMDR PROCESSING 68 cases LENS to facilitate EMDR processing 1 to 11 sites usually 5-7 Immediately prior to EMDR processing More efficient response to EMDR Increased interoceptive awareness Decreased visible abreaction SUD decreases more quickly

46 THE LENS MOPPING UP Ongoing symptoms after EMDR SUD does not remain at 0 Ongoing pain activity LENS Further symptom improvement Decrease in pain activity Additional material for EMDR processing emerges Mopping up Completes integration phase

47 LENS & EMDR CASE STUDY DEPERSONALIZATION DISORDER Attachment trauma Multiple caregivers Impaired social & employment functioning Sexual acting out? Social anxiety Ecstasy experience with former boyfriend Triggers intractable depersonalization CT scan shows right temporal lobe abnormality On MRI interpreted as artifact EEG slight anomalies but no diagnosis of seizure disorder

48 LENS & EMDR CASE STUDY DEPERSONALIZATION DISORDER Referred by psychiatrist for NFB Previous Sensorimotor Psychotherapy, EMDR Low dose naltrexone limited effect Regular and high dose naltrexone 150mg per day best functioning 200mg triggers anxiety Neuroptimal: mild improvements

49 INITIAL MAP DEPERSONALIZATION

50 INITIAL SUPPRESSION MAP DEPERSONALIZATION

51 LENS & EMDR CASE STUDY DEPERSONALIZATION DISORDER 48 sessions of LENS Initially tolerates only small number of sites Variable pulse application to remove suppression Panic attack while traveling with family in car Usually 7 sites prior to EMDR Tolerates Alpha applications on whole head Significant improvement in social anxiety Significant improvement in depersonalization Normalized social & employment functioning

52 LENS REGULAR MAP POST TREATMENT DEPERSONALIZATION DISORDER

53 LENS SUPPRESSION MAP POST TREATMENT DEPERSONALIZATION DISORDER

54 LENS & EMDR CASE STUDY DDNOS Severe attachment issues Graduate degree in psychology Unable to work Dissociative symptoms ADD Depression Pornography addiction On antidepressant and stimulant medication

55 LENS & EMDR CASE STUDY Stabilization Sensorimotor Psychotherapy EMDR Neuroptimal Modest improvements All prior to LENS map DDNOS

56 LENS & EMDR CASE STUDY DDNOS Further improvements with LENS Tolerates whole head Alpha application Low dose naltrexone added > 40 sessions LENS Usually 7 sites prior to EMDR Some 21 site sessions in between EMDR sessions Decides to move Return to employment

57 INITIAL REGULAR MAP DDNOS

58 POST TREATMENT REGULAR MAP DDNOS

59 NEURAL REGULATION THE BODY LENS neurofeedback to the body Area of pain Acupuncture spot Triangulate electrodes ECG electrodes 100% duty cycle application Long application Use of alpha filter Reduces muscle tension Appears to facilitate healing Mind-body connection

60 THE BODY LENS NEUROFEEDBACK LENS neurofeedback to the body Area of pain Acupuncture spot Triangulate electrodes around the area 100% duty cycle application

61 ALPHA AND THE BODY HORSLEY & SHÄFER /26/2018

62 ALPHA AND THE BODY MARSHALL & WALSH /26/2018

63 ALPHA & THE BODY SEPARATE BUT IDENTICAL Muscle activity 10hz Similar frequency at multiple sites Not innervated by brain alpha rhythm Continues if brain isolated from body Low frequency accentuates tremor High frequency accentuates jerky movements

64 NEURAL REGULATION THE BODY Body oriented interventions LENS neurofeedback to the body Photonic stimulator Scenar-cosmodic

65 Adaptation from Oschmann 2015 Grounding acupuncture spot K1 Reduction in inflammation Delivering LENS to K1 on both feet 2-channel alpha body application INFLAMMATION BODY LENS

66 GROUNDING & INFLAMMATION KIDNEY 1

67 GROUNDING & INFLAMMATION OSCHMANN 2015

68 GROUNDING & INFLAMMATION KIDNEY 1

69 BODY LENS CASE STUDY COMPLEX REGIONAL PAIN SYNDROME Intractable pelvic pain Multiple interventions unsuccessful Attachment trauma Sexual abuse Medical trauma CRPS triggered by medical intervention

70 COMPLEX REGIONAL PAIN SYNDROME Weaned off opiates Difficulty tolerating LDN LENS to head all sites LENS to K1 bilaterally Photonic stimulator to pain area Marked reduction in pain activity DID diagnosis emerges Ego-state work Lasting reduction in pain activity PELVIC PAIN

71 LENS & EMDR BODY LENS Male DID, Substance abuse Severe birth trauma Severe early childhood medical trauma Sexual abuse Initially unwilling to participate in psychological treatment Treatment centre Returns for LENS Registers in undergraduate program EMDR >40 sessions Body sensations limited response to treatment Birth trauma SUDS level limited response

72 LENS & EMDR BODY LENS Body LENS on neck area while administering tactile bilateral EMDR Focus on body sensation Body LENS for entire EMDR session ca. 40 minutes SUD stays reduced for first time Body sensations and muscle spasms reduced 5 sessions Move to other body areas with medical trauma

73 LENS & EMDR LENS EFFECTS Removal of EEG suppression More flexible alpha activity Increased excitatory/inhibitory balance Pacing of trauma processing Sense of self Enhanced neuroplasticity? Default network connectivity?

74 Helps to stabilize dissociative clients Decreases SUDS Increased self-regulation Decreased alexithymia/numbing Increased mnemonic access More able to verbalize experiences Decreased blocking, looping More efficient EMDR processing More rapid symptom resolution LENS & EMDR LENS EFFECTS 8/26/2018

75 LENS & EMDR SYNERGISTIC EFFECTS ON EEG Altered default network connectivity (Landin- Romero et al, 2013) Decreased alpha after EMDR (Pagani et al. 2013) Increased gamma during BS (Pagani 2013) Activity in gamma band observed in healthy volunteers in ACC and left PFC upon exposition to emotional stimuli 8/26/2018

76 STOCHASTIC RESONANCE DISRUPTIVE STIMULUS Role in sensory signal detection in brain Visual, sensory, tactile Information processing in a non-linear system enhanced by the addition of low level noise Alters response threshold/signal-to-noise ratio Hypothesized functional mechanism of EMDR (Miller, 2016; Khalfa, 2018) TMS can induce stochastic resonance Induces behavioral facilitation when stimulated are is in a suppressed state (Schwarzkopf et al, 2011) A functional mechanism of LENS? 8/26/2018

77 STOCHASTIC RESONANCE CORTICAL CONNECTIVITY Modulates neural synchronization within and between cortical sources (Ward et al, 2010) Synchronization in alpha and gamma frequency bands TMS can induce stochastic resonance Induces behavioural facilitation when stimulated area is in a suppressed state (Schwarzkopf et al, 2011) A functional mechanism of LENS? 8/26/2018

78 LENS & EMDR EMDR HYPOTHESIS Alternation between interoceptive and exteroceptive awareness - Body vs BS Alternation between salience and default network connectivity greater coordination within the default mode network between vmpfc and PCC nodes associated with better working memory It may be that the relationship between activity in the default mode network and its anti-correlated networks, instead of the DMN itself, is most functionally relevant. 8/26/2018