17 April 2014

Introduction to Slow Cortical Potentials (SCP's)

Among the many questions I fielded at the BFE Meeting in Venice, a large number came from individuals looking to know more about slow cortical potentials. Much of this was due to Dr. Ute Strehl's 2-day workshop on slow cortical potentials. If anyone ever has the chance to sit in on a talk by Dr. Strehl, I would highly recommend them to do so.

Slow cortical potentials (SCPs) are not particularly a topic for novice clinicians.  Making sense of the underlying source of SCPs can be a little difficult. In terms of their functional measurement, it's an additional hurdle to overcome for collecting a clean signal and timing the training with the client correctly. We at the BFE have had several clinicians new to neurofeedback embark on the journey of SCPs for research at their university or clinical application in their private practice. I'm happy to report that each group that has reached out to us for guidance through our online class has attained their goals for using SCPs.

We thought it might be useful to review the basic concepts related to the nature of SCPs, for anyone that might be considering adding this EEG technique to their clinic. For those that are looking for more in-debt explanations, feel free to look up articles by Dr. Ute Strehl and Dr. Niels Birbaumer. Recommended articles have been added to the end of this post. 

What are slow cortical potentials?
Slow cortical potentials are slow event-related, direct-current shifts in the EEG, originating from the large cell assemblies in the upper cortical layer. Let's break that previous, information-dense sentence down. SCPS are:
  • Slow. In terms of speed, they can occur from 300 milliseconds to over several seconds. Compared to most EEG activity that is monitored for neurofeedback, that is a very long time. Equipment for measurement of SCPs must be specialized to collect these longer changes, and needs to average the activity from many trials to gain an overall trend of the EEG activity. 

Example of SCP average of activation and inhibition. Note - this image is generated by a subject that is not yet used to SCP training.

  • Event-related potentials. This means there are changes in EEG activity based on responses to events. If an image or sound is presented to an individual, the presentation of the stimulus will cause  a change in the brain's potential, as a reaction to the stimuli. Interestingly, this change in potential can be of exogenous origins (reaction to a presented external stimulus) or endogenous origins (reaction to expectation of stimuli). The brain reacting to the expectation of a stimulus, without actually being presented the stimulus, means the change in event related potential can be consciously generated at will. If it can be generated at will, it can be trained.
  • Direct current shifts in EEG. SCPS are general measures of electrical activity. The vast majority of neurofeedback is based on measuring subsets of the EEG activity, divided into bandwidth frequencies (such as Theta, Alpha, Beta). The SCP signal however is general electrical activity in amplitude. These changes are weak shifts so it is necessary to run many trials to get an overall trend in activity.
  • Originate from large cell assemblies in the upper cortical layers. The thalamo-cortical system acting as a "neuronal pacemaker" triggers the general activation of these cell assemblies, which then expands outward via cortico-cortical connections of inhibition and excitation. The degree of activation/depolarization of these cell assemblies is the focus of SCP training.

Studies show that changes in SCPs leading to increased negativity reflect greater depolarization of the large cell assemblies, which in turn lowers the threshold of excitement of neurons in the brain, leading to increased neuronal activity. 

Inversely, changes in SCPs leading to increased positivity reflect less depolarization of the cell assemblies, which in turn increases the threshold of excitement of neurons in the brain (greater inhibition making it more difficult for neurons to activate), leading to less neuronal activity.
The clinical implications of slow cortical potentials and their training are reflected in epileptics, individuals with ADD and those suffering from migraines. 

  • Increased SCP negativity is observed in epileptics a few seconds before a seizure. Increased SCP positivity occur immediately after a seizure is finished. Training for increased positivity (less activity/greater inhibition) with SCPs has shown to decrease the frequency of seizures.
  • Training for increased negativity with SCPs, reflecting greater activation of the cortical networks, has been shown to improve attention in individuals with ADHD.
  • Migraine sufferers that pursue similar training as epileptics have shown decreases in the frequency of episodes and other headache parameters.

Slow Cortical Potentials Software Suite
Following Dr. Strehl and Dr. Birbaurmer's protocol, initial training starts with the subject taking turns practicing both to activate/excite and deactivate/inhibit their brain activity. Whether the subject is correctly activating or inhibiting their brain activity, the BFE's SCP Suite displays feedback to either show success in terms of each 0.5-second period of the 8-second trial or as a continuous single feedback output for the trial, depending on what the clinician and subject prefer. After training progresses past the first transfer trial session (training without feedback to see if the subject can generalize the training), the protocol then increases the focus on activating/exciting or deactivating/inhibiting brain activity, depending on the client's circumstance. For example, an ADHD child would now train to activate/excite their brain, such that they would focus on an activation to inhibition trial ratio of 2-to-1 (twice as many attempts to activate the brain than to inhibit the brain).

Example of activation trial with feedback from 0.5-second periods. Subject had initial difficulty activating, but then persevered through the trial.

Recommended reading:  
Self-regulation of Slow Cortical Potentials: Strehl, U., Birbaumer, N. A New Treatment for Children With Attention-Deficit/Hyperactivity Disorder Pediatrics November 1, 2006 118: e1530-e1540.

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11 March 2014

Adding Neurotherapy to Your Practice - The Swingle Method

On March 4th, Dr. Paul G. Swingle joined us online to present a webinar on "Adding Neurotherapy to Your Practice". He provided information on using his ClinicalQ and Braindriving methods as a great way to get started in the field.

Health professionals looking to "dip their toes" into proverbial pool that is neurofeedback are often quite overwhelmed by the field. Even with its expanding user-base, information can still be just as difficult to sift through, in search of tangible applications.

Popular questions that come up are always where do you start: Should it be with the theory of EEG utility, or basic clinical applications? Invest in biofeedback equipment and learn as-we-go, or collect volumes of literature for hours of analysis, before any commitment? Depending on the individual, there really is no clear answer and there are many approaches one can take.

Dr. Paul Swingle, a clinical leader in the field of neurotherapy, has helped introduce many therapists to the world of electrodes, brain waves and feedback training. His clinic in Vancouver, Canada, hosts several workshops every year to bring individual up to the level of neurofeedback practitioners.

The ClinicalQ & BrainDryvr method, as designed by Dr. Swingle over the last 40 years, provides an excellent introduction for professionals that desire to add neurofeedback into their practices. The method uses specific, quantified measurements of brain activity, compares them against recorded norms, and outlines how to go about shaping those brain waves to more desirable EEG patterns.

Seeing this need for professionals that want to learn about how neurotherapy can beneficial to their practice, Dr. Swingle presented a 1-hour webinar on that exact topic. Please feel free to watch the below presentation. We at the BFE hope it will give you an introduction to Dr. Swingle's methods and how they can be used to help you and your clients.

If would would like a PDF copy of the "Adding Neurotherapy to Your Practice" powerpoint used in the above video, please follow this link.

31 December 2013

Wishing You All the Best in 2014!

We want to take a moment to express thanks for all the support we have received this past year. We wish our colleagues and friends all the best in 2014 and continued success in this exciting field! It has been a busy year for us. In 2013 we launched a new website, offered a number of live online events and numerous new product releases. A great way to keep on top of what we are doing is to join our mailing list. If you are not on our mailing list, click here to sign up.

New Website
This year we launched a new website and are continuing to build and update the content so that it stays fresh and remains a good source of information on biofeedback and neurofeedback, especially for those just entering the field.

New Meeting Website
We also created a dedicated meeting website where we provide information about our annual meeting - this year it is Venice, Italy from February 11-15, 2014 with 5-day BCIA workshops starting on the 10th. You can register here.

Improved Online Shop
We continue to improve our online shop and this year added tech sheets for all BFE software suites. These information sheets provide a comprehensive list of everything needed to use the software. You will see a button to download the tech sheets included in the descriptions of each suite.

Live Webinars
Dr. Paul G. Swingle joined us again to present a series of webinars on his ClinicalQ and BrainDryvr methods covering topics such as PTSD, Attention Problems, Sleep Disorders and a presentation on Art and the Brain. We also hosted webinars on Integrative Medicine (Dr. Robert McCarthy), Tennis - Optimizing Performance (Stephanie Nihon, MSc, BCIA, BCN), HRV and Hypnosis for Trauma (Sue Intemann, LPC and Maggie Minsk, LPC), Mental Conditioning for Intense Focus in Baseball (Dr. Wes Sime & Dr. Ben Strack). 
If you missed any of these events, recordings are available in our online shop.

New Software Suites
The year 2013 saw the release of three new software suites: Tennis Performance by Stephanie Nihon, MSc, BCIA, BCN, Integrative Medicine by Dr. Robert McCarthy and Sternman Operant Conditioning by Dr. Barry Sternman, with more planned for 2014! 
View our complete catalogue of software suites.

Online Classes
Classes offered in 2014 included a wide variety of topics that included Reaction Time, Optimizing Performance & Health, ClinicalQ and BrainDryvr, Hemoencephalography, Z-Scores, ADHD Assessment and a Voice Master Class.We will be scheduling classes throughout 2014 and can also offer them on demand. Feel free to contact us at shop@bfe.org with questions. 
View a listing of classes here.

Expanded Social Media Presence
Our mission statement includes the goal of educating communities around the world in the field of biofeedback. What better way to do this than through social media? We have tried to reach out and we are not alone in this effort. This past year we have noticed many more of you out there doing an amazing job spreading the word about bio/neurofeedback via Facebook, Twitter, LinkedIn and various other platforms. These efforts help our field and we encourage those of you who have not yet "jumped in" to do so!

And finally, we would like to acknowledge the involvement of the many professionals who have donated their time to help create the educational materials we offer in the BFE Shop as part of our Learn From the Best Program, as well as all of our sponsors. It is truly an honor to work with such an outstanding group of professionals.

We look forward to seeing you in 2014!


25 October 2013

Neurotherapy for Post Traumatic Stress Disorder

Dr. Paul G. Swingle is a Vancouver based psychologist and an expert in the field of neurotherapy. He is the author of the ClinicalQ and BrainDryvr software suite published by the BFE and will be presenting an upcoming webinar on Post Traumatic Stress Disorder. We recently spoke to him about his work in this area.

What are the advantages of using neurotherapy as part of the treatment for PTSD?
Neurotherapy can normalize or improve the brainwave architecture - that is, the way the brain is functioning - and then we typically combine that with some other psychological process for helping the person deal efficiently with the overwhelming emotions associated with the exposure to the traumatic event.  It marries well with other kinds of therapy whether its experiential, EMDR, cognitive behaviour and so forth. Once the brain is functioning more efficiently, then it just markedly enhances the efficacy of these other procedures.

When exposed to the same traumatic experience, why do some experience PTSD, while others do not?
 When I was treating combat veterans at Harvard Medical School McLean Hospital, we had situations in which we would have 3 or 4 veterans, one of whom was hospitalized with PTSD. He was disabled by the event whereas although all of the other people experienced the same thing and might have such problems such as bad dreams, they  weren't disabled by the event. The difference with the person who was disabled was his neurological condition prior to walking into the combat theatre. So, we know one of the areas that we can work with in terms or increasing stress tolerance, but what about the damage that's been done - namely the post traumatic stress disorder - and that is a marked impact on the ability to regulate emotional reactivity. The flashbacks, and all of the rest of it, are associated directly with neurological conditions that we can identify when we do EEG assessments. And if we can identify it, then we know where to go to help correct the problem. 

How does the ClinicalQ assessment work?
The ClinicalQ is an EEG assessment that measures brain activity at five critical locations. The results of the assessment are then compared to a clinical database that is remarkably accurate in terms of indicating why a person is coming to see us. I saw a client the other day - a young man who had been exposed to a recent severe emotional stressor that triggered a predisposition to depressed mood states. When I explained this to him, his  jaw dropped to the floor. How could I possibly know that from looking at brainwave activity? Well, the brain tells us everything. If you've been exposed to a severe emotional stressor recently, it is very likely that the brain is going to show the effects.  And if you have a predisposition for a certain disorder such as depression, exposure to severe emotional stressors may likely trigger that condition. 

Do you think that combat veterans - most of which are young men - are hesitant to seek treatment for PTSD because of stigmas that exist?
That's really a crucial point. Decades ago, when we were dealing with PTSD there was a presumption of a weakness of character and that an individual that was disabled by the exposure to this severe emotional stress had some kind of deficit. We know now that there are neurological conditions that render us more susceptible to one type of disorder than another. With regard to post traumatic stress disorder, there's a very specific area of the brain that's associated with this vulnerability. So, if the client was a police cadet,  prior to going into the policing theatre we would have a look and see if he was neurologically vulnerable and we would do some preventative neurotherapy to better prepare him for the severe stresses of police duty. The focus is on brain functioning - it's exactly what we would do for an Olympic level athlete, exactly what we would do for a CEO of a large company. It's just making the brain more efficient to deal with severe stress. It has absolutely nothing to do with strength of character or mental illness or anything of that nature. 

Are there other therapies that are effective with post traumatic stress disorder?
As I said before, all therapies marry perfectly with neurotherapy.  I do a lot of hypnosis for these kinds of conditions. Once you get the brain so it's functioning efficiently you can use hypnosis for trying to modify the core emotional belief that gets triggered in these post traumatic stress disorder conditions. A good example is the feeling that you're not safe. One of the situations that we get with get severe stress...automobile accidents are a good example of this. When you're driving through an intersection and you have the green light, somebody t-bones you there's a situation where something came right out of the blue. So, after you get all of the physical things sorted out you still have this angst about the world not being a safe place and that's a core emotional belief - its beyond the arena of words. So hypnosis is often an extremely efficient way of having the person reorganize that emotional belief.  

Do you have advice for PTSD sufferers that might not have access to neurotherapy?

A lot of it depends on extent of disability. If you're dealing with somebody who has full blown flashbacks where they become absolutely incapacitated and they're not present, then the notion of giving them advice or home treatment is completely misguided because you need somebody to be able to shepherd the person through all of that. For lesser conditions, we use things like my sweep harmonic,  for example,  which is something akin to EMDR, but it uses sound. If you listen to that sound while you are trying to make the fear as intense as possible, you'll find that it blows it away. So any situation in which the individual is trying to feel, what every cell in their body is telling them to avoid, under conditions in which it is manageable is a positive treatment. For military veterans, it is best to inquire with their case worker who should be familiar with these options.

The BCIA (BiofeedbackCertification International Alliance) website provides a list of practitioners that have been certified in neurofeedback.

You can learn more about Dr. Swingle and his methods on the BFE Website or by visiting the Swingle Clinic website.

In an upcoming webinar, Dr. Swingle will discuss his approach to treating PTSD.

Presented by: Dr. Paul G. Swingle
Date: November 12, 2013
Time: 3:00-4:00 pm Eastern Time (US & Canada)

Any questions can be directed to Dr. Swingle's BFE Team at blueswingle@gmail.com.

17 September 2013


We invite you to visit us at the ISNR Conference in Dallas!

At the Thought Technology Booth (1&2)
Intercontinental Hotel - Dallas, TX
September 18-22, 2013

Dr. Francois Dupont will be on hand to discuss BFE neurofeedback software suites and will be demonstrating the Monastra-Lubar ADHD Assessment software at the Thought Technology vendor seminar. Dr. Dupont is one of the creators of that suite and has worked on a number of other neurofeedback suites including his own Integrated Neurofeedback.

Neurofeedback suites we are featuring at ISNR:

ADHD ASSESSMENT    (Download Flyer)
Vincent Monastra, Ph.D., Joel Lubar, Ph.D. & Francois Dupont, Ph.D 

Paul G. Swingle, Ph.D. 

Michael Thompson, MD & Lynda Thompson, Ph.D.

Dr. Robert E. McCarthy

Francois Dupont, Ph.D

  • Pick up a coupon for a 10%  discount on any purchase in the BFE Shop by September 30, 2013
  • Enter the ISNR raffle to win a FREE copy of the Integrative Medicine suite
  • Receive a coupon for FREE entry to upcoming Integrative Medicine webinar 
  • All attendees at the Thought Technology vendor seminar will receive a FREE copy of  the ADHD Assessment suite

16 August 2013

Software Suites for Tinnitus, Upper Trapezius Evaluation and Insomnia

Over the years, the BFE has devoted a lot of resources and effort to the creation and adaptation of research, assessment and training methods. We have at least 35 different software suites, big and small, that cover a wide variety of topics. Some are far encompassing, like Dr. Robert McCarthy's Integrative Medicine Suite for starting up a state-of-the-art integrative medicine practice, and others are niche-specific, such as Dr. Catriona Steele's Dysphagia Suite for speech-language pathologists to treat patients with difficulty swallowing.

Getting the word out on all of these packages can obviously be difficult or confusing. Most clients have heard or are familiar with our "big three" - Setting Up For Clinical Success Suite (Thompsons Suite), Optimizing Performance & Health Suite (Sue Wilson Suite) and the ClinicalQ & BrainDryvr Suite (Swingle Suite). The popularity of those methodologies tend to overshadow our smaller, simpler suites. As wonderful as the big three are, they don't completely cover all the clinical bases. There are still many simple, smaller suites that empower a therapist to easily evaluate or treat a specific patient condition.

This post is devoted to a few of the BFE's smaller suites, that can easily be integrated into a clinician's practice as an additional treatment tool. We have included a sample of three below.

Tinnitus Suite
Have any clients that suffer from that persistent background ringing or roaring in their ears? The Neurofeedback for Tinnitus Suite provides a simple treatment methodology for reducing that sensation via neurofeedback training of alpha/delta ratios on several sites of the head. There is the choice between the 30-minute training protocols, based on research, or free-flowing sessions that end whenever the clinician decides. Tinnitus literature, questions and sample data are provided with the software.

Sample Screen from Tinnitus Suite

Upper Trapezius Evaluation Suite
The Upper Trapezius Evaluation Suite provides an excellent, simple evaluation for upper trapezius asymmetry or over-activity with the use of surface electromyography (EMG or sEMG). It's based on research in pain by Susan Middaugh, PhD, and is applicable to clients that suffer from stress-related ailments (back pain, neck pain, tension headaches) or to athletes that need to maximize movement fluidity by avoiding upper body tension (especially golfers and goalies). The automated assessment guides the subject and therapist through 11-minutes of simple movement exercises. At the end, a report is generated with the relevant muscle tension means arranged in a simple table, with norms for objective data interpretation.

Evaluation Report from Upper Trapezius Suite

Sleep Onset Insomnia Suite
Everyone occasionally has trouble getting to sleep. For clients that have more trouble than not, this suite's treatment style would be of help to them. In the Sleep Onset Insomnia suite, Dr. Lothar Niepoth shares his simple method for teaching clients to relax into sleep. Two methods, one for use with surface electromyography and the other for use with EEG, teach the subject to relax their body and relax their mind. About 90% of subjects find the muscle work to be good enough for learning to get to sleep, while the other 10% find it necessary to do some EEG work. This isn't a technique that takes months of client coaching; just one to a few sessions and they are ready for a night's good rest.

Sample Training Screen from Insomnia Suite

To learn more about these suites and the sensor and hardware required to use them, visit the software section of the BFE Online Shop. Once there, click on the individual suites download the tech sheets provided with the description of each suite.

Please feel free to contact us at education@bfe.org with any questions you may have.

20 June 2013

In Montreal with Dr. Paul Swingle

This is a guest post by the BFE's Research Manager Jon Bale.

Jon Bale and Dr. Paul Swingle
As the BFE's Research Manager, I spend most of my time moderating online sessions, teaching online classes, or guiding the software development of the BFE's suites. The opportunity to attend the 1-day Swingle Workshop at the end of May, held in Montreal, was therefore a welcomed change to my work in the digital realm. Facilitating the workshop also presented the chance to finally meet Dr. Paul Swingle in person. It's funny to think that with the 4 years of work Dr. Swingle and myself have done together - including the ClinicalQ & BrainDryvr Suite, Swingle Grand Rounds, Dr. Swingle's Webinar Series - we have never actually physically met.

The 1-day workshop gave a brief introduction to Dr. Swingle's ClinicalQ & BrainDryvr method, but the majority of the day focused on the interpretation of ClinicalQ assessment results. Dr. Swingle dispensed of tips and advice for reading relevant statistics true to his personality: calm and direct, with a touch of humour. "Whenever you get elevated slow frequency in the front of the brain and elevated slow frequency in the back of the brain in a young person, smoking dope is the likely culprit. To be fair, in Vancouver it's already a 50 percent chance of being right when accusing a young person of smoking dope."

Dr. Swingle's style of interaction was consistent with my experiences of him in our online sessions. Participants freely asked questions and referenced their own cases, all of which Dr. Swingle comfortably answered after a thoughtful pause. I did not see any appearance of his inner "New Yorker", with the rough and tough personality, that he enjoys mentioning about himself. Clinicians, including myself, seemed to be enamored with his breadth of knowledge. As one individual described him, "I am just in awe of Dr. Swingle and his work."

Finally meeting Dr. Swingle was quite a pleasure for me, after all these years. In this video, he shares a few words about the workshop, his ClinicalQ and BrainDryvr software suite and the BFE.

If you wished to attend Dr. Swingle's workshop, but could not due to scheduling constraints, please feel free to have a look at the upcoming BFE webinars being given by Dr. Swingle. While the workshop covered a wide range of clinical topics, his 1-hour online webinars each focus on a specific disorder. In addition, the BFE hosts monthly grand rounds sessions with Dr. Swingle during which participants can present cases to Dr. Swingle for review.

Upcoming webinars include:
Attention Problems in Children ADHD - August 13, 2013 - 3:00-4:00pm EST
PTSD - November 12, 2013 - 3:00-4:00pm EST

Grand Rounds:
Summer Session: Jul 11 | Aug 8 | Sep 12
Fall Session: Oct 10 | Nov 14 | Dec 12

We hope to see you online soon!
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