مشخصات کتاب

Neurofeedback in the Treatment of Developmental Trauma. Calming the Fear-Driven Brain

دسته بندی: عصب شناسی
ویرایش:  
نویسندگان: Sebern Fisher  
سری:  
 
ناشر: W. W. Norton & Co. 
سال نشر: 2014 
تعداد صفحات: 0 
زبان: English 
فرمت فایل : EPUB (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) 
حجم فایل: 2 مگابایت 

کلمات کلیدی مربوط به کتاب نوروفیدبک در درمان ضایعه رشدی. آرامش مغز ترسناک: تروما، ptsd، cptsd، ترومای رشدی، بسل ون در کلک، نوروفیدبک

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توضیحاتی درمورد کتاب به خارجی

Foreword by Bessel van der Kolk, MD: How often is an experienced clinician-researcher confronted with a new paradigm that profoundly changes his understanding of what he has done all his professional life? How often does a remarkably novel way of understanding the mind, brain, and body come along, one that has been around for at least three decades yet remains at the periphery of clinical practice and neuroscience? A few years ago I served on a medical panel in which we all were asked to name the greatest advance we were then involved in. One person mentioned mosquito netting to combat malaria, another that she had found a gene for anorexia (huh?, I thought), and I mentioned that we were working on ways to reconfigure electrical communication patterns in the brain in order to help people feel more fully alive in the present. The audience stared in disbelief, but I had no chance to elaborate on my statement. In her book, Sebern Fisher does so eloquently. One way in which we judge credibility of new treatment techniques is by the way the bearer of the tidings behaves. If a skittish, intense person pushes me hard into taking an interest in their amazing new therapy that will solve most of mankind’s ills, I usually squirm away. However, when a calm, curious, confident, and humorous individual engages me into looking at familiar things from an intriguing new angle, my curiosity is piqued. I had the good fortune of meeting Sebern Fisher at an attachment conference in Providence, Rhode Island in the fall of 2007. She showed me a series of family drawings sketched by a very impaired 10-year-old boy who had been treated with neurofeedback (see Figure 4.1). The first drawing consisted of a stick figure, which a 3-year-old could have produced. Twenty sessions later his family portrait had taken on complexity, nuance, and character. Another twenty sessions later the drawing looked like the work of a full-fledged young artist. I was intrigued. I had never encountered a treatment approach that could shift the perceptual system of a human being so dramatically in such a short period of time. My intrigue, combined with Sebern’s thoughtfulness, gentleness, and sharp analytical skills, prompted me to eagerly accept her invitation to spend a weekend with her in Northampton, Massachusetts to become more familiar with whatneurofeedback could do, specifically with regard to patients suffering from developmental trauma. Sebern explained that she could show me all the electroencephalograms and statistical analyses 1 that had been collected on neurofeedback, but none would be as eloquent as the patients she had treated, and she wanted me to meet them. One snowy afternoon Sebern hooked me up to a small computer in her home office to display an electroencephalogram (EEG) of my brain waves on the screen in front of me, an EEG that was more sophisticated than what one million dollars worth of equipment could produce in the EEG laboratory in which I had worked in medical school. Nice to see how technological advances had democratized access to brain wave activity. Subsequently, I interviewed three of Sebern’s patients, all of whom had suffered from developmental trauma. One was a woman who had been plagued with intractable epileptic seizures and confined to her apartment in a housing project, waiting for her next seizure to occur, hoping that this would not happen at a time when she was to pick up her baby from daycare. She told me that neurofeedback had cured her seizures after numerous medications had failed to do so, and had helped her to become sufficiently focused to attend college and get a degree in journalism. The next young woman had been chronically isolated and out of touch with her environment. After neurofeedback training, she came across as vivacious and inquisitive. The third patient was most familiar: A young woman who had grown up shuttled between residential treatment programs, hospitals, and foster care placements and who, a few years prior to our meeting, had matured out of Child Protective Services, suffering from dissociative identity disorder and chronic self injurious behavior, without any identifiable skills. Young people like her tend to be too confused, frightened, and dysregulated to benefit from most therapy programs, and, lacking more effective interventions, are often managed on mood stabilizing medications, which make them less impulsive but also less able to learn and engage deeply in school, work, or relationships. A bright woman, she described what it was like to have been plagued by chronic noises in her head and an inability to focus on schoolwork, therapy, or consistent relationships because of a disastrous combination of a chronic state of terror and extreme mental confusion. During our two lengthy interviews she gave me the most lucid description anybody has ever given me of what it was like to have been a chronically dissociated, self-destructive, terrified adolescent. Of the many memorable things she told me, one in particular stands out: “Yes, I slowly became an attached person. When you are not afraid and confused you can know people differently.” When I asked her to summarize what neurofeedback haddone for her she said, It calmed me down. It stopped the dissociation. I can now use my feelings; I’m not running away from them; I’m not held hostage by them. I can’t turn them off and on, but I can put them away. I may be sad about the abuse I went through, but I can put it away. I can call a friend and not talk about it if I don’t want to talk about it, or I can do homework, or clean my apartment. I’m not anxious all the time, and when I am anxious I can reflect on it. If the anxiety is coming from the past I can find it there, or I can look at how it relates to my life now. And it’s not just negative emotions, like anger and anxiety—I can reflect on love and intimacy or sexual attraction. Neurofeedback freed me up to live my life the way I want to because I’m not always in the thrall of how I was hurt and what it did to me. I’m not in fight or flight physically all the time. She appeared completely cured, and three years after our interview she graduated near the top of her class in nursing school. Sebern’s patients are the sorts of patients who utilize enormous public health resources, usually with very little to show for it. They barely function. These are the treatment-resistant people we know so well, and who have inspired us at the Trauma Center in Boston to explore a whole range of unconventional treatments. What Sebern’s patients told me was the sort of anecdotal evidence that we need to inspire us to begin a serious exploration of how—and for whom—these treatments work. I felt in my element: I love to study promising new treatments that have not been tested before, like, over the years, Prozac, EMDR, sensory integration, and yoga for PTSD. Probably the greatest challenge in mental health is how we can help patients with severe affect regulation problems, like those I interviewed at Sebern’s office. This usually results from severe childhood abuse and neglect—otherwise known as developmental trauma—in which lack of synchronicity in the primary caregiver relationship leads to abnormal rhythms of brain, mind, and body. These patients are so chronically hyperaroused or shut down, and unable to filter out irrelevant information, that they have trouble engaging in whatever they are doing in a focused manner (except when they are involved in re-enacting their traumas). Our field has struggled to come up with treatments that can help them to be fully alive in the present, without being hijacked by fear, confusion, or distraction, and thus far we have been painfully unsuccessful. As Sebern says in this book: “Stress never lies with the events that we identify as stressful—it lies in our reaction to them.” Neurofeedback raises the brain threshold and generally increases stress resiliency as it increases stability. We are supposed to learn affect regulation during the first few years of life. However, if the system that regulates emotional arousal does not become hardwired in the brain early in life there is little chance that subsequent experience can engage neuroplasticity to such a degree that it can override the critical periods of development. Research on monkeys and infants raised with sensory and emotional deprivation in orphanages has shown that it is virtually impossible for the brain to acquire such capacities outside of these criticalperiods. My meetings with Sebern’s patients held out the promise that neurofeedback might be able to accomplish what we had thus far failed to do. Upon my return to Boston we at the Trauma Center arranged to get ourselves trained in neurofeedback, and to start a regular clinical and research program. We were interested in brain function and physiology, and, somewhat surprisingly, one of the strongest groups of supportive colleagues came from Boston University’s Department of Sports Medicine. One application of neurofeedback’s capacity to change focus and attention has been in the area of performance enhancement. 2 Neurofeedback training has been shown to improve cognitive flexibility, creativity, athletic control, and inner awareness. 3 I do not know of any other psychiatric treatment that can do that. In Italy, Bruno Demichelis, the head psychologist of MilanLab, a research center established by soccer club AC Milan, taught his players to maintain a state of relaxation while watching video recordings of their errors, which led to increased mental and physiological control. In 2006, several of these players were members of the Italian team that won the World Cup. The following year, AC Milan won the European championship. Chris Kaman of the Los Angeles Clippers, the 7-foot NBA center, is a poster child for neurofeedback training. In his early years in the NBA he had trouble concentrating and often lost track of what he was doing. After a series of neurofeedback sessions under the supervision of psychologist Tim Royer he averaged a career-high 17.9 points, 13.7 rebounds, and three blocks per game, and became a dominant center in the NBA. Kaman attributes his athletic improvements to neurofeedback. 4 Some of the best work in the area of neurofeedback and performance enhancement has been done by John Gruzellier in London, who studied the effects of 10 sessions of neurofeedback on a group of music students. A panel of judges from the Royal College of Music evaluated their performance of a piece of music before and after neurofeedback training. When compared with five alternative treatment groups, only the neurofeedback group improved their real-life musical performance by approximately 10%, a huge difference in such a competitive field. These studies on performance enhancement fit in well with the effects of neurofeedback on traumatized individuals: It helps to stabilize and focus attentional systems in the brain. Neurofeedback truly is a different paradigm from what we are accustomed to. Communication patterns in the brain are mediated by chemical and electrical signals. Because of the enormous clinical and commercial potential of psychiatric medications thus far, only the chemical paradigm has received significant interest from the scientific community. The electrical patterns in the brain have been almost entirely ignored. Even brilliant neuroscientists like Antonio Damasio and JaakPanksepp invariably express the hope that the abnormal brain patterns that they find in their research studies will some day be rectified when somebody discovers the right chemical intervention. Neurofeedback offers an alternative to drugs and seems to be able do things that medications up to now have failed to deliver. When neuroimaging techniques became available they allowed us to observe metabolic patterns in the brain and localize particular mental activities. However, localization does not necessarily lead to effective intervention—it just gives us a better idea of where things take place. In contrast, sophisticated EEGs allow us to measure shifting communication patterns in real time and can assist us to alter specific brain wave configurations by finding the right locations and frequencies for neurofeedback intervention. By providing brains with feedback we can change brain wave patterns and help people’s minds to become more alert, attentive, focused, and organized. As Sebern says about her patients suffering from developmental trauma, and indeed all those who engage in neurofeedback training, When we provide feedback to the brain we are, essentially, providing it with a mirror of its own function and inviting it to make more of some frequencies and less of others, that is, to oscillate differently. In neurofeedback, we seem to be nudging the brain to set up new oscillatory patterns that enhance both its natural complexity and its inherent and necessary bias toward self-regulation. In effect, we may be freeing up innate but stuck oscillatory properties in the brain and allowing new ones to propagate. In neurofeedback, you see an evolving presence and dimensionality of the person who is training. They expand their focus, think new thoughts about old problems, and typically their vocabulary grows and becomes more nuanced. They are able to escape the ruts of their narrative. It amazes me that this powerful approach has been available as long as it has without yet finding widespread acceptance. Neurofeedback is applied neuroscience— it is a new frontier in helping innumerable people who up until now have been condemned to just make the best of feeling chronically fearful, unfocused and disengaged. Sebern Fisher, a sensitive clinician and immensely experienced neurofeedback practitioner, is the right person to teach us how to integrate it into clinical practice. —Bessel A. van der Kolk, MD Medical Director, The Trauma Center at JRI Professor of Psychiatry, Boston University School of Medicine

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