New developments in neurofeedback and the centrality of compassion in health care

It is an exciting time to be in the world of neurofeedback and practicing the Othmer Method in particular.

I had the pleasure of attending the EEG Institute's 2019 Advanced Practice Summit at the end of May and wanted to take a moment to review some of the highlights. Beyond the excitement of significant technological advances and new methodologies, the moments that stood out all reflect core components of what makes this specific neurofeedback modality so powerful.

Technological progress tends to be nonlinear-an idea or technology emerges, but the surrounding society may not yet be ready to recognize and utilize its potential, or the technology may not be advanced enough for mass adoption. At some point, a threshold is crossed. A numerous enough body of experimenters refining the technology and its application combined with new technical developments democratize access to it, and the rate of development tends to accelerate on an upward curve.

Though neurofeedback has 60+ years in development and practice, by all appearances we may now be crossing one of those thresholds. As this year's summit demonstrated, the rate of developments appears to be hastening. Within the Othmer Method, much of this can be attributed to the commitment of the Othmer family combined with the growing pool of practitioners and scientists experimenting, refining, sharing knowledge and experiences, and pushing the field forward. I ascribe much of this to how the Othmers and EEG Institute utilize many aspects of open source models. They are a hub or node that pushes development, but by democratizing access to their ideas and encouraging debate and sharing of ideas and experiments amongst their pool of practitioners, we see new ideas constantly being proposed, tested, revised, evaluated and pushed back into circulation for more testing and trial. The feedback loop this creates seems to inspire more knowledgable practitioners as well as propelling the field forward.

Most excitingly, the past year has produced a number of significant developments within the Othmer method. A broader array of frequencies, new placements, and infra-low synchrony are all additions which offer the potential to deepen the effectiveness and expand the scope of our practice. For these developments alone, this Summit was well worth the time.

In the broader field of interventional brain tech, the past years have witnessed an explosion of new technologies. John Mekrut offered an interesting overview of some of the more (and less) promising of them. He notes a review which cautions, "We identified a link to research or a resource to support claims for 33 of the 41 devices, but we only found a link to one or more relevant peer-reviewed research papers for 8 of the devices claims overall. Of the remained, 29 had links to citations to general science research and scientific concepts." So, there's a lot of new tech and ideas coming forward, much of it based on hypotheticals built off of research which implies that a device could do this or that, but it's reasonable to assume that a lot of these new toys will fail to live up to their claims. We can hope that some of them, however, will point to new avenues and interventions for brain-based disorders.

The two presentations that most captivated me were nonclinical, and their inclusion in the Seminar format reflects important priorities inherent in the development of the Othmer method.

Matthew Fleishmann reported on an ongoing project coming out of Eugene, Oregon.

The "Neurofeedback Advocacy Project," (neurofeedbackadvocacyproject.com) is committed, "to implement neurofeedback within our existing healthcare system with particular concern for agencies working with the underserved." In the past two years, they have partnered with three local agencies serving marginalized and underserved populations. Their results have been stunning, with Othmer method neurofeedback providing dramatic improvements in very difficult to treat patient populations. Results have been so impressive that each of these agencies is looking to extend the program by adding staff and equipment. The difficulties in billing insurance have driven a cash payment model for neurofeedback, thereby excluding large swaths of the population most in need of our services. We can only hope that the Advocacy Project’s successes will encourage the adoption of neurofeedback in public health and social service agencies on a broader scale.

Of all the presentations, Dominic Vachon's, "The Science of Compassion and its Practical Application to Neurofeedback Practice" hit closest to home.

Dominic is an expert on compassion in medicine and its importance to both health care providers and patients alike. Dominic's organization (The Notre Dame Hillebrand Center for Compassionate Care in Medicine) promotes as its mission "to advance the application of the science of compassion at every level of medical education and practice in order to transform clinician well-being and patient care and to restore the spirit of compassion in health care."

Their conclusions and the solutions they promote speak deeply to me both as an Emergency Nurse and as a neurofeedback provider. The implications of their research also confirm the importance of the Othmer Method’s emphasis on the role of the trained clinician.

The emerging body of research looking at the neuroscience of connecting with patients is consistently pointing to the importance of a compassionate connection between provider and patient in promoting and maintaining the well being of both.

Per Dominic, compassion and connection with clients (or patients) are more than 'being nice' and more than just bedside manner. It's integral to their healing and well-being.

The Notre Dame HIllebrand Center identify 4 components of compassion:

1. Noticing another's suffering (cognitive/attentional component)

2. Empathically feeling the other person's pain (affective component)

3. Wishing or desiring to see relief of that suffering (intentional component)

4. Responding or acting to help ease or alleviate that suffering (motivational component)

Humans are social creatures, and evolutionary development has hardwired in emotional responses that motivate collaborative and empathic drives towards social cooperation.

One of the most profound indications of this is the existence of mirror neurons in our primate brains. When we see pain or suffering in another person, these mirror neurons will activate in our own brains in a pattern which reflects and partially reproduces the same neuronal patterns present in those whose suffering we witness. As the 4 components of compassion indicate, to resolve our own discomfort as the observer, we must not only feel the other’s pain, but wish or desire to see the relief of their suffering and respond or act to help ease it.

Working in Emergency Medicine, we often find ourselves running at a full sprint for 12+ hours in an environment saturated with human suffering. Dominic challenges the protective responses that so many of us develop under such intense emotional pressures. The emotional detachment so many of us in acute care cherish as protective and even necessary to function can actually be harmful not just to our patients, but to our own well being. Suppressing empathic connection to others is antithetical to our social being as a species, and can actually cause us harm.

Homelessness, mental health crises, and social marginalization drive so many to the one place in society that won't turn them away, but it doesn't mean we have resources to meaningfully assist those people. Overwhelmed by a barrage of genuine, legitimate suffering, but for which we often have no meaningful solutions, we begin to wall ourselves off to those we serve. As compassion science indicates, acknowledgment of that suffering combined with our very limited capacity to help can cause us suffering as well, regardless of whether or not we consciously acknowledge it as such. So we tell ourselves, "they made their choices," we learn to harden our responses, or distance ourselves from the very things which so many of us live but a step away from ourselves.

Compassion science is now confirming how such distancing is detrimental not only to the well being of the patient but the provider themselves. Dominic identifies a spectrum of clinician emotional involvement in patients, identifying a sweet spot between total disconnect and over-involvement, which appears to be protective against burn-out and emotional stress in caregiving. Dominic calls for a culture shift, not just in individual practitioners, but in broader organizations themselves, as necessary to remedy this. I've found that by deepening my well of resilience and calming my internal world neurofeedback has furthered my capacity for compassion and connection with my patients in the Emergency Department, thereby increasing my satisfaction in my role there. The most rewarding aspects of my work are so much more than getting the right life-saving drug at the right time or patching together broken parts, but the privilege of sharing what may be some of the most vulnerable and frightening moments in a person’s life.

How incredible would it be if the populations that we in Emergency Medicine see but are often unable to help were able to access this powerful treatment modality, as the Neurofeedback Advocacy Project envisions?

How does this relate to the Othmer method and neurofeedback?

An essential element of the Othmer method is the role of the clinician. Beyond the need for personalization of protocols and interventions and the need respond to changes in the course of treatment, it emphasizes the presence of a caring, empathetic presence throughout an individual's healing. This component can easily be neglected in our fast-paced health care environments or in one-size-fits-all home training methods, but its importance and significance cannot be overstated.

It is truly a source of joy to be able to play this role in supporting another’s healing and growth.

This was a phenomenal annual Summit! It's an exciting time to be a part of this rapidly progressing field. Whether new technologies and methods or the expansion of neurofeedback to marginalized populations most in need of (and often the least able to access) our methods, this Summit left me hopeful regarding our field's growing contribution to healing and recovery, and in nurturing fulfilling lives for those we are lucky enough to accompany on this path.