The Low Energy Neurofeedback System (LENS): Theory, Background, and Introduction

Len Ochs, PhD

SUMMARY. This article presents the concepts, operations, and history of the Low Energy Neurofeedback System (LENS) approach as they are now known and as it has evolved over the past 16 years. The conceptual bases and practical operating principles as described are quite differ- ent from those in traditional neurofeedback. The LENS, as a behavioral neurofeedback applica- tion, often provides the same qualitative outcome as that in traditional neurofeedback, with reduced treatment time. doi:10.1300/J184v10n02_02 [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: Web- site: © 2006 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Neurofeedback, EEG biofeedback, biofeedback, neurotherapy, LENS, low energy neurofeedback system, EEG, brain stimulation

INTRODUCTION Evolution of LENS and Relevant Concepts

The Low Energy Neurofeedback System The major implication of this paper is that (LENS) is an EEG biofeedback system used in both the physically and psychologically trau- clinical applications and research in the treat- matized brain has demonstrated vastly greater ment of central nervous system functioning. It capacity for recovery than has previously been is unique in the field of neurofeedback in that appreciated. Secondarily, the LENS appears to instead of only displaying information on a help the traumatized person achieve clearly in- computer screen to assist the patient in condi- creased performance in relatively short periods tioninghealthierbrainwavepatterns,theLENS of time, with a quite non-invasive, low technol- uses weak electromagnetic signals as a carrier ogy procedure. On the other hand, other kinds wave for the feedback to assist in reorganizing of EEG biofeedback may be just as effective as brain physiology. The following describes the the LENS under some conditions. Although no rationalefortheLENSsystem,aswellassubse- claims are being made here that the LENS is quent discoveries. Also presented are some better than any other form of treatment, it is, suggestions for future research and practical however quite different from other neuro- application of the LENS technology. feedback modalities, as well as from other

Len Ochs is affiliated with Ochs Labs, Sebastopol, CA. Address correspondence to: Len Ochs, 8151 Elphick Lane, Sebastopol, CA 94596 (E-mail: lochs@earthlink. net). [Haworth co-indexing entry note]: “The Low Energy Neurofeedback System (LENS): Theory, Background, and Introduction.” Ochs, Len. Co-published simultaneously in Journal of Neurotherapy (The Haworth Medical Press, an imprint of The Haworth Press, Inc.) Vol. 10, No. 2/3, 2006, pp. 5-39; and: LENS: The Low Energy Neurofeedback System (ed: D. Corydon Hammond) The Haworth Medical Press, an imprint of The Haworth Press, Inc., 2006, pp. 5-39. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. - 5:00 p.m. (EST). E-mail address: [email protected]]. Available online at http://jn.haworthpress.com © 2006 by The Haworth Press, Inc. All rights reserved. doi:10.1300/J184v10n02_02 5 6 LENS: THE LOW ENERGY NEUROFEEDBACK SYSTEM neurostimulation techniques such as audio/vi- the predominant energy of the EEG, in which sual stimulation and particularly transcranial lies the dominant frequency. The dominant fre- magnetic stimulation, where the intensities quencyis thefrequencyatthatmomentata spot used are thousands of times stronger than on the person’s head which is stronger than any LENS uses. Lastly, there appears to be no basic other frequency. With that as a hypothesis, it scienceyetrevealedtohelpunderstandthephe- seemed appropriate to suggest that a treatment nomena described here, thus creating a new approach might be to tie the stimulation fre- areaofinquiryintheneuro-behavioralsciences. quencytothedominant,orpeak,EEGfrequency. Thefollowingsectionispresentedforhistor- Since from 1 in 4,000 children and about 1 in ical purposes to outline the order and context in 20,000 adults are estimated to be photosensi- which the significant components in the devel- tive (Quirk et al., 1995), and thus vulnerable to opment of the LENS were observed including: experiencing a seizure with photic stimulation, a description of the instrumentation; the means this could occasionally present severe prob- of measuring and controlling the feedback in- lems. Photo-hypersensitivity refers to the reac- tensity; the problems and benefits observed in tivity to light that is strong enough to elicit con- the development of this system; and treatment vulsions–whether the person is epileptic or not. management problems and how they evolved, If, for instance, the person were to have a sei- particularly with regard to different popula- zure–whether from epilepsy or the stimulation tions. evoking a photohypersensitive seizure–the fre- History. During the summer of 1990, Harold quency of that seizure would become the domi- L. Russell, PhD of Galveston, Texas, tele- nantfrequency.Inotherwords,ifthestimulation phoned Len Ochs, PhD in Concord, California. frequency equaled the dominant frequency, the He asked Ochs to develop a device which pro- stimulationwouldfurtherstimulateanypre-ex- vided fixed-frequency photic stimulation. His isting seizure. Fortunately this could be dealt interest was based upon the work of Marion Di- with easily by programming the software to amond,PhD(1988)inherworkontheeffectsof prevent the software from ever being equal to environmental stimulation on cortical com- the dominant frequency. An example of how to plexity in rats. Russell (Carter & Russell, 1981, do this was to define the stimulation frequency 1984, 1993) had experimented with exposing as some percentage of the dominant frequency. school children with performance problems Itwas anticipatedthatthisstrategywouldbegin and high inter-test variability to daily, 20-min- to displace and disperse some of the energy of ute repeated cycles of 10 Hz, for one minute, any seizure activity to other non-seizure brain- then 18 Hz for a minute, for six weeks. Russell wave frequencies. Fortunately, setting the stim- used bright red flashing lights inside impro- ulation frequency to some percentage greater vised welder’s goggles. His idea was to use the than 100% of the dominant EEG might satisfy flashing lights to stimulate the brains of the those in the neurofeedback community (Lubar, school children. 1985) advocating for increasing EEG frequen- It was my impression that any simple fixed- cies for enhanced cognitive control. Further, frequency stimulation would be an inefficient using a percentage less than 100% of the domi- way to provide the desired stimulation to alter nant frequency might satisfy those advocating brainwave activity. The degree to which a per- decreasing EEG frequencies for enhancing son’s EEG (electroencephalographic activity) emotional integrity and decreasing chemical is influenced by external (e.g., photic) stimula- dependence (Peniston & Kulkosky, 1991). tion depends on many factors, including their Russell agreed to pay for the programming of dominant brainwave frequency from moment- the original software according to this concep- to-moment, and the intensity and frequency of tion.Hence,thesoftware was programmedinto the stimulus used. Although the intensity and devices that would be called electroencephal- frequency of a fixed stimulation frequency ographic entrainment feedback (EEF). could influence the EEG, another factor that The original EEF software was designed to might have bearing on entrainability of the link together the J&J I-330 EEG module 201 EEG is the size of the difference, at any mo- (and afterward the J&J I-400), and the Synetic ment, between the stimulation frequency and Systems Synergizer (Seattle, Washington), a Len Ochs 7 light-and-sound generationdevicewhich fit in- more rapidly in the replacement unit for the side an IBM-clone computer through software I-330 C2. We had to introduce a time lag be- know as BOS, a DOS-based interpreted plat- tween the occurrence of any EEG event and the form developed by William Stuart, of Bain- feedback tied to its occurrence. The critical bridge Island, Washington. As originally con- learning from this experiment was that techni- ceived, thesoftwarewas to allow theSynergizer cal precision does not necessarily lead to clini- card to set the flash frequency of the lights in- cal efficacy. The current use of the LENS em- side some welder-type goggles, and to continu- ploys extremely weak intensities of feedback ouslyresettheirspeedasthedominantEEGfre- anddoesinvolvethepatient’sownEEGdriving quency of the person’s brain changed on a thefeedback,butdoesnotinvolveanyconscious moment-to-moment basis. The software also participation or even positive intention. set and reset the frequency of binaural auditory tones coming through ear phones, in the same Differences Between the LENS way it set the light frequency. The feedback and Traditional Neurofeedback might pulsate at 105% of the dominant fre- quency during one 10-second period, then 95% The following statements reflect the current of the dominant frequency during the next, and statusoftheEEGbiofeedbackfieldatthistime. alternate between the two conditions. The soft- ware never let the flash frequency equal the 1. The field of EEG biofeedback or neuro- dominant frequency. feedback is relatively new. There are rel- The initial system, funded by Russell’s AVS atively few studies with chronic condi- group, involved many features that have now tions, controlled or otherwise, that offer been discarded, while the current software now understandings of what will work, under includes many features that were not yet con- what conditions, to what extent, and with ceived. Discarded features central to the origi- whattime,physical,andmonetarycosts. nal conception were: the necessary use of visi- 2. Each of the various kinds of EEG bio- ble light feedback, the use of sound feedback, feedback involves its own set of rituals, theuseof fixedtimelimitsfor changingoffsets, with relatively little analysis of what al- the use of the same size offsets from the domi- ternatives might be used. nantfrequency,thenecessaryuseofoffsets,the 3. None of the forms of EEG biofeedback necessary use of alternating offsets, and the appear to have ever cured a progressive necessary use of offsets of arbitrary sizes. condition such as Alzheimer’s, multiple New features include the generation of the sclerosis, Parkinsonism, or dementia. feedback signal from within the EEG (the elec- However, they probably have increased troencephalograph) device itself, as well as the functioning and quality of life for many ability to control the feedback, using the J&J people in the earliest stages of any of I-330 C2 family of EEGs. The use of the J&J thesediseases,perhapsforatleastseveral I-330 C2 permitted the portable use of the sys- years and when applied properly. tem from a suitable desktop or notebook 4. Each form of EEG biofeedback seems to computer. complement and enhance the effects of It is important to note that there were many all of the others, as well as other forms of technical inadequacies of the first generation therapy. EEF system. Yet the results from this techni- 5. Based on interviews with former patients cally“inadequate”systemappearedtobebetter of nearly each form of EEG biofeedback, than any other treatment for closed-head each approach seems roughly compara- trauma. Interestingly, the results were not quite ble in effects, no matter how inexpensive as good when the more technically sophisti- or how expensive the treatment was, with cated second generation system was intro- some specific differences from treat- duced. This led those involved to try to dupli- ment-to-treatment to be defined with cate some of the inadequacies of the original later research. system. The major required change was to re- 6. Nearly all forms of EEG biofeedback tard the feedback, which was produced much work with easy cases and become more 8 LENS: THE LOW ENERGY NEUROFEEDBACK SYSTEM

cumbersome and delicate (with satisfac- stimulus is offset from the dominant EEG fre- tory outcomes) with complex cases, but quency to the patient’s reactivity, and closely appear nevertheless at their clinical effi- related to their vitality and degree of symptom cacy limit with the current technologies suppression. because of technical problems of manag- The LENS may be used as a tool to use in a ing coherence and other issues. treatment context with other EEG biofeedback 7. Finally, while each form of EEG biofeed- orneurofeedbackmodalitiesorasasinglesolu- back may appear scientific, the applica- tion to several problems. The LENS is being tion of each is probably more of a studied as a potential treatment of adults and physiologically-based art than science at children with CNS-mediated disorders in the this stage of the game. Even so, all of the USA, Australia, Canada, Germany and Mex- forms of EEG biofeedback seem to offer ico. It has been shown to produce rapid resolu- provocative and interesting hope for tion of difficult cognitive, mood, anxiety, clar- many who have been declared to be at the end of their options for improvement. ity, energy, physical movement and pain problems when compared with more tradi- The LENS differs from traditional EEG bio- tional forms of psychotherapy or medication feedback in that the LENS does not require the treatment.No efficacycomparisonsareoffered person to understand the meaning of, or labori- in relation to other forms of EEG biofeedback, ouslyattendforahalfhourtothefeedbackinor- or neurofeedback, since no comparative studies der to influence their brainwave activity and have been undertaken. benefit from the treatment. No attentional, dis- It is importantto note that the LENS does not crimination, prolonged stillness, or learning require the patient’s attention, focus, orienting demands are placed on the individual. In addi- toward feedback, home practice of self-regula- tion, the LENS uses a somewhat different con- tion techniques, or, indeed, any conscious par- ceptual approach to selection of which EEG ticipation in any self-regulatory activity (ex- sites to train. Traditional neurofeedback uses cept showing up and not removing the protocols based on either symptoms or on ab- electrodes from the head). The LENS appears normalities found in QEEG brain maps, with to operate on the basis of the biophysical prop- both approaches often utilizing only a limited ertiesofthefeedbacksignalsthemselves,onthe number of electrode sites for training. In con- tissues of the brain and related structures such trast, the LENS treatment is also guided by a asthevascularsystem.Inadditiontonotrequir- topographicEEG map,butonewhichprioritizes ing attention, focus, and attention toward feed- electrodesiteabnormalitiesbased on both EEG back, the LENS approach, tolerates gross amplitude and EEG variability. Unlike other movement and artifact without reducing effi- neurofeedback approaches, LENS treatment is cacy, or inappropriately rewarding maladaptive then administered at all 19 (or more) electrode behavior or physiological reactions. sites. Treatment consists of the delivery of a Feedbacksignalsofdifferentintensities,fre- tiny electromagnetic field carrying the feed- quencies, and wave form shapes appear to have back signal down the electrode wires for only one second at each of the chosen electrode sites different clinical effects. There are only the be- during every session. This input stimulation ginnings of sophisticated research into the varies from moment-to-moment, updated 16 properties of the OchsLabs system. It is still too times per second based on the dominant EEG early to draw any conclusions about the mecha- frequencychanges.Generallybetweenoneand nisms or properties of the systems used. The seven of the ordinary electrode sites are treated LENS can be used with extremely hyperactive during each session. patients and still maintain apparent efficacy. Finally, central to the application of LENS The LENS feedback exposures can be as short treatment is the concept of patient reactivity/ as one second per session for the appropriate sensitivityandtheresponseofthepatient’s ner- patient and still have apparent efficacy, which vous system. We adapt the duration of stimula- means that it demands relatively little coopera- tion,sessionfrequency,anddegreetowhichthe tion from the patient. Len Ochs 9

Benefits of LENS myalgia, and explosive autism, the success rate has reached over 80%. The more the patient’s The LENS appears to: (a) increase ease of history has been complicated by lifelong prob- functioning;(b) increase clarityof functioning; lems preceded by an intergenerational history (c) reduce the amplitude and variability (in- of problems in parents and grandparents, and cluding spiking) of the EEG activity across the when the patient’s problems have been numer- 1-40 Hz spectrum at each of the standard 10-20 ous and complex, it is much more complicated electrode sites when there is some amplitude to judge the efficacy of this approach; thus, the andvariabilitytostartwith;(d)increasetheam- “success rate” may drop precipitously. plitude and variabilityof the EEG when there is Side effects from the use of the LENS have too little variability sometimes to show the full been similar to those that result from any extentofthepathology,beforeitdiminishesthe change in situation (biofeedback, meditation, amplitude and variability; (e) reduce or alleviate moving a household, body work; i.e., disrup- central nervous system problems as described tive upon over stimulation) but transient and below; (f) allow new information (psychother- not involving any organ system damage or dys- apy, counseling, education, relationship-spe- function. The three most common side effects cific information from a spouse or co-worker, whentherehasbeenoverstimulationhavebeen etc.) to be recognized, taken in, used and re- fatigue, anxiety or hyperactivity, and no im- membered much more easily without interfer- provement in clinical symptoms. All of these ence or defensiveness. situations resolved themselves, usually within The LENS appears to shorten the treatment a few hours or days, by temporary withdrawal times required for the improvementof some se- from treatment and decreased exposure to rious cognitive, mood, energy, pain, and motor feedback. controlimpairments.TheLENSalsoappearsto Optimal Kinds of Cases. The LENS appears offer patients previously considered untreat- to have its best effects for: (a) mild traumatic ableanewoptionforremediationofsymptoms. brain injury if the person was formerly high Based on experience with both EEG biofeed- functioning; (b) the diffuse pain of fibromy- back research, and the use of pulsating lights algia and its associated fatigue and mental fog- and other energy fields in neurological exami- giness, but leaving untouched any underlying nations to study seizure activity, it is hypothe- myofascial pain for conventional treatment; sized that the mechanism of action involves al- and (c) explosive behavior, regardless of its tering the person’s maladaptive inhibitory cause, whether it is in an adult, a non-autistic neurotransmitter activity. The LENS has been child, or an autistic child. declared a “minimal-risk” device by several More Difficult But Positive Cases. The LENS independent human subject review boards has been shown in uncontrolled, anecdotal ex- (IRBs). perience, to produce less consistent, less reli- Improved functioning has been observed for able, and more difficult-to-obtain–but neverthe- those patients receiving the LENS treatment less still positive, results in cases of: (a) autism: whohadplateauedintheirrecoveryfrommotor more sociability, greater affection, verbal skill, paralysis and CNS-mediated cognitive and more grace and balance; (b) trauma from child- mood impairment after mechanical and psy- hood sexual or physical abuse, work, and war chological trauma. Reported improvements stress; (c) clinicaldepression secondary to anx- have persisted since data collection was begun iety disorder; (d) bipolar disorder secondary to in 1994 (and even earlier with antecedent anxiety disorder; (e) alcohol and cocaine ad- systems). diction: less craving, less defensiveness and Improvement has been reported in most of depression; (f) childhood schizophrenia and the subjects (N = 2500, in approximately Asperger’s syndrome: less fear, greater inde- 90,000 sessions as of 2005) who have been pendence and achievement; less compliance treated with the LENS. When the subjects for (not to be equated with oppositional), greater this research and treatment have fallen within independence,lessfearfulnessandanxiety,and the areas that are known to be particularly treat- more self-direction; (g) some types of chronic able such as mild traumatic brain injury, fibro- fatigue syndrome: greater energy and clarity; 10 LENS: THE LOW ENERGY NEUROFEEDBACK SYSTEM

(h)attention-deficitdisorders;(i)physicalhead While these effects are clear to the profession- injury symptoms from moderate to severe. In als who use the LENS, it remains the job for the latter case positive outcomes were found in controlled, double-blind, randomized studies clinical research that was conducted under Of- to demonstratethese effects to others. It also re- fice of Alternative Medicine-National Insti- mains for basic research to describe the mecha- tutes of Health Grant to determine the efficacy nisms that allow these effects to take place, as of the LENS on reducing cognitive deficits well as the variables which minimize and among people suffering from closed head inju- ries (Schoenberger, Shiflett, Esty, Ochs, & maximize the effects. Matheis, 2001). The current the LENS process involves: It is important to note that while clinical im- provement has been noted in all of the condi- 1. Assessing the sensitivity, reactivity, fra- tions cited above, the course of treatment with gility, hardiness, and prior history of the LENS alone was often inelegant, cumber- problematic symptoms that are no longer some, involving trial and error and clinical present. This is done with a simple ques- skill. The reasons for the complexity of treat- tionnaire found in the Appendix B. mentarereasonablywellunderstood.However 2. Anassessmentlookingatthefollowing: we still have not evolved treatment protocols to a. The relative proportion of different solve the treatment complexity problems and frequency band activity within the make them as apparentlysuccessful and easy in raw EEG. If there is more delta ampli- thediscreteconditionsthatwerenotedaboveas tude, then it is likely there may be an areas of application where the best effects have acquired problem such as head injury. been achieved. If alphais predominantthentheremay be more of a pervasive developmental issue such as ADD with genetic influ- METHODOLOGY AND DISCUSSION ences. b. The clinical reaction to a standard The LENS Treatment Process dose of stimulation feedback. There is no substitute to putting a toe in the wa- The LENS works by continuously monitor- ter, experiencing some of the feed- ingEEGactivityandthenusesthesereadingsto back, andthenlookingatwhathappens determine the frequency of very small electro- over the next twenty-four hours. magnetic fields that are “offset” several cycles Then, despite theoretical ideas about persecond(hertz)fasterthanthepatient’sdom- the appropriateness of the dose, the inant brainwave. This feedback stimulus input person may find that the dose in that isthendelivereddownelectrodewiresatgener- administration is just right, or too ally seven or fewer electrode sites in the course much. Signs that it may be too much of a treatment session, for only one second per are that the person is profoundly fa- site. This input is much weaker than what the tigued, or restless and overly ener- brain receives from holding a cell phone to gized, both of which usually disappear one’s ear. within twenty-four hours. How can non-perceivable feedback to the c. Assessmentofwhichoffsetfrequency brain that is of such minimal magnitude still be from the dominant frequency is most influential? While the mechanism of how this efficacious at which to present stimu- happens remains to be determined, it is clear lation. fromboththedocumentedeffectsofthesefeed- d. If the prospective client appears rea- back signals on the amplitudes and variability sonably sturdy, an offset evaluation is of brainwaves, that (a) this feedback is being performed to assess these factors. processed by the brain, and (b) the impact of e. If the person appears from the evalua- thesesignals,whenusedcorrectly,canimprove tion to be vulnerable to over stimula- people’s functioning in their own experience tion, a much shorter and less intense and theexperienceof others who observe them. evaluation is done, giving all the in- Len Ochs 11

formation above except a suggestion present,insomepatientswhohavehadseizures about which offset to use. The offset inthepastbutwheretheyarenotcurrentlypres- frequency is then presumed to be 20 ent, they have been known to reappear for a Hz faster than the dominantfrequency brief period of time. Hence the pre-treatment forthemostsensitive-reactiveclients. interview is useful in anticipating a complex or problematic treatment. This allows both the 3. Mapping. Construction of a topographic therapist and client a chance to review whether map of EEG activity, without necessarily the re-experiencing of seizures (or other prob- providing any feedback, of amplitudes lems such as anger outbursts, tics, inconti- across the 1-30 Hz spectrum across the nence,ormigraines)issomethingthattheclient entire scalp. Electrode site selection in will tolerate. treatment is determined by ranking EEG Reaction Patterns Observed During Treat- activity from least to highest in each EEG ment. An interesting complexity appears when band, in microvolts amplitude and stan- symptoms become worse during LENS treat- dard deviationsum for eachsensor site.A ment. Many of these patterns we are about to single channel EEG is used, monitoring discuss have been considered “side effects.” In each of the standard 10-20 electrode sites fact, they may better be considered as stages in in sequence. While amplitude and stan- treatment that are sometimes experienced in dard deviation measurements appear to gaining mastery over symptoms. These prob- be reliable enough and reasonably corre- lems are of five types. lated with quantitative EEG (QEEG) patterns, measuring correlations among First,vasculartypereactionpatterns:whether multiple sites is not currently possible talking about vascular (throbbing pain), peri- since the sites are measured in sequence, ods of anger, rage, sadness, obstinacy, explo- and not simultaneously. siveness, bed wetting (below age six), tics, or 4. Treatment providing the feedback in the convulsions, these episodes become sharper, dose and at the offset frequency as sug- butshorterinduration,andfartherapartintime. gested by the above evaluations, in a se- As they become increasingly brief, they are ex- quence prescribed by the map. perienced increasinglyas a fraction of their for- 5. Monitoring the subjective reactions of mer intensity, and may not show at all on the the patient through self report and the re- surface, in the behavior of the patient. It is often ports of others when available, and the said that as treatment proceeds, the reactions objective changes in the EEG (obtained pass faster and have less of a grip on the patient. by periodic remapping) to continue or Finally, their intensity diminishes. modify the dosage and site sequences In the end, patients often reflect that circum- used in the treatment. stances that would have evoked a symptom no 6. Involving other tactics to evaluate in- longer do. They are completely inarticulate as ferred EEG comodulation (correlated ac- to what process is happening inside themselves tivity in amplitudeand/or standard devia- tobringaboutthischange.However,theyretro- tion)across thescalp.Comodulationmay spectivelydonoticethedifferenceandattribute be responsible for treatment complexity, it to the LENS treatment. as well as the duration and stubbornness It has been mentioned that the results of their condition. brought about from the LENS may be either the result of placebo or hypnosis. Yet many of the Most recipients of the LENS input stimula- recipients of the LENS had numerous previous tion will have no immediate reaction to the use treatments, and many novel ones. Each of these of this procedure. Some will have relatively individuals had the opportunity to have hypno- short courses of treatment. However, some of sis or placebo work during prior treatment ex- those with latent emotional conflicts and perience. If placebo and hypnosis, either di- intergenerational genetic physiological prob- rectly or indirectly, have not occurred in the lems will require longer treatment processes. past for these patients, it would seem implausi- Even though this type of stimulation has ble that the LENS would finally bring them the been found to reduce seizures when they are placebo results that prior attempts had failed to 12 LENS: THE LOW ENERGY NEUROFEEDBACK SYSTEM bring. Theyare involvedin receivingtheLENS and relax. When this reaction occurs, the intense treatment because previous placebos have not pain experienced during spasticity reduction worked. Therefore, it is assumed that placebo typically lasts from three to five days. It is often plays very little part in their current improve- accompanied by the sequence of uncontrolled ment. muscle contractions, jumping limbs, increases in sensation, and then the return of partial or Treatment with LENS complete movements. Note: This kind of pain can be reduced or often completely eliminated It is most important to understand that just with the use of a modality called photonic stim- starting the use of the LENS does not bring an ulation. immediate halt to patient symptoms; in fact, The third type of reaction is the surprise they may appear worse for a while. While these re-appearance of convulsive or tic-related phe- symptoms are ones the patient has had in vary- nomena that may have long since disappeared. ing degrees previously and are not caused by This is actually considered a sub-type of the the treatment, the change in the way the prob- first class of vascular reactions. These prob- lem manifests itself and is now experienced is lems re-appear after their long absence, to the directly attributable to the LENS treatment. near-horror and fright of the parents, care giv- The increasing sharpness of these problems, ers, and referral sources. Bed wetting, tics, sim- predictable or not, is always of concern for pa- ple or generalized convulsions, and emotional tients, care givers, and referral sources alike. It explosions, may suddenly appear for a few is also important to know that we expect the weeks before they subside and make way for therapist to predict and discuss the anticipated higher functioning levels not seen before. changes in how the problems may shift in their Anticonvulsantmedicationhasbeenextremely manifestations in order to give the patient pre- useful as an adjunct when the severity of the be- dictabilityand confidence in both the treatment havior warrants. The advent of more functional process and therapist. A therapist who does not behavior after the cessation of these symptoms predictthissequenceisdeprivinghimorherself has led to the speculation that the untoward be- oftheconfidenceofthepatient.Further,itisim- havior had been inhibited by the same mecha- portant to be considerate of the patient, allow- nisms thatkept the patientlimitedin other ways inghimorhertochoosenottobecomeinvolved of functioning. When the behavior has reap- in this approach if the possible consequences peared, and then once again remitted, it may be are not appealing. that the brain found another mechanism to con- Second, muscular type reactions: muscle trol the aberrant behavior while permitting the contraction pain in non-spastic muscles, and flourishing of adaptive and useful skills. Nev- the terrible muscle contraction pain in those ertheless, everyone involved needs to provide with spastic muscles, may occur in head injury, support,care,andsafetyinthepresenceofdiffi- strokepatients,andwheneverthereisparalysis. cult behavior. To date no one has been caught Muscle contraction pain of a non-spastic type foreverinatrapofregressive,destructive,orbi- simply diminishes with time, in contrast to the zarre behavior, although the behavior has on vascular pattern cited above. There is also pain rare occasion been extreme and frightening to from the LENS-evoked spasticity reduction nearly everybody involved in the very unusual thatisseeninconditionssuchasTBIandstroke. instances when it has occurred. This has been in nearly every instance almost The fourth type of reaction has been the intolerable to the patient and those close to the emergenceof adaptivebut unvalued, or frankly patient. Special care needs to be taken with pa- disvalued, behavior in the patient. Examples of tients who are hypersensitive to pain medica- this have been: less fearfulness and greater in- tion and are, therefore, unable to use it to allevi- dependence of autistic and Asperger’s chil- ate this temporary pain. This intense pain dren, which may be outside of the parents and appears to be a function of the decreased brac- schools value systems (i.e., children who ex- ingofferedbynon-spasticmusclefibers,which press anger at siblings when anger is felt to be permits the spastic muscles to contract with in- “bad,” children and young adults that become creasing vigor before they too begin to soften moreinterestedintheirown andothers’sexual- Len Ochs 13 ity, children who become more independent, suffered, but she declined. He was asked to be adventurous, and exploratory, and, therefore, supportiveofherinheranger,consideringwhat begin to take risks which frighten parents; chil- she lived with for years. Over the next few days dren who voice their own points of view and under her relentless attacks he regressed to his needs may be contrary to what the parents see former state. At the end of treatment they left: appropriate; and children who no longer feel him in pain, his three-dimensional vision again compelled to sit still within the constraints of a lost, and drinking again, and with her as his rigid school system). All of these behaviors long-suffering care taker. This illustrates the have occurred as greater functioning, greater importance sometimes of working with the en- independence, and greater self-control became tire social system, rather than narrowly focus- more prominent. Some parents who have ing on a particular physiological problem in blanched at the changes in their children will isolation. It also illustrates the inadvisability of usually keep struggling to be supportive, while working under fixed time limits. other parents have done little but glory at the A fifth type of reaction is the recapitulation changes in their children. It is advised to avoid of previous symptoms, from the most recent to treatment if, in discussions with the patient or the oldest. Often patients will re-experience family,theyareunwillingtorisktheoccurrence first, recent symptoms, and in the last stages of of such behavior. In the approximately two treatment, re-experience symptoms that they dozen autistic or Pervasive Developmental experienced as infants. They will often wonder DisorderchildrenIhavetreatedwiththeLENS, why,forinstance,astherapyisabouttobecom- only one has failed to respond at all, for pleted, they are experiencing abdominal pain. unknown reasons, while all the rest have When questioned, they can often remember delightedtheirparentswiththeirachievements. having such pain or remembering stories of Another example of a positive reaction with how they had such pain in childhood. These are untoward effect occurred in the treatment of an transient reactions and often pass in a week or older man who had experienced a traumatic so. brain injury more than a dozen years before he Diagnoses. The LENS is a non-specific entered treatment. As someone from out of treatment approach; that is, treatment planning town, he had allocated only a week for treat- is not guided by diagnosis, which is seen by ment before he needed to resume his travels. some as a weakness of LENS treatment. Part of One of the major problems he had experienced the problem with treating many conditions that sincehisheadinjurywasrage,whichshowedit- have been resistant to amelioration within con- self in verbal and physical violence. Other ventional medical and psychological circles is problems were chronic angina for which he threefold. First, there is much misdiagnosis. tookmedication(andfrequentdrinksofalcohol Many of the diagnoses that are proffered are from a flask always with him), and a loss of catch basins and euphemisms, and are substi- three-dimensional vision. After his first treat- tutes for professional ignorance. The problems ment he was freed from heart pain and an- of diagnoses of many of these conditions, such nounced that he no longer needed to drink to as Asperger’s, Parkinsonian variants, tuberous control the pain. Within 45 minutes after the sclerosis, attention-deficit disorder, fibromy- treatment he announced that his three-dimen- algia, bipolar disorder, etc., are often beyond sional vision had returned. At first he walked the discriminative skills of many practitioners uncertainly as if he was wearing his first pair of and the most fashionable diagnoses are often trifocals. The next day his wife accompanied used. Second, many conditions are beyond the him to therapy. He was visibly distressed. She discriminative capabilities of the diagnostic had announced to him that she had suffered his systems themselves, or their existence as inde- abuse long enough and that she was no longer pendent entities is controversial and at the going to take it–since she no longer had to. She whim of what the medical-insurance system continued to hurl invectives at him and he ac- will accept given political (turf) and economic cusedheroftryingtodestroythegoodeffectsof considerations. Third, the diagnostic name it- the treatment.She was offered treatmentfor the self can say little about the treatment when the post-traumatic stress which she most certainly individual differences among people with the 14 LENS: THE LOW ENERGY NEUROFEEDBACK SYSTEM same diagnosis can demand major differences grammed and set; a selection is made on the de- in treatment strategies. vice’s front panel, or programmed to change in Considerable heterogeneity of brainwave a way unrelated to the person’s actual brain ac- patterns has been found within the broadly de- tivity. Thus the input stimulation is not individ- fined diagnostic categories. Replacing treat- ualized to the unique and ever changing ment guided by diagnosis, LENS treatment is brainwave patterns. predicated on the fact that many psychological Fourth, the LENS uses electromagnetic en- and medical conditions involve various types ergyfieldsinfinitesimalinstrength,whileother of abnormal EEG activity (Hughes & John, devices use much stronger signals. The LENS 1999). LENS treatment is designed to reduce may, despite the weakness of its energy fields, abnormalbrainwave patterns and is individual- obtain its power through sustained resonance ized based on the distinctive amplitude and between the person’s EEG activity and the pul- variability patterns found through topographic sation frequency of the field returned, which brain mapping, as well as the patient’s subjec- maybe receivedby thebrainbecauseof itsabil- tive reactions to treatment. Finally, it may be ity to detect patterns. While much of this is said, considering the vast responsibilitiesof the speculation, it has been observed that when the brain, that the brain, itself, is a non-specific or- resonant pattern of the feedback is broken gan. This means that injuries to it may take this (whenthelinkbetweenthedominantfrequency shape or that, without any specific predictable and the feedback is broken) there are no longer outcomes,associatedwithaparticularlocation, any beneficial effects from our stimulation. size, depth, or type of injury. Although some Thatis,whenthefeedbackresonanceisbroken, outcomesarecertaininagrosssense,thepartic- bothnegativeaswellaspositiveeffectscanstill ularities of any injury are always some unique appear, but, depending on the frequencies, in- combination for the individual involved. The tensities, and doses involved, they appear with practicesofcliniciansusingtheLENSareoften much less consistency and predictability. filled with almost nothing but patients who are Anoteontheuseofthewordresonance:Res- exceptions to medicaland psychologicalpredic- onance tends to be used in two ways in current tions of “no recovery possible.” medicalparlance.InthephraseMagneticReso- Differences between the LENS and Conven- nance Imaging, resonance is achieved by the tional Photic Stimulation Systems. The LENS power of the magnetic field on the electrons differs from currently available consumer (or adding energy to the electrons to move them professional) AVS devices in the following into higher order shells. Persinger (1974), ways. Most of these devices are considered en- Sandyk (1994), Rife (1953) and others use the trainmentdevices.Theylockthebrainwaveac- word resonance to refer to a state in which a tivity on the frequency used to stimulate. The stimulus intensity or frequency matches a LENS disrupts the way the brain locks onto fre- known or theorized fixed frequency in the quencies, or clusters of frequencies, hopefully body. The word “resonance” is used here in a helping to free the brain from rigid patterns so new way in the history of science: that of the thatitcanhavetheflexibilitytopursuethetasks changes in the stimulus continuously matching that it and the person need it to pursue. Second, changes in a physical variable (such as brain most of the AVS devices use light frequencies. waves or heart rate). In this sense the resonance The LENS uses various frequencies of electro- is a dynamic one, rather than a static one. magnetic energy instead of photic stimulation, Hence, this is a feedback system. However, un- with is accompanying small risks of evoking a like other biofeedback systems that feed back seizure. Light has not been use in most of our informational stimuli, the LENS feeds back applications for the past seven years. physical stimuli, the physical properties of Third, with the LENS, the person’s EEG ac- which affects physiological changes. tivitycontrolsthefrequencyofthepulsationsin The LENS Equipment Requirements. LENS the energy field. This customizes the pulse rate requires a brain wave measurement device; a to the person’s own activity as it continuously computer fitted with an EEG device that con- changes. The stimulation frequency of con- trols the emitted energy-field; software to link sumer sound and light systems is both pre-pro- the brainwaves with the stimulation radio fre- Len Ochs 15 quency (RF) carrier wave and a system that can • thinking in terms of under- and over- deliver levels of energy field feedback at low arousal phenomena but precise levels of intensity. These levels are • maximizing the amplitudes of some EEG lower in intensity than the electrical field that frequencies while inhibiting the ampli- surrounds digital wrist watches. tudes of other frequencies in relation to In order to provide feedback, the individual particular problems is first fitted with the EEG electrodes. In our • locating electrode sites for training previous systems, the patient used to wear • using topographicmaps to providea treat- glasses with components mounted on surface ment plan of the lenses, or sat with the glasses mounted on • resisting micromanaging the inhibit and a stand at some distance in front him or her. The reinforcement settings of the EEG in bio- operator monitors the computer screen and feedback treatment controls and intensity and duration of feedback • deferringtosubjectivereports,ratherthan so the person remains comfortable. The contin- quantitative measures of the EEG as ei- ued presence of the equipment operator is nec- ther signs of pathology or progress. essary to watch the quality of the electrode con- tact,andtodeterminethatthepatientpreferably Therewerenocluesintheliteratureforguid- remains motionless for a few seconds before ance in the preliminary clinical work with the the stimulation is given. LENS or its predecessors, so the initial treat- While the final determination on how the ment guidelines became: Try it on oneself first, LENS works must rest with a great deal of re- alwaysstrivetomaintainpatient’scomfort,and cut back if symptoms reflecting over stimula- search, we believe that the LENS achieves its tionfollowatreatment–evenifthepost-session results by breaking up the rigid, self-protective discomfort had nothing to do with the treat- way the brain has of responding after psycho- ment. logical(stress)orphysicaltraumaandrestoring EEG Site Location. Between 1990 and 1995 the inhibitory capacity of the cortex.. There is the predecessors to the LENS most frequently evidence that during any kind of trauma the found success with consistent use of FPZ as the brain protects itself from seizures and over- electrode site for the active electrode (with the loads by releasing neurochemicals that protect reference on an ear lobe, and ground at the back it from these dangers. Unfortunately, the pro- of the neck). Depression was typically dis- tectionalsoreducesfunctionalcapacity,notun- patchedinsix sessions. Thisraisedthequestion like the effect of swelling on joint articulation. about the efficacy of choosing any specific site Long after the trauma is over and the danger is over another at the start of the treatment: one past, the ‘protection’ may still remain. The per- site appeared to be as good as the next when us- son can, therefore, become stuck in various ing the precursors to the LENS in the early kinds of disabilities due to the reduced neural 1990s. An observation that had no meaning at flexibility of functioning. the time was that delta, primarily, and theta, Technology Development of the LENS. secondarily, were predominant in the frontal There was something wrong with nearly all the EEG amplitude of nearly all of the patients. In LENS design elements and procedures from 1995 Ochs wrote a short piece titled Many the point of view of those experienced in tradi- Kinds of Depression Are Curable to spread the tional EEG recording and EEG neurofeedback. good news. This is acutely evident in relation to: No clear differences in either the way the original light feedback was tolerated or the • the established practical concerns regard- speed of treatment were found when monitor- ingshapingreinforcementcontingencies ing the EEG at the sites that were historically • using visual and/or auditory, or radio fre- popularwithtraditionalEEGbiofeedbackther- quency feedback carriers for the feedback apists: occipital locations of O1 and O2, the top of information to the brain of the scalp at CZ, or the site of insult or its con- • managing high and low frequency EEG tra-coupdamage.ThecentralforeheadsiteFPZ activity was tried because the side effects were mini- 16 LENS: THE LOW ENERGY NEUROFEEDBACK SYSTEM mal, results were as good here as at the other an unsystematic way the electrode was moved sites, and because it was easier to avoid elec- throughout the standard 10-20 sites. At times trode paste in the hair of the patients during the there was a remarkable response from sites no- initialrapport-buildingsession. Thefrontalsite body had talked about; at other times there was was therefore selected as the point for use at the no response from any sites addressed. commencement of treatment. The frontal site To better understand what was happening, has indeed always been more prone to artifact less expensively than with quantitative EEG from eye movement, jaw movement, facial ex- brain mapping, single-channel data was col- pression changes, swallowing, etc. However, lected from all the sites, one site at a time, and since the artifact itself decreased as a function this data was fed into Microsoft Excel’s surface of treatmentprogression, it seemed plausibleto map. An exampleof the resultingmap is seen in accept the artifact decrease as one of the global Figure 1, which displays an example of a case indicators of improvement. This suggested the with high delta amplitudes throughout the right selection of FPZ as an initial starting site. As a hemisphere. consequence, the artifact component of the A histogram (bar graph) was then created, EEG records was and still is kept, rather than one bar per electrode site. At first the data made discarded, as is done in conventional neuro- nosensewhenitwassimplyorganizedintheor- feedback treatment. der in which the data was collected. But, when Another consideration was related to the rank-ordered from lowest-to-highest ampli- work of Davidson and Hydahl (1996) and their tudesforeachEEGband,itthenappearedthatit observationthattheleftfrontalareawaslessac- was a picture of the functionality of the sites– tivated in depression. Moving the electrode lo- that is, the lower the measured amplitude in cated at the front-center of the forehead to the microvolts, the more the cortex appeared to be left produced, again, no improvement in pa- inhibiting the subcortical activity from reach- tientswithdepressivefeatures.Thisisnottosay ing the cortex so that it could be measured. The that lateralizing the traditional EEG biofeed- greater the inhibitory activity exerted by the back might not make a difference in the suc- cortex, the higher the level of functioning. Fig- cessful treatment of depression. Using the LENS approach, however, the clinical efficacy ure2illustratesthedatafromFigure1inthisbar of changing the electrode placement to the left graph format, displaying the amplitudes and frontal area and the practicality of using FPZ standard deviations of the data, rank ordering overrodealltheotherconsiderationspertaining the electrode sites. The rank ordering became to the selection and use of the more standard the clue about which sites to select for treat- electrode sites. ment, and in which sequence. A consistent, or- Interestingly, in 1995, with no changes in ganized way to select active electrode sites equipmentorsoftware,theselectionofFPZasa mightbe to proceedfrom those with lowest am- siteno longerseemedefficacious.In contrastto plitudes to those with the highest amplitudes. the delta and theta amplitudes that were pre- This might not have been the only way to select dominant in the frontal EEGs of previous pa- sites, or necessarily the best way, but at least it tients, alpha now seemed more predominant in was empirical and not based on static experience the frontal EEGs of those entering treatment. or research based on aggregated data. Instead of rapid resolution of depression, irrita- Therationaleforthiswasthatinstartingwith bility and moodiness often resulted from treat- the better-functioning (lower amplitude) sites ment. In contrast to the rapid resolution of de- and proceeding to lower functioning (higher pression that had previously been seen, and in amplitude) sites, the better functioning sites contrast to any certainty about how to treat that might respond more rapidly and stimulate the depression and about placing the active elec- more poorly functioning sites. By the time the trodeatFPZ,therewasnolongeranyideaabout siteswiththeloweramplitudeswereaddressed, where to place the electrode, either on the basis the higher amplitudes at other sites would have of the literature or my own experience. This in- already decreased, lessening the work that cluded experimenting with placing the active wouldneedtobedone.Thisturnedouttobetrue electrode at C3, C4, OZ, O1, O2, and at CZ. In whentheamplitudeswereamongthehighest. Len Ochs 17

FIGURE 1. LENS Map

Delta Means by Amplitude

15-17 13-15 Right 11-13 9-11 7-9 5-7 3-5 1-3

Posterior

FIGURE 2. Delta Means and Standard Deviations by Sensor Site

50

45

40

35

30

25

Amplitude 20

15

10

5

0 FP1 T3 C3 FZ F3 01 T5 F7 CZ PZ 02 P3 T4 P4 C4 F8 F4 FP2 T6

Site

Delta Mean Delta SD

The Need for Mapping. A person’s perfor- necessary to move away from the forehead site mance can be impaired, even though the EEG and move the electrode to other sites around the activityat any one site is low and smooth across scalp without the historical biases about elec- thespectrum.Itisnecessarytoseewhatkindsof trode placement. The next stage was to look at amplitudes are at other sites. It thus became each site for evidences of focal high amplitude 18 LENS: THE LOW ENERGY NEUROFEEDBACK SYSTEM andhighvariabilityactivity,andprovidestimu- could not verbalize the quality they didn’t like, lation at that site until the EEG activity was low but reacted physically, or just said that they and stable. The activity at each site was as- didn’t like it. Others invoked a variety of verbal sessed and worked with until ideally no high (> and non-verbal startle responses. One individ- 2.0 μV) amplitude/variability activity was ob- ual became explosive and frightened staff served. members in other rooms with the volume of his Italsobecameclearthattheinformationused outbursts. to make the surface maps could be used to gen- In each of these cases, the therapist’s re- erate treatment plans, specifying the order of sponse was to change the direction of the lead- sitestobeusedintreatment.Thisgivesthether- ing frequency or offset. If the lights were set to apist an empirical basis for starting treatment flash at +5 Hz faster than the dominant fre- where the cortex is most functional, and work- quency, the polarity was changed to let them ing toward points of less functionality, thereby flash at Ϫ5 Hz (more slowly than the dominant building upon the patient’s strengths in devel- frequency). In nearly all instances of this prob- oping their discriminatory capability. lem, changing the polarity of the leading fre- The Beginnings of Mapping. Beginning in quency, or offset, decreased the immediate un- 1996, performing inexpensive surface EEG comfortable reactions. Further polarity changes maps that showed the relative amplitude and at the occurrence of these reactions continued variability of the EEG at each electrode site (as to manage and minimize the reactions. Chang- seen in Figure 1) provided an unexpected treat- ing the polarity of the feedback offset was the ment benefit, in addition to providing graphic preferred way to minimize these reactions be- pre and post measures. These maps were ac- cause the software permitted fast and easy quiredby measuringtheactivityateachsitein a changes of polarity. While a brightness control specified sequence, using a single-channel was available, it involved more time and com- EEG instrument. Maps constructed in this way plex manipulation of the controls. donotallowaccuratemeasurementsoftherela- Alternating polarities had so much impact in tionships among sites. The unexpected benefit the early 1990s that the old procedure, then of thesequentialmapsis thattheydo providean called EEF (EEG Entrainment Feedback) was explicit plan of which sites to treat, and in what modified to allow for specific sequences of sequence. Beginning at the sites of the lowest pre-programmedpolarityalternation.Alternat- activity, and working toward sites with the ingpolaritieswasoneoftheimportantelements highest activity, is the same as working from of the patent. The alternating polarities seemed wherethecortexismostfunctionaltowhereitis to decreasethe hyper reactivityof patients.One least functional. of the major differences between the ap- Hyper-Reactivity: Alternating the Polarity proachesintheearly1990sandnowisthatthere of the Leading Frequency (Offset). One of the are few, if any, immediate reactions of discom- first clear reactions encountered in the use of fort for which the alternating polarities would precursors to the current LENS was hyper reac- be needed. In contrast to the measures taken tivity to the visual feedback stimuli. Initial during those early days, today’s strategies tend work began in 1990 with two individuals with to be much more subtle. post-traumatic stress symptoms (PTSD). Nei- What’s in a Name? The LENS process was ther had been successfully treated with stan- originally called EEG Entrainment Feedback dard psychotherapy, relaxation training, or (EEF), despite the urging of others, who per- with biofeedback (including EEG biofeed- sistedintheargumentthatthesystemseemedto back). One of the individuals reacted strongly be freeing the brain from being locked up (en- tothevisualandauditoryfeedback.Shejumped training on itself). The ultimate inspiration for in her seat, and complained of a headache and changing the name from EEF to EDF (EEG backache. Disentrainment Feedback) was found in Chaos: Later, patients complained about some as- Making of a Science, by Gleick (1988, p. 293). pects of the feedback. Some expressed dislike Gleick used the word “disentrainment,” refer- ofthe“flicker”ofthelights.Otherscomplained ring to the unlocking of a system. This enabled about the color; others, the brightness. Some the precursors to LENS to be seen as disen- Len Ochs 19 trainment systems. The name of the process symptoms, using light stimulation devices was changed from EEF to EDF. After that, the available to consumers showed that they en- name changed to Neurophotic Stimulation, to joyed lights at full brightness. At that time, the EEG-Driven Stimulation, and finally, to the operating presumption was the brighter the Flexyx Neurofeedback System (FNS), terms lights, the better the results. Once the idea was that were less theoretically encumbered and grasped that red lights were both too irritating more descriptive names. and too bright, the use of red lights gave way to It should be emphasized that the treatment the more tolerable green ones. The desensitiza- effects observed were not due to training to in- tion process was developed gradually, slowly creasesomecomponentsoftheEEGbandorin- introducing the patients to increased light hibit others, even though the observable brightness. This desensitization process al- changes in the EEG activityacross the 0 - 40 Hz lowed them to maintain their comfort with band appeared comparable to those obtained lights of increasing brightness. After desensi- from the traditional EEG biofeedback training. tizing them to the green lights, it was again pos- Experienced EEG clinicians and researchers sible to use the glasses with the red light-emit- have been observed attempting to truncate the ting diodes (LEDs), and eventually with EEGbandactivityatoneendor theother,or ata continued desensitization, at full brightness in selected frequency, either based on some theo- that generation of hardware and software, as reticalbasis,orpreviousexperience.EarlyEEF well. work was also done this way (i.e., attempting to While the green LEDs, with their decreased “speed” the EEG by using positive leading fre- brightness, worked for those who had per- quencies). The system is now run by primarily formed well prior to their head injuries, they controlling dosage: the duration of the session were inadequate to meet the sensitivities of a and the intensity of the feedback signal. second group of patients with heterogeneous It is important to understand that in no way, diagnoses prior to their exposure to the LENS, as some people think, is the EEG ever “sped” or including diagnoses of borderline and various “slowed,” with the LENS. Under most condi- anxiety problems. These patients required tions the amplitude and standard deviation greenLEDswithtissuepaperfoldedoverthem, across the spectrum is reduced. Furthermore, or with masking from manila folder material, this effect is accomplished from the biophysi- andevenpartialcoveringfromvinylblackelec- cal effects of the feedback signal and its reso- trical tape. Only with such masking could these nance with the EEG of the person, rather than ultra-hypersensitive patients be comfortable, from any reinforcement to elaborate or inhibit even with the lights at their lowest intensities. the activity in certain bands or frequencies. This ultra-hypersensitivity was observed even Subjects’ sensitivity to the brightness of the without light. old visual feedback was recognized while As clinical work continued with both head working with Dr. Herbert Gross’ patients, a injury and non-head injury patients, it soon neuropsychiatrist who specialized in head in- became apparent that greater incidence of be- jury. The patients’ brightness sensitivity be- havioral and physical pathology seemed to cor- came apparent when the brightness of the lights respond with increasingly prominent hyper- could not be sufficiently reduced to permit pa- sensitivity to the visual feedback. In other tient comfort. Although good results had been words, patients with depression, energy prob- achieved using red LEDs, among the most irri- lems, irritability, explosiveness, violence, dis- tating colors one could employ, the protocol tractibility, short-term memory problems, dif- waschangedtousegreenLEDswhenitwasob- ficulty in organization, problems following served that the red LEDs annoyed the head in- conversation, and difficulty reading, may have jured population. This change worked well for all had irritable brains as evidenced by rela- thegroupofheadinjuredpatientswhohadbeen tively large amplitude, low frequency activity, functioning extremely well prior to their head withrelativelyhighstandarddeviations.Thisis injuries. anentirelytestablehypothesis,andtotheextent Hypersensitivity. An informal survey of itisdeterminedtobetrue,isaratherremarkable “normal” people, in contrast to those with statement about human functioning and func- 20 LENS: THE LOW ENERGY NEUROFEEDBACK SYSTEM tional impairment. In fact, diagnosis of hyper- therapist using the old I-400 system might use sensitivity might include much lower level only green lights, masked glasses, and never light than is usually used in the detection of raise the brightness above “1” in brightness and photo-hypersensitivity, with more sensitive 1% in duty cycle during the entire course of behavioral observations than frank seizure or treatment. Work has been progressing since EEG spike and wave prominence. This discus- 1998 using the profoundly low intensity feed- sion of photohypersensitivity refers to pre- back, and while the electromagnetic stimuli are 1999 work with the antecedents to current not visible, this still produces changes in the LENS work. EEG when the EEG is observed after the feed- Historical note: The following discussion back stimulus has been given. was applicable when LENS feedback was ad- Here is an example of how the need for de- ministered for periods of up to 20 minutes per sensitizationwasdiscoveredintheoriginalsys- session. Since 1999, the feedback exposure is tems. Ordinarily, the brightness of the lights typically as brief as one second per electrode was varied frequently during a treatment ses- site, with an average of four sites worked with sion and over the course of treatment. Just dis- duringanysession,whichtypicallyoccursonce cussing the brightness of the lights, and none of aweek.Thusdesensitizationpre-1999wasquite the other treatment variables such as electrode different from that which has occurred since site, for example, an intensity of “1” may have thenthroughthepresent.Itisplacedhere,rather been used during the first six sessions. As the thaninanappendix,togivethereaderasenseof sessions progressed, symptom intensity de- theflowoftheLENSdevelopment,aswellasto creased. In the seventh through the tenth ses- contrast the current practice. sion, intensity was increased to a brightness of Desensitization. Desensitizationused tobea “2.” In the eleventh through the thirteenth ses- cornerstoneofourearlyworklinkingEEGwith sions the brightness was increased to “4.” In photic stimulation.There is no question that for other words, not only was the brightness in- some patients, desensitization of some type creasing, but the pace of increase was coming maystillbeimportantwhentheyappeartohave more and more rapidly as time progressed. Per- energy and sudden-onset problems. However, haps in the fourteenth session the brightness as the mix of patient diagnoses and presenting was increased three times, from “6” to “18” to problems became more complex, and more pa- “36.” The brightness ratings are in quotation tients showed fatigue as a major complaint, de- marks because they are arbitrary in value. No sensitization began to play a smaller part. At luminosity values were ever formally evalu- this present time, because the feedback signals, ated for the numerals used to indicate bright- even though not visible, evoke EEG changes ness. Yet the brightness values were linearly much more rapidly than they used to be, it is of- controlled by current flow; so that relative to ten not possible to expose patients for a brief each number, a brightness of “2” is half that of enough time to the signals to start the desensiti- “4.” Whereas initially going from “1” to “2” zationprocess.Thedifferencebetweenandone would have been uncomfortable for this hypo- and two seconds can be profound to a very sen- thetical patient, in the end leaping from “18” to sitive patient. “36” would have been quite comfortable. In the Withthemorerecent,briefertreatmentdura- meantime, symptom intensities across the tions characteristic of the LENS, there does not entire range would commonly have dropped seemtobeenoughtimeorreasontoconductde- precipitously. sensitizationthewayweusedtodoit.However, During one session, by accidentally using desensitization can still be accomplished through new software with a hidden defect, a protocol theuseoftheoffsetsettings.Heredityalsoplays was loaded that held the light frequency low a part. When parents had a history of mood or and constant during the feedback periods, re- energy problems, problems were chronic, or vealing EEG activity which was initially seen slowinonset,desensitizationbecamelesshelp- when the patient’s complaints were prominent. ful and gave way to the application of feedback A young woman in her thirties, otherwise high with only the gentlest touch, the briefest and functioning, complained of a post-puberty his- least frequent application. For this group, the tory of premenstrual fatigue, irritability, racing Len Ochs 21 thoughts and sleeping problems, leaving her quency at which we provide the stimulation are with severely restricted professional job func- all ways to increase the power of the feedback tioning fifty per cent of the time each month. stimulation and treatment dose. She left her job to avoid the continuous, ex- Desensitization and Level of Functioning. treme effort needed to fulfill her professional Another past observation,equallytestable,was duties two weeks of each month. For two men- thatthelevelofsomepatients’functioningcon- strual cycles after desensitization had been sistently increased as their comfort increased completed, her sleep problems ceased, as did with progressively brighter light feedback. her racing thoughts, irritability, and diurnal fa- This means that depression, irritability, reac- tigue. During her third premenstrual cycle, tions to bright or interrupted light, impatience however, her fatigue returned and was ever and explosiveness lifted, non-focal pain de- present. Examination of her EEG spectrum re- creased, violence ceased, distractibility, anxi- corded under moderately bright light showed ety reactions, organization, problems follow- relativelylargeamountsofhighamplitude,low ing conversation, and difficulty reading were frequency activity when the brightness was all markedly ameliorated–without any claim consistentacrossallfourfeedbackperiods.The that they were totally erased. The problems session was constructed using a one-minute, were improved enough that friends, spouses, no-feedbackpre-baseline,four 18-second peri- distant relatives, employers, and last, the pa- ods of feedback (during which feedback stimu- tients, themselves, were delighted and sur- lationmayormaynotbegiven),andaone-min- prisedattheimprovement.Academicgradeim- ute no-feedback post-baseline, all repeated 17 provements were noticed as well. These times. All recording was done eyes closed. The observations were echoed by physicians and electrodesitewasCz,withaleft-earreference. neuroscientists not involved in this treatment The high amplitude, low frequency activity (although no attempt was made to keep them was not present when the light brightness was blind to who was involved in the treatment). In reduced to 10% during the first and third retrospect, it may have been that the enhanced 18-second feedback-possible periods. The in- ability of the cortex to inhibit electrophysi- formal hypothesis that alternating brightness ological reactions from the increased bright- would have no effect in accelerating change in ness of the feedback stimulation was the sign EEG amplitudes seemed patently wrong. Al- that the cortex had repaired itself. In contrast, if ternating flashes between the left and right eye someone’s brain had become re-traumatized, it succeeded in lowering the amplitude of the was very difficult to re-desensitize the person EEG more than when we lowered the bright- for unknown reasons. ness of the feedback light stimulation, perhaps We learned that it was not always possible to because there was only half as much stimula- desensitizesomeone.Desensitizationwasindi- tion being given. cated especially when a person was energetic, At the current time, the intensity of the feed- and less useful when the person often felt fa- back signals (which are no longer photic stimu- tigued. It is also possible that new techniques lation) are so weak, their effects so strong, and will permitsuccessful partialdesensitizationof the treatment times necessarily so short, that is- those people otherwise unable to tolerate the sues of desensitizationhave takena back seat to standard process. dosage. The exposures are now so short that it PaceofDesensitization.Therewas acharac- hasbeendifficulttoseehowtomanageadesen- teristic desensitization curve, even though the sitizationprogram.Ithasnotbeenuntilrecently entire desensitization process could take any- that six years of experience with the low power where from five minutes to five months. The electromagnetic carrier wave feedback has al- initial pace of desensitization was always rela- lowed us to understand how to begin to inte- tively slow, relative to its much higher rate of grate our prior experience with lights into cur- change at the end of the treatment process. The rent LENS work. Currently, increasing the desensitization curve appeared to have been an number of electrode sites that we work with accelerating curvilinear function in which the during each session, decreasing the interval be- slope of the rate of change of the light intensity tween sessions, and decreasing the offset fre- was often imperceptible initially, but its rate of 22 LENS: THE LOW ENERGY NEUROFEEDBACK SYSTEM change was geometric at the end. Put another seek full intensity, partly for aesthetic reasons, way, the initial brightness changes may be 1% and partly, upon questioning, because they at a time, but increase in units to 20% at a clip think that brighter is inherently better and that occurred in the final minutes of the process. all treatments inherently involve the struggle to We found that during a long desensitization tolerate discomfort–which they feel they should process, lasting months, the final 80% of the do if they really want to improve. brightness changes may occur in one treatment However, it is probably not legitimate to session. This pattern was consistent across all equate the stimulation from fixed or ramping patients whenever the need for desensitization frequencies of the audio-visual stimulation was present. The desensitization curve was (AVS) systems with that of the LENS and its reminiscent of the logarithmic curves in the predecessors. The AVS systems’ stimulation Weber-Fechner law of perception, in which intensity may be seen as ambient light, or brightness increases logarithmically with the “noise” stimulation, not nearly so tightly re- absolutevalueof thebrightness of thestimulus. lated to the living, dynamic EEG. This may be The observation of the adaptation of the brain supported by the observation that AVS users may cast light on the flip side of the brightness need to use much brighter light intensities than estimation: that is, on the place that the rate of what was ever used in the LENS predecessors. reconnectivity of the cortex plays as it regains Itseems tomethattheinherentresonanceof the competence. LENS-type stimulation allows the LENS stim- Decreasing Light Intensity After Desensiti- ulation to remain at very low intensity and still zation. One patient, early in the exploration of have dramatic physiological and behavioral ef- the LENS, suffered workplace abuse trauma fects.Itisapparentlynotthecasethatbrighteris and re-experienced symptoms formerly mini- always better, nor that tolerating increased dis- mizedbytheLENS.Sheremainedfreefromher comfort will accelerate recovery. In fact, when former dislike of the brighter lights, however. comfort is used as a cue for intensity settings, There was the implication that she had not re- and the feedback LENS intensity is minimized, lapsed into photosensitivity and, therefore, did improvements in energy, mood, and cognitive not need a lowering of the light intensity. Con- integrity are often noted. This has been our tinued treatment with the LENS at high levels experience with our older light stimulation of intensity, however, did not lead to a decrease systemandwiththenewerversionsofLENS. in her new trauma symptoms, which showed When the LENS treatment is completed, the themselves prominently as depression, anxi- cortex may be in a very different state than it ety, and anger. High amplitude and variability was at the start of treatment. Whether or not pa- in low EEG frequency bands again showed it- tients had been desensitized, the patients were, self in her record. It was hypothesized that the in fact, more receptive to and discriminating intensitymight be re-stimulatingher pathology aboutexternalstimuli,butnothypersensitiveor (i.e., perpetuating her re-traumatization). As a hyper-reactive. Their responses were more test of this hypothesis the intensity of the lights flexibleandappropriatetotheleveloffeedback was drastically lowered and almost immedi- present in the moment. In view of the greater ately she reported a decrease in her depression. sensitivity, is it any wonder, then, that high in- During this same period, Russell was using the tensity, strobic feedback would act as if it was LENS with a few patientswho had experienced overloading the cortex of these individuals and cerebral vascular accidents. He applied this in a sense replicating the internally-produced change in approach to the therapy he was doing pathology that once was there? Decreasing the and found that motoric and cognitive rehabili- feedback stimulation after the desensitization tation progress was stimulated and accelerated process might be more effective because the by lowering the intensity of the lights. brain has, through the course of treatment, Interestingly,manyusersofpre-programmed become more responsive to feedback. frequency, commercially-available sound and The pathology of some brains may require a light systems run their systems at full intensity. major change or reorganization at the start of The colors and patterns are visually interesting therapy, and trying to work locally at the site of at full intensity. The patients most often will damage may not be useful if the person is very Len Ochs 23 energetic. Once the brain has been globally re- treatment. Yet delta, theta, and alpha activity organized by the desensitization process and may not be the entire problem because activity the patient is comfortable at full intensity, con- in these bands is commonly present when tinued feedback at the peak level of intensity higher functions are not engaged. may now overwhelm the cortex. This repre- Occasional high amplitude activity in low sentsamethodbywhichonemaysafelyexperi- frequencies (which is often seen as pathologi- ment with replicating trauma and recovery cal) may be present in individuals who not only from trauma. After desensitization, by lower- function well, but who are exceptionally cre- ing the intensity of the feedback, we may be ative. These exceptions are not understood. moreabletolocallystimulatethecortex–some- Thus one needs to be careful about glibly thing that we were unable to do at the start of pathologizing all EEG slowing, just as spinal treatment.Atthisstageintreatment,behavioral anomalies were overly pathologized early in changes may be more closely tied to what is the history of MRI.1 commonly thought of as local cortical neuro- In individuals having problems, however, psychological functions. In other words, local the presence of activity in these slower fre- site feedbackand localsite recovery may be ad- quency bands may translate into sections of the dressable only after global feedback and reor- cortex, by their impaired inhibitory function- ganization has taken place. This might also ing, permit the delta, theta, and alpha activity to mean that following LENS treatment, further show themselves and be recorded at the scalp. localized treatment with traditional neuro- Thatis, these areas of the cortexno longer func- feedback might have more affect than it would tion properly, and do not inhibit the low fre- have had previously. quency activity. It is the poor functioning of the In an interesting side note, a highly func- cortex that fails to inhibit the physiology that tional scientist was put on an older LENS sys- gives rise to the excessive EEG activity, which tem,andnotonlyfeltnothing,butwasunableto allowsthehighamplitudeEEGactivitytobere- be overdosed by extremely high levels of corded; that is the problem–not the activity it- brightness.Itmaybethatoneofthedefiningas- self. The task, then, of the treatment is to bring pects of functioning well is that the brain is able back the functioning of these impaired sections to flexibly respond to high stimulation input, at of the cortex. The sign that these areas are re- least in relatively short exposures. turning to normal function is twofold. First, the Cortical Permeability. In the early days of EEG amplitudes become inhibited and lower. using EEG-driven feedback, it was noticed that Second, functional improvement results. The the EEGs of high-functioning individuals were objectistoreducethepermeabilityofthecortex rather quiet, low amplitude recordings. In con- so that it regains its inhibitory and integrative trast, the EEGs of dysfunctional and physically functions. This, in turn, permits higher function- traumatized individuals were typically filled ing to return. with high-amplitude, low frequency band ac- Decreases in the Amplitude and Variability tivity. Recollect that the cortex is one of the last ofLowFrequencyActivity.Therewere,andare, organs to develop both ontogenetically and decreasesinEEGamplitudeandvariabilitythat phylogenetically. The ostensive purpose of the accompany LENS feedback if the initial ampli- cortex is to provide the integration and inhibi- tudesarehighenough.Decreasesappearacross tion of subcortical brain center activity, which the entire 1-30 Hz spectrum, but especially in resultsintheappearanceofourhigherfunction- the low frequency 1-12 Hz EEG range, includ- ing capabilities. ing that activity which is clearly and even prob- The appearance of this EEG slowing that is ably attributable to artifact. seen as high amplitude delta, theta, and alpha These decreases are sensitive to the level of activity, has been, in the view of traditional intensity of the feedback. There is a window at EEG and neurofeedback circles, considered a any time in which the feedback intensity will problem. Activity in these frequency bands is decrease the amplitude and variability. If the often inhibited during neurofeedback. Discus- intensity is too low or too high–a Yerkes- sion of delta, theta, and alpha excesses was and Dodgson curve–amplitude reduction will not is often prominent in exchanges of ideas about occur. In fact, if the intensity is (resonant and) 24 LENS: THE LOW ENERGY NEUROFEEDBACK SYSTEM toohigh,theamplitudesmayrise,asmentioned in EEG activity. Ordinarily we have screened above. out those with unusually low amplitude EEG The range of intensity in which the ampli- activity(lessthan1μV)becausetheyhavebeen tudesdropwillvarywiththephaseoftreatment. particularly refractory to our methods.2 For those with the energy and stamina, higher One more type of EEG activity is important levelsoffeedbackwilldecreaseamplitudesand to mention: normal or high amplitude EEG ac- standard deviations early in the treatment. As tivity, accompanied by standard deviations of treatment progresses and the patient becomes below 1. The EEGs of those with these abnor- more sensitive and less hyper reactive, the in- mally smooth EEG recordings are often seen to tensity will need to be reduced in order to con- show dramatic rises in elevation following tinue to reduce the levels of activity. Reducing LENS treatment, often accompanied by in- the level of intensity is necessary to reduce the creases in functioning. This appears to be a due amplitude and standard deviation, and to to a treatment-induced lifting of suppression of increase the functioning the patients. the EEG. The increase in functioning may be These evoked (by feedback) amplitude and due to the freeing of energy bound by the variability reductions may reflect, on a neur- neurochemistry of suppression. Those with onal level, organic events which parallel the re- problems functioning speak of the enormous covery of energy, mood, and cognitive capaci- effortittakestothink,organize,plan–inshortto ties. These alterations in functional reactivity compensate for both their symptoms and due to appeartorepresentthequietingofthebrain,and the suppressive effects of neurochemical pro- the containing of emotional and attentional im- tection. pulses in a state of ambient readiness. The re- Diagnostic Considerations. The LENS has covery of skill was apparent in both those who been successfully and reliably used with au- had clear mechanical and physical trauma, and tism, Asperger’s syndrome, post-concussive those who suffered lifelong energy, emotional, disorders, depressive disorders, post-traumatic anxiety, and cognitive functional problems. stress disorders, attention deficit disorder with This lowering of the EEG’s amplitude using and without hyperactivity, chronic fatigue syn- the LENS stands in contrast to other attempts to drome, fibromyalgia, and spastic paresis fol- increase amplitudes of the same EEG bands us- lowing cerebral vascular accidents. The im- ing traditional EEG biofeedback. Whether it is provements have been significant enough to the feedback itself, the desensitization process, have made noticeabledifferences in the lives of alternate offset polarity, or some other element patients, both at home and at work. It may be of the procedure that automatically affects the more useful to think about the above disorders amplitude and variability decrease, the key as variations of a single disorder (cortical per- point is that these decreases occur in the LENS meability or insufficiency), in which the cortex process without the treatment directing this, is inadequate to the task of inhibiting the which is so characteristic of traditional EEG bioelectrical activity. biofeedback. The implication is that some ele- The Potential Central Locus of “Periph- ment(s) in the LENS treatment process triggers eral” Problems. Most pathology is treated pe- a self-organizing/corrective mechanism in the ripherally, even when there are known central brain which optimizes functioning, and which nervous system mechanisms. To date, periph- requires no conscious involvement of the eral treatment has been attempted though exer- individual receiving the feedback. cise, diet, etc., except where frank neuroleptic In addition to the frequent appearances of or neurosurgical intervention has been in- EEG slowing, we encounter infrequent in- volved. For instance, fibromyalgia is typically stances of patients with EEG suppression, or seen as a muscle problem, since the tender very low amplitude and low standard deviation points have been muscular, even though the EEG activity. These have been most frequently balance problems, mental fog, and fatigue are seen in chronic fatigue and fibromyalgia, and typically seen as central problems. usually interlaced with depression. Depres- The LENS provides a behavioral way to di- sion, seen apartfrom occurrencesof chronicfa- rectly influence central mechanisms versus the tigue, is most often accompanied by elevation indirect means used in traditional EEG feed- Len Ochs 25 back. With the LENS, the signals picked up well–until the programmer was persuaded to from the brain are ultimately fed back into the supply an option for permitting the lights to tissues of the brain. The information the LENS strobe180degreesoutofphase.Additionally,it feeds back to the brain has no graphic or sym- was suggested that alternating hemispheres bolic meaning, as does the information from were stimulated with the left-right alternating traditional EEG neurofeedback, so there is feedback. This strategy seemed to inhibit high nothing to interpret. However, while the infor- voltage activity relatively rapidly across the mation is fed back directly into the brain, it is spectrum. The use of alternating light feedback also not targeted (i.e., certain frequencies are was especially useful later in treatment. Using not associated with particular functions) and alternating feedback as the first element of there is no selectivity of where the feedback treatment prevented treatment from having the signals go in the brain. carry-over between sessions that it did when it It is true, however, that only one site at any was used later in treatment, wherein it appears one time establishes the resonance source for to amplify treatment effects. The transfer of the feedback and that is the site of the active learning value from alteration of phase later in electrode. So while the feedback is believed to treatment may correspond developmentally permeate all of the brain tissues and is non-spe- with the acquisition of stereoptic vision. cific in that sense, it remains resonant only with Initially, it looked as if the work with alter- the site of the active electrode, the site whose nating sides flashing might be an example, sub- dominant frequency is generating the basis for ject to experimental verification, of the power the feedback signal (feedback frequency = of accidental digressions from pre-planned de- dominant frequency + offset). signs. Initially it looked as if the left-right alter- The extent of the promise of this approach nating stimulation was extremely significant in can only be imagined. Emerging theories of a number of ways. However, years later, the brain function, specifically with regard to the questionchangedastowhetherthiswasjustan- self-organizingcapabilityofthebrain,willfind other way of reducing the intensity of stimula- the LENS a significant intervention model for tion, only providing 50% of the intensity at any both clinical treatment and pathology simula- one time. This question could be resolvable tion studies. nowbydoingathoroughanalysisoftheelectro- The Corrected Technical Inadequacy Un- magnetic field emitted by any visual stimula- corrected: Alternating Hemispheric Feedback. tion device so that the concurrent visual and One of the more interesting sides of exploring electromagnetic influences can be understood theLENS has been theextentto which precon- for their individual contribution to any observed ceptions about accuracy have been unneces- phenomena. sarily attached to efficacy. There were clear Consciousness Is Optional. Psychologists inaccuracy problems in our first generation and traditional biofeedback therapists tend to software, causing the left and right lights to hold to the model of treatment as a conscious strobe180degreesoutofphase.Itwas assumed process. Yetanunknown percentof patientsre- that they had been flashing in phase synchrony. ceive therapy that is primarily conversational When the lights flashed at lower frequencies, for long periods of time with minimal concrete however, they were observed to flash together results (even though they may report feeling only inconsistently. The asynchronously flash- better). Non-psychotherapeutic psychiatrists, ing lights were called to the attentionof the pro- on the other hand, tend to see medication as the grammer with the intention of emphasizing primary component in the recovery and symp- how remarkable it was to obtain good results tom alleviation/management process, relegat- with phase dyssynchrony. ing the patient’s conscious participation and As the second generation software was de- learning a secondary, if not functionally irrele- veloped, left-right flash phase synchrony was vant role. initially looked at as an imprecise sloppiness, The LENS appears to offer a behavioral and not included. While the desensitization non-pharmacologic, non-surgical and non-psy- process seemed identical in the second-genera- chotherapeutic way to influence behavior, cog- tion system, the results seemed to hold less nitive function, and feeling states, especially 26 LENS: THE LOW ENERGY NEUROFEEDBACK SYSTEM with regard to symptoms that result from me- state of passive-allowing of experience seems chanicaland/orpsychologicaltrauma.LENS is facilitated by the LENS as it increases the pa- behavioral and not medical because the signals tient’s awareness of being drawn into different are profoundly minimal in intensity. It seems states of consciousness. likely that functioning, and not structure is di- Most of our self-regulatory processes are rectly influenced; the adaptability of the indi- non conscious, and not voluntary. To take on a vidual and subsystems of the individual are in- mission of micromanaging even a significant fluenced, and adaptability is learning. portionofthesenonconsciousprocessesseems Our subjects show significant decreases in to me to significantly reduce one’s available EEG amplitude and standard deviation without conscious resources for tasks usually requiring specific instructions to suppress this activity. large amounts of consciousness: learning new LENS, therefore, complements both pharma- skills, and appreciating and enjoying life. It cologic and psychotherapeutic techniques. seems ideal to me to find ways to maximize our Conscious self-development associated with non conscious skills, so that we can find greater psychotherapycanbevaluable,butcanproceed ease and clarity for our conscious lives. better when the patient’s consciousness is Is the EEG Really Necessary to Drive the clearer and thereby more able to process infor- Feedback? This question is of central impor- mation. tance. If the EEG is unnecessary to enhance the Is It Self-Regulation Even Though It Is Not a clarity and ease of our conscious experience, Conscious, Deliberate Process? The use of the then ways can be found much less expensively LENS has been criticized as inducing passive to efficaciously use the fixed and/or pre-set fre- change in the patient, which has little chance of quency feedback in treatment. promoting either a sense of empowerment or There were several inadvertent triple blind long-term change in the patient’s psychologi- studies conducted during the history of the cal status. It is here hypothesized that the LENS.Tripleblindstudiesareoneswhereeven LENS, instead, shortens treatment by eliminat- an experimenter does not know who gets what ing a major portion of the time-consuming procedures. Not only were the subjects and ma- feedbackprocess,clarifiesthepatient’stenden- chine operators blind to the study, but I knew ciestocontroltheinnerflowofconsciousexpe- only in retrospect exactly what happened. Un- rience, and still permits the chance to desensi- beknownst to me or anybody else, during the tize, drop defenses, and allow neurochemistry use of our earlier light feedback system, it was to return to productive homeostasis. Further, discovered that the EEG had somehow been the EEG disentrainment supports, but does not disconnected from the lights and that the flash force, the patient to experience unfamiliar rate had remained at 4 Hz regardless of the in- states of consciousness that enhance the strument readings to the contrary. After some chancesof recognizingthesestateswithfurther investigation it became clear that there was a treatment. While the person receiving the bug in the program, installed by accident by the LENS treatment may feel as if they are “not do- programmer after he “upgraded” the software. ing anything” and are not involved in a con- This bug prevented any change in the LENS scious learning process, they have nonetheless programming without effectively disconnect- brought themselves to a setting that is structured ing it from the EEG. toallowtheirbraintoadaptandlearnataneuro- Reviewing the records of the half-dozen pa- logical level. tients seen during the time of the problem, all Traditional neurofeedback therapy undoubt- were found to have regressed during the period edly contributes to the acquisition of self-regu- that the EEG was disconnected from the visual latory skills, as well as operantly conditioning feedback. They were all either more hypersen- healthier brainwave patterns. However, the sitive, or more depressed. Patients were pro- elimination of the lengthy and hard work in vided with enough free treatment to correct the front of a computer screen with LENS treat- problem and they began to progress again. ment still seems to promote acute patient This experience yielded several different awareness of the operation of his or her defen- conclusions.First,itappearsthatusingtheEEG sive structure and process. The acquisition of a to influence the feedback stimulation rate is in- Len Ochs 27 deed necessary and useful. Second, programs advance the welfare of the patient, reduce that were developed that intuitively compen- feedback intensity. sated for the irritating fixed-frequency feed- One of the seductive elements in the use of back by dropping the intensity of the light feed- the LENS is that longer treatment sessions can backthatwas originallyused furtherreinforced appear to work well for some treatmentpopula- the utility of very low intensity levels. Third, tions, such as autisticchildren.This may fit into thedefaultfixedfrequencywas changedfrom4 preconceived ideas that a therapist may have Hz to 20 Hz, to guard against inadvertent delta about the necessity of lengthier sessions. The and theta feedback occurring in the event of a consequence of longer sessions is that while programming error. Last, considering the ac- they work in the short term, on a week-to-week tual effects of over stimulation conditions in basistheycontributetoaslowerpacefortheoc- replicatingpathologicalstates and functioning, currence of improvements. The therapists it may be possible that we can better study cen- maintain that longer sessions do work for this tral nervous system problems by using the population. My response is “But have you tried proper kinds andlevelsof feedbackstimulation briefer . . . ?” to experimentally replicate and even tempo- Duration of Treatment and Factors that De- rarily evoke problems in the brain to more termineTreatmentLength.Thedegreeofsensi- accuratelystudybrainfunctioning,impairment tivity to the LENS feedback, how rapid the rate and recovery. of desensitization, and the pre-existing dura- Frequency of Treatments. The optimal treat- tion of the symptoms and efforts to compensate ment schedule is one that leaves the individual for them are the best determinants of the dura- refreshed. There is no treatment schedule that tion of treatment. For example, the average du- affects everybody the same way. Treatments rationoftreatmentforaformerlyhighfunction- can be effective when delivered on a daily basis ing,multi-taskingpatientwhohadaheadinjury if the patient can tolerate this level of feedback. 2.5 years prior to treatment, is approximately 6 On the other hand, it is possible to leave the pa- sessions with seven or fewer seconds of feed- tient slightly disoriented, fatigued, and with a back during each session. If the person had life- headache from sessions which are too frequent longproblemspriortothetrauma,thetreatment or long in duration, or where the offset is too time ranges from 40 to 70 sessions. If the prob- low. While each patient is different, these fac- lemisseverepost-strokeorspinalcordbruising tors generally underlie clients’ reported post- paresis, the course of treatment may number session discomfort. With such patients, much into the hundreds of sessions. However, for less frequent treatments may be the ones that those with mild to moderate stroke, even with speed the course of treatment the most. Treat- paralysis, shocking relief from paralysis may ment effects do appear to need a criticalmass of be seen in between 6 and 14 sessions. An aver- treatments to overcome the rigidity of the age of three sessions has produced startling re- system that perpetuates the symptom systems sultswithpeoplewhohavebeenoverlystressed and pathology. by work and/or home conditions over several The therapist must be willing to rely on the years. No matterif the patientis suicidal, if they signs of subjective discomfort of the patient, were high functioning before the protracted such as fatigue, rigidity, obsessiveness, and de- stress their treatment has averaged three pression that will not respond, and be willing to sessions. take the risk of giving too little feedback by re- Reducing Treatment Time with Offsets. The ducing the stimulation even to such small antecedentsystems to the LENS were designed amounts that it seems ridiculous (i.e., one sec- with offsets from the start, originally to reduce ond per month) if need be. Thus while the range the chance of elaborating a seizure that might of feedback intensity dose can be enormous havebeentriggeredbytheoriginalbrightflash- (e.g., ranging from three sessions/day to six ing feedback lights. At that time offsets were seconds per week) the primary cues for deci- called “leading frequencies,” because it was sion making all come from the patient to the thought that they led the dominant frequency to therapist who is willing to risk anxiety and the rise or lower. The term “offset” was felt to be appearance of being foolish, but who will, to more descriptive. 28 LENS: THE LOW ENERGY NEUROFEEDBACK SYSTEM

If the feedback signal frequency could never exposed to the first offset. If the amplitudes of equal the peak, or dominant frequency, two ef- delta and alpha are measured after exposure to fects were anticipated. First, the feedback fre- feedback at different offsets from the measure quency might not elaborate seizure activity if dominant frequency, the amplitudes resulting there was a tendency toward seizing. Second, fromeachoffsetcanbeassessed.Theoffsetthat the offset feedback frequency might shift en- produced the lowest band amplitude would be ergy away from the seizure frequency, which the one to select during treatment to achieve would be the peak EEG frequency at that time. maximum decrease in amplitude activity. In drawing energy away from the dominantfre- The problem with providing several differ- quency, the amplitude of the dominant fre- ent offsets in an evaluation, if the offsets are quencywouldbelowered,correspondingtothe presented in the same order, time after time, is effect ordinarily seen. that order effects may be influencing the re- Defining Frequency Offset. The offset eval- sults.Infact,itisprobablytruethatordereffects uation originated from examining patient data influence the observed responses of EEG am- in a typical year-end review. Up to that time we plitudes to the offsets. To randomize the order rotatedthrougheachofthestandardoffsetsof5, of presentation, however, brings its own prob- 10,15,and20Hzateachsitewetreated.During lems. In order to prevent the patient from being one particular year-end review of data it was over stimulated, there is limited opportunity to noticed that patients considered more sensitive present stimulation during any one session. showed lower EEG amplitudes during the peri- Offset evaluations ordinarily provide a signifi- ods when higher offsets (15 or 20 Hz) were cantdoseoffoursecondsofstimulation,andare used; and patients considered more reactive reserved for those patients who are sturdy and less sensitive showed lower EEG ampli- enough to tolerate them. So it seems inadvis- tudes during the periods when the lower offsets able to do a comprehensive presentation of (5 or 10 Hz) were used. If higher functioning stimulation with counterbalanced orders of levels accompanied lower amplitudes, then it presentation and hope to find the “real” or might be wasting time to expose patients to off- “right” offset. Rather, the offset evaluation is sets that didn’t do much to lower their ampli- viewed as a starting place from which to derive tudes. The task then became to design an evalu- the offset. ation that demonstrated the EEG response to Interestingly, it was found that the numbers each of the standard offsets. It initially used a defined as offsets have face validity. A patient baseline of one minute, followed by each of the who is reasonably insensitive and foggy at the offsets, structured as follows: start of the treatment will often have an offset closer to 5 or 10 Hz. If the patient, in later treat- • One second of feedback with an offset of ment, declares that they are not much clearer 5, followedby one minuteof post baseline and better functioning, one would expect that a monitoring repeat offset evaluation will show the offset re- • One second of feedback with an offset of defined at a higher number. The patient, then, 10, followed by one minute of post base- will also seem more discriminant, less foggy, line monitoring and more functional.And in fact,the repeatoff- • One second of feedback with an offset of set evaluation often redefines the offset at 15, followed by one minute of post base- closer to 20. line monitoring Figure 3 displays an example of an offset • One second of feedback with an offset of evaluation. It shows the response of the delta 20, followed by one minute of post base- frequency band amplitude and standard devia- line monitoring tion to one second of feedback stimulation at thefourdifferentoffsetfrequenciesof5,10,15, Toreducethepossibilitythatrelaxingduring and 20 Hz. It can be seen that the most effective the 1-minute baseline would affect the EEG offset frequency for reducing delta was 5 Hz. amplitudes during the stimulation, the baseline Does the EEG Change with LENS Stimula- waslengthenedtosixminutestobesurethatthe tion? There is usually a question in the minds of patienthadstabilizedinrelaxationbeforebeing both the prospective patient as well as the pro- Len Ochs 29

FIGURE 3. Delta Response to Different Offsets cessful than using alpha offset for reducing elevated amplitudes across the frequency spec- 14 trum. In addition, delta offset responses are fa- 12 vored over the reactions to offsets within the 10 theta band because clinical experience has 8 shown that using delta offset data was most ef- 6 fective in reducing both delta and theta activity MicroVolts 4 (in comparison with using theta offsets). 2 0 In Figure 4 it is clear that delta amplitudeand 5101520standard deviation dropped from the baseline following feedback. In contrast to Figure 3, this Offset Frequency figure presents the average of data from all four Mean Standard Deviation of theoffsets. However, italsoshows thatalpha amplitude and standard deviation slightly in- creased. This demonstrates that measurable EEG changes can be documented in a brief ten spective therapist about whether the LENS ac- minute evaluation, with as littleas four seconds tuallychanges the EEG. After all, therapists us- of feedback being given during that time. ing traditional neurofeedback complained that Reducing Treatment Time with Brain Map- they saw relatively little change in the EEGs of ping. Quantitative EEG (QEEG) was discon- someoftheirpatients.WhilechangeintheEEG tinuedintheearly1990s becauseitdidnotoffer itselfmay or may not be correlatedwith achiev- clear and reliable guidance in defining which ing the kind of change that a patient wants, at sites to work with and in what sequence. The least it can serve as encouragement that some- LENS practitioners were seeking treatment thing positive may happen sooner rather than planninganswers about patientswho presented later. The offset evaluation has three purposes. more complex problems. These problems cre- First, as above, it empirically defines an offset. ated uncertainty about how best to bring about Second, it provides a chance for the non-sensi- progress, and especially in choosing electrode tive patient to put a toe in the water and experi- sites. A useful mapping system would graphi- ence a standardized dose of feedback. If the pa- cally specify the order and sequence of sites to tient is known to be very reactive (e.g., to light, treat. The operational definition of an “appro- sound, medications, weather changes, foods, priate” electrode site is one with reduced odors, and other people), one can presume an evoked EEG amplitude within five minutes. offset of 20, and use a less demanding proce- It has been our clinical experience that by dure than the offset evaluationto provide an ex- simplymappingtheamplitudeandstandardde- perience. In either case we use a test dose of viationof the EEG at 19 or more electrodesites, feedbackstimulationtobeassureaswecanthat we can specify electrode site sequencing and the experience leaves the patient comfortable. placement. As a basis for treatment planning Finally, we can compare the baseline and feed- with LENS this seems to speed the rate of EEG backsectionsoftheevaluationtoseeiftheEEG change, wasted treatment time is avoided, and has changed in amplitude and standard devia- discomfort is minimizedby choosing and treat- tion. ingmultipleelectrodesitesduringeachsession, We have two choices in selecting an offset followinganorderfromlowestamplitude/vari- frequency to use in LENS sessions. One choice ability to greatest amplitude/variability. istousethegraphofdeltaresponsestothealter- EEG Coherence Issues. EEG coherence is native offset frequencies. The other choice is to correlated phase activity in a frequency band use the alpha responses. Delta activity has al- between different EEG sites. Variability in the waysseemedmoreresponsivethanalphaactiv- form of standard deviations can also be corre- ity,perhapsbecausealphaactivitymaybemore lated, but is usually not talked about in relation genetically determined. Therefore, we use the to coherence across electrode sites. Interest- graph of delta activity for selecting our offset ingly a major EEG reference makes no mention frequency. This choice has proven more suc- of coherence in its index (Niedermeyer & da 30 LENS: THE LOW ENERGY NEUROFEEDBACK SYSTEM

FIGURE 4. Offset Evaluation: Averaged Frequency and Standard Deviation Changes

Average Amplitude 9.00 8.00 7.00 Average Amplitude Delta 6.00 5.00 Average Amplitude Alpha 4.00

MicroVolts 3.00 2.00 1.00 0.00 PreBase Feedback Condition

Average Standard Deviations (SDs) 9.00 8.00 7.00 Average SDs Delta 6.00 5.00 Average SDs Alpha 4.00

MicroVolts 3.00 2.00 1.00 0.00 PreBase Feedback Condition

Silva, 1999) making the following discussion have correlated amplitudes which may reflect highly speculative. the probability of high coherence. A review of The Clinical Side of Coherence. There are 100 topographic maps, sorted into piles of patients who are easier to treat, and those who low-to-high areas of similar amplitude was are more complex. “Easier” means that ampli- roughly correlated with patients who were, re- tudes reduce and stay low at the sites treated. spectively easy-to-hard to treat. This evaluation The easier patients do not suffer an exacerba- was crude and bears systematic and precise in- tion of their symptoms after initial treatments. vestigation. “Complex” means that (a) frequency band am- Hunches About Coherence and Systems. plitude at any site may increase after it lowers, Correlated activity may mean that the activity (b) another frequency band may increase in ac- occurs in a system, an integrated pattern. As tivity at the site monitored, (c) band amplitudes withanysystem,theactivityasawholebehaves at the same site may see-saw (alpha and delta different than the behavior as the sum of the amplitudes may see-saw), (d) band amplitudes parts. Changes in the activity at specific sites at one site may fall while the same band ampli- thatarepartofasystemwouldbeexpectedtobe tudes may rise at a different site, and (e) symp- more resistant to change, and especially to last- toms may flare up after the session. Coherence ing change. Therefore, it is expected that a sys- problems may be recognized by any of these tem would need to be worked with as a whole items. On the topographic maps, map areas system, rather than at just at one or two sites. showing pools of the same color are, in fact, Components of Systems. There are three ma- showing areas with the same amplitudes of ac- jor components of systems: (a) sites that are not tivity within a frequency band. The sites, then, involved in a system, (b) sites that react to the Len Ochs 31 activity in a system and either amplify the sys- fashion, the crowd thins, with more collabora- tems activity or dampen the system’s activity, tors losing motivation as it does. In the end, the and (c) the generators of the system’s activity, instigators may or may not be moved. How- influenced by the other components. When a ever,thereisnowmuchmoreroomfortrafficto site responds to treatment and remains affected flow and the intersection can be more func- withoutreboundingafterthesession,itactsasif tional. It is the function of the LENS map to itisunrelatedtothesystem.Iftherewerenosys- empirically define which of the sites are by- tem present, as is sometimes the case, the per- standers, collaborators, and perhaps, the insti- sonwouldexperiencea“miracle,”asuddenand gator(s)–thegenerators. Of course this is some- noticeable reduction in symptoms. thing of a conjecture and may to a large extent Ramifications of Coherence for the LENS be unnecessary. However, it does provide a Treatment Planning: A Story. As a metaphor, methodology for approaching the complex let’s say that there are three types of people in a clinicalpictureswith which we deal.In fact,us- riotous intersection. First, there are the by- ing the LENS map the way we do may be one of standers. They are the ones who are easily the factors contributing to the relatively short moved by those trying to reduce the noise in the treatment times. There may well be alternative intersection. They are not particularly involved ways of organizing the treatment approach that in the activity, and do not contribute to the could result in further reduction in treatment noise. But their presence does encourage the duration, more efficacious results, or both. others fomenting the noise. The Brain as a System. There are such things Second, there are the collaborators. They assimpleproblems.Thesecasesgenerallyhave have varying degrees of interest and involve- a sudden onset of symptoms without an ment in generating the noise in the intersection. inter-generational or genetic basis to the symp- They provide reinforcement and energy for the tom. The treatments are even simpler for those instigators of the noise and they derive satisfac- people who were especially high functioning tionfrom theirinvolvement.The degreeof ease before their injury or trauma. Treatment of with which the collaborators can be moved is a these individuals with acquired CNS problems function of their relationship with the instiga- is often a joy. They may be the cases shared tors, and with the amount of energy they have. among colleagues, the ones which impress the Last, there are the instigators. They provide the audiences, and propel the sales of EEG equip- energy for the crowd. ment.For these instances,itis quiteplausibleto In any system, there are the energetic apply traditional neurofeedback or the LENS sources, the other components that are influ- methodtooneortwoofthestandard10-20elec- enced and in turn influence, and the uninvolved trode sites and watch the miracles happen. Un- parts. The trick for treatment is to discover how fortunately, informal surveys of therapists us- to move the less-involved parts, continue to re- ing all of the current models of neurofeedback duce the overall energy in the system, and to equipment on the market evoke reports that nudge the system toward lower noise and from 50 to 80 percent of the time the therapists greater flexibility. do not feel like they know what they are doing. It may be said that our job is to reduce the They feel lost about treatment direction and noise in the above intersection: to increase the disappointed at the results they are obtaining. ease with which messages are exchanged in the Achieving success with LENS at any one brain. If we ask each person in the intersection electrode site (i.e., reducing EEG amplitude tomove,theonesthatfirstmovewillbetheones andvariability)canleadtobehavioralrebounds least involved: the bystanders. With the by- and reactions such as transient hyperactivity or standersabsent,thereislessencouragementfor fatigue.Whendoingtopographicmapssequen- the collaborators and the instigators. tially at different electrode sites, it is quite ap- The next to move will be the least motivated parent when the problems that a person has of the collaborators. Their absence provides seem to be occurring within a system or multi- still less reinforcement for the more motivated ple systems of activity as measured across the collaboratorsand the instigators, making it eas- scalp. The complex cases invariably show ier to move more collaborators. In a reiterative many kinds of EEG activity (i.e., unwanted 32 LENS: THE LOW ENERGY NEUROFEEDBACK SYSTEM rises in amplitudes and variability) that are tremely reactive individual is so reactive to caused by isolated successes at the sites that stimuli and caught up in the emotional, cogni- were treated in isolation. If a site or a few sites tive, glandular, vascular, immunological, and/ are treated without recognition of the extant ormotoricelementsofthereactionsthatthereis systems, then there are often untoward post- literallyno opening for being aware of the stim- session problems. uli.Hypersensitiveindividualsarerarelyaware This hypothesized activity occurring in sys- of much about their situations or of their feel- tems may be the same as hypercoherence: the ings. They are aware of their reactions to these same frequency appearing at multiple sites situations and feelings, rather than of the situa- across the scalp at the same time. If these sites tions themselves. For example, they may be are linked together, and if the therapist is treat- overwhelmed by their reactions of discomfort, ing one or a few of the sites, changes in those or overwhelmed by the difficulty of taking few sites will cause a reaction in the rest of the things in. system which may both evoke strong concern The LENS ordinarily reduces the amplitude or worry in the patient, and create management and variability of the EEG across the spectrum. problems in treatment, as well as cause unnec- Inotherwords,theEEGbecomeslesshyper-re- essarily long and uneconomical treatment active to the LENS feedback. This may be a processes. function of the enormous dynamic range of the The topographic mapping process that we feedback intensity, which can potentially be utilize holds promise to enable the therapist to varied by 100,000 gradations from the weakest understand how to approach the areas involved to most intense feedback intensitylevels. Turn- in the pathology in a graded, elegant way, and ing the feedback on and off will at times show without any biases based on “known facts” correlated amplitude and variability changes in stemming from neuropsychology or literature the EEG on the screen, even though patients reports.Mappingreducesthechancesthatasta- cannot feel the feedback. As the patient’s hy- tistically unusual site plays a prominent part in per-reactivitydrops,thepatienttendstoexperi- the functional pathology. It reduces the chance ence a subjective increase in ease, greater abil- thatthe unusual siteor combinationof sites will ity to follow conversations, to understand what be missed, delaying the problem’s resolution. is read, and to think more clearly.Clarityis a re- Themapsshowthefrequencybands’evoked flection of greater perceptual acuity and a less- amplitude undulations shrinking spatially, ening of mental fog. Often there are reports of dampening, and eventually stabilizing in am- increasing quiescence and decreases in rest- plitude as treatment progresses. This translates lessness.Theintersection,asintheabovestory, into being able to observe the chaotic energy has become quieter and more functional. An- systems moving around and rearranging them- otherwaytoputitisthatthepatientisbecoming selves across the scalp surface as they become more sensitive–but less hyper-reactive. The re- electrically less noisy. The surface maps are sult is that the patient is more aware of the envi- transformed into other graphs that specify ronment and of inner feelings; more aware of which sites are to be worked with, and in which likes, dislikes, needs, and satisfactions of those sequence (see Figure 2). needs. The good and bad news is that while the Having these maps of evoked activity avail- patient can be happier and unhappier, there is able also permits the therapist to compare cur- morechance,becauseof decreasedhyper-reac- rent versus previously measured values. When tivity, to be more thoughtful about life. there is too much of a discrepancy, the loss of Sensitivity: Its Acknowledgment, Manage- accuracy indicates that the map is no longer a ment, and Benefits. The phenomenon of sensi- faithfulguidetotreatmentandthatanothermap tivity to feedback intensity is one of the most is needed to accurately predict the strategic site intriguing aspects of the LENS. There is an ap- sequences. parent relationship between dysfunction and Sensitivity vs. Hypersensitivity.When pa- reactivity to stimulation. Patients express this tientsfirstentertreatmenttheytendtoseethem- verbally and/or motorically. This can also be selves as overly sensitive. In fact, they tend to observed during treatment as increasing delta, be quite reactive, but quite insensitive. An ex- theta, or alpha activity across a number of sites, Len Ochs 33 withoutareturntobaselinewithinfiveminutes. scription medicationcan cause this kind of sup- These factors led me and my colleagues to con- pression. Internal automatic self-medication sider alternative treatment models arising from with perhaps inhibitory neurotransmitters might our new views regarding brain trauma and its also cause this kind of suppression. resolution. At first it was thought that the rises in ampli- The apparent plasticity of the dysfunction tude that occur with the LENS treatments were underthefeedbackoftheLENSitselfcastscon- signs of over stimulation and signs of pathol- siderable doubt on the traditionally held view ogy. However, it has become apparent that that much post-trauma dysfunction is attribut- most amplitude and standard deviation in- able to the trauma; perhaps it is largely attribut- creases occur in the context of increasingly able to the brain’s own protective mechanisms. competent functioning–although not infre- Rather than working with trauma-induced quentlyinthecontextofsomenarrowlydefined braindamage,inthecaseofbraininjurywemay andextremelydisruptivesymptoms.Forexam- need to be working with the brain’s own ple, while the patient is becoming more relaxed self-protective neurochemical systems. and less depressed, there may be an increase in What is most important is that we apparently seizures, tics, temper, muscular pain, toileting are far more sensitive than we have ever ex- accidents, and perhaps substance abuse. These pected, at least when we become injured or in are not seen as side effects of treatment now. In anywaydysfunctional.Muchofthemedicales- contrast, they are now seen as transition states tablishment, and to a certain extent the psycho- duringwhichshort-termcompensationsandin- logical rehabilitation establishment, has taken hibitions have been released. They occur in up the “Jack LaLane” exercise, gain-through- those with histories of the observed problems. pain approach to rehabilitation. This was the It may be that the very problematic, potentially mentality which was originally applied to the dangerous, and most likely socially very em- LENS work until it was recognized that the op- barrassing symptoms were intuitively suppres- posite was the only approach that consistently sed–and most likely forgotten, until the current produced positive outcomes. It has turned out treatment. that the more we take into account sensitivity, Thesesymptoms,dependingon theirpathol- making treatmentas gentle as possible in previ- ogy and severity,typicallylast a week, and then ously unimaginable ways, the neuronal strength remit. They may also re-occur when a virus, ofthepatientshasbeensupported,andrecovery other infection, or other body change is still follows far more often than not. pre-clinical and unobserved. However, after This shift in paradigm regarding the units of one or two infection or bodily change cycles, analysis, intervention and mechanism of action they no longer appear. often means that the feedback intensity is kept It is extremely important that each prospec- to a minimum. During the early sessions the tive patient be interviewed for such previous therapist needs to know how to be content to historical symptoms. Their presence is not nec- make very small interventions until the patient, essarily a contraindication for the LENS ap- with decreased symptoms, becomes ready for proach. But if they were present at one point in morepungencyinthefeedback.Ithasonlybeen his or her life, it is a chance to ask the patient when the patient’s sensitivity has been care- whether the symptoms for which he or she is fully considered that maximum speed of treat- seeking relief are important enough to out mentisachieved.Otherwisevaluabletreatment weigh the risk of re-encountering for a short time is spent recovering from treatment-in- time the intensely problematic symptoms from duced relapses. earlier life. It takes a relativelyshort while, dur- Suppression. EEG activity suppression. Al- ing treatment, for the brain to integrate–rather most without exception, all relatively high am- than inhibit–problematic pathophysiology, and plitude EEG band activity drops (even with thus bring marked relief. high beta) following LENS feedback. How- TheWhat,Why,andHow oftheLENS.There ever, low amplitude and standard deviations are three considerations concerning the LENS can and do rise. When this occurs the low activ- and its mechanism: What is happening, why it ity is understood to have been suppressed. Pre- happens, and what treatment strategies bring 34 LENS: THE LOW ENERGY NEUROFEEDBACK SYSTEM about the effect. These can be labeled, respec- suredamplitudes,makingthetaskfromthestart tively: permeability, inhibitory neurotransmit- a difficult one. ter activity alterations, and applied chaos the- While treatment of acute patients with good ory. The statements addressing each area of premorbid histories may respond to a simpler concern are testable. treatment strategy, such a strategy may not suf- What. Changes in cortical permeability: It ficeforpatientswithcomplicated,life-longhis- hasbeenobservedthatindividualswithchronic tories and symptoms. In contrast, without try- central nervous system functioning problems ingtospeedorslowtheEEGactivity,theLENS have higher levels of recordable low frequency addresses all of the of the standard 10-20 sys- electrical activity at scalp sites. It has further tem scalp sites as a method to control the feed- been observed that as the functioning of the in- back in a sequence based on a ranking of dividual improves with treatment, the ampli- site-permeability (irritability) from least to tudeoftheEEGdiminishesacrossthespectrum most. By using this method, the activity at both at each scalp site. the sites that have problems in isolation, and at On a descriptive level, the most parsimoni- sites that act in coherence systems, can be de- ous way to picture what happens as functioning creased in a predictable manner. This may re- improvesandasthemeasuredevokedEEGam- duce treatment time and expense in compli- plitude drops, might be in terms of decreasing cated cases, and increase the longevity of a permeability of the cortex: the higher ampli- positive outcome. tude activity probably remains present sub- cortically. It may be that it is simply not mea- surable at the scalp surface as the cortex CONCLUSION re-assumes its integrative capacity and blocks The LENS has shown significant effects in the appearance of the higher amplitude sub- the treatment of a variety of CNS mediated dis- cortical activity at the surface. The use of in- orders. Ongoing research will be required to dwelling (needle) electrodes at various depths fully understand the mechanisms of action and simultaneously may help differentiate cortical algorithms for directing treatment (e.g., site se- from subcortical activity, and show with treat- lection, feedback intensity, duration, etc.). The ment, evidence of increased cortical activation following are some tentative conclusions re- as differentiated from subcortical activity. garding the benefits and underlying principles Why. Inhibitory neurotransmitteractivityal- of the LENS. ternations: Feeding back frequency informa- Treatment benefits include: decreased feel- tion that is different from that which is mea- ings of irritability, anger, fatigue, anxiety, de- sured, but nevertheless still a function of the pression,anddecreasedanginawhencausedby frequency measured, may place different corticalproblems.Improvedmentalclarity(de- neurochemicaldemandsonthesynapseswhich creased “mental fog”), sleep, energy, concen- feed the measured activity. If there is post-trau- tration,attention,short-termmemory,improved matic inhibitory neurotransmitter activity in- vision and speech when due to cortical prob- terferingwithcorticalfunction(i.e.,makingthe lems, and increased ease of functioning. Tangi- cortex more permeable) and if the mechanism ble clinical improvements are typically noted perpetuating this activity is disturbed and is al- within three to six sessions. Reductions in EEG tered, then the synaptic neurotransmitter mix amplitude and variability will often be noted mightbealteredtoonceagainpermitdecreased withinthefirstfiveminutesofthefirstsession. permeability and proper cortical functioning. The LENS in the Current Social/Scientific/ How. Applied chaos therapy: Most neuro- Clinical Context. The following are issues of feedback treatment focuses on the shaping of concern expressed by non-The LENS profes- activity in one or two frequency bands through sionals. voluntarycontrolsatoneortwosites.Oneofthe complaints about the duration of neurofeed- Invasiveness back treatmentis that it takes too long and is too expensive. The sites commonly treated are, as In contrast to traditional EEG feedback, the often as not, the ones showing the highest mea- LENScouldbeconsideredminimallyinvasive. Len Ochs 35

The field strength of the stimulation is only treatment is flexibility of neural functioning, 10-18watts/cm2,whichisfarlessinvasivethan and there is no unilateral influence on the brain medication or electroconvulsive therapy, and to either produce more fast-wave activity or microscopic in comparison to transcranial more slow-wave activity. The patient’s brain is magnetic stimulation or even in comparison to left free to do as it needs to, when it needs to, as the stimulation received from holding a cell the amplitude and variability decrease across phone to one’s ear. the spectrum. Hopefully, both LENS and general neuro- Other-Directed (Therapist Regulated) feedback procedures will maximize the ability vs. Self-Regulation of the patient to be self-regulating. However, it isnaivetoholdthepremisethattraditionalEEG Two attitudes are interwoven in this contro- biofeedback places the patient in charge of the versy. One idea is that consciousness is a re- structure of the treatment, or that neuro- quirement for self-regulation. If the regulation feedback is teaching self-regulation in the that occurs is not conscious and intentional,it is sense of learninga conscious skill. It seems that not self-regulation. Yet the spinal cord and the more important scientific concern needs to lower brain centers are not only responsible for be: Under which clinical conditions is LENS or many of our life-support systems, but they also traditional neurofeedback most effective and can learn and adapt quite nicely without con- efficient? Each system may have its own scious intervention. In other words, we may be domains of applicability. just as smart subcortically (and unconsciously) as we are consciously. So it seems wasteful to Physical or Psychological Harm devalue non-conscious self-regulation and to throw away resources that can be mobilized for The Thalidomide tragedy has made every- learning and life enhancement. Furthermore, one aware of the importance of looking at although conscious effort and work is involved long-term effects of a prospective treatment, with traditional neurofeedback, it is not so and rightly so. It is always worth reviewing the much teaching self-regulation as it is facilitat- probability that wherever there is change, there ing the operant conditioning of healthier is disruption. And whether good or bad, there brainwave patterns. can always be unpleasant as well as beneficial The second controversy is the locus of con- effects, even if the treatment is “entirely natu- trol issue, or who is in control, therapist or pa- ral.”Oneissuehereisnotwhetherthereare“un- tient? This issue seems to be grounded in the pleasant side effects,” but to identify what they naïve belief that traditional biofeedback places are. Side effects or adverse reactions have been the patient in charge, and that he or she is truly noted with traditional neurofeedback technol- engaged in self-regulation. There is, of course, ogy (Hammond, Stockdale, Hoffman, Ayers, theimplicationthatwhenatherapistisadminis- & Nash, 2001) and in fact, if misapplied tradi- tering an energy field, the process is controlled tional neurofeedback has the potential to evoke by the therapist. In fact, the design of the treat- iatrogenic effects, including seizures (Lubar et mentprotocolusedintraditionalbiofeedbackis al., 1981; Lubar & Shouse, 1976, 1977). Once also under therapist control (i.e., whether to en- identified,theprospectiverecipientofthetreat- hance a particular high frequency activity and ment can weigh the benefits against the risks of inhibit low frequency activity). Further, the op- treatment. The unpleasant side effects of treat- eration of the threshold, which determines ment discovered to date echo the unpleasant ef- which EEG activity gets which kinds of rein- fects of any other kind of change process, forcement,islikewiseundertherapistcontrolin whetheritishypnosis,psychotherapy,biofeed- traditional EEG biofeedback. back, yoga, etc. With the LENS system, no pa- Similarly,thetherapistisclearlyincontrolof tientover thelastthreeyears has everreporteda the structure of the LENS session, but is guided new symptom;thatis,onethathadneverbefore bythepatient’ssubjectivesenseofwhatiscom- beenexperiencedbythatpatient.However,any fortable and uncomfortable. In contrast, when current symptom, physical or psychological, usingtheLENSprotocols,thegoaloftheLENS can be temporarily exacerbated. 36 LENS: THE LOW ENERGY NEUROFEEDBACK SYSTEM

Another issue here is to differentiate un- Summary pleasant“side-effects”from disruptivesigns of health and recovery. As people become clearer LENS is an innovative type of neuro- abouttheirownreactionstoadifficult,unpleas- feedback that has evolved over the past 16 ant, and even treacherous world, they are in- years. It involves the use of very weak electro- clined to become more angry, sad, or anxious, magnetic energy fields which are fed back to and appropriately so. They are apt to become the brain based on the brain’s dominant fre- less tolerant of what ought not to be tolerated. quency from moment-to-moment. This feed- However, itis theamountof increasedthought- back is usually effective in reducing high am- fulness and productivity about the noxious ele- plitude activity, in many cases shortening the ments of life that makes these reactions differ- length of treatment that is required in compari- entfromthehyper-reactive,blindreactionsthat son with traditional neurofeedback. Treatment characterized their lives prior to the LENS treatment. These considerations need to be sessions are brief, and because of the minimal made clear when individuals are considering demands it places on the patient it is very ap- LENS treatment. pealingtosomepatientsandopensuptreatment optionsfornewpopulationsofpatients.Thena- Dearth of Literature ture of LENS technology will also facilitatedo- ing double-blind, placebo controlled studies It must be acknowledged that apart from this which can advance our field. volume, there is only a limited scientific re- search (Donaldson, Sella, & Mueller, 1998; Mueller, Donaldson, Nelson & Layman, 2001; NOTES Schoenberger et al., 2001) on the use of LENS. Weknow littleabouttheeffectsofvariable-fre- 1. Some proportion of activity in the different fre- quency feedback on EEG activity. However, quency bands seems healthy, with either too much or too little being potentially problematic. Delta, for example, we now have considerable clinical experience seems to have a functional role in facilitating inner con- inworkingwithanumberofdiagnoses.Aswith centration by suppressing extraneous cortical inputs. A most clinical areas of application of traditional delta deficit can correlate with reduced frontal cortical neurofeedback,adequatelycontrolledoutcome regulation or gating of maladaptive behavioral impulses studies with LENS are lacking. Therefore, the or extraneous cues, and can be found in conditions such informed consent process with patients must as cocaine addicts, alcoholics, ADD, subtypes of OCD, and schizophrenia (Alper, Prichep, Kowalek, Rosenthal, acknowledge these facts to allow patients to & John, 1998). Increased theta band activity may be make an informed decision about using a more seen in highly experienced mediators, and increased investigational treatment. delta and theta EEG activity have also often been found in association with various kinds of cognitive activity, Fear of LENS Treatment Being Too Rapid such as performing calculations (e.g., Fernandez et al., 1995; Klimesch, Doppelmayer, Russegger, & Pachinger, 1996). Finally we should mention a frequently ex- 2. Offsets were originally implemented to reduce the pressed concern about the LENS producing possibility of exacerbating seizure activity and EEG therapist unemployment because it is too rapid slowing. When amplitudes are unusually low, an offset or effective. It is true that the LENS often re- of zero may help to stimulate the physiology to increase duces treatment time, making for more rapid amplitude. However, we have very little experience to patient turnover, and placing new demands on state this with any confidence. a’therapist’s marketing skills. However, it also often increases a’therapist’s effectiveness, opens up treatment as an option to new popula- REFERENCES tions,andmakestreatmentmoreaffordableand Alper, K. R., Prichep, L. S., Kowalek, S., Rosenthal, M. enjoyable. Further, it increases the number of S., & John, E. R. (1998). Persistent QEEG abnormal- patientsatherapistcanhelpinshorterlengthsof ity in crack cocaine users at 6 months of drug absti- time. nence. Neuropsychopharmacology, 19 (1), 1-9. Len Ochs 37

Carter, J. L., & Russell, H. L. (1981). Changes in verbal operant conditioning in intractable epileptics. Ar- performance of IQ discrepancy scores after left hemis- chives of Neurology, 38, 700-704. phere EEG frequency control training. American Lubar, J. F., & Shouse, M. N. (1976). EEG and behav- Journal of Clinical Biofeedback, 4, 66-68. ioral changes in a hyperactive child concurrent with Carter, J. L., & Russell, H. L. (1984). Application of bio- training of the sensorimotor rhythm (SMR): A pre- feedback relaxation procedures to handicapped chil- liminary report. Biofeedback & Self-Regulation, 1 dren: Final resort. (Project No. 443CH00207, Grant (3), 293-306. No. G008001608). Washington, DC: Bureau of Edu- Lubar, J. F., & Shouse, M. N. (1977). Use of biofeed- cation for the Handicapped. back in the treatment of seizure disorders and hyper- Carter, J. L., & Russell, H. L. (1993). A pilot investiga- activity. Advances in Clinical Child Psychology, 1, tion of auditory and visual entrainment of brain wave 204-251. activity in learning disabled boys. Texas Researcher, Mueller, H. H., Donaldson, C. C. S., Nelson, D. V., & 4, 65-73. Layman, M. (2001). Treatment of fibromyalgia in- Davidson, R J., & Hydahl, K. H. (Eds.) (1996). Brain asymmetry. Cambridge, MA: Bradford Books, MIT corporating EEG-driven stimulation: A clinical out- Press. comes study. Journal of Clinical Psychology, 57 (7), Diamond, M. C. (1988). Enriching heredity: The impact 933-952. of the environment on the anatomy of the brain. New Niedermeyer, E., & da Silva, F. H. L. (Eds.) (1999). York: The Free Press. Electroencephalography: Basic principles, clinical Donaldson, C. C. S., Sella, G. E., & Mueller, H. H. applications, and related fields. Philadelphia, PA: (1998). Fibromyalgia: A retrospective study of 252 Lippincott, Williams & Wilkins. consecutive referrals. Canadian Journal of Clinical Ochs, L. (1995). Many kinds of depression are curable. Medicine, 5 (6), 116-127. http://www.flexyx.com/articles/deprcure.html Fernandez, T., Harmony, T., Rodriguez, M., Bernal, J., Peniston, E. G., & Kulkosky, P. J. (1991). Alpha-theta Silva, J., Reyes, A., et al. (1995). EEG activation pat- brainwave neurofeedback therapy for Vietnam vet- terns during the performance of tasks involving erans with combat-related posttraumatic stress disor- different components of mental calculation. Electro- der. Medical Psychotherapy: An International Journal, encephalography & Clinical Neurophysiology, 94, 4, 47-60. 175-182. Persinger, M. A. (Ed.) (1974). ELF and VLF electro- Gleick, J. (1988). Chaos: Making a new science. New magnetic field effects. New York: Plenum Press. York: Penguin Quirk, J. A., Fish, D. R., Smith, S. J., Sander, J. W., Hammond, D. C., Stockdale, S., Hoffman, D., Ayers, M. Shorvon, S. D., & Allen, P. J. (1995). Incidence of E., & Nash, J. (2001). Adverse reactions and poten- photosensitive epilepsy: A prospective national study. tial iatrogenic effects in neurofeedback training. Jour- Electroencephalography & Clinical Neurophysiol- nal of Neurotherapy, 4 (4), 57-69. ogy, 95 (4), 260-267. Hughes, J. R., & John, E. R. (1999). Conventional and Rife, R. R. (1953). History of the development of a suc- quantitative electroencephalography in psychiatry. cessful treatment for cancer and other virus, bacteria Journal of Neuropsychiatry and Clinical Neurosci- and fungi. San Diego: Rife Virus Microscope Insti- ence, 11, 190. Klimesch, W., Doppelmayer, M., Russegger, H., & tute. Pachinger, T. (1996). Theta band power in the hu- Sandyk, R. (1994). Improvement in word-fluency per- man scalp EEG and the encoding of new informa- formance in Parkinson’s disease by administration of tion. NeuroReport, 7, 1235-1240. electromagnetic fields. International Journal of Neu- Lubar, J. L. (1985). Changing EEG activity through bio- roscience, 77 (1-2), 23-46. feedback applications for the diagnosis and treatment Schoenberger, N. E., Shiflett, S. C., Esty, M. L., Ochs, of learning disabled children. Theory into practice. L., & Matheis, R. J. (2001). Flexyx neurotherapy Ohio State University, 24, 106-111. system in the treatment of traumatic brain injury: An Lubar, J. F., Shabsin, H. S., Natelson, S. E., Holder, G. initial evaluation. Journal of Head Trauma Rehabili- S., Whitsett, S. F., Pamplin, W. E., et al. (1981). EEG tation, 16 (3), 260-274.

doi:10.1300/J184v10n02_02 38 LENS: THE LOW ENERGY NEUROFEEDBACK SYSTEM

APPENDIX A

This article seeks to offer some historical background, an outline of the theoretical basis for how the Low Energy Neurofeedback System (LENS) works, and the approach to treatment which is evolving from the applied clinical work and research being initiated by OchsLabs. The LENS is still evolving at a rapid pace. It is thus impractical to conceive of this overview as being up-to-date for any length of time. The reader is cautioned to avoid any conclusion that this information reflects current practice. The reader is also cautioned to avoid seeing any information presented herein as a claim for the LENS to be efficacious for any condition, medical or psychological. This is the most objective depiction possible of the evidence on hand for its benefits and risks. No claims are being made. The reader is cautioned that the purpose of this article is to enumerate some of the phenomena, issues, and concerns which were encountered, and not to provide a decision tree about which settings, options, conditions, and choices are to be made in any particular clinical instance. The information about settings, conditions, and treatment options presented are to exemplify the concepts. The actual number of options and considerations in the treatment planning process are outside the scope of this article. Further, there is still not enough concrete research-based information about the particular benefits or drawbacks of any particular setting or settings, or whether such settings are useful or necessary. Compo- nent analyses are needed to determine which conditions (protocols) are necessary and useful. The reader of this article may find more questions being raised than answered. This is the nature of the opening of a new arena of observation and study. In this case, this arena is the area of behavioral bio- physics: the interaction of resonant (feedback) physical stimuli on brain functioning. It is possible to ask of most of the statements in this article, “What is the evidence?” “Where are the data?” In fact, after 15 years of this exploration there is still a search for the fundamental questions. Furthermore, after 15 years, how to do research with the LENS is only beginning to clarify itself.

APPENDIX B CNS Functioning Assessment

Name ______Date of Birth ______Age ______

Today’s Date ______Time ______Diagnosis ______

Are you able to drive a motor vehicle? Yes Partially No Are you able to work or study? Yes Partially No Are you able to sustain a close relationship with someone? Yes Partially No

How frequently do you have problems in the following areas? Please pick a number from 0-to-10. “0” means Not at all, and “10” means All the time. If one or more of your parents had this, or a similar problem, place a P in the column headed by “Parents?” If the problem came on suddenly, put an S in the column head by “Suddenly?”

Sensory Frequency (0-10) Parents? Suddenly? Light, in general, or lights, bother you Problems with the sense of smell Problems with vision Problems with hearing Problems with the sense of touch

Emotions Problems of sudden, unexplained changes in mood Problems of sudden, unexplained fearfulness Problems of unexplained spells of depression Len Ochs 39

Problems of unexplained spells of elation Problems with explosiveness Problems with irritability Problems with suicidal thoughts or actions

Clarity Feel “foggy” and have problems with clarity Problems following conversations (with good hearing) Problems with confusion Problems following what you are reading Realize you have no idea what you have been reading Problems with concentration Problems with attention Problems with sequencing Problems with prioritizing Problems not finishing what you start Problems organizing your room, office, paperwork Problems with getting lost in daydreaming You cover up that you don't know what was said or asked of you

Energy Problems with stamina Fatigue during the day Trouble sleeping at night Problems awakening at night Problems falling asleep again

Memory Forget what you have just heard Forget what you are doing, what you need to do Problems with procrastination and lack of initiative Problems not learning from experience

Movement Problems with paralysis of one or more limbs Problems focusing or converging the eyes

Pain Head pain that is steady Head pain that is throbbing Shoulder and neck pain Wrist pain Knee pain All-over pain Joint pain Other pain (specify)

Other Problems Problems with nausea Skin problems Problems with speech or articulation Dizziness Noise in ears (Tinnitus)