Early in learning neurofeedback I remember how hit or miss it all seemed in tracking client training effects. Good-enough tracking was my aspiration, without knowing exactly what that was in the midst of the many new skills I was learning. As time passed, I began to have a sense of what good-enough tracking was, how it always included what was clear to me along with any questions yet to be understood. Along the way what those questions needed to be became clearer.
I can still be surprised by unexpected training responses. And people still ask me the same question people asked 20 years ago. They ask if ………….., that has been happening to them, has anything to do with their neurofeedback training? Sometimes the answer is a clear, ‘Yes, I think it does and here’s why’. Sometimes, it’s not so clear. When it’s not clear, how I organize my thoughts and responses to this question has changed over time.
In thinking about the evolution of my neurofeedback tracking skills and how I answer this question now, a familiar Zen koan comes to mind. If a tree falls in the forest and no one is there to hear it, does it make a noise? If we translated this into the neurofeedback domain the koan would have to be, if changes result from neurofeedback training and no one associates them with neurofeedback, or notices them at all, do they still have an impact?
From the perspective of Attuned Neurofeedback, the answer is of course yes. Within the larger field of neurofeedback this question can be complex in a different way than the Zen master intended. This is because there is not always agreement as to exactly what we are affecting when we put a sensor on someone’s head and train them with neurofeedback.
Although we routinely use information from our neurofeedback systems to monitor training changes, our conversation today is about the Attuned Neurofeedback structure for tracking neurofeedback training. A structure that optimizes the tracking information a neurofeedback provider receives, while building the important attuned alliance between clinician and client.
I trace my early influence for this way of working to my first neurofeedback mentor and the agreement she made with her patients. The agreement was that once they began neurofeedback, everything they experienced from then on was a effect of training until training was ruled out. She also impressed upon them the importance of reporting anything they noticed that was different between one session and the next, even if they didn’t think it was related to their neurofeedback training.
In my own practice I’ve found working with, everything is a training effect until training is ruled out, very humbling. It’s a way of saying the buck stops here without the pretense that we could possibly understand everything the brain and nervous system might do in response to any given neurofeedback session. To meet this deep and ethical commitment to good neurofeedback practice we need a simple and clear structure to see us through.
In building this necessary structure we begin with the understanding that a sensor placed anywhere on the head, whether targeting a specific symptom or an area of brain functioning, affects the entire arousal organization of the brain. In committing to this perspective, we are committing to a whole body, whole person approach to tracking training effects after every neurofeedback session.
Next, we’ll rule out any environmental factors occurring since the last training session. These factors may come from an external event such as getting fired or moving to a new house. Or they may come from an internal event such as becoming ill or falling in love. Any environmental factors we discover may completely explain changes our client has experienced, or they may be co-mingled with changes arising from the neurofeedback training.
After ruling out environmental factors it’s time to divide our observations into 4 areas of human functioning. We’ll label these areas: physiological, cognitive/attentional, emotional/psychological, and interpersonal. To simplify our tracking further we can use these 4 categories to organize the traditional arousal tracking questions that many neurofeedback providers already use. This will allow us to observe as many ‘trees’ as possible within the human nervous system.
As an aside, the categories used here were chosen to support clear communication with our neurofeedback clients. They are not intended to meet criteria used in academic discourse or research. Making our language accessible to clients is a primary goal in good neurofeedback practice. This requires us to be flexible in finding whatever terms and language supports the greatest understanding between client and clinician.
In getting back to our 4 categories, for physiological effects we will observe for changes in falling and staying asleep, energy levels, food or drink desires, GI activity and bowel function, along with pain and muscle tone. These changes are often easiest for clients to track when other types of markers may be unclear or feel elusive. Additionally, this category often gives us the clearest information for modifying neurofeedback protocols when needed.
In the area of cognitive or attentional effects, focus and task completion are useful markers of change. Task completion is a complex behavior that includes a number of dimensions. Because stable attention allows us to accomplish routine, habitual tasks, the type more difficult for our novelty-wired human brains, this marker allows us to observe changes in attention as they are expressed in everyday life.
Our emotional and psychological orientation category includes changes in feelings, mood states and how a person is relating to him or herself. Does our client have a greater ability to stay even and tolerant in difficult situations? How are they speaking about themselves as they talk about their week? This category can shine a light on a persons’ experience of self.
Lastly, in the interpersonal realm we can observe how our client is interacting with others, especially during conflict situations where arousal often becomes high. We can also gather information on how others are orienting towards our client. We may get this interpersonal information, or information on any of our 4 categories, through the clients’ self-report or through the report of a trustable other.
We’ve now made our way through a number of elements of an attuned, whole person approach to tracking neurofeedback training. Through observing for changes in the areas of functioning we’ve discussed; we are tracking nervous system arousal in its’ many varied manifestations. It’s my belief that the many trees and branches within the human nervous system do make a sound and do experience an effect, whenever change occurs from neurofeedback training. And, that this is the case even when we don’t hear them, or we miss that the changes were directly related to the neurofeedback training.
Luckily, the dilemma of our neurofeedback koan can be resolved by committing to a thorough tracking structure such as the one offered from our Attuned Neurofeedback perspective. Feel free to try out any elements of our perspective that are of interest and let us know how it goes during one of our websites, zoom meetings.
In the meantime, I hope you’ve enjoyed this exploration through elements of Attuned Neurofeedback practice. Until next time remember, everything is about the training ‘til
the training is ruled out.
Be well,
Ellen
