LENS AND NEURAL REGULATION

BRAIN AND BODY

Ulrich Lanius Ph.D.

INTEGRATING THERAPIES

BRAIN AND BODY

• Series of case studies

• Standalone intervention vs. adjunctive

• LENS and EMDR: synergistic effects

• Overlap in functional mechanisms?

• Theory and practice

• Adaptation of LENS applications

• Brain and body

DEVELOPMENTAL TRAUMA

INFORMATION PROCESSING THERAPIES

• Neglect and abuse produce dysregulated brain activity

• Interferes with effective Adaptive Information Processing (AIP)

• AIP theory as well as recent research support the notion of EMDR Therapy intervening at a neurobiological level

• Similarly LENS neurofeedback can be considered to be a neurobiologically based intervention

• Both forge adaptive associations among neural networks in the brain

HYPOTHESESNEUROFEEDBACK & EMDR

• The addition of LENS neurofeedback during all three trauma treatment phases can increase Adaptive Information Processing by directly intervening at the level of the electrical or frequency level domain of brain and body

• LENS will facilitate EMDR treatment effects of PTSD, mood and anxiety as well as symptoms in clients with concurrent attachment disorder.

CASE STUDY INCLUSION CRITERIALENS & EMDR

• No response to treatment as usual• Pharmaceutical intervention• Body psychotherapy (eg Sensorimotor, Somatic

Experiencing) • Conventional neurofeedback• EMDR

– Can’t identify target– Blank when processing– Can’t tolerate body activation when processing– No change or lasting change in SUD level

ADDITION OF LENS NEUROFEEDBACK

TYPES OF INTERVENTIONS

• Delivering LENS neurofeedback prior to starting EMDR Therapy

• Delivering LENS neurofeedback and EMDR in the same treatment session

• Delivering LENS neurofeedback between EMDRsessions

• Delivering LENS to the body during EMDR in the same treatment session

• Providing alternating bilateral stimulation directly to the brain through LENS neurofeedback

WHAT IS THE LENS?

BRIEF HISTORY

• Developed in 1990 by Dr. Len Ochs, Ph.D.

• Dr. Ochs recognized that using a normative database may not be the best approach, and decides “I’ll never tell the brain what to do”

• Disruptive stimulus – LENS

• No need for client to focus on task

• Dr. Ochs discovered that patients responded dramatically faster to interventions

PASSIVE NEUROFEEDBACK

THE LENS

• Limited or no awareness

• Hum activity from Digital Signal Processor – all NFB

• Low energy stimulus – e.g. watch battery

• Little effect unless signal feeds back information

• Based on dominant frequency

• Statistical means of extracting the power of EEG – e.g. highest amplitude

• Feedback about frequency at offset

• Break up existing neuronal pattern - brain not trained to specific frequency

• Disruptive stimulus – move brain from its “parking spot”

• Removing “the auto-protective mechanisms of the brain”

• Brain reorganizes itself

THE LENS

HOW THE LENS WORKS

Traditional biofeedback: uses a normative database to teach, or train, the brain using operant conditioning to emit pre-determined “optimal” frequencies at each of the 10/20 sites.

The LENS: Using real-time Dominant Frequency (DF) calculations, it is believed the LENS’s paradoxical feedbackTM interrupts maladaptive patterns acquired in response to head trauma, physical or emotional trauma, genetic factors, environmental influences, anoxic events, chemotherapy treatment, medications, etc.

It is thought that the paradoxical feedback disrupts the timing of the thalamico-cortical signals, disrupting the brain defensive neurochemistry that cuts connectivity.

“It is much easier to trip someone than to teach them how to fall.” L. Ochs

TREATING WITH THE LENS

LENS SESSION

Three sensors are attached to the patient, and the LENS session is administered. The average length of a LENS session is 1-8 minutes.

CREATING A MAP 10/20 SITES

The LENS utilizes the standard international 10/20 sites, which are nothing more than evenly distributed over the scalp, and gathers information at each of 21 sites as it provides treatment.

10-20 SYSTEM

TREATING WITH THE LENS

STANDARD MAP

The LENS Map, which reflects the EEG information gathered at each of the 21 sites, guides patient treatment by providing the order in which to treat the 21 sites.

TREATING WITH THE LENS

STANDARD MAP

• Amplitude plus standard deviation

• Dominant frequency plus standard deviation

• Target in sequence from lowest amplitude to highest amplitude

STANDARD MAPSURVIVOR PATTERN

TREATING WITH THE LENS

SUPPRESSION MAP

• Coeffcient of variability

• SD/amplitude

• SD/dominant frequency

• Target in sequence

• Most suppressed to least suppressed

• Faster, more efficient than standard map

SUPPRESSION MAPSURVIVOR PATTERN

SUPPRESSION

EEG EFFECTS

SUPPRESSION

EFFECTS

• Related to notion of burst suppression• Stress related release of endogenous opioids• Opioids do not create burst suppression• Decreased amplitudes• Inactivated brain states, eg. anesthesia, coma, hypothermia• Decrease in cerebral metabolic rate• Absence of higher level brain activity• Brain inactivation• Pattern of high activity and no activity• Spikes and flatlines

DISSOCIATION

INHIBITORY NEUROTRANSMITTERS

• Endogenous opioids & cannabinoids

• Opioid blockade facilitates cognitive processing and cortico-thalamocorticalprocessing of visual stimuli (Lensing 1995)

• Naltrexone: alpha blocking

• Increased visual pursuit behavior

• Increased visual contact in social situations

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BRAIN ACTIVATION

DISSOCIATIVE RESPONSE

SUPPRESSION

EEG EFFECTS

LENSTHE NOTION OF SUPPRESSION

• “Survivor pattern”

• Lack of variability/flexibility

• Lack of adaptive response of the brain to environmental input

• Amplitude suppression

• Dominant frequency suppression

• Suppression of specific frequencies

• Coefficient of variability

SUPPRESSION

EEG EFFECTS

SUPPRESSION

EEG EFFECTS

SUPPRESSION VS SLOW WAVE ACTIVITY

DIFFERENCES

• Slow wave faster than suppression

• No burst suppression in normal sleep

• Delta activity

• Associated with slow wave sleep

• Increased declarative memory

SUPPRESSION

REMOVAL

• Increase in functioning

• Increased amplitudes

• Increased slow wave activity

• Increased definition on regular map

• Regular map will look more dysfunctional

• Rapid removal of suppression may be issue in Dissociative Disorders

LENS

EEG & SUPPRESSION

In fact, the EEG at the end of a successful LENS treatment can look more typical of what accompanies impairment of functioning than it did at the beginning from the traditional qEEG point of view.

Len Ochs

TREATING WITH THE LENS

REMOVAL OF SUPPRESSION

• Increased amplitude

• Greater variability

• Increased level of functioning

• Severe DD do not tolerate removal of supression

• Increased access to mnemonic material

• Desensitization – going slow

EEG ACTIVITY

EFFECTS OF PTSD

• Beta (Cohen et al. 2012; Huang et al. 2014)

• Gamma (Cohen et al. 2012; Huang et al. 2014)

• Alpha (Begic 2003; Huang et al. 2014)

• Theta (Todder et al. 2012; Huang et al. 2014)

• Alpha/theta ratio (Veltmayer et al. 2006)

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ALPHA ABNORMALITIES

HUANG ET AL 2014

• Decreased alpha-band activity in PTSD • Bilateral FPs• Bilateral dlPFC (more R than L)• Bilateral anterior aspects of superior temporal

gyri (more R than L)• Bilateral precuneous cortices• Bilateral sensorimotor cortices (more R than L)

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EFFECTS OF PTSD

ALPHA ABNORMALITIES

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Huang et al. 2014

NEUROFEEDBACK AND PTSD

KLUETSCH ET AL. 2014

• Childhood abuse PTSD

• Pz only – default network - reducing alpha

• Decreased alpha amplitude followed by alpha rebound – removal of suppression?

• Increased salience network connectivity with right insula

• Increased default network connectivity with bilateral posterior cingulate, right middle frontal gyrus and left mPFC

NEUROFEEDBACK AND PTSD

NICHOLSON ET AL. 2016• Childhood abuse PTSD• Pz only – default network - reducing alpha• Decreased alpha amplitude followed by alpha

rebound• Decreased PTSD Sx and reduced arousal• Shift in amygdala complex connectivity• From areas implicated in defensive, emotional

and fear processing/memory retrieval to prefrontal areas implicated in emotion regulation/modulation

NEUROFEEDBACK AND PTSD

NICHOLSON ET AL. 2016

THE ROLE OF ALPHA

DOMINANT FREQUENCY

• Dominant frequency in brain and body• Increased alpha frequency associated with increased

memory and cognitive functioning• Decrease of alpha frequency in Alzheimer’s• Involvement of theta• Alpha: attentional suppression in visual cortex• Faster rhythms modulated by slower ones• Alpha inhibits slower oscillations• Gamma rhythm nested in alpha rhythm

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DOMINANT FREQUENCYALPHA

• Alpha dominant frequency in normal adults

• Infants and toddlers: delta and theta

• Alpha dominant frequency in the body

• Mind-body connection?

• Lowered dominant frequency in trauma survivors

• Excessive low frequency band amplitudes

ALPHA WAVES

FUNCTION

• Alpha suppression with gaze orientation

• Alpha and beta gating mechanism for gamma, especially after initiation of saccades.

• Decreased alpha: exteroceptive

• Increased alpha: interoceptive

• Alpha inhibits information processing (Klimesch, 2012)

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DISSOCIATION

INHIBITORY NEUROTRANSMITTERS

• Endogenous opioids & cannabinoids

• Opioid blockade facilitates cognitive processing and cortico-thalamocorticalprocessing of visual stimuli (Lensing 1995)

• Naltrexone: alpha blocking

• Increased visual pursuit behavior

• Increased visual contact in social situations

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LENS

A HYBRID APPROACH

• Integrates findings from traditional NFB

• Kluetsch et al. (2014), Nicholson et al. (2016)

• Focus on alpha band

• Apply to LENS NFB

• Use of LENS maps

• PTSD and Traumatic Stress Syndromes

• Maybe applicable to other populations

LENS

ALPHA FEEDBACK

• Applications include 8-12hz band filter – alpha filter

• 100 percent duty cycle

• Longer duration

• Smaller offset

• Increased use of narrow band

• More easily tolerated

• Decreased alpha with strong alpha rebound

• Theta crossover

THE LENS

ALPHA-THETA

• Prior to EMDR processing

• Client unable to proceed to trauma processing

• In addition to other stabilization activities

• More rapid stabilization

• General symptom improvement

• Decreased anxiety

• Improved mood

• Greater effects than stabilization as usual

LENS & EMDR

AN INTEGRATED APPROACH

NEUROAFFECTIVE PSYCHOTHERAPIES

LENS & EMDR• Standalone vs. Integration w/ EMDR

• Use in stabilization

• Increase in cognitive capacity

• Increase in self-regulation

• Ego state communication

• Improved trauma processing – EMDR and SP

• Mopping up

• Integration

THE LENS

EMDR PROCESSING

• 68 cases• LENS to facilitate EMDR processing• 1 to 11 sites – usually 5 -7 • Immediately prior to EMDR processing• More efficient response to EMDR• Increased interoceptive awareness• Decreased visible abreaction• SUD decreases more quickly

THE LENS

MOPPING UP

• Ongoing symptoms after EMDR

• SUD does not remain at 0

• Ongoing pain activity

• LENS

• Further symptom improvement

• Decrease in pain activity

• Additional material for EMDR processing emerges

• Mopping up

• Completes integration phase

LENS & EMDR CASE STUDY

DEPERSONALIZATION DISORDER

• Attachment trauma• Multiple caregivers• Impaired social & employment functioning• Sexual acting out?• Social anxiety• Ecstasy experience with former boyfriend• Triggers intractable depersonalization• CT scan shows right temporal lobe abnormality• On MRI interpreted as artifact• EEG slight anomalies but no diagnosis of seizure disorder

LENS & EMDR CASE STUDY

DEPERSONALIZATION DISORDER

• Referred by psychiatrist for NFB

• Previous Sensorimotor Psychotherapy, EMDR

• Low dose naltrexone – limited effect

• Regular and high dose naltrexone

• 150mg per day best functioning

• 200mg triggers anxiety

• Neuroptimal: mild improvements

INITIAL MAP

DEPERSONALIZATION

INITIAL SUPPRESSION MAP

DEPERSONALIZATION

LENS & EMDR CASE STUDY

DEPERSONALIZATION DISORDER• 48 sessions of LENS• Initially tolerates only small number of sites• Variable pulse application to remove suppression• Panic attack while traveling with family in car• Usually 7 sites prior to EMDR• Tolerates Alpha applications on whole head• Significant improvement in social anxiety• Significant improvement in depersonalization• Normalized social & employment functioning

LENS REGULAR MAP – POST TREATMENT

DEPERSONALIZATION DISORDER

LENS SUPPRESSION MAP – POST TREATMENT

DEPERSONALIZATION DISORDER

LENS & EMDR CASE STUDY

DDNOS

• Severe attachment issues

• Graduate degree in psychology

• Unable to work

• Dissociative symptoms

• ADD

• Depression

• Pornography addiction

• On antidepressant and stimulant medication

LENS & EMDR CASE STUDY

DDNOS

• Stabilization

• Sensorimotor Psychotherapy

• EMDR

• Neuroptimal

• Modest improvements

• All prior to LENS map

LENS & EMDR CASE STUDY

DDNOS

• Further improvements with LENS

• Tolerates whole head – Alpha application

• Low dose naltrexone added

• > 40 sessions LENS

• Usually 7 sites prior to EMDR

• Some 21 site sessions in between EMDR sessions

• Decides to move

• Return to employment

INITIAL REGULAR MAP

DDNOS

POST TREATMENT REGULAR MAP

DDNOS

NEURAL REGULATION

THE BODY

• LENS neurofeedback to the body• Area of pain• Acupuncture spot• Triangulate electrodes• ECG electrodes• 100% duty cycle application• Long application• Use of alpha filter• Reduces muscle tension• Appears to facilitate healing• Mind-body connection

THE BODY

LENS NEUROFEEDBACK

• LENS neurofeedback to the body

• Area of pain

• Acupuncture spot

• Triangulate electrodes around the area

• 100% duty cycle application

ALPHA AND THE BODY

HORSLEY & SHÄFER 1888

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ALPHA AND THE BODY

MARSHALL & WALSH 1956

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ALPHA & THE BODYSEPARATE BUT IDENTICAL

• Muscle activity 10hz

• Similar frequency at multiple sites

• Not innervated by brain alpha rhythm

• Continues if brain isolated from body

• Low frequency accentuates tremor

• High frequency accentuates jerky movements

NEURAL REGULATION

THE BODY

• Body oriented interventions

• LENS neurofeedback to the body

• Photonic stimulator

• Scenar-cosmodic

INFLAMMATION

BODY LENS

• Adaptation from Oschmann 2015

• Grounding acupuncture spot K1

• Reduction in inflammation

• Delivering LENS to K1 on both feet

• 2-channel alpha body application

GROUNDING & INFLAMMATION

KIDNEY 1

GROUNDING & INFLAMMATION

OSCHMANN 2015

GROUNDING & INFLAMMATION

KIDNEY 1

BODY LENS – CASE STUDY

COMPLEX REGIONAL PAIN SYNDROME

• Intractable pelvic pain

• Multiple interventions unsuccessful

• Attachment trauma

• Sexual abuse

• Medical trauma

• CRPS triggered by medical intervention

COMPLEX REGIONAL PAIN SYNDROME

PELVIC PAIN

• Weaned off opiates• Difficulty tolerating LDN• LENS to head – all sites• LENS to K1 bilaterally• Photonic stimulator to pain area• Marked reduction in pain activity• DID diagnosis emerges• Ego-state work• Lasting reduction in pain activity

LENS & EMDR

BODY LENS• Male

• DID, Substance abuse

• Severe birth trauma

• Severe early childhood medical trauma

• Sexual abuse

• Initially unwilling to participate in psychological treatment

• Treatment centre

• Returns for LENS

• Registers in undergraduate program

• EMDR >40 sessions

• Body sensations limited response to treatment

• Birth trauma SUDS level limited response

LENS & EMDR

BODY LENS

• Body LENS on neck area while administering tactile bilateral EMDR

• Focus on body sensation

• Body LENS for entire EMDR session ca. 40 minutes

• SUD stays reduced for first time

• Body sensations and muscle spasms reduced

• 5 sessions

• Move to other body areas with medical trauma

LENS & EMDR

LENS EFFECTS

• Removal of EEG suppression

• More flexible alpha activity

• Increased excitatory/inhibitory balance

• Pacing of trauma processing

• Sense of self

• Enhanced neuroplasticity?

• Default network connectivity?

LENS & EMDR

LENS EFFECTS• Helps to stabilize dissociative clients• Decreases SUDS• Increased self-regulation• Decreased alexithymia/numbing• Increased mnemonic access• More able to verbalize experiences• Decreased blocking, looping• More efficient EMDR processing• More rapid symptom resolution

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LENS & EMDR

SYNERGISTIC EFFECTS ON EEG

• Altered default network connectivity (Landin-Romero et al, 2013)

• Decreased alpha after EMDR (Pagani et al. 2013)

• Increased gamma during BS (Pagani 2013)

• Activity in gamma band observed in healthy volunteers in ACC and left PFC upon exposition to emotional stimuli

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STOCHASTIC RESONANCE

DISRUPTIVE STIMULUS• Role in sensory signal detection in brain • Visual, sensory, tactile• Information processing in a non-linear system

enhanced by the addition of low level noise • Alters response threshold/signal-to-noise ratio• Hypothesized functional mechanism of EMDR (Miller,

2016; Khalfa, 2018)• TMS can induce stochastic resonance • Induces behavioral facilitation when stimulated are is

in a suppressed state (Schwarzkopf et al, 2011)• A functional mechanism of LENS?

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STOCHASTIC RESONANCE

CORTICAL CONNECTIVITY

• Modulates neural synchronization within and between cortical sources (Ward et al, 2010)

• Synchronization in alpha and gamma frequency bands

• TMS can induce stochastic resonance

• Induces behavioural facilitation when stimulated area is in a suppressed state (Schwarzkopf et al, 2011)

• A functional mechanism of LENS?

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LENS & EMDR

EMDR HYPOTHESIS• Alternation between interoceptive and

exteroceptive awareness - Body vs BS• Alternation between salience and default

network connectivity• greater coordination within the default mode

network between vmPFC and PCC nodes associated with better working memory

• It may be that the relationship between activity in the default mode network and its anti-correlated networks, instead of the DMN itself, is most functionally relevant.

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