The Learning Curve in neurofeedback of Peter Van Deusen: A review article

A CURVA DA APRENDIZAGEM DE PETER VAN DEUSEN EM NEUROFEEDBACK: ARTIGO DE REVISÃO

Valdenilson Ribeiro Ribas Renata de Melo Guerra Ribas Hugo André de Lima Martins About the authors

ABSTRACT

The Learning Curve (TLC) in neurofeedback concept emerged after Peter Van Deusen compiled the results of articles on the expected electrical activity of the brain. This concept was subsequently tested on patients at four clinics in Atlanta between 1994 and 2001. The aim of this paper was to report the historical aspects of TLC. Articles published on the electronic databases MEDLINE/PubMed and Web of Science were reviewed. During patient evaluation, TLC investigates categories called disconnected, hot temporal lobes, reversal of alpha and beta waves, blocking, locking, and filtering or processing. This enables neuroscientists to use their training designs and, by means of behavioral psychology, to work on neuroregulation, as self-regulation for patients. TLC shows the relationships between electrical, mental and behavioral activity in patients. It also identifies details of patterns that can assist physicians in their choice of treatment.

Key words:
brain-learning; learning curve; neurofeedback

RESUMO

A TLC em neurofeedback surgiu após uma reunião de periódicos organizada por Peter Van Deusen sobre as atividades elétricas cerebrais esperadas e depois testadas em diversos pacientes em quatro consultórios, em Atlanta, de 1994 a 2001. O objetivo deste artigo é relatar o aspecto histórico da TLC. Realizou-se uma revisão na base eletrônica MEDLINE/PubMed e Web of Science. A TLC investiga as categorias denominadas desconectados, temporais quentes, inversões de alpha e beta, bloqueando, trancando, filtrando e processando e, em seguida, possibilita, em seus designs de treinamento, que o (a) neurocientista trabalhe, por meio da psicologia comportamentalista, a autoneuroregulação do paciente. A TLC mostra as relações entre as atividades elétricas, mentais e comportamentais nos pacientes e também fornece uma identificação detalhada dos padrões que podem ajudar os médicos na escolha dos tratamentos.

Palavras-chave:
aprendizagem cerebral; curva de aprendizagem; neurofeedback

INTRODUCTION

Electroencephalography (EEG): a brief history

Electricity was first described by Thales of Miletus (624-546 BC)11. Ganz JC. Some physics from 550 BC to AD 1948. Prog Brain Res. 2014;215:13-23. when he observed that lodestone (magnetite), a naturally occurring magnet, and amber (after rubbing with fur) attracted other objects. Later, William Gilbert (1544-1603)22. Smith M. William Gilbert (1544-1603): physician and founder of electricity. J Med Biogr. 1997;5 (3):137-145. published a study showing the Earth was magnetic and that this was why compasses point North; Otto von Guericke (1602-1686)33. Harsch V. Otto von Gericke (1602-1686) and his pioneering vacuum experiments. Aviat Space Environ Med. 2007;78(11):1075-1077. invented an electrostatic machine consisting of a sulfur sphere; Pieter van Musschenbroek (1692-1761)44. de Micheli-Serra A, Iturralde-Torres P, Izaguirre-Avila R. How electricity was discovered and how it is related to cardiology. Arch Cardiol Mex. 2012;82(3):252-259. became renowned in the field for creating the Leyden jar, a device to store electrical charge. A number of scholars furthered our understanding of the electrical properties of living organisms, including Luigi Galvani (1737-1798),55. Verkhratsky A, Parpura V. History of electrophysiology and the patch clamp. Methods Mol Biol. 2014;1183:1-19. Alessandro Volta (1745-1827),66. Sperati G. [Alessandro Volta and first attempts at electrotherapy of deafness]. Acta Otorhinolaryngol Ital. 1999;19(4):239-243. Georg Ohm (1789-1854)77. Geddes LA, Geddes LE. How did Georg Simon Ohm do it? IEEE Eng Med Biol Mag. 1998;17(3):107-109. and Michael Faraday (1791-1867).88. Giddens WR. The origin of electrochemical nomenclature. J La State Med Soc. 2001;153(9):471-475. In around 1780, for example, Galvani dissected a frog and left it on a lab bench. However, the frog twitched when one of his assistants touched its crural nerve with a scalpel.99. Aloysio Luigi Galvani (1737-1798) discoverer of animal electricity. JAMA. 1967;201(8): 626-627. It was at this time that Galvani began to establish a relationship between electrical activity and nerve impulses.1010. Bresadola M. Medicine and science in the life of Luigi Galvani (1737-1798). Brain Res Bull. 1998;46(5):367-380.,1111. de Medeiros Kanda PA. Historia da Eletroencefalografia. [Video]. In: Curso EEG. Copyright Sinapsy and saudeciencia.com.br, São Paulo, YouTube (2012, November 14). [Video file]. Retrieved (2015, December 21) from www.youtube.comwatchv2-dH0bSKeec.
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A contemporary of Galvani, Alessandro Giuseppe Antonio Anastasio Volta (1745-1827),1212. Partin C. Profiles in cardiology. Alessandro Volta. Clin Cardiol. 2002; 25(11):541-543. became intrigued with Galvani's ideas; however, perhaps because he had graduated in physics, he believed that living organisms could not actually produce electricity.1313. Cajavilca C, Varon J, Sternbach GL. Resuscitation great. Luigi Galvani and the foundations of electrophysiology. Resuscitation. 2009;80(2): 159-162. Subsequently, in Florence, Leopoldo Nobili (1784-1835)1414. Isler H. [Romantic origins of electrophysiology]. Schweiz Rundsch Med Prax. 1992;81(49):1485-1488. invented the needle galvanometer. This galvanometer was refined in 1858 by William Thomson (1824-1907),1515. Gallagher HW. Sir William Thomson, physician. Ulster Med J. 1973;42(1): 15-27. Carlo Matteucci (1811-1868)1616. Rocchietta S. [Carlo Matteucci (1811-1868), a pioneer of electrophysiology. On the first centenary of his death]. Minerva Med. 1968;59(84): 4485-4486. and particularly the German researcher, physiologist Emil du Bois-Reymond (1818-1896)1717. Loos H. [The relation between physiology and medicine in Emil du Bois-Reymond]. Z Gesamte Hyg. 1985;31(8):484-485. who demonstrated nerve action potential.1818. Zhang M. [Emil du Bois-Reymond--the father of experimental electrophysiology]. Sheng Li Ke Xue Jin Zhan. 2013;44(2):158-160. In 1875, Richard Caton (1842-1926)1919. Haas LF. Hans Berger (1873-1941), Richard Caton (1842-1926), and electroencephalography. J Neurol Neurosurg Psychiatry. 2003;74(1):9. described the electrical brain activity of rabbits and monkeys, using a one-channel galvanometer. This experiment marked the birth of electrophysiology.1111. de Medeiros Kanda PA. Historia da Eletroencefalografia. [Video]. In: Curso EEG. Copyright Sinapsy and saudeciencia.com.br, São Paulo, YouTube (2012, November 14). [Video file]. Retrieved (2015, December 21) from www.youtube.comwatchv2-dH0bSKeec.
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The difficulty at that time was to find sophisticated equipment that could capture the low-intensity electrical activity of the brain (microvolts). In this scenario, another researcher named Willem Einthoven (1860-1927)2121. Raju TN. The Nobel chronicles. 1924: Willem Einthoven (1860-1927). Lancet. 1998;352 (9139):1560. excelled by improving galvanometers and allowing their use in cardiology and neurology, for which he received the Nobel prize for medicine in 1912.1111. de Medeiros Kanda PA. Historia da Eletroencefalografia. [Video]. In: Curso EEG. Copyright Sinapsy and saudeciencia.com.br, São Paulo, YouTube (2012, November 14). [Video file]. Retrieved (2015, December 21) from www.youtube.comwatchv2-dH0bSKeec.
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Later, a researcher called Vladimir Pravidich-Neminsky (1879-1952)1111. de Medeiros Kanda PA. Historia da Eletroencefalografia. [Video]. In: Curso EEG. Copyright Sinapsy and saudeciencia.com.br, São Paulo, YouTube (2012, November 14). [Video file]. Retrieved (2015, December 21) from www.youtube.comwatchv2-dH0bSKeec.
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,2222. Tudor M, Tudor L, Tudor KI. [Hans Berger (1873-1941)--the history of electroencephalography]. Acta Med Croatica. 2005;59(4):307-313. captured the electrical activity of a dog's nerves using an Einthoven Galvanometer, recording the image on photographic paper adhered to a revolving drum. The results, waves shown as traces over time, were published in 1913 and recognized as the first printed electroencephalogram (EEG).2222. Tudor M, Tudor L, Tudor KI. [Hans Berger (1873-1941)--the history of electroencephalography]. Acta Med Croatica. 2005;59(4):307-313. At around this time, Hans Berger (1873-1941)2323. Gloor P. Hans Berger and the discovery of the electroencephalogram. Electroencephalogr Clin Neurophysiol. 1969:Suppl 28:1-36. was the first scientist to record human brain electrical activity using the Einthoven Galvanometer. It was Berger who described alpha and beta rhythms and proposed the EEG model of 3 cm per second still used today.2424. Wiedemann HR. Hans Berger (1873-1941). Eur J Pediatr. 1994;153(10): 705. Edgar Douglas Adrian (1889-1977)2525. Eccles JC. Edgar Douglas Adrian 1889--1977. Exp Brain Res. 1978; 31(1):153-154. reproduced and published several studies based on Berger's findings.2626. Raju TN. The Nobel Chronicles. 1932: Charles Scott Sherrington (1857-1952), Edgar Douglas Adrian (1889-1977). Lancet. 1999;353(9146):76. In 1935, in the United States, Herbert Henri Jasper (1906-1999),2727. Andermann F. Herbert Henri Jasper 1906-1999: an appreciation and tribute to a founder of modern neuroscience. Epilepsia. 2000;41(1): 113-120. using more modern and sensitive equipment than Berger's devices, published many studies on animals and humans.1111. de Medeiros Kanda PA. Historia da Eletroencefalografia. [Video]. In: Curso EEG. Copyright Sinapsy and saudeciencia.com.br, São Paulo, YouTube (2012, November 14). [Video file]. Retrieved (2015, December 21) from www.youtube.comwatchv2-dH0bSKeec.
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,2727. Andermann F. Herbert Henri Jasper 1906-1999: an appreciation and tribute to a founder of modern neuroscience. Epilepsia. 2000;41(1): 113-120.

Electroencephalography developed further with the studies on epilepsy by the Gibbs couple, Frederic Andrews Gibbs (1903-1992) and Erna L. Gibbs (1925-1987),2828. Mahmoudi Nezhad GS, Dalfardi B. Frederic Andrews Gibbs (1903-1992). J Neurol. 2016;263(1):195-196. who also described the complex spike-wave.1111. de Medeiros Kanda PA. Historia da Eletroencefalografia. [Video]. In: Curso EEG. Copyright Sinapsy and saudeciencia.com.br, São Paulo, YouTube (2012, November 14). [Video file]. Retrieved (2015, December 21) from www.youtube.comwatchv2-dH0bSKeec.
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,2929. Hayne RA, Belinson L, Gibbs FA. Electrical activity of subcortical areas in epilepsy. Electroencephalogr Clin Neurophysiol. 1949;1(4):437-445. The first multi-channel devices were created by Albert Melvin Grass (1910-1992)3030. [No authors listed]. End innovators and pioneers Albert Melvin Grass. Am J Electroneurodiagnostic Technol. 2009;49(2):207-215. in 1939. Subsequently, Nathaniel Kleitman (1895-1999),3131. Dement WC. Remembering Nathaniel Kleitman. Arch Ital Biol. 2001; 139(1-2):11-17. William Charles Dement (1928),3232. Mathis J. [The history of sleep research in the 20th century]. Praxis (Bern 1994). 1995;84(50):1479-1485. Giuseppe Moruzzi (1910-1986)3333. Pompeiano O. Giuseppe Moruzzi, 1910-1986. Pflugers Arch. 1988;412(4):S9-S11. and Horace Winchell Magoun (1907-1991)3434. Marshall LH. Horace Winchell Magoun. Biogr Mem Natl Acad Sci. 2004;84:250-269. contributed much to electroencephalography with their discoveries and descriptions of the stages of sleep and the K-complexes.1111. de Medeiros Kanda PA. Historia da Eletroencefalografia. [Video]. In: Curso EEG. Copyright Sinapsy and saudeciencia.com.br, São Paulo, YouTube (2012, November 14). [Video file]. Retrieved (2015, December 21) from www.youtube.comwatchv2-dH0bSKeec.
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,3535. Erwin CW, Somerville ER, Radtke RA. A review of electroencephalographic features of normal sleep. J Clin Neurophysiol. 1984;1(3):253-274.

After the discovery of qualitative EEG by Berger, the physicist Dietsch (1932) from the Physics and Technology Institute at Jena, Germany, applied Fourier analysis to seven EEG recordings and became the first researcher in quantitative EEG (QEEG).3636. Collura TF. History and evolution of computerized electroencephalography. J Clin Neurophysiol. 1995;12(3):214-229. This achievement, in conjunction with the advancement of computing and digital EEG, enabled the discovery of Biofeedback/Neurofeedback.3737. Duffy FH, Hughes JR, Miranda F, Bernad P, Cook P. Status of quantitative EEG (QEEG) in clinical practice, 1994. Clin Electroencephalogr. 1994;25(4):VI-XXII.

EEG-BIOFEEDBACK/NEUROFEEDBACK: A PRACTICAL APPLICATION

Concurrent with the development of the digital EEG for assessment purposes, a separate group of researchers began demonstrating the capacity of the brain to shift its own activation patterns when given feedback. In 1968, Dr. Joe Kamiya published an article about his experiences with alpha brain waves in Psychology Today.3838. Kamiya J. Conscious control of brain waves. Psychol Today. 1968; 1:56-60. Despite criticism by Martin Orne and others, Kamiya and James Hardt at the Langley Porter Psychiatric Institute of the University of California published an original article demonstrating the effectiveness of training by neurofeedback.3939. Hardt JV, Kamiya J. Anxiety change through electroencephalographic alpha feedback seen only in high anxiety subjects. Science. 1978;201(4350):79-81.

Although the Fast Fourier Transform (FFT) had been used to break down and digitize the analog waveforms of the traditional EEG signal, the process was very time-consuming until the advent of the digital computer in the 1970s.3737. Duffy FH, Hughes JR, Miranda F, Bernad P, Cook P. Status of quantitative EEG (QEEG) in clinical practice, 1994. Clin Electroencephalogr. 1994;25(4):VI-XXII. Increasingly, as computation grew in speed and power while becoming more accessible in size and cost over the ensuing decades, digital quantitative EEG has moved from large university laboratories3737. Duffy FH, Hughes JR, Miranda F, Bernad P, Cook P. Status of quantitative EEG (QEEG) in clinical practice, 1994. Clin Electroencephalogr. 1994;25(4):VI-XXII.,4040. de Medeiros Kanda PA, Anghinah R, Smidth MT, Silva JM. The clinical use of quantitative EEG in cognitive disorders. Dementia & Neuropsychologia. 2009;3(3):195-203. literally into the offices of individual professionals.3737. Duffy FH, Hughes JR, Miranda F, Bernad P, Cook P. Status of quantitative EEG (QEEG) in clinical practice, 1994. Clin Electroencephalogr. 1994;25(4):VI-XXII.,4141. Bahn E, Nolte W, Kurth C, Ramadori G, Ruther E, Wiltfang J. Quantification of the electroencephalographic theta/alpha ratio for the assessment of portal-systemic encephalopathy following implantation of transjugular intrahepatic portosystemic stent shunt (TIPSS). Metab Brain Dis. 2002;17(1):19-28. Because of its high test/retest reliability and temporal resolution, it has formed the basis for much of the research that, during the 1990s, provided a detailed view of the living brain that infuses the "geographical" brain of Brodmann and others.3636. Collura TF. History and evolution of computerized electroencephalography. J Clin Neurophysiol. 1995;12(3):214-229.,3737. Duffy FH, Hughes JR, Miranda F, Bernad P, Cook P. Status of quantitative EEG (QEEG) in clinical practice, 1994. Clin Electroencephalogr. 1994;25(4):VI-XXII.

In the 1980s, researchers such as E. Roy John4242. John ER, Thatcher R. Neurometrics: Clinical applications of quantitative electrophysiology: John Wiley & Sons;1977.,4343. John ER. Neurometric evaluation of brain function in normal and learning disabled children: University of Michigan Press;1989. and Robert Thatcher4444. Thatcher RW, North D, Biver C. Evaluation and validity of a LORETA normative EEG database. Clin EEG Neurosci. 2005;36(2):116-122.,4545. Thatcher R, North D, Biver C. Parametric vs. non-parametric statistics of low resolution electromagnetic tomography (LORETA). Clinical EEG and neuroscience. 2005;36(1):1-8. began aggregating processed EEGs into so-called "normative databases".4444. Thatcher RW, North D, Biver C. Evaluation and validity of a LORETA normative EEG database. Clin EEG Neurosci. 2005;36(2):116-122.,4646. John ER, Prichep LS. The relevance of QEEG to the evaluation of behavioral disorders and pharmacological interventions. Clin EEG Neurosci. 2006;37(2):135-143.,4747. Thatcher RW, Biver CJ, North DM. Quantitative EEG and the Frye and Daubert standards of admissibility. Clinical EEG and Neuroscience. 2003;34(2):39-53. These quickly became an integral part of the QEEG used by brain researchers, allowing them to compare EEG patterns of sub-groups of the population (e.g. anxious, compulsive, inattentive, etc.) against the population as a whole and to identify differentiating variables.4646. John ER, Prichep LS. The relevance of QEEG to the evaluation of behavioral disorders and pharmacological interventions. Clin EEG Neurosci. 2006;37(2):135-143.

HISTORY OF THE TLC ASSESSMENT (TRAINERS' QEEG)

In 1991, Peter Van Deusen formed a mentoring relationship with Joel F. Lubar, a professor at the University of Tennessee-one of the pioneers and most prolific researchers in the field.4848. Goodwin B. Peter Van Deusen began the duties of administration of the Rolling Plans Memorial Hospital. Sweetwater Reporter Journal, 1979;12:15e. After training his own brain and experiencing significant changes, he had an opportunity to begin working under the supervision of two psychologists-a behaviorist and a family therapist-and a psychiatrist/psychopharmacologist. Integrating these three apparently disparate viewpoints for nearly a year led to a view of the process that would inform and underlie the system he developed for brain training.4949. Dupee M, Werthner P. Managing the stress response: The use of biofeedback and neurofeedback with Olympic athletes. Biofeedback. 2011;39(3):92-94.

Following that experience, Van Deusen continued with the project of applying the technology of brain training, not from a pathology-based viewpoint but as a means of producing lasting changes in the patterns and systems that presented at his practice on Attention Development Programs (ADP).5050. Monastra VJ, Lubar JF, Linden M, et al. Assessing attention deficit hyperactivity disorder via quantitative electroencephalography: an initial validation study. Neuropsychology. 1999;13(3):424-433.

He argued that mental health diagnoses, which were proliferating at a dizzying pace during the 1990s, were largely just descriptions of symptoms, so his approach focused on identifying behavioral issues targeted for change without labeling them. In courses with various colleagues breaking new ground in the field of brain training during this period, he recognized multiple descriptors of brain function, including patterns and relationships of frequencies, synchrony, symmetry and variability that could identify macro divergences from the peak brain patterns that most interested him.4949. Dupee M, Werthner P. Managing the stress response: The use of biofeedback and neurofeedback with Olympic athletes. Biofeedback. 2011;39(3):92-94.

From 1993 to 2001, ADP operated 3-4 practice sites in Atlanta and worked with more than 500 patients with a broad range of training issues. Van Deusen did all assessments and training plans, personally trained nearly 200 patients in one center and supervised the trainers in the others.4949. Dupee M, Werthner P. Managing the stress response: The use of biofeedback and neurofeedback with Olympic athletes. Biofeedback. 2011;39(3):92-94. During this period, he implemented multiple training approaches as the technology advanced. In 2001, Van Deusen left his practice and began traveling half or more of each year to teach courses on assessment and training to professionals in 32 US states, Canada, Australia, Korea, Brazil and six European countries.4848. Goodwin B. Peter Van Deusen began the duties of administration of the Rolling Plans Memorial Hospital. Sweetwater Reporter Journal, 1979;12:15e. During this period, he began gathering material from a number of published studies identifying patterns in the EEG and formalizing them into a brain-based assessment process, which he presented at various national conferences. This TLC Assessment5151. Van Deusen PM, Guerra-Ribas RM, da Silva EPL, Lima da Silva T, Ribas VR. Tratamento de paciente com depressão pela técnica The Learning Curve-TLC em Neurofeedback: estudo de caso. In: IV Congresso de Biomedicina e Farmácia da Faculdade ASCES, 2014, Caruaru/PE, Brasil. Associação Caruaruense de Ensino Superior, 2014;4: 234. began being used by professionals around the world.4949. Dupee M, Werthner P. Managing the stress response: The use of biofeedback and neurofeedback with Olympic athletes. Biofeedback. 2011;39(3):92-94.

TLC TRAINING CATEGORIES

The Learning Curve (TLC) in neurofeedback is a brain training technique based on an investigative protocol developed by Peter M. Van Deusen,4949. Dupee M, Werthner P. Managing the stress response: The use of biofeedback and neurofeedback with Olympic athletes. Biofeedback. 2011;39(3):92-94.,5151. Van Deusen PM, Guerra-Ribas RM, da Silva EPL, Lima da Silva T, Ribas VR. Tratamento de paciente com depressão pela técnica The Learning Curve-TLC em Neurofeedback: estudo de caso. In: IV Congresso de Biomedicina e Farmácia da Faculdade ASCES, 2014, Caruaru/PE, Brasil. Associação Caruaruense de Ensino Superior, 2014;4: 234. following compilation of results of articles about expected patterns of brain electrical activity in humans. According to Sterman et al. (1996),5252. Sterman MB. Physiological origins and functional correlates of EEG rhythmic activities: implications for self-regulation. Biofeedback Self Regul. 1996;21(1):3-33. changes in patterns that involve the predominance of expected waves and the synchronization between the two cerebral hemispheres may represent different cognitive and behavioral states, including signs and symptoms of attention deficit, depression, anxiety and fear, among others.4949. Dupee M, Werthner P. Managing the stress response: The use of biofeedback and neurofeedback with Olympic athletes. Biofeedback. 2011;39(3):92-94.,5353. Sterman MB, Egner T. Foundation and practice of neurofeedback for the treatment of epilepsy. Appl Psychophysiol Biofeedback. 2006; 31(1):21-35.

The TLC protocol4949. Dupee M, Werthner P. Managing the stress response: The use of biofeedback and neurofeedback with Olympic athletes. Biofeedback. 2011;39(3):92-94.,5151. Van Deusen PM, Guerra-Ribas RM, da Silva EPL, Lima da Silva T, Ribas VR. Tratamento de paciente com depressão pela técnica The Learning Curve-TLC em Neurofeedback: estudo de caso. In: IV Congresso de Biomedicina e Farmácia da Faculdade ASCES, 2014, Caruaru/PE, Brasil. Associação Caruaruense de Ensino Superior, 2014;4: 234. was created from reading, interpreting and reproducing the results of a number of authors.5454. Teicher MH, Glod CA, Surrey J, Swett C, Jr. Early childhood abuse and limbic system ratings in adult psychiatric outpatients. J Neuropsychiatry Clin Neurosci. 1993;5(3):301-306.

55. Teicher MH, Ito Y, Glod CA, Andersen SL, Dumont N, Ackerman E. Preliminary evidence for abnormal cortical development in physically and sexually abused children using EEG coherence and MRI. Ann N Y Acad Sci. 1997;821:160-175.

56. Debener S, Beauducel A, Nessler D, Brocke B, Heilemann H, Kayser J. Is resting anterior EEG alpha asymmetry a trait marker for depression? Findings for healthy adults and clinically depressed patients. Neuropsychobiology. 2000;41(1):31-37.

57. Ito Y, Teicher MH, Glod CA, Harper D, Magnus E, Gelbard HA. Increased prevalence of electrophysiological abnormalities in children with psychological, physical, and sexual abuse. J Neuropsychiatry Clin Neurosci. 1993;5(4):401-408.
-5858. Glod CA, Teicher MH, Hartman CR, Harakal T. Increased nocturnal activity and impaired sleep maintenance in abused children. J Am Acad Child Adolesc Psychiatry. 1997;36(9):1236-1243. Van Deusen combined six categories, classified by the authors cited above,5454. Teicher MH, Glod CA, Surrey J, Swett C, Jr. Early childhood abuse and limbic system ratings in adult psychiatric outpatients. J Neuropsychiatry Clin Neurosci. 1993;5(3):301-306.

55. Teicher MH, Ito Y, Glod CA, Andersen SL, Dumont N, Ackerman E. Preliminary evidence for abnormal cortical development in physically and sexually abused children using EEG coherence and MRI. Ann N Y Acad Sci. 1997;821:160-175.

56. Debener S, Beauducel A, Nessler D, Brocke B, Heilemann H, Kayser J. Is resting anterior EEG alpha asymmetry a trait marker for depression? Findings for healthy adults and clinically depressed patients. Neuropsychobiology. 2000;41(1):31-37.

57. Ito Y, Teicher MH, Glod CA, Harper D, Magnus E, Gelbard HA. Increased prevalence of electrophysiological abnormalities in children with psychological, physical, and sexual abuse. J Neuropsychiatry Clin Neurosci. 1993;5(4):401-408.
-5858. Glod CA, Teicher MH, Hartman CR, Harakal T. Increased nocturnal activity and impaired sleep maintenance in abused children. J Am Acad Child Adolesc Psychiatry. 1997;36(9):1236-1243. in the protocol to be used by all trainers that employ the TLC method. These are: 1) disconnected; 2) hot temporal lobes; 3) reversals; 4) blocking; 5) locking; 6) filtering or processing.

Disconnected is a category that emerged from reading several studies by Martin Teicher et al.5454. Teicher MH, Glod CA, Surrey J, Swett C, Jr. Early childhood abuse and limbic system ratings in adult psychiatric outpatients. J Neuropsychiatry Clin Neurosci. 1993;5(3):301-306.

55. Teicher MH, Ito Y, Glod CA, Andersen SL, Dumont N, Ackerman E. Preliminary evidence for abnormal cortical development in physically and sexually abused children using EEG coherence and MRI. Ann N Y Acad Sci. 1997;821:160-175.

56. Debener S, Beauducel A, Nessler D, Brocke B, Heilemann H, Kayser J. Is resting anterior EEG alpha asymmetry a trait marker for depression? Findings for healthy adults and clinically depressed patients. Neuropsychobiology. 2000;41(1):31-37.

57. Ito Y, Teicher MH, Glod CA, Harper D, Magnus E, Gelbard HA. Increased prevalence of electrophysiological abnormalities in children with psychological, physical, and sexual abuse. J Neuropsychiatry Clin Neurosci. 1993;5(4):401-408.

58. Glod CA, Teicher MH, Hartman CR, Harakal T. Increased nocturnal activity and impaired sleep maintenance in abused children. J Am Acad Child Adolesc Psychiatry. 1997;36(9):1236-1243.

59. Ito Y, Teicher MH, Glod CA, Ackerman E. Preliminary evidence for aberrant cortical development in abused children: a quantitative EEG study. J Neuropsychiatry Clin Neurosci. 1998;10(3):298-307.
-6060. Teicher MH. Scars that won't heal: the neurobiology of child abuse. Sci Am. 2002;286(3):68-75. Teicher investigated the effects of physical and psychological abuse in childhood, and demonstrated neurological morphological, functional and behavioral abnormalities in the frontal and temporal lobes. These changes possibly derive from effects caused by the promoter scenario of anger, shame and desperation of the victim.

Thus, Van Deusen started to observe the patients that he treated in Atlanta and found, during the workup, several reports involving situations of physical and psychological abuse and negligence. One individual was not physically abused as such, but reported that all her sisters had been sexually abused by her father. She then added that she was his 'darling' and suffered a constant invasion of personal limits that had a similar nervous system response. With much distress, this victim reported that "every day when I woke up, I saw my father sitting on my bed staring at me". She reported that over time, this situation became so unbearable that she started waking up earlier, before her father came to her room, and hiding under the bed.4949. Dupee M, Werthner P. Managing the stress response: The use of biofeedback and neurofeedback with Olympic athletes. Biofeedback. 2011;39(3):92-94.

After this case, between 1994 and 2001, Van Deusen reread articles on cases of abuse that generally were of a psychological nature and realized that there are nuances of psychological abuse at the conceptual level, involving the paradox between very intense religious beliefs and breaking these dogmas.4848. Goodwin B. Peter Van Deusen began the duties of administration of the Rolling Plans Memorial Hospital. Sweetwater Reporter Journal, 1979;12:15e.,4949. Dupee M, Werthner P. Managing the stress response: The use of biofeedback and neurofeedback with Olympic athletes. Biofeedback. 2011;39(3):92-94. The results of Van Deusen using QEEG identified a pattern related to high beta waves (23-38 Hz) with the patient's eyes closed. All the results in the right temporal lobe (T4), both percentages and relative numbers, were exactly double those in the left temporal lobe (T3). However, the result was exactly the opposite (T3 = 2T4) in cases of neglect, regardless of whether it was an intentional separation (conscious rejection) or a necessity due to a disease that forced the mother to stay away from her baby.4949. Dupee M, Werthner P. Managing the stress response: The use of biofeedback and neurofeedback with Olympic athletes. Biofeedback. 2011;39(3):92-94.,5757. Ito Y, Teicher MH, Glod CA, Harper D, Magnus E, Gelbard HA. Increased prevalence of electrophysiological abnormalities in children with psychological, physical, and sexual abuse. J Neuropsychiatry Clin Neurosci. 1993;5(4):401-408.,5959. Ito Y, Teicher MH, Glod CA, Ackerman E. Preliminary evidence for aberrant cortical development in abused children: a quantitative EEG study. J Neuropsychiatry Clin Neurosci. 1998;10(3):298-307.

Hot temporal lobe is a category that emerged from reading several studies by Othmer and other authors,4949. Dupee M, Werthner P. Managing the stress response: The use of biofeedback and neurofeedback with Olympic athletes. Biofeedback. 2011;39(3):92-94.,6161. Pivik RT, Broughton RJ, Coppola R, Davidson RJ, Fox N, Nuwer MR. Guidelines for the recording and quantitative analysis of electroencephalographic activity in research contexts. Psychophysiology. 1993;30(6):547-558.

62. Werthner P, Christie S, Dupee M. Neurofeedback and biofeedback training with Olympic athletes. Neuroconnections. 2013;2:32-38.

63. Henriques JB, Glowacki JM, Davidson RJ. Reward fails to alter response bias in depression. J Abnorm Psychol. 1994;103(3):460-466.

64. Othmer E, Othmer SC, Vannier MW, Fishman PM, Holland WH. A simple time synchronization device for polygraph, analogue tape and digital computer as used in sleep research. J Biomed Eng. 1979;1(2):127-128.
-6565. Othmer E, Othmer SC, Fishman PM, Vannier MW. Electromyogram processing for sleep research. Int J Biomed Comput. 1980;11(1):33-39. involving discussions about the activation of the amygdalae in the temporal lobes that use the beta and high beta waves to communicate with the hypothalamus to warn of danger. Peter M. Van Deusen et al. observed patients who had anxiety, panic, fear, phobia or insecurity and found a pattern of waves in the temporal lobes with their eyes closed, for both (T3) and (T4); the beta waves (15-23 Hz) were above 17% and high beta waves above 10%. An ideal pattern of expected beta waves of 14-17% and high beta waves of at most 10% were found by studying a control group without any of these feelings.4949. Dupee M, Werthner P. Managing the stress response: The use of biofeedback and neurofeedback with Olympic athletes. Biofeedback. 2011;39(3):92-94.,6262. Werthner P, Christie S, Dupee M. Neurofeedback and biofeedback training with Olympic athletes. Neuroconnections. 2013;2:32-38.

Reversal is a category based on the findings of authors5151. Van Deusen PM, Guerra-Ribas RM, da Silva EPL, Lima da Silva T, Ribas VR. Tratamento de paciente com depressão pela técnica The Learning Curve-TLC em Neurofeedback: estudo de caso. In: IV Congresso de Biomedicina e Farmácia da Faculdade ASCES, 2014, Caruaru/PE, Brasil. Associação Caruaruense de Ensino Superior, 2014;4: 234.,5656. Debener S, Beauducel A, Nessler D, Brocke B, Heilemann H, Kayser J. Is resting anterior EEG alpha asymmetry a trait marker for depression? Findings for healthy adults and clinically depressed patients. Neuropsychobiology. 2000;41(1):31-37.,6161. Pivik RT, Broughton RJ, Coppola R, Davidson RJ, Fox N, Nuwer MR. Guidelines for the recording and quantitative analysis of electroencephalographic activity in research contexts. Psychophysiology. 1993;30(6):547-558.,6363. Henriques JB, Glowacki JM, Davidson RJ. Reward fails to alter response bias in depression. J Abnorm Psychol. 1994;103(3):460-466.,6666. Wheeler RE, Davidson RJ, Tomarken AJ. Frontal brain asymmetry and emotional reactivity: a biological substrate of affective style. Psychophysiology. 1993;30(1):82-89.,6767. Davidson RJ, Coe CC, Dolski I, Donzella B. Individual differences in prefrontal activation asymmetry predict natural killer cell activity at rest and in response to challenge. Brain Behav Immun. 1999;13(2):93-108. who prompted Van Deusen to study and understand the patterns of alpha and beta waves. Van Deusen and his team confirmed that the right hemisphere (Fp2, F4, F8, C4 and T4) and rear part of the brain (P4, T6 and O2) are optimal regions for an abundance of alpha waves.5151. Van Deusen PM, Guerra-Ribas RM, da Silva EPL, Lima da Silva T, Ribas VR. Tratamento de paciente com depressão pela técnica The Learning Curve-TLC em Neurofeedback: estudo de caso. In: IV Congresso de Biomedicina e Farmácia da Faculdade ASCES, 2014, Caruaru/PE, Brasil. Associação Caruaruense de Ensino Superior, 2014;4: 234.,6868. Benca RM, Obermeyer WH, Larson CL, et al. EEG alpha power and alpha power asymmetry in sleep and wakefulness. Psychophysiology. 1999;36(4):430-436. Thus, alpha waves are expected to be higher (10-15%) in the right side and posterior brain compared to the left side and anterior brain. According to these findings, when there is a reversal of alpha waves, the person may experience symptoms of depression with hopelessness (helpless, sad, with little energy and some suicidal ideations). On the other hand, a predominance of beta waves is expected in the front and left side of the brain (5%) and, if there is a reversal, the individual may experience symptoms of agitated depression (moody, angry, irritable, nervous and/or anxious).5151. Van Deusen PM, Guerra-Ribas RM, da Silva EPL, Lima da Silva T, Ribas VR. Tratamento de paciente com depressão pela técnica The Learning Curve-TLC em Neurofeedback: estudo de caso. In: IV Congresso de Biomedicina e Farmácia da Faculdade ASCES, 2014, Caruaru/PE, Brasil. Associação Caruaruense de Ensino Superior, 2014;4: 234.

Van Deusen and his team corroborated other findings5151. Van Deusen PM, Guerra-Ribas RM, da Silva EPL, Lima da Silva T, Ribas VR. Tratamento de paciente com depressão pela técnica The Learning Curve-TLC em Neurofeedback: estudo de caso. In: IV Congresso de Biomedicina e Farmácia da Faculdade ASCES, 2014, Caruaru/PE, Brasil. Associação Caruaruense de Ensino Superior, 2014;4: 234.,5656. Debener S, Beauducel A, Nessler D, Brocke B, Heilemann H, Kayser J. Is resting anterior EEG alpha asymmetry a trait marker for depression? Findings for healthy adults and clinically depressed patients. Neuropsychobiology. 2000;41(1):31-37.,6161. Pivik RT, Broughton RJ, Coppola R, Davidson RJ, Fox N, Nuwer MR. Guidelines for the recording and quantitative analysis of electroencephalographic activity in research contexts. Psychophysiology. 1993;30(6):547-558.,6363. Henriques JB, Glowacki JM, Davidson RJ. Reward fails to alter response bias in depression. J Abnorm Psychol. 1994;103(3):460-466.,6666. Wheeler RE, Davidson RJ, Tomarken AJ. Frontal brain asymmetry and emotional reactivity: a biological substrate of affective style. Psychophysiology. 1993;30(1):82-89.

67. Davidson RJ, Coe CC, Dolski I, Donzella B. Individual differences in prefrontal activation asymmetry predict natural killer cell activity at rest and in response to challenge. Brain Behav Immun. 1999;13(2):93-108.
-6868. Benca RM, Obermeyer WH, Larson CL, et al. EEG alpha power and alpha power asymmetry in sleep and wakefulness. Psychophysiology. 1999;36(4):430-436. and described emotional features of the prefrontal cortex involving both the left and right hemispheres. Consequently, the left hemisphere was named the side of approximation, presenting characteristics of happiness, expansiveness, enthusiasm and optimism.5151. Van Deusen PM, Guerra-Ribas RM, da Silva EPL, Lima da Silva T, Ribas VR. Tratamento de paciente com depressão pela técnica The Learning Curve-TLC em Neurofeedback: estudo de caso. In: IV Congresso de Biomedicina e Farmácia da Faculdade ASCES, 2014, Caruaru/PE, Brasil. Associação Caruaruense de Ensino Superior, 2014;4: 234. The right hemisphere, on the other hand, was called the side of avoidance, demonstrating dark, depressed, and withdrawal feelings and rage.4949. Dupee M, Werthner P. Managing the stress response: The use of biofeedback and neurofeedback with Olympic athletes. Biofeedback. 2011;39(3):92-94. Thus, it is important to maintain a balance (left/right or manic versus depressive), with the left side being slightly more dominant as it processes around 5% more beta waves (15-23 Hz).4949. Dupee M, Werthner P. Managing the stress response: The use of biofeedback and neurofeedback with Olympic athletes. Biofeedback. 2011;39(3):92-94.,5151. Van Deusen PM, Guerra-Ribas RM, da Silva EPL, Lima da Silva T, Ribas VR. Tratamento de paciente com depressão pela técnica The Learning Curve-TLC em Neurofeedback: estudo de caso. In: IV Congresso de Biomedicina e Farmácia da Faculdade ASCES, 2014, Caruaru/PE, Brasil. Associação Caruaruense de Ensino Superior, 2014;4: 234. Similarly, these authors analyzed the anterior and posterior portions of the brain and stated that the alpha waves should predominate in the back of the brain because they are an electrical brain activity that serves to integrate data, while beta waves should predominate in the front of the brain, as their function is to process data and take action.5151. Van Deusen PM, Guerra-Ribas RM, da Silva EPL, Lima da Silva T, Ribas VR. Tratamento de paciente com depressão pela técnica The Learning Curve-TLC em Neurofeedback: estudo de caso. In: IV Congresso de Biomedicina e Farmácia da Faculdade ASCES, 2014, Caruaru/PE, Brasil. Associação Caruaruense de Ensino Superior, 2014;4: 234.,6161. Pivik RT, Broughton RJ, Coppola R, Davidson RJ, Fox N, Nuwer MR. Guidelines for the recording and quantitative analysis of electroencephalographic activity in research contexts. Psychophysiology. 1993;30(6):547-558.,6666. Wheeler RE, Davidson RJ, Tomarken AJ. Frontal brain asymmetry and emotional reactivity: a biological substrate of affective style. Psychophysiology. 1993;30(1):82-89.

Blocking is a category based on the experiences of Amen et al.,6969. Raji CA, Willeumier K, Taylor D, et al. Functional neuroimaging with default mode network regions distinguishes PTSD from TBI in a military veteran population. Brain Imaging Behav. 2015;9(3):527-534.

70. Voloh B, Valiante TA, Everling S, Womelsdorf T. Theta-gamma coordination between anterior cingulate and prefrontal cortex indexes correct attention shifts. Proc Natl Acad Sci U S A. 2015;112(27):8457-8462.

71. Agam Y, Greenberg JL, Isom M, et al. Aberrant error processing in relation to symptom severity in obsessive-compulsive disorder: A multimodal neuroimaging study. Neuroimage Clin. 2014;5:141-151.
-7272. Amen DG, Carmichael BD. High-resolution brain SPECT imaging in ADHD. Annals of Clinical Psychiatry. 1997;9(2):81-86. who explained the function of the anterior cingulate cortex and proposed the term 'hot cingulate'.7373. Johnson D. "How do you know unless you look?": brain imaging, biopower and practical neuroscience. Journal of Medical Humanities. 2008;29(3):147-161.,7474. Amen DG. Change Your Brain, Change Your Life (Revised and Expanded): The Breakthrough Program for Conquering Anxiety, Depression, Obsessiveness, Lack of Focus, Anger, and Memory Problems: Harmony;2015. This expression is used for the set of symptoms caused by impaired communication between the emotional circuitry that surrounds nerve cells of the orbitofrontal region, basal ganglia and anterior cingulate gyrus, which is responsible for emotional responses to pain, regulation of aggression and emotions, motivation, resolution of cognitive conflict, and completing tasks.7171. Agam Y, Greenberg JL, Isom M, et al. Aberrant error processing in relation to symptom severity in obsessive-compulsive disorder: A multimodal neuroimaging study. Neuroimage Clin. 2014;5:141-151.,7575. Amemori K-i, Amemori S, Graybiel AM. Motivation and affective judgments differentially recruit neurons in the primate dorsolateral prefrontal and anterior cingulate cortex. The Journal of Neuroscience. 2015;35(5):1939-1953. When conflict arises in communication between the emotional circuitry and anterior cingulate gyrus, symptoms arise such as obsessive thoughts, compulsive behavior, addictions and/or phobias. There is a mixture of emotion and reason in thought processes. Obsessive Compulsive Disorder (OCD) is an example of dysfunction of the anterior cingulate cortex.4949. Dupee M, Werthner P. Managing the stress response: The use of biofeedback and neurofeedback with Olympic athletes. Biofeedback. 2011;39(3):92-94.

Locking is a category based on the findings of authors dedicated to studying the communication between the brain hemispheres.7676. Summerfield C, Mangels JA. Coherent theta-band EEG activity predicts item-context binding during encoding. Neuroimage. 2005;24(3):692-703.

77. Tecchio F, Graziadio S, Barbati G, et al. Somatosensory dynamic gamma-band synchrony: a neural code of sensorimotor dexterity. Neuroimage. 2007;35(1):185-193.

78. Singer W. Synchronization of cortical activity and its putative role in information processing and learning. Annu Rev Physiol. 1993;55:349-374.
-7979. Berman AE, Stevens L. EEG manifestations of nondual experiences in meditators. Conscious Cogn. 2015;31:1-11. Their studies motivated clinical studies of Van Deusen observing there are norms for the percentage of coherence between slow and fast waves. Thus, between 1994 and 2001, Peter M Van Deusen observed and confirmed patterns, as very low coherence is related to little cooperation between the areas and consequently reduced efficiency, slow processing and errors.7878. Singer W. Synchronization of cortical activity and its putative role in information processing and learning. Annu Rev Physiol. 1993;55:349-374. Low synchrony levels can be related to injuries or physical disturbances in transmission, but are often the result of overly excitable brains, which burst into beta when there is no task to be done, thus blocking the resonance. Very high consistency characterizes excess communication between the left hemisphere (predominance of reason) with the right hemisphere (predominance of emotion), unnecessary communication between the areas with locked responses, which can be related to mental rigidity or obsessiveness, perhaps to anxiety, inflexibility and diminished creativity.7979. Berman AE, Stevens L. EEG manifestations of nondual experiences in meditators. Conscious Cogn. 2015;31:1-11.

Filtering or processing is based on the ratio of the percentage of theta waves divided by beta waves, and expresses the relationship between rational and intuitive styles of thought of an individual. When the ratio of theta (4-8 Hz) to Beta (13-21 Hz) exceeds 2 in an adult with eyes open, cognitive processing issues begin to appear and increase as the ratio grows. These issues are identified in a category called "Processing". Ratios below 1.2 in adults correlate with distractible/impulsive styles often related with hyperactivity. The category for this pattern is Filtering.5050. Monastra VJ, Lubar JF, Linden M, et al. Assessing attention deficit hyperactivity disorder via quantitative electroencephalography: an initial validation study. Neuropsychology. 1999;13(3):424-433.,8080. Saad JF, Kohn MR, Clarke S, Lagopoulos J, Hermens DF. Is the Theta/Beta EEG Marker for ADHD Inherently Flawed? J Atten Disord. 2015. [Epub ahead of print].,8181. Delgado-Mejia ID, Palencia-Avendano ML, Mogollon-Rincon C, Etchepareborda MC. [Theta/beta ratio (NEBA) in the diagnosis of attention deficit hyperactivity disorder]. Rev Neurol. 2014;58Suppl 1:S57-S63. The original data were gathered at Cz in the sensorimotor cortex, but the TLC extends it as a general indicator for all sites.4949. Dupee M, Werthner P. Managing the stress response: The use of biofeedback and neurofeedback with Olympic athletes. Biofeedback. 2011;39(3):92-94.

50. Monastra VJ, Lubar JF, Linden M, et al. Assessing attention deficit hyperactivity disorder via quantitative electroencephalography: an initial validation study. Neuropsychology. 1999;13(3):424-433.
-5151. Van Deusen PM, Guerra-Ribas RM, da Silva EPL, Lima da Silva T, Ribas VR. Tratamento de paciente com depressão pela técnica The Learning Curve-TLC em Neurofeedback: estudo de caso. In: IV Congresso de Biomedicina e Farmácia da Faculdade ASCES, 2014, Caruaru/PE, Brasil. Associação Caruaruense de Ensino Superior, 2014;4: 234.

The alpha/theta ratio metaphorically represents a bridge between subconscious and conscious processes. Thus, a person can know that he/she is angry and why he/she is angry or can be angry and not understand why he/she is angry.8282. Schutze MD, Junghanns K. The difficulty of staying awake during alpha/theta neurofeedback training. Appl Psychophysiol Biofeedback. 2015; 40(2):85-94.

The expected value for the ratio of the total percentage of alpha waves divided by the total percentage of theta waves is 1.0 in the frontal cortex when the individual has his eyes closed. When the eyes are open, this value should decrease to 0.7 and, if the individual is doing a task, this value should remain at 0.7 or drop further; 1.5 for the back of the cortex when the individual is with his eyes closed. When he/she opens his eyes, it is expected that this value should decrease to 0.9 and, if the individual is doing some task, the value is expected to remain at 0.9 or decrease even further; the central portion of the cortex (sensorimotor) can follow the same patterns as the frontal cortex or posterior cortex.8282. Schutze MD, Junghanns K. The difficulty of staying awake during alpha/theta neurofeedback training. Appl Psychophysiol Biofeedback. 2015; 40(2):85-94.,8383. Gruzelier J. A theory of alpha/theta neurofeedback, creative performance enhancement, long distance functional connectivity and psychological integration. Cogn Process. 2009;10(Suppl 1):S101-S109.

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  • 2
    This study was conducted on the postgraduate degree in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco (UFPE).

Publication Dates

  • Publication in this collection
    Apr-Jun 2016

History

  • Received
    02 Feb 2016
  • Accepted
    06 May 2016
Associação de Neurologia Cognitiva e do Comportamento Rua Itapeva, 538/ 132, 01332-000 São Paulo - SP - Brasil, Tel: (55 11)3288-8684/3288-9923 - São Paulo - SP - Brazil
E-mail: demneuropsy@uol.com.br