QEEG and Neurotherapy in psychological assessment and ...groups.psychology.org.au/Assets/Files/QEEG Neurotherapy psychological... · Energetics; regional/systemic arousal and activation

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Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark

Quantitative EEG and neurofeedback therapy in the assessment and treatment of psychological disorders

C. Richard Clark BA (Hons) PhD, MACS, BCN, FASSA Joint Clinical Director, Brain Health Clinics, Adelaide, Australia Professor, School of Psychology, Flinders University, Adelaide, Australia [email protected] www.brainhealth.com.au


Outline   Brain dynamics, conscious versus preconscious informa�on processing, and rela�onship to neurofeedback therapy

  EEG and brain func�on   EEG markers of a�en�on and learning difficul�es -‐ examples

  Quan�ta�ve EEG (QEEG) in the assessment of psychological disorders and an ADHD case example

  Procedures and mechanisms of neurofeedback therapy

  Professional Development and Na�onal Cer�fica�on in the theory and prac�ce of neurofeedback

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Brain dynamics, preconscious informa�on processing, psychological func�on and their

rela�onship to neurofeedback therapy


  Medica�on: modula�on of global neurotransmi�er systems ac�vity

  Psychological and behavioural therapies: reshaping conscious content and behaviour; language, imagery, feelings

  QEEG/Neurotherapy: assessing and normalising the preconscious, systemic brain electrical ac�vity required to establish and maintain conscious working memory func�on

Treatment modali�es affec�ng brain and psychological func�on

Synergies can be obtained with mul�-‐modal approaches

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Preconscious processing extends over ~400ms and involves mul�ple interac�ng systems   Sensory sampling: A repeated sampling (~10Hz) and processing to cogni�on of

sensory events (thalamocor�cal system)   Valency and feelings: Parallel evalua�on of the valency of such events; genera�on of

related feelings (limbic system)   Ac�va�on: direc�on of a�en�on to distributed cor�cal representa�ons/associa�ons

of valent event (limbic system; brain stem)   Working memory binding: Binding of selected representa�ons as adap�ve working

memory networks – precursor to conscious awareness and mental opera�ons

PHASE BOUND WORKING MEMORY ACTIVATIONS

1y/2y Mul�modal Cor�cal hubs

Lateral Midline

PARALLEL, HEIRARCHICAL AND DISTRIBUTED PROCESSING

Systemic dysregula�on impacts on quality and content of conscious func�on but not directly accessible by conscious func�on


Release of re�cular inhibi�on allows material thru to cortex; alpha desynchronises

Activity of these systems characterised by distinctive spatial and temporal rhythms seen in the EEG

1. LIMBIC/SEPTO-‐HIPPOCAMPAL

SYSTEM

N. RETICULARIS

ACC NEOCORTEX

THETA RHYTHMS (3-‐7 Hz)

GAMMA RHYTHMS (25-‐200 HZ)*

Cor�cal/ subcor�cal inputs

2. THALAMO-‐ CORTICAL

ALPHA (8-‐13HZ)

MOTOR SENSORY

BETA (14-‐24 HZ)

4. BRAINSTEM SLOW WAVE ACTIVATION

5. VASCULO-‐GLIAL SLOW WAVES

3. INTRACORTICAL

Limbic inputs influence selec�on of thalamic material for cortex

Lateral Inhibi�on by NRT from causes synchronised thalamocor�cal bursts

Thalamocor�cal bursts seen as alpha rhythms

Increased brainstem monoamines decrease NRT inhibi�on

Synchronised septo-‐hippocampal bursts

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Auditory Sound

Somatosensory Body

PMC Prepara�on

Thalamocortical system Cognitive representation of world – cortex as global workspace -‐

SPL Spa�al

IPL Conceptual

Temporal Conceptual

VI-‐4 Visual V5

Mo�on

Brocas Speech Prefrontal

Execu�ve

Wernicke Language

Motor Ac�on

Mul�modal convergence zones

DELTA (1-‐4 HZ), ALPHA (8 -‐13 HZ) BETA (14-‐25 HZ)

INTRA-‐CORTICAL GAMMA

(25-‐200 HZ)


Cuneus

Pre-‐cuneus

Paracentral lobule

Superior frontal

Frontal pole

Medial Orbito-‐frontal

Ant. CC

Olfactory bulb

Amygdala Hippocampus

Mamillary bodies

Fornix

Cingulate cortex Medial Thalamus

Limbic-‐cortical system Affective processing of world

Entorhinal Parahippocampal

Insula Salience assessed via viscerosensory analysis of dorsal and anterior

insula. Iden�fies ac�va�ons for control of a�en�on to lateral cor�cal fields via cingulate systems

3D perspec�ve

Post. CC

Retro Splenial

Mid CC

Neural correlate: Theta rhythm (3-‐7 Hz)

Septum

(Sensory event -‐> emo�on -‐> viscerosensa�on -‐> salience -‐> feelings/a�en�on -‐> episodic memory)

.. group of interconnected cor�cal and subcor�cal structures dedicated to linking visceral states and emo�on to cogni�on and behaviour (Mesulam, 2000).

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Raphe (Serotonin) Mo�va�on/Implicit learning …

SN/VTA (Dopamine) Movement Mo�va�on/Explicit learning …

LC (Noradrenaline) Aler�ng, vigilance …

Basal forebrain (Ach) A�en�on …

Brainstem ARAS (Ach, Glu) Arousal …

Adapted from “THE MIND’S MACHINE, FIG 4 Sinauer Associates Inc

INFRASLOW (0.001 – 0.05 HZ) AND SLOW (0.01 – 2 HZ) CORTICAL POTENTIALS

(Glutamate) Glia, blood-‐epithelial interface Metabolism, O2, Glucose .. (??)

MONOAMINES 0.01 – 1 HZ

Lat. Hypothalamus (Orexin) Supermodula�on, wakefulness

Tuberomamm. N. (Histamine) Sleep-‐wake cycle

Modulation of brain activity Energetics; regional/systemic arousal and activation


Radial Thalamocortical Corticolimbic Fast and speci�ic Limited domain Information transfer Sensory, semantic, conceptual Tangential Monoaminergic Slow, non-‐speci�ic Large domain Modulatory

Local ac�va�on determined by convergent interac�on of these systems

Underlies convergent processes of (a) regional priming & ac�va�on (SCP; lateral inhibi�on) (b) cogni�ve elabora�on (Alpha1, 2) (c) affec�ve biasing (Theta) and (c) phase-‐locked, working memory ac�va�on (Gamma) of salient informa�on leading to awareness

Cor�cocor�cal Glutamate (+), Aspartate (+)

Brainstem and basal forebrain modulatory afferents Dopamine, Noradrenaline, Serotonin, Histamine, Acetylcholine

Thalamocor�cal Glutamate (+), Aspartate (+)

Interneuron, (lateral inhibi�on etc.) GABA (-‐), Pep�des

Limbic-‐cor�cal Glutamate (+), Aspartate (+)

FUNCTIONAL CONVERGENCE OF

SYSTEMS DETERMINE LOCAL CONTRIBUTION TO REPRESENTATIONAL

PATTERNS

Vasculo-‐glial modula�on

“Moment to moment seeking of regional mimina”

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§  Breakdown in these preconscious processes affects conscious awareness §  Such dysregula�on not directly accessible to conscious awareness §  Examples of psychological condi�ons involving such dysregula�on: Developmental

disorders e.g. ADHD, ASD, language disorders, �cs; Anxiety disorders (GAD, Panic disorder); Trauma and stress disorders; OCD; Depressive disorders

§  Neurotherapy works on dysfunc�on through modula�on of related brain electrical fields

Example Evolu�on of brain electrical field ac�vity associated with processing a simple

s�mulus event

Resul�ng in standing fields reflec�ng distributed working memory

Here seen bilaterally over temporal,

parietal and frontal regions; and centrally over cingulate regions 400ms post-‐event

Brain electrical fields & preconscious processes


EEG and brain func�on

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EEG re�lects brain electrical �ield activity

  EEG reflects the electrical component of the open fields of cor�cal pyramidal cells; organised in no�onal columns

  Pyramidal neurons most numerous in cortex (>100,000 million)

  Electrical fields capture degree of synchronisa�on of underlying ac�vity (~1cm radius, ~50 million pyramidal cells) & reveals the oscillatory “rhythms of the brain” or EEG

SCALP

NEOCORTICAL LAMINAE


  EEG measured using sensing electrodes (1 to 256) placed on scalp; usually 19 channels.

  Scalp impedence prepara�on necessary

  Electrode gels generally used to facilitate signal capture

  Signals amplified, digi�sed (~200-‐1000 samples/sec) and preprocessed to allow visualisa�on & analysis

Brain electrical �ield activity and the EEG

Amplifier and computer

Electrode cap

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EEG display demonstrating temporal and site variability in oscillatory frequency & power, re�lecting composite neurological activity

Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark Adapted from Sherlin, 2009

Amplitude and frequency

characteris�cs of the EEG

Modulatory, SCPs

Relaxed but alert

Slow and infraslow

Mental work (ac�ve LCPs)

Vasculoglial, brain stem SCPs

Thal-‐Ctx disconnec�on

Ctx cogni�ve

Limbic-‐Ctx affec�ve

Thal-‐Ctx Res�ng alert

Thal-‐Ctx Motor alert

Ctx mental processes

Awake

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Examples of EEG indicators of a�en�on and learning difficul�es


Normal EEG of awake alert state Abnormal Thal-‐Ctx alpha

Excessive posterior alpha ac�vity reflec�ng abnormal thalamocor�cal func�on underac�va�on affec�ng

sensory integra�on, sensory a�en�on and related learning

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Abnormal midline limbic theta resulting in attentional dysregulation – theta-beta subtype

Excess theta (limbic cor�cal network) and reduc�ons in beta (intracor�cal dysregula�on) in >50% of ADHD:

evalua�on issues


High beta spindling related to pre-‐epilep�c auras, epilepsy, cor�cal irrita�on and some forms of encephalopathy.

10022915: EC; 7 yrs. Inattentive problems.

Widespread spindling

Intracortical overactivation resulting in attentional dysregulation – beta spindling subtype

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Quan�ta�ve EEG in the assessment of psychological disorders


Quan�ta�ve EEG (qEEG) quan�fies power, frequency and phase of electrical field oscilla�ons

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Absolute Power by resonance band (Frequency: 1-‐30Hz)

Normality across resonance bands (z-‐score)

Quantifying & parameterising spectral frequencies in the EEG

Spectral plot Power

Resonant frequency

SD

Resonant frequency

Measures of test-‐retest and split half reliability


Absolute Power by resonance band

(Frequency: 1-‐30Hz) Measure of normality across

resonant frequency power (z-‐score)

Z-‐score

Resonant frequency Resonant frequency

Power

2sd

Quantifying & parameterising spectral frequencies in the EEG

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ADHD case example QEEG assessment Male teenager Case CRC112

CRC112


EEG traces, spectral values and spectral statistics relative to age matched normative database

Theta bursts over midfrontal regions

Theta excess (5HZ)

Sta�s�cal outliers (>4sd) at 5Hz -‐ Limbic

SPECTRAL POWER

SPECTRAL STATS

Z-‐score

Power

Frequency

2sd threshold

CRC112

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Brain mapping of statistical abnormality using 3D source

localisation (LORETA)

Localised bilaterally to Brodmann areas 24, 32 and 33 of anterior and middle cingulate gyrI – associated with affec�ve and a�en�onal regula�on, and impac�ng on frontal and parietotemporal recruitment, respec�vely

All slices

Z scores

Image source: Hoffstaedter et al 2014

CRC112

Peak ac�va�on


Pre-‐treatment Post-‐treatment

-‐

-‐

STEN SD

PRE-‐POST ANALYSIS ADHD CASE

Pre-‐treatment Post-‐treatment

CRC112

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Neurofeedback therapy


Neurofeedback generally involves sensory (auditory, visual, tactile) feedback based on real-‐time analysis of targeted brain function

Neurofeedback therapy   Operant training mediated by feedback of targeted brain ac�vity over mul�ple sessions   Complex form of behavioural therapy, with posi�ve and nega�ve feedback determined by related valency of targeted brain ac�vity

Amplifier

Electrodes

AV feedback

Operant training curve for neurofeedback gains

Treatment sessions

Improvem

ent

Slow early changes

Fast acquisi�on stage

Asymptote, consolida�on

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Neurofeedback reinforcement process Real�me deriva�on from 19 channel EEG of composite training metric, based on ac�vity of system target(s) from

QEEG analysis. Training proceeds either in terms of metric or z-‐score transform based on reference norms

19 channel EEG – training may use selected EEG components from one or more sites

Time

Power Phase Coherence

Z-‐score TRAINING

REINFORCEMENT THRESHOLD Computed

ac�vity of targeted system based on proximity to sta�s�cal norm

More

Less

+

_

0

Computed ac�vity of targeted system based on raw measures such as power, phase or coherence

Nega�ve reinforcement provided

Posi�ve reinforcement provided “REWARD”


Neural mechanisms underlying reinforcement learning (see Kandel et al, 2012, Principles of Neural Science)

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Amplifier

Electrodes

AV feedback

  Single or mul�ple sites on scalp   Training of scalp or source rhythms   Passive (sub-‐conscious brain ac�vity) or ac�ve (slow cor�cal poten�als related to ac�ve a�en�on)




Amplifier

Electrodes

AV feedback

  Many hardware systems e.g. Mitsar, EEGer, Neuroscan, Lexicor, Q20, PET …

  Many so�ware systems e.g. EEGer, Neuroguide, Bioexplorer, Thought Technology …

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Extract of a sample neurofeedback session – here using z-‐score training of source activity


End of presentation

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QEEG and Neurotherapy in psychological assessment and ...groups.psychology.org.au/Assets/Files/QEEG Neurotherapy psychological... · Energetics; regional/systemic arousal and activation