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How to Choose Between Neurotherapy Modalities

Publication date: 16 April 2012

Neurotherapy at its broadest covers a wide range of techniques and therapies, including neurofeedback and biofeedback, transcranial Direct Current Stimulation (tDCS), Cranial Electro-Stimulation (CES) and Audio-Visual Stimulation (AVS). But how does a practitioner select which is appropriate for any given client?

In a recent blog post I reviewed Richard Davidson's theory of emotional style (presented in his book, 'The Emotional Life of Your Brain' co-authored with Sharon Begley). I believe Davidson's ideas offer a framework for choosing neurotherapies, and for tailoring therapy for the individual – in effect, for realising the goal of personalised health care. In this blog post I attempt to link some of the dimensions of emotional style to neurotherapy interventions.

To recap, Davidson posited a set of six dimensions making up emotional style, each grounded in distinct brain systems. Each individual can be placed on the continuum of each dimension, between its extreme poles, for example between high and low resilience. Although there is no single ideal emotional style, there are some that are not helpful and don't feel good.

In what follows I'll discuss four of the dimensions of emotional style - the ones I consider to be most significant - and some neurotherapy options. I'm not going to cover every possibility that makes sense, as there are too many.

Resilience

Resilience means how quickly you can recover your mental equinimity (or return to your emotional baseline) when adverse events happen. Resilience is embodied in the left-right balance of the brain's frontal lobes. Activation of the left side correlates with emotional positivity or high resilience.

Resilience Interventions

  1. Mindfulness. Research has shown that over time mindfulness practice “corrects” right side dominance. Actually mindfulness can help to change almost all the dimensions of emotional style, so I won't consider it in detail here.
  2. Transcranial DC Stimulation. In tDCS we apply two electrical poles to the head – one positive and one negative. Depending on the practitioner's choices we can either enhance activity in a particular region or inhibit it. The obvious choice to raise resilience is to enhance left side activity and inhibit the right. In fact in tDCS research, this protocol has been used to successfully (and safely) treat depression.

Outlook

In Davidson's scheme outlook means one's underlying emotional positivity. Neurologically it is embodied in the Prefrontal Cortex (PFC) activation, and particularly it's ability to sustain activation of motivation, reward and pleasure centres.

Outlook Interventions

  1. Loving-kindness meditation. Known in Buddhism as the Metta Bhavana, this practice is often taught on mindfulness courses. It is a practice of systematically cultivating positive emotions.
  2. Hemoencephalography (HEG) Neurofeedback. The PFC is behind the forehead, which is the standard placement of the HEG sensor. HEG neurofeedback trains up the “muscle” of the PFC. The PFC is heavily involved with “executive function” – including concentration, planning and decision making, motivation, keeping to task, and of course emotional regulation. For this reason HEG neurofeedback can have wide ranging benefits.

Self-awareness

In order to successfully regulate out emotions we must first be aware of them – particularly their bodily manifestations. In my experience as a therapist it's difficult to think our way out of a difficult emotional state, without at the same time the underlying physiology.

Self-awareness Interventions

  1. Muscle Tension Biofeedback. My experience is that a lot of stressed people aren't really aware of muscle tension.
  2. Heart Rate Coherence Biofeedback and Breathing Biofeedback. Even assuming some awareness of the physiological expression of emotion, it's another thing to change it. It only happens with the right attitude – allowing the natural intelligence of the body to express itself, rather than force of will. This is an important aspect of Emotional Intelligence.

Attention

Attention is the ability to maintain the mind's focus stably in one place. What aspect of life does not rely on this fundamental capacity? William James rated its importance this highly: "The faculty of voluntarily bringing back a wandering attention, over and over again, is the very root of judgement, character, and will".

An important aspect of attention is flexibility in style of attention. At times we need a sharp, narrow, one-pointed focus, while at other times a broader, open focus. In keeping with the mind-body principle, different styles of attention have different physiologies.

What has attention to do with emotion? Emotional disorders such as depression and anxiety often involve an over-focus on negative thoughts and feelings, and an inability to shift attention away from these.

Attention Interventions

Any therapy that strengthens the PFC and executive function will help attention, so all the above tools can play a useful role in strengthening attention.

Assessment

Of course decisions need to be based on an individual assessment of which dimensions are the weak points. I'll have to leave discussion of assessment of emotional style to another post.

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