QEEG and Neurotherapy in psychological assessment and ...groups.psychology.org.au/Assets/Files/QEEG...
Transcript of QEEG and Neurotherapy in psychological assessment and ...groups.psychology.org.au/Assets/Files/QEEG...
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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
Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
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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Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
Brain dynamics, preconscious informa�on processing, psychological func�on and their
rela�onship to neurofeedback therapy
Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
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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Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
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
Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
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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Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
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)
Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
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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Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
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
Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
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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Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
§ 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
Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
EEG and brain func�on
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Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
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
Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
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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Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
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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Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
Examples of EEG indicators of a�en�on and learning difficul�es
Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
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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Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
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
Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
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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Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
Quan�ta�ve EEG in the assessment of psychological disorders
Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
Quan�ta�ve EEG (qEEG) quan�fies power, frequency and phase of electrical field oscilla�ons
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Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
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
Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
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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Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
ADHD case example QEEG assessment Male teenager Case CRC112
CRC112
Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
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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Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
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
Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
Pre-‐treatment Post-‐treatment
-‐
-‐
STEN SD
PRE-‐POST ANALYSIS ADHD CASE
Pre-‐treatment Post-‐treatment
CRC112
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Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
Neurofeedback therapy
Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
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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Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
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”
Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
Neural mechanisms underlying reinforcement learning (see Kandel et al, 2012, Principles of Neural Science)
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Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
Neurofeedback generally involves sensory (auditory, visual, tactile) feedback based on real-‐time analysis of targeted brain function
Neurofeedback therapy
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)
Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
Neurofeedback generally involves sensory (auditory, visual, tactile) feedback based on real-‐time analysis of targeted brain function
Neurofeedback therapy
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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Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
Extract of a sample neurofeedback session – here using z-‐score training of source activity
Presenta�on of the Psychology and Neurofeedback Special Interest Group of the Australian Psychological Society by Professor Richard Clark
End of presentation