Хроническая боль, хроническая усталость
Pete
Here's my reading of Fibromyalgia, Chronic Pain and Chronic Fatigue
I usually expect to find that there is a serious history of trauma in people who present with these diagnoses. Unlike many people dealing with trauma histories, however, these folks tend to bury their pain and block it off. As a result, you may see a scooped-out pattern in the 6-8 Hz band which gives us access to our own subconscious. You may also see, if the person has dissociated the experience, high levels of Delta. And, if they have been actively blocking the emotional responses to that pain, their anterior cingulate (between AFz and Cz) may be hot (more fast activity on the midline than on either side), but most often, by the time they've moved to FM, the anterior cingulate is burned out and will show more slow activity than the sides).
Some of these folks will show expected patterns of beta/hibeta in the temporals or overall or right-side or back/front beta reversals, but again, for many that high-energy anxiety pattern may have burned itself out.
Very commonly you will see lots of alpha--essentially a self-anesthetizing technique to keep the person from feeling the emotional drive. But the alpha will usually be slow, often as low as 6-10 Hz instead of 8-12. And often it will not block--remaining the dominant frequency even with eyes open and at task. This can also tie to the fact that FM is often related to Alpha/Delta sleep, where intrusions of alpha into the usual period of Delta sleep in the first half of the night block the physiological restoration processes that normally occur then. The combination of this with failure to complete 5 dream cycles during a night (because the brain is so slow, or because of the very fast activity (when that is still present) that keeps waking the person up early in the dream cycle. In any of these cases, physical pain and fatigue are common results.
Often sometime around 40 years of age, the unexpressed psychic pain somatizes and appears as physical pain. You may well find that coherence levels (both fast and slow frequencies), especially in the back of the brain, are very high. This tends to correlate with extreme sensory sensitivity. Also, slowing in the prefrontal cortex can, like the slowing in the anterior cingulate, result in inability to block pain signals that don't necessarily have a physiological cause.
So the training really does benefit from the Whole-Brain approach. Training down the eyes-open alpha is an important goal, but of course that may allow the client to begin feeling the psychic pain, so any fast or reversed activity also needs to be trained. As with any person with a history of trauma, it's a good idea to start by working with them to identify sources of stress in their lives and coaching them to identify and remove some of those. Also teaching RSA breathing and asking the client to perform 2-3 minutes of that multiple times during the day, can help to shift them out of sympathetic mode. Training the brain patterns will help to unwind the patterns that have codified this complex over years. Any such client should also be looking at approaches to rebuilding the burned-out adrenal system with B vitamins and other such supports. Many FM sufferers will arrive to start training with multiple psycho-active meds in their daily regimen, so keeping an eye on the side-effects and effects of over-medication can be very important, as training can cause the brain to pick up the slack and actually make the medications cause negative effects (if they aren't already).
Perhaps the most difficult issue with FM/CF/CP is the likelihood of secondary gains. Because of their diagnosis, many of these people are essentially exempted from most social/familial and personal expectations. It is not easy for them to believe it, but they are very likely actually to resist training that helps them to release those brain habits because of what they will lose. It's a delicate issue, but one which a good trainer will try to bring to the client's attention and help them make a positive decision that the gain is worth the loss. Unfortunately, if the client can't even admit there will be some losses, then they can't see their own part in the resistance to change, and it's very difficult to help them make a lasting change.
Alex
I would be interested to hear what Peter thinks of Swingle's approach to Chronic Fatigue/Fibromyalgia. To oversimplify (but not that much), it is basically: restore sleep. And he recommends doing this by normalizing the beta/theta ratio at O1. Most of the time by increasing theta.Whilst he does identify a few other patterns that present, he says that in many cases, these resolve themselves when sleep is restored.
(A brief article on his approach: http://www.swingleclinic.com/wordpress/wp-content/uploads/2015/03/Fibromyalgia-and-Chronic-Fatigue.pdf. And a video discussion: https://www.youtube.com/watch?v=ZXt24rfMJFQ).
The reason I think this is very plausible, is because it seems to converge with some other approaches to these conditions. What they all have in common, is trying to quieten down the amygdala. The connection with sleep is that a lack of sleep puts the amygdala in a hypersensitive condition; whilst conversely, emotional hypervigilance stops proper sleep. So you have a negative feedback loop going on. But if you can get sleep restored, you can, by contrast, get a positive feedback loop going, because, as Swingle says somewhere, sleep, especially REM, is "the most powerful psychotherapy on the planet".
In regard to these other approaches:
There are a couple of popular programs ("Gupta Program"; DNRS) that get patients to visualize positively, meditate, and interrupt negative thoughts, all with the aim of retraining the emotional circuits of the brain away from fright-or-flight mode.
There is a doctor here in the UK who treats them using a couple of anti-depressants (http://www.me-cfs-treatment.com/). One of them, amitriptyline, is used as a sleep aid, whilst the other is used to lift mood. He also prescribes, basically, doing nothing mentally taxing for about 6 months. His "golden rule" is getting proper sleep.
A recent study, using FMRI-guided neurofeedback, improved fibromyalgia (http://fibro.healthylliving247.press/?p=1098). I think I am right in saying that the improvement in participants' pain was PRECEDED BY improvement in their sleep.
My impression from what Peter is saying is that it is probably very similar, but I can't interpret the meaning of the frequency patterns identified very well.
Pete Normalizing sleep is probably the number one objective for anyone who comes for neurofeedback. That's like saying that getting your car to run well on the highway is the number one goal of auto mechanics. Who can argue with it? But the question for me is always, why is the person not sleeping well? Not to mention, "how" is the sleep non-restorative. Does the person have difficulty falling asleep, do they awaken often during the night, do they awaken once and can't go back to sleep, do they sleep deeply but can't wake up in the morning, etc. Each of those is likely to appear as one or more patterns in the brain that we train to try to improve sleep. But my experience tells me that, when I see a widely-disruptive problem like FM, we can't just train on the surface of it. There are reasons why that brain has established those patterns, and we need to undo them from the most basic to the surface. If you can't sleep because of serious un-recognized trauma, I haven't found that you can just "fix" the sleep and not do anything with the trauma sequelae that are interfering with sleeping in the first place.
Exactly what the connection between the amygdalae way up in the front of the temporal lobes and the Occipital lobes is not clear to me. However, when I see highly activated temporals (T3/T4/T5/T6), that suggests to me that the amygdalae are firing off alarms without cause. They are overly activated.
Paul's assessment is, as you probably know if you have compared it with the TQ7, is much simpler and provides a lot less information. So whether it even tells you that there is a lot of slow alpha, or that the alpha doesn't block in some places or that hippocampal theta levels are essentially scooped out across the back of the brain, I don't know. Certainly if I saw someone who woke up frequently with high levels of beta or who had terminal insomnia (couldn't go back to sleep after a few hours), I'd look at the back of the head, though usually the whole right-rear quadrant (T4, T6, P4 and O2) for high levels of fast-wave activity at the expense of slow activity. And training that would be one of the parts of the Whole-Brain Training Plan. But I could show you various maps of FM clients who don't have that pattern.
If anti-depressants or visualizing and positive thinking are fixing FM, then I guess the doctors Paul talks about who say "Oh no," when they see a chronic pain or FM client on their list can relax. Easy to fix. Glad to hear it, because the folks I've seen were definitely NOT easy to help for many of the reasons I mentioned.
I have great respect for Paul and have long found his thoughts on neurofeedback very interesting--since the days 15 years ago when we sat on the floor in the hall outside the "Foundations of Neurofeedback" course at the Future Health conference, waiting to go on last after people had been sitting for more than 12 hours listening to one speaker after another. He showed the Quick-Q, and I showed the (at that time) TLC Assessment. Both have advanced since those days, and I certainly can understand the attraction of whatever Paul's is called now (if you can use one of the various sheets designed to automate all the calculations it requires), but I wouldn't even start with someone without knowing about the symmetry and coherence and variability relationships throughout the brain with eyes closed and open and at task. I agree with him 100%--and have since the beginning--that the process of labeling someone with a diagnosis is a total waste of time (and money), since it is essentially simply a description of the symptoms. Looking at the brain is what tells us what is holding those symptoms in place, and that guides us to where and what to train. Both of us are pragmatic in that way.
If you use Paul's approach, and it works for your clients to resolve the problems of chronic pain/fatigue or fibromyalgia, that's wonderful. Stay with it.
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