David Yourman, Ph.D. NYS Licensed Psychologist

Psychotherapy and Neurofeedback in Brooklyn and Manhattan

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Neurofeedback, ADD, ADHD and Psychostimulants

According to many sources, we are going through a veritable epidemic of attentional problems in the US today. There are different opinions about why this is so. Some argue that there is no such problem, but that ADD/ADHD is being over-diagnosed. Some point to the smorgasbord of electronic devices that young people’s faces are often glued to. Others argue that it has more to do with a diet that is dominated by overly processed foods that are very high in rapidly metabolized carbohydrates. Still others would point to chronic sleep deprivation as the main culprit.
It is possible that all of these are true. Perhaps ADD is diagnosed too frequently. It certainly would appear that web surfing and video games don’t exactly contribute to one’s ability to attend to less-than-riveting stimuli. Eating lots of simple carbs with a high glycemic index can certainly contribute to attentional difficulties (this happens because after eating the carbs, the body overproduces insulin which makes you drowsy). Finally, there can be no doubt that lack of sleep, by itself, creates significant attentional problems.

I will make an argument that neurofeedback is an excellent way to approach problems with attention. In October 2012 the American Academy of Pediatrics report on Evidence-based Child and Adolescent Pyschosocial Interventions concluded that for the Attention and Hyperactivity behavioral problems, Biofeedback was a “Level 1 Best Support’ intervention, the highest level of support.” Unlike amphetamine therapy, it has no side effects either in the short- or long-term and thus may be viewed as a preferred approach.

I was always very puzzled by the fact that giving kids that had ADHD or ADD amphetamines (Adderal, Ritalin, etc.), calmed them down and promoted improved focus and attention. It seemed counter-intuitive. A kid is so hyperactive that he is bouncing off walls. So you give him speed and suddenly he’s calm and attentive. This makes sense, how?
The answer is: Because it shifts brainwave activity. It turns out that it is not very complicated. When you need to focus on something your dominant brainwave frequencies need to be higher (faster) (brainwaves are electrical signals – measured in “cycles per second” or “hertz.”) your brain needs to be able to flexibly “upshift” to faster brainwaves. People with ADD/ADHD have a harder time upshifting than other people. Psychostimulants such as Ritalin, Adderal and Dexedrine force an upshift in brainwave frequency.

It is fair to say that many people with attentional problems have brains that simply tend to idle a bit slower than others. It is almost never the case that a person cannot pay attention to anything. Most people, even those with high-end ADD, can attend to things they find interesting or exciting. Why? Same reason, excitement speeds up brainwave activity. Unfortunately, a great deal of that which we ask our children (and ourselves!) to do is fairly mundane. That is where the challenge comes in.

So let’s stay with the fatigue model. When one is tired the capacity to pay attention is reduced. When one is VERY tired, the capacity to pay attention disappears. When we are tired, our brains downshift – as if they were lobbying for sleep (“Please, go to sleep for Pete’s sake.”) This is pretty straightforward. Now, imagine that your brain often behaved as if it were tired and wanted sleep. Severe ADD is somewhat like that. Again, psychostimulants push your brain into the fast lane.

However, there are a number of disadvantages to psychostimulants. They only work when you take them. The brain does not learn how to pay attention more readily from these drugs. Also, they are not effective for everybody. In addition, they have side effects that are for some, a problem. These include, increased anxiety/jitteriness, sleep disturbance, appetite suppression and growth inhibition. The last is remedied by periodically going off the PS (in the summer, for example). There are not many longitudinal studies that have investigated problems connected to long-term psychostimulant use. It is prevailing opinion that they are safe in the short-term. There is no consensus among researchers about long-term use of these drugs. Many people, I believe justifiably so, are leery about giving their children or themselves psychostimulants for many years.

The Neurofeedback Difference
Essentially, what we are training with neurofeedback is increased flexibility. What this means, in terms of attention, is that it provides the brain with increased capacity to upshift when necessary (for increased focus and attention) and downshift that is desirable (for relaxation and sleep). Unlike amphetamines, it teaches your brain how to shift more readily, rather than using a brute force method to make your brain idle faster.

Using neurofeedback to train the brain is a non-intrusive, holistic approach to helping Central Nervous System function. It is non-intrusive because the only thing that happens during training is that the brain is provided with information (feedback) about its electrical activity. Our brains readily make use of this information to better self-regulate. This is a training model, not a treatment model. It is holistic, because it has a general action of better self-regulation. We don’t use specific “protocols” for a given problem. In my experience with better self-regulation we observe improved focus and attention, improved sleep, improved mood, decreased reactivity and improved performance.

What is Affect Theory and Why Is It So Important?

“Affect” is the term that Silvan S. Tomkins used to describe the nine inherent human affects that, taken together, form a core system of human motivation. According to this theory, the affects turn a person’s conscious attention to matters requiring action (e.g., a predator attacking), allowing one to discriminate among the vast quantity of sensory data that may be bombarding an individual. These nine affects are thought to be “hard wired” and universal. They do not vary from culture to culture. Thus, an aboriginal tribesperson from a remote location would recognize anger or joy or excitement on the face of someone from New York City or Shanghai, and vice versa. Six of these are classified as negative affects because they are punishing to the organism (distress, anger, fear, shame, disgust and dissmell), two are deemed positive (interest and enjoyment) because they are inherently rewarding, and one is classified as neutral (surprise) serving to reorient a person’s attention. Tomkins argued that biological drives, such as hunger and the sex drive, are very site specific but that the affects are far more general. In other words, an almost limitless number of things may provoke or extinguish an affect such as distress of anger, whereas only lack of sufficient food will cause hunger and eating alone will relieve it.

In addition, affects can override drives. For example, while one is sufficiently interested by something, hunger or fatigue can be forgotten for periods of time. It is through these affects that we register that something feels good or bad.

Many emotional problems occur for people when negative affects are too easily triggered. For example, when a person is suffering from anxiety, what they are really experiencing is low-level fear. This fear triggers a response from a part of the autonomic nervous system, called the sympathetic nervous system, that prepares the individual for fighting or fleeing. This includes a rapid rise in heart rate, blood pressure, release of adrenaline, change in blood flow patterns, and rapid shallow breathing. This affect, fear, evolved to quickly get an organism out of trouble.

It is highly punishing and very hard to tolerate where it goes on beyond a short time frame.

Anyone that has suffered from high level of anxiety can tell you that it is extremely punishing.

When distress is a predominating affect, the result will be some kind of depressed state. For some people, that might mean a low-level state of depression where life is “dull,” or “grey.” At a higher level, it might include frequent crying, lack of initiative, or even an inability to get out of bed. At its worst, suicidal thoughts and impulses can be present.

It is often the way we learn to handle negative affect that cause serious problems in life. If we learn that certain situations provoke anxiety, we might become avoidant to a point that is self- defeating. For example, if a person becomes so anxious at the thought of a job interview and avoids them at all cost, it is sub optimal.

I absolutely do not believe that people engage in behaviors with the purpose of intentionally harming themselves, we are not wired that way. In fact, most behaviors that might be described as “self-sabotaging” or “self-destructive,” are really attempts to avoid painful feelings. In other words, we learn at an early age that in some circumstances the best we can do is to avoid something that is even worse than a given bad situation. An example of this would be when a child learns that she gets attention only when she misbehaves and acts out. Now, the attention she receives is negative attention, but that is preferred to not being attended to at all. Later in life this paradigm of “misbehaving” can cause all kinds of trouble — but the internal belief is that behaving badly, whatever that means, is a way to get more attention and feel less bad. What was once an adaptive behavior becomes maladaptive.

The good news is that psychotherapy and neurofeedback, together or separately, can greatly increase one’s capacity to develop more adaptive ways of meeting life’s challenges.