Health Tech Forum – August 2017: Dr. Sharon Niv Speaks about Karuna’s approach to Chronic Pain Management
Cognitive-related brain areas – How we assign meaning to an experience. Same stimulus and different meaning
Emotion-related Brain Areas – Limbic system and associated homeostatic/stress mechanisms.
Sensory discriminating – Nociception, the sensory input. Where is it?
All three outputs are needed in order to be assessed as pain. Pain is an output, it is NOT an input. Nociception is only 1/3 of what travels to the brain. Perception must also be assigned meaning(cognitive-evaluative)
In the clinic…
Experience has already been scrutinized and meaning assigned to threat or harm. Pain narrative is a pain behavior. It’s a proxy of the true experience, often distilled down to a number from 0 and 10.
We break up the world into concepts and labels in our everyday functioning. When we walk down the street, we label the car as a car. We cross someone on the street and label them as a woman and it’s associations. Attractive. Caucasian. Tall.. etc.
When we do this labeling, and conceptualization, we subtly create a duality between our self and other. Patients who have lesions in the back part of the brain called the association cortex are not able to distinguish between self and other. One patient with that lesion was not able to point to any items outside his own body.
There are different types of space; physical, psychological, and mental space. The sense of space can also go away which results in a substrate space. There is also non-dual space where the subject and object collapse.
Previc1)http://www.ncbi.nlm.nih.gov/pubmed/16439158 describes 4 levels of physical space:
- Peripersonal – space within 6.5 ft of our body. The posterior inferior parietal region.
- Extrapersonal focal – representation of objects above the horizontal plane and recognizes faces at distances beyond 6.5 ft. Inferotemporal region.
- Extrapersonal action – system that allows us to navigate. Superior and medial temporal regions.
- Extrapersonal ambient – orients us in space. Parietooccipital region.
The occipital to temporal pathway controls the WHAT. The occipital to parietal pathway controls the WHERE. The posterior parietal cortex and the posterior superior temporal sulcus are usually engaged in exercises where you have to point out objects in space. Allocentric space is the space of the objects we represent outside ourselves. This is contrasted with an egocentric frame of reference which is how we represent objects in the world with us in the center.
Very clever experiments have been conducted in the virtual reality space. Space gets distorted in the virtual world. We can still identify with our arm even if it is lengthen to twice it’s length.
With neurofeedback now going mainstream1)http://www.newsweek.com/neurofeedback-brain-regulation-neuroscience-457492 it’s important to take a closer look at it’s underlying mechanics. Neurofeedback works by reading electrical activity of the surface of your brain scalp with EEG(electroencephalography). This data is in turn fed to a computer and represented visually or auditory. The brain learns what the reward signals are and over time works to modulate itself according to the feedback given to it.
The brain is able to physically reorganize itself to form to neural connections throughout its lifetime. Through neuroplasticity the brain is constantly getting shaped as we experience, adapt, and learn.
neurons that fire together, wire together
Self organization and self regulation are a fundamental part of brain operation. Complex systems like the brain self organize, are open, and constantly exchange information across boundaries. Brain doesn’t only process information, it also generates information. Complex systems are defined by their nonlinearity and it’s behavior cannot be predicted solely on the interactions of its lower level components. The behavior of the brain as a complex system cannot be predicted by the sum of the local interactions of it’s neurons. Brain waves organize in a way that show self similarity over time. The fluidity of brain processes depends on evolving complexity. Neurofeedback seeks to tune brain oscillations to achieve a balance between network flexibility and stability.2)http://journal.frontiersin.org/article/10.3389/fncom.2016.00020/full
One study showed that network resets in the medial prefrontal cortex of rats correlated with letting go of prior beliefs in favor of exploratory behavior. 3)http://science.sciencemag.org/content/338/6103/135 There was an updating of the belief system in these rats. It reflected a network switch to a state of instability, which then diminishes as the new stable representations are formed.
The [Precuneus], anterior cingulate, and angular gyri are thought to control self-referential thinking. PET scans in one Danish study 4)H. Lou, B. Luber, M. Crupain, et al. Parietal cortex and representation of the metal self. Proceedings of the National Academy of Science 2004; 101:6827-6832. The effective stimulation had a latency of 160ms showed increased activation in the left prefrontal cortex, medial precuneus, and posterior cingulate regions.
|4.||↑||H. Lou, B. Luber, M. Crupain, et al. Parietal cortex and representation of the metal self. Proceedings of the National Academy of Science 2004; 101:6827-6832. The effective stimulation had a latency of 160ms|
Paper Review: Source-space EEG neurofeedback links subjective experience with brain activity during effortless awareness meditation
Judson Brewer ran a study to test whether source-localized EEG neurofeedback could follow effortless awareness in novice and expert meditators.1)van Lutterveld, R., et al., Source-space EEG neurofeedback links subjective experience with brain activity during effortless awareness meditation, NeuroImage (2016), http://dx.doi.org/10.1016/j.neuroimage.2016.02.047 The EEG neurofeedback was done with the gamma-band (40-57 Hz) measuring PCC activity. Verbal probes were used to assess the correlation with subjective experience of effortless awareness. The suggests brain activity within the PCC is strongly correlated with the subjective experience of effortless awareness.
|1.||↑||van Lutterveld, R., et al., Source-space EEG neurofeedback links subjective experience with brain activity during effortless awareness meditation, NeuroImage (2016), http://dx.doi.org/10.1016/j.neuroimage.2016.02.047|
Neurofeedback is used for self-regulation of ongoing brain oscillations. It has been postulated that optimal brain functioning depends on a homeostatic setpoint which balances network flexibility and stability. 1)http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4270171/
Individuals note improvements in attention and memory. With increased fluidity in cognitive processing, an individual is able to move between objects of awareness much more easily. Our neurofeedback program emphasizes increasing embodied awareness to open up the field of perception. Clients report a feeling a balance between internal and external perception.
Theta(4-8Hz) amplitude change is proportional to ADHD symptom changes.
Complexity exists in nature, order and disorder. Synchronization emerges from the coupling between individual elements. There needs to be coupling. Increased synchronization leads to more order.1)Complexity and coherency: integrating information in the brain, https://www.researchgate.net/profile/Giulio_Tononi/publication/222493040_Complexity_and_coherency_Integrating_information_in_the_brain/links/0fcfd50ff3a2f562c7000000.pdf
In real-world biological systems, the system self organizes to highest complexity for optimal information procesing and dynamic range. High criticality corresponds to high correlation over space.
Random walk model can be used as a statistical model for critical dynamics.
|1.||↑||Complexity and coherency: integrating information in the brain, https://www.researchgate.net/profile/Giulio_Tononi/publication/222493040_Complexity_and_coherency_Integrating_information_in_the_brain/links/0fcfd50ff3a2f562c7000000.pdf|
Contemplative Practice Starts with The Body: Understanding Somatic Awareness, Brain Dynamics, and Healing Presence in Mindfulness and Other Disciplines
Catherine Kerr’s alpha framework elucidates 3 points”
- Body scan – training alpha aynamics by shifting attentional spotlight
- Trainig generalizes up to encompass regulation of thoughts
- Spontaneous sensations arising during practice appear may play a calibrating role in maintaining network “volume” levels1)http://journal.frontiersin.org/article/10.3389/fnhum.2013.00012/full