Q&A with Margaret Ayers
QUESTION: You started out working in Dr. Barry Sterman's laboratory at UCLA. How did you get started in this lab? What was it like in the beginning, and what work did you do?
ANSWER: Dr. Les Navron, the chairman of my Ph. D. psychology program drove me from San Diego to Los Angeles to introduce me to Barry Sterman. Dr. Navron told Barry Sterman that my special interest was psychophysiology and biofeedback and that I was the brightest student he had ever had. Thanks to him, I was hired by UCLA Medical School to do electroencephalograms in a research study, which was done in Building 60 of Sepulveda VA. In charge of that study was Dr. Barry Sterman. I did research in epilepsy, all night sleep study of unipolar depression and awake feedback for unipolar depression. The most interesting was presented in 1976 at AAPB (it was named the Biofeedack Research Society at that time) on quadriplegia by Sterman, B. Ayers, M., and Goodman, S. We found that quadriplegic individuals produced excessive 12-15Hertz brain wave activity. So we trained an individual to inhibit the 12-15Hertz or SMR. After inhibiting the SMR or 12-15Hertz activity, she received more motor control. She was able to feed herself with a wrist cuff and her constant arm spasticity went away. This is when I first realized that normalizing the EEG is what returned homeostasis and motor control.
QUESTION : Tell us about your transition from the laboratory to clinical work. When did it first strike you that EEG biofeedback would have important clinical applications?
ANSWER: Transitioning from research to clinical work was getting to be like Sherlock Holmes. What are the clues, is there evidence, and how do we solve the problem? There is nothing more exhilarating than helping people heal themselves and gain control of the their brains.
QUESTION: You started what may be the first neurofeedback clinic in the world. When did you open your clinic, and what were your first cases?
ANSWER: I had a full time EEG biofeedback clinic in 1976. Everyone else was still in research labs. However, I knew that if this work was ever to get out all over the world, it had to prove itself clinically. Sidney Ross, an engineer who worked with Barry Sterman leased me two of his Neuroanalyzer EEG biofeedback machines that I connected to a large pen and ink Grass EEG machine. The lease fee per month was greater than my cost of living. Barry Sterman had opposed me doing the work clinically and Sidney Ross leasing me the equipment. Thank goodness Sidney Ross prevailed.
Trying to educate people about brain biofeedback in 1976 was precarious. My first client was referred by his neurologist. He was a blind quadriplegic with epilepsy and extreme muscle spasticity. The clues were obvious and I decided to be neurologically site specific with EEG feedback. I trained the arm and leg areas on the sensorimotor cortex and obtained reduced pain and spasticity in twenty sessions. The word got around town that Ayers was a miracle worker. Then I worked with severe unipolar depression and ten years later, one of the people I had helped ten years earlier came back saying she had her own successful catering company and was very happy. I wrote to Dr. Karl Pribram at Stanford to tell him of my success with unipolar depression and he was kind enough to write back wishing me continued success in this work, both clinically and in my research. However, no one wanted to publish EEG feedback with unipolar depression in 1976. So, I found a writer, Jack Adler, who wrote a popular article about my work with depression that was published in the national health magazine, Let's Live.
QUESTION: What types of cases do you think are most responsive to EEG work? What types of cases are the most rewarding to you?
ANSWER: The easiest cases for EEG feedback are ADHD, dyslexia, closed head trauma, depression and insomnia. Restoration of control and self-healing of people, regardless of their problem brings me great joy.
QUESTION: When did it occur to you that you could work with severe trauma and coma patients?
ANSWER: Medicine seemed unable to significantly help patients with strokes or comas when those injuries lasted more than two months. I decided to do research and clinical work with those individuals who were told that there was no help available and to go home and accept the limitations. I had a client who had a stroke, went into a coma and had her plug pulled against her wishes. She later reported remembering the doctor saying she was just a vegetable. Her motivation for walking was so that she could go back and slug the doctor.
Even in level two coma where there is no response to light, sound or pain, patients still have intact senses of hearing, touch, eyesight and joint proprioception. This means that perhaps they are conscious but just unable to respond. My research was how to be the ignition switch for the brain engine.
QUESTION: We learned that you worked with the late Rodney Dangerfield, and were present when he came out of a coma, to spend final time with his family and doctors. Joan Dangerfield was quoted as saying your work was “truly astounding” and that she is “forever grateful for giving me those moments”. Can you share anything with us about this moving experience?
ANSWER: Joan Dangerfield was a heroine of love and never giving up. Having the physician invite me to work on Rodney Dangerfield and being well published in stroke and coma using all digital real time EEG feedback was an asset. Working on a client in a coma is both physically and emotionally intense. It is like working on forty people at the same time. Dr. Penny Montgomery assisted me by keeping track of monitors, collecting and keeping track of the EEG data. Rodney Dangerfield had been in the coma for over 30 days. I told Joan that the first thing we would see was his eyes staying open, then the light of life coming into his eyes, he would start tracking the coma light and his jaw would start to tighten. What an exciting process! It happened in exactly that sequence and his jaw tightened into a smile! I jumped up and shouted “YES”. I always talk to coma clients as I know that they can hear what is said. I only do feedback for about five minutes at a time while watching for fatigue in the EEG, as coma clients get very tired very quickly. Now, how does one use humor with the greatest comedian, Rodney Dangerfield? Well, one of the many things I said was “Rodney, if I bring you out of this coma, maybe I'll finally get some respect.” There is no greater privilege in the world than helping someone regain awareness. Rodney was able to show his love for Joan. When these precious moments of life that we take for granted are restored, I am reminded to be thankful for them each day!
QUESTION: Your work is based upon your unique approach to reading high-resolution single-channel EEG records for assessment and planning. Tell us something about how you developed this approach, and how you continue to develop it.
ANSWER: The machine that I invented on which I have three patents in America, one in Japan, one in Germany and one in England, and which is the world's first all digital real time EEG feedback, I wanted to see what brain waves did in the big picture as well as microscopically. Clients in wheelchairs who were having seizures and unable to walk, reportedly had normal EEGs. I wondered what was wrong with the machine as they couldn't possible have normal EEGs with these symptoms. I realized that the Qeeg is not a real EEG. The analog EEG was only able to move the pens at a rate of 25 Hertz, so complex patterns were not seen. Remember, the average Qeeg takes 120 samples per second that are then added and averaged so the original EEG is lost. You must see the real EEG because there are patterns for depression, post viral infection, epilepsy, anoxia, head trauma, coma, migraine, allergy and other clinical conditions. Berger and Gibbs were the first to identify patterns in the EEG associated with clinical problems.
The Pentium chip allowed us to collect mathematical data at a phenomenal speed and NASA used this software software based on integral calculus to collect data. I received this $50,000 software and hired my own programmers to modify the software to heal, not kill. It took a year and a half and is easy to use in windows. Instead of 126 samples, added and averaged, I take 250,000 samples a second, not added or averaged so you only have primary, real time data. Signal processing methods, such as Fast Fourier, using averaging are not real time. At 250,000 samples per second, using integral calculus, we can predict the frequency of the slope of the signal before it happens so we can feed back the information in less than one thousandth of a second. This makes incredible changes in the speed of your senses.
The big picture was found by using an EEG that would show up to 400 Hertz, the raw EEG, and could also display any filtered out frequencies. That is how I found that if you inhibited the abnormal theta, the abnormally high beta activity would go to a normal microvolt level. The excessive beta was simply an attempt by the brain to compensate or inhibit the abnormal theta microvoltage.
QUESTION: You have your own approach to the EEG and brain dynamics. I've been told that you don't believe in the SMR (sensorimotor rhythm) in the commonly accepted sense. What is your view of what we call SMR, and how would you suggest that we enlighten our understanding?
ANSWER: There is no SMR. You must realize that there is a profound difference between a rhythm and a frequency in the EEG. Often a rhythm comes from a specific neurological site such a thalamus, as opposed to a frequency that comes from any cortical area. The sleep spindle in stage two of sleep is a rhythm precisely the same frequency and amplitude each time it occurs. When you see frequencies in the range of 12-15Hertz in the wake state they vary in amplitude and frequency. Also, the behavior of producing a sleep spindle is the brain's way of locking into sleep. The behaviors associated with producing frequencies in the 12-15Hertz range do not resemble behaviors in stage two sleep. Additionally, I have seen spasticity, epilepsy and quadriplegics who produce excessive frequencies in the 12-15 Hertz range, but have not motor control. Remember, it was the 1976 paper by Sterman, Ayers and Goodman, presented at AAPB (then called BRS) where we trained a quadriplegic to inhibit 12-15 Hertz activity and she gained control of spasticity to the extent that she could feed herself. She eventually had a child.
Normalizing the EEG by inhibiting the abnormal waves results in motor inhibition. If I can solely inhibit theta, 4-7 Hertz, in a level two coma and allow them to come to a conscious level, then motor inhibition is not a specific frequency of 12-15 Hertz, SMR. It is solely normalizing the EEG to get motor control.
QUESTION: You have written that your approach is based on the realization that brain function is primarily inhibitory in nature. Please explain your view on this and how it guides your work.
ANSWER: Inhibition is the paradoxical behavior necessary for life. Every field, from engineering with inhibitory gates, biology and physics has inhibition as a basis for homeostasis. All sensory information arriving at the sensory cortex is passed through sensory nuclei on its way to the cortex. The neurons within the nuclei have inhibitory messages from cells with short axons. This is called surround inhibition. Surround inhibition reduces the neural elements needed to carry information further by restricting impulse activity to neural channels that most excited from the stimulus. Surround inhibition is present in all sensory systems such as visual and auditory, but largely absent from the thalamus. After thalamus, descending axons from excitatory connections with inhibitory interneurons. This allows motor cortex to improve the contrast of incoming competing somatic messages by accentuating surround inhibition. If you have overwhelming surround inhibition, then you might pay attention to other incoming sensory information. Overwhelming inhibition such as disease or poison can shut down ion channels leading to death. It is inhibition that sets the stage for homeostasis. Inhibiting what does not belong in the EEG normalizes the EEG and restores homeostasis.
QUESTION: You take a very flexible, dynamic approach to training and change sites and frequencies on as as-needed basis. What concepts and guidelines direct you in this work?
ANSWER: Remember, if you are a true Sherlock Holmes, you first look for clues. You must have instrumentation that allows you to see the raw EEG, all of the frequencies and primary raw microvolts. The method of signal processing the EEG in its raw real time would be analog or my invention, all digital real time. Fast Fourier or other averaging signal processing of the EEG only displays distorted secondary data. Then I look at the clues. What is missing in the EEG? Is there extreme variation in microvolts minute by minute? Is there an abnormal dominance of slow wave activity? Are the microvolts of theta abnormally high? Is there too much high beta? Now what am I going to do to make it more normal?
Neurologically site-specific EEG training based on clues initiates EEG feedback to improve the problem. If I have a stroke client dragging or plopping the foot, then I can go to the sensorimotor cortex and place one electrode on the sensory area and one on the motor strip of the leg area which is just behind FZ and just ahead of PZ. I always see changes in gait within twelve sessions. You can train the arm area, self-esteem area, area for body perception, frontal area for appropriate judgment, impulse control and initiation of behavior, and so on. It is critical to know the neuroanatomy for site-specific EEG feedback.
QUESTION: I have heard that you believe there may be negative or iatrogenic effects of strongly reinforcing beta. What is your view on this?
ANSWER : If you are not looking at the raw EEG, you have no idea what you are doing. I have gotten clients from many clinics doing beta training with a monopolar hookup on CZ. They had been diagnosed as ADHD. During feedback, they developed tics, seizures and anxiety, which had not previously existed. Deep underneath CZ is the corpus callosum, which is composed of association fibers. Beta training at CZ results in magnifying communication back and forth between hemispheres. I wish the field would stop doing CZ training. ADHD is characterized by excessive theta 4-7HZ, in the right frontal-temporal areas. So, be Sherlock Holmes, with the clues and inhibit abnormal excessive theta and is microvolts.
QUESTION: What you see as the greatest possible benefits from neurofeedback? What is its true potential?
ANSWER: The greatest benefit from neurofeedback is teaching people that they are responsible for and in control of their own health and healing. This is the greatest tool in history.