Recently my wife, my daughter and I went to hear Dr. Muhammad Yunus, author of Banker to the Poor and the creator of the concept of micro-lending and the Grameen Bank. Both Dr. Yunus and the Grameen Bank were awarded the Noble Peace Prize in 2006 for their work. He has a new book, Building Social Business: the New Kind of Capitalism that Serves Humanity’s Most Pressing Needs. As we listened, Dr. Yunus spoke about some of his book’s ideas.

I believe that many of his ideas have extraordinary implications for those of us who provide (or benefit from) neurofeedback. Technology initiatives created by Yunus, if applied to the field of neurofeedback, may enable people to benefit from neurofeedback in parts of the United States and other parts of the world where such services are presently limited because of insufficient local expert resources. Such technology initiatives could make it more feasible for institutions to provide neurofeedback services on a wide-scale basis. Economic models created by Yunus suggest ways in which delivery of neurofeedback services may be extended to many people who cannot now afford them.

A main theme of Yunus’ most recent book is the vast potential power of technology if harnessed in the service of human welfare. Technology, Yunus explained, is like a hugely powerful car, a car that can be driven in any direction. He said that right now most corporations drive all such cars in the direction of maximum profit and in doing so, lock up technology. What might happen, he asked, if such companies would divert a small amount of their resources to driving in the direction of maximum social good?

Or better yet, he suggested, what if more companies were developed specifically with the intent of maximizing social welfare? He suggested that if such were to occur — if companies would move in the direction of harnessing the limitless potential of technology in the service of social welfare — most of the world’s problems could be solved.

Illustrating his idea, he told us about efforts in India to get MDs to live in villages and provide medical care. He explained that, provided with well-equipped clinics and good salaries, the MDs would live only a short time in a village before returning to live in larger cities.

He and his people approached GE and other companies and asked them to create small, inexpensive devices that could enable MDs to provide remote care. They said to these companies, don’t build fancy devices with many bells and whistles; build simple devices that will be small and inexpensive. Design them with lots of intelligence so they are easy to use; and design them with the capability of communicating from anywhere in the world, so that consultation with experts is available when needed.

A specific application of this initiative involved infant mortality, the rate of which is very high in India. Part of the problem, Dr. Yunus explained, is that many people have no ready access to medical clinics and adequate fetal monitoring during pregnancy. His group asked GE to build a fetal monitor, a small device that could be easily used and capable of communicating with distant health care professionals. Because more than half the people in India have cell phones, cell phone can be used to convey information to MDs anywhere in the world.

Hearing Dr. Yunus outline his ideas and his technology initiatives, I could not help but think about their potential applicability to current neurofeedback equipment and to the ways in which neurofeedback is provided.

Presently, most neurofeedback systems (combinations of hardware and software) are expensive, complex and expert knowledge intensive. Those systems that are simple and inexpensive are of very limited use and cannot be used in the treatment of most clinical applications. Thus the cost and complexity of most neurofeedback systems act as a limiting factor on neurofeedback utilization.

Current models for providing neurofeedback also limit the number of people who can be treated. Most models are expert intensive; learning to use the equipment properly requires a lot of training and supervised experience. Expert knowledge is needed both at the beginning of the neurofeedback treatment, when one needs to decide how to proceed, and as the treatment process unfolds and fine tuning is required. Additionally, several current models of neurofeedback require that a complex evaluation process (quantifiable electroencephalogram, QEEG) be done at the outset, as part of the treatment planning process.

In addition to the expertise neurofeedback presently requires, models of delivery also limit its widespread use. Today most neurofeedback is provided in a clinician’s office, one-to-one, patient and therapist, or patient and a technician who works under the supervision of an expert. Even when practitioners take seriously their responsibility for providing some amount of pro bono work, if such work relies upon existing technologies and practice models (that is, face-to-face in the therapist’s office), the potential of pro bono work will always be severely limited.

New practice models could make possible the delivery of services at much lower cost to many more people. Just one example:  while for most of my practice I have delivered all services myself, I am aware of the dental-chair model, where one expert and one or more clinicians deliver services to several people simultaneously. Because most insurance reimbursement models do not permit the dental-chair model, usually this approach is only possible to do legitimately where insurance is not an issue.

Even with the dental-chair model, however, significant expert involvement is required. Dr. Yunus got me thinking of the physician sitting in New Delhi supervising work done in remote villages. Even as models exist now, for some phases of neurofeedback, it is not much of a leap to imagine one neurofeedback expert remotely supervising several technicians who are each working in the same time interval with several people. Furthermore, it is possible that families of patients could be trained to assist with some aspects of the process. This has been done for many years with the home treatment model.

Much of what has been discussed so far has involved alteration of the individual practice model. Yet perhaps the greatest potential for expanding neurofeedback services is that the changes discussed could make it more feasible for institutions to provide neurofeedback services. Inexpensive, intelligent equipment, less dependent upon one-to-one expert intervention, could make it more possible for neurofeedback to be underwritten and provided in schools, prisons, nursing homes and other institutional settings.

While existing neurofeedback equipment can be used for such purposes, why not develop less expensive units specifically designed for the remotely supervised dental-chair and related models? Tentative moves in this direction have already been made. A few biofeedback companies have for a long time made relatively inexpensive equipment. In fact, none of what I am suggesting here is radically different from what some people may have been thinking about; and it is likely that there are currently other efforts in this direction of which I’m unaware.

None-the-less, an integration of new practice approaches with advances in neurofeedback technology would make the possibility of providing neurofeedback on a mass basis more feasible.  I remember reading some years ago about “mind gyms” that were opened. I don’t know if any of these prospered or if any are currently viable. But it is likely that the motivation of opening such gyms was to maximize profit. If one approached the endeavor with the idea of maximizing social benefit instead of with a profit motive, might such a concept of the brain gym unfold in new ways?

Who could benefit from the changes discussed above? Remote practice models could allow provision of services to remote areas, as has been done with the fetal monitoring project. And because this model allows for the provision of services at a lower cost and reduces the number of experts needed to provide services on a one-to-one basis, such changes could greatly increase provision of services everywhere, rural and urban.

• Soldiers and veterans worldwide, suffering from traumatic brain injury, PTSD, depression, anxiety and more could benefit from neurofeedback.
• Many people in prisons could benefit. And I believe it is likely that providing neurofeedback in the prisons could significantly reduce recidivism and increase the productive value to society of prisoners after their release.
• Many more children with ADD or learning disabilities could benefit from this process, which has already helped so many such people.
• Numerous anecdotal reports indicate that children and their families suffering from the ravages of Fetal Alcohol Syndrome and Reactive Attachment Disorder could benefit from opportunities to do neurofeedback.
• The clinical experience of many neurofeedback therapists suggests that many families around the world, confronted with challenges associated with the Autism Spectrum Disorders, would find that neurofeedback provides the possibility of positive change difficult to imagine.
• As the population in the United States and elsewhere ages, enormous numbers of older people could benefit from the unique manner neurofeedback enables brain exercise.

It is beyond the scope of this essay to list the many additional ways that the widespread application of neurofeedback might benefit people throughout the world.

While the above list focuses only on traditional “clinical” problems, one of the most exciting applications of neurofeedback can be summarized by the term “peak performance.” Already there are examples of world-class Olympic athletes who have bettered their competition performances because of neurofeedback. The same is true of some professional singers, as well as golfers who have improved their game.

In the broadest sense, all of what neurofeedback does – whether working with autistic kids or

Olympic athletes – can be considered to be in the service of enhancing peak life performance. Whether the objective is clinical change or helping healthy people to perform more effortlessly and effectively in all areas of life, there is ever-mounting anecdotal and formal evidence that neurofeedback changes lives.

Much of what has been discussed above requires modifications to existing treatment delivery models. Institutional changes at many levels would further facilitate widespread neurofeedback delivery.

• Corporations could commit resources to both equipment development and to the refinement of the many ways technology can assist in recruitment and training of service providers, recruitment of patients and program evaluation.
• Insurance companies could consider altering reimbursement models to encompass reimbursement of patients treated in the dental-chair model and for remotely supervised work.
• Psychologists and other health-care professionals could open their minds and practices to other than one-to-one-in-the-office ways of doing business, as well as to the potential value of the dental-chair model and remotely supervised treatment.
• As the equipment becomes increasingly intelligent, psychologists and other health-care providers will need to become more comfortable with healthcare delivery paradigms different from the current therapist-centric models.
• Psychology and other professional licensing agencies will need to be more open to the possibility of providing services to individuals in areas outside the geographic bounds of a given professional license.
• The academic community and other shapers of public opinion, who have so often cited “lack of research” as reason for dismissing neurofeedback, need to examine the sometimes corrosive impact upon clinical innovation of blind insistence upon large-scale, double-blind studies and be more open to other models for validating a treatment’s worth.

Who might pay for what has been discussed? Dr. Yunus shared with us the manner in which his programs encourage people to consider for any given social problem how the problem can be solved in a way that does not require continued infusions of capital. Thus, one of the central tenets of microeconomics is that money is lent for revenue generating purposes and loan interest rates are scaled to the lender’s ability to pay. Further, it is anticipated that individuals will pay back loans and go on gradually to bigger enterprises that are self-sustaining.

The above model suggests the question of whether there is a way to make widespread dissemination of neurofeedback services self-supporting. If the equipment is inexpensive, if it is minimally reliant upon expert input; and if people are asked to pay according to their means (poor people paying very little), is it not possible that in many developing countries neurofeedback might be delivered on a large-scale basis in a self-sustaining way?

In his talk Dr. Yunus told us that the first time he used an iPhone he thought:  This is so intuitive and fun; you touch it once and you know how to use it.

He went on to say that his experience with the iPhone led him to consider the potential of such a device aimed at education. He imagined a small device, very intuitive in its use, applicable to all levels of education, which would present progressively more challenging topics in an intuitive, fun, and exciting way. Implicit in his remarks was how much such a device would contribute to increasing world literacy.

Reflecting on the iPhone and the future of neurofeedback, I wondered what will happen when the first Steve Jobs of the neurofeedback world (or the next technology company devoted to social welfare) fully commits to taking neurofeedback to the next level. It is not a huge transition from current technology to a device that has sufficient intelligence to decide what neurofeedback to do and to modify the training as needed. Using such a device, perhaps the user will place a sensor cap on and initiate training, taking the need for a therapist out of the equation entirely.

Whether or not such a device is ever developed (and I think it will be), there is every reason to believe that with even modest changes to existing technology and the creation of new practice models, it will be possible to provide neurofeedback to many more people.

It is difficult to overestimate the degree of good achieved, worldwide, when this occurs.

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