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Dynamic Neural Retraining

Snake oil often resides on the apparent cutting edge of medical advance. This is a marketing strategy – exploiting the media hype that often precedes actual scientific advances (even ones that don’t eventually pan out). The slogan of this approach could be, “Turning tomorrow’s possible cures into today’s pseudoscientific snake oil.”

The strategy works because, to the average person, the claims will sound plausible and scientific and will contain familiar scientific buzz words. There is therefore a proliferation of stem cell clinics, anti-oxidant supplements, and personalized genetic medicine.

We can add to the list of cutting edge pseudoscience, neural plasticity and brain training. Neuroscientists are discovering that even the adult brain has greater capacity for plasticity than was previously thought. Plasticity is the capacity of the brain to rewire itself, to acquire new abilities or compensate for damage. Mostly this is simply a technical description of a very common phenomenon – learning. Shoot a basketball 1000 times and (surprising to no one) you (meaning your brain) will get better at shooting baskets. Some of this is physical, such as developing the necessary strength in the involved muscles, but mostly this is the brain learning how to shoot baskets through plasticity.

One legitimate question that neuroscientists are researching is how generalizable (transferable) such training is. In other words, can learning to shoot baskets make you better at some other similar task, like throwing a baseball? Or – can doing one form of mental task make you smarter in general, or give you cognitive skills that apply outside of the task at hand? This question has not been fully resolved. There is mixed evidence, partly because of variable study techniques but also because there are numerous permutations of this question – which tasks transfer to which abilities. There are also different populations – young, adult, older adult and healthy vs cognitively impaired.

A 2012 review of brain training in general stated:

Sparse evidence coupled with lack of scientific rigor, however, leaves claims concerning the impact and duration of such brain training largely unsubstantiated.

I personally don’t like the term “brain training” as it suggests it is something other than simply learning. What we can conclude from the existing evidence is that performing and practicing mental tasks makes you better at those tasks. It is unclear how much they transfer to other skills or to basic mental ability (like memory or concentration) but the mixed evidence suggests significant limits on such transferability. One large study showed no transferability, even to similar tasks. Other studies do show some general memory enhancement in older adults.

Where there appears to be general agreement is the following – computer-based training programs work as well as traditional programs (pen and paper) and do not require computer savvy, video games may have some benefit (although maybe not as much as computer programs optimized for cognitive benefits), novelty seems to be an important feature, and overall being mentally active is good for mental ability.  Open questions include the degree and manner in which cognitive skills transfer, and whether “plasticity-based” programs are better than other training programs.

There are now many companies and products exploiting this complexity, and the fact that this is a relatively new area of research with many open questions, to make specific claims for their products that are not justified by the evidence. One of the worst offenders is a product called Dynamic Neural Retraining (which results in an unfortunate acronym). The website for this product has all the red flags of snake oil. There is a page, for example, for testimonials but none for published research supporting their claims.

They also go way beyond the existing research, claiming that certain disorders (some legitimate, some dubious) are caused by limbic system dysfunction, and their program can change the limbic system through neural plasticity. Not a single link in this chain of claims is scientifically substantiated.

They target vulnerable populations, like those who believe they suffer from multiple chemical sensitivity. This is not a recognized disorder, and so people who believe they have this syndrome are likely responding to popular myths, are likely to be misdiagnosed (meaning they likely have a genuine underlying condition that is being neglected, which may be psychological or physical), and are also likely to respond to a placebo intervention (at least for a time).

Such products also benefit from the non-specific effects of the intervention. Just doing something, anything, to address a chronic problem is likely to make someone feel better. In the case of “brain training” interventions, there are real cognitive benefits to the increased mental activity. The problem is the layer of pseudoscience placed on top of this legitimate but limited intervention. The DNR “system” also employs other interventions, some of which are legitimate therapies, like cognitive behavior therapy. This is what I have called the “part of this complete breakfast” approach – give standard and proven therapy and then add the pseudoscience for marketing purposes.

Conclusion

“Brain training” remains a problematic area. Evidence-based recommendations include basic advice, such as – keep mentally active, keep physically active, and engage in novel activities. Video games and widely available brain training games (cheap or free) are likely as effective as expensive programs with expansive claims. Just do a Google search to see how much is available - here is one example (there, I just saved you $300).

Until there is rigorous research demonstrating specific and significant advantages for a particular “brain training” program, I would not believe the hype.

 

 

Posted in: Neuroscience/Mental Health

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23 thoughts on “Dynamic Neural Retraining

  1. windriven says:

    “I personally don’t like the term “brain training” as it suggests it is something other than simply learning.”

    It also suggests that it is necessary to differentiate “brain” training from, say, “spleen” training or “duodenum” training. Although I must say, I have a very clever duodenum. ;-)

  2. Janet says:

    I’ll just keep doing the NYTimes crosswords–sometimes I even get the Saturday done with ZERO references.

    Remember “subliminal learning” anyone? I knew people who spent tons of money on that scam.

    @Windriven

    I really DO train my bladder–although I think my brain has something to do with it! ;-)

  3. mousethatroared says:

    Firstly, I must say – “The slogan of this approach could be, “Turning tomorrow’s possible cures into today’s pseudoscientific snake oil.”” – Spot on!

    Secondly, “Shoot a basketball 1000 times and (surprising to no one) you (meaning your brain) will get better at shooting baskets. Some of this is physical, such as developing the necessary strength in the involved muscles, but mostly this is the brain learning how to shoot baskets through plasticity.”

    I often hear about “muscle memory” Meaning that practice has allowed our muscles to take over a particular task without our conscious thought. Playing a musical instrument would be an example. Maybe this is a stupid question, but is this entirely brain based or are the nerves and muscles “learning” as well?

    Thirdly – Awhile ago I heard that N-back training was good for memory. I happen to have terrible word recall…which got worse in my thirties*. I downloaded a couple of n-back apps and found them to be incredibly tedious. So don’t play them. It seems that all the articles I read recommend puzzles and games for memory, but that does not seem very similar to word recall (well maybe crossword puzzles).

    After reading this article, it sounds like I should take a different tact. Directly practicing the skills that concern me, writing and speaking fluidly, more often would be a better focus than n-back training or puzzles or games.

    *maybe by my sixties I will only be able to draw and paint and will have stopped bugging the folks on SBM.

  4. mousethatroared says:

    @Janet – ha, some days I think my bladder has a mind of it’s own.

    I know, sorry – TMI.

  5. UncleHoot says:

    “Shoot a basketball 1000 times and (surprising to no one) you (meaning your brain) will get better at shooting baskets. Some of this is physical, such as developing the necessary strength in the involved muscles, but mostly this is the brain learning how to shoot baskets through plasticity.”

    Or even when you aren’t shooting baskets. I’m sorry that I’m too lazy to look it up right now, but there was a psychology study many years ago which had equal numbers of men shooting baskets. The control group did nothing more than shoot. The other group would also spend time THINKING about shooting baskets – imagining the process, if you will. That group became much more proficient.

  6. UncleHoot says:

    Quoting myself: “Or even when you aren’t shooting baskets.”

    Hmm… 5 minutes of research and it appears that this study may be urban legend! I guess I can’t trust my college professors… ;-)

  7. nybgrus says:

    @mouse:

    To the best of my knowledge it is merely the sublimation of conscious activity into unconcious neural “macros.” In other words as you learn a task, you need to be aware of and try to get right each and every little step of it. With practice, you develop neural connections such that when you initiate a well learned “muscle” memory task, the subsequent steps involved are automatically activated in sequence without need for further conscious thought. However, there is no indication that the muscles themselves are “learning” anything; i.e. if you took the brain connection away the muscle would not be able to perform the task independently.

    The only wrinkle there is that fine movements can actually cause modifications of the innervation of muscle. When we are born our nerves innervate large bundles of muscle fibers. So when the baby tries to activate a muscle, many fibers are recruited simultaneously which is why babies’ movements are jerky and awkward. Over time and with practice, those muscles that need more fine control get more and more innervation allowing for larger numbers of smaller bundles of fibers to be recruited sequentially rather than smaller numbers of large bundles of fibers, thus allowing finer and more streamlined motion. The capacity for this is obviously variable and determined by genetics and epigenetics (just thought I’d toss that one in for ya!) as well as the environment in general.

    Now, I recall that the capacity for re-innervation in babies diminishes drastically over time. How much of that is retained in adults I do not know. But we also thought the brain was pretty “fixed” for a long time and we are seeing now how much plasticity there is, so I wouldn’t be too suprised if there is at least some plasticity in muscle fiber recruitment as well. Perhaps someone else knows more on this specific topic?

    In any event, the bulk of the “muscle memory” is actually encoded in subconscious neural connections within the brain.

  8. mousethatroared says:

    Hey nybrgus – I suspect that I have come across a reference to this… “The only wrinkle there is that fine movements can actually cause modifications of the innervation of muscle. When we are born our nerves innervate large bundles of muscle fibers.” etc. Which made me curious when I read SN’s article. Thanks for the clarification.

  9. Quill says:

    “Mostly this is simply a technical description of a very common phenomenon – learning.”

    That makes perfect sense to me, where a five-cent technical description has become a five-dollar marketing phrase that replaces that much simpler word, learning. Learning sounds all schoolhouse-y, hardly something you can create a buzz about and sell to the buzz-able. But neural plasticity! And brain training! Why that sounds like exactly the sort of sophisticated & expensive things Dr. Oz must do on his rare Saturdays off.

  10. pmoran says:

    As designated “snake oil” goes this, is not so bad. SN allows that it may well be helpful to some patient groups who are not easily or well served by the mainstream, i.e. those with MCS, CFS, fibromyalgia, GWS and the like. It recognises that changing how people think about their illness may the key to helping many of them.

    Some quotes —

    “Through the Dynamic Neural Retraining System™ participants will learn to recognize the unconscious reactions associated with a Limbic System impairment and how to consciously interrupt the associated trauma cycle.”

    “The condition of Multiple Chemical Sensitivity indicates that the brain is stuck in a distorted self-protective mechanism.”

    “The hyper vigilance in the systems of the body relaxes which allows the natural growth and healing processes to resume.”

    “Hyper-viligance” is mentioned in many contexts.

    We might not approve of some of the jargon, but there are indications that the program is based upon some sound insights.

  11. mousethatroared says:

    SN“Mostly this is simply a technical description of a very common phenomenon – learning.”
    Quill “That makes perfect sense to me, where a five-cent technical description has become a five-dollar marketing phrase that replaces that much simpler word, learning.”

    Oh well, to play devil’s advocate, Cognitive Behavior Therapy is basically just learning too, but sometimes it is useful to distinguish different approaches with specific vocabulary.

  12. Quill says:

    @mousethatroared: I’ve no quarrel with the term Cognitive Behavior Therapy as it refers to something specific, that is measurable, and is exactly as you say quite useful in distinguishing approaches and treatments. I would have a problem with Quantum-CBT(tm) or The Energy Balancing Brain Training Institute where for only $2,995.00 for a weekend workshop (gourmet lunches included!) you could have your brain trained in the latest “scientific” techniques.

    It’s not so much the words themselves as the uses they are put to, or tortured into, that bother me. :-)

  13. pilotgrrl says:

    Wasn’t this a fad on Nintendo Game Boys a few years ago? Same concept, different name. IIRC, it was called “brain training”.

  14. mousethatroared says:

    @Quill – hmm, yes I would guess the problem is in over promising results from the product rather than having a specific or trademarked named. Possibly the vagueness of “brain training” is a bit suspect. But then “mindfulness” and “brainlock” sound rather similar…well brainlock, not so much, that’s rather descriptive.

    Sorry, I digress.

  15. joebrence9 says:

    As a Physical Therapist, and clinical researcher, focusing on the understanding and treatment of chronic pain, this program doesn’t sound that off…

    We do know that pain is 100% an output from the brain based upon a multitude of inputs (including psychological variables such as depression, anxiety, pain catastrophizing, etc—Melzack’s Neuromatrix).
    If we can improve a sense of well-being, while decreasing the perception of the threat of an illness, I suspect pain can improve.

    This program appears to be de-threatening, a threatened nervous system, and I somewhat blame the nocebo that we often elicit when giving or explaining a diagnosis such as fibromyalgia (ie. Do you suspect that giving someone a diagnosis of fibro may lead to catastrophic thoughts, kinesiophobia and fear avoidance? I would argue it does. Did this improve or hinder that individuals condition? What if we explained that we know that they hurt, and its likely due to an overactive nervous system, but have an expectation that they can get better if they take an active approach to care… )

    I agree that the site does look a bit snake oily, but the concept is being heavily studied by groups such as Body In Mind (http://www.bodyinmind.org/resources/journal-articles/) and we are finding that altering an understanding or perception of a threat, will make the brain less protective.

    Just some thoughts…

  16. mousethatroared says:

    joebrence9 – some of the concepts that they say they employ are well studied…like exposure therapy. But are any of the concepts shown to be effective when they are administered through DVD without any appropriate diagnoses and monitoring for improvements or customized direction from a therapist? Also does the content of the DVD actually match the approaches studied?

    $149 (plus shipping and handling) is lot of money. If there is a problem finding appropriate therapy, there are good self-help books out there that would cover many of the approaches they mention and they are a lot cheaper.

    “What if we explained that we know that they hurt, and its likely due to an overactive nervous system, but have an expectation that they can get better if they take an active approach to care…”

    So what do you then say if they take a proactive approach and they don’t get better? Does that just mean they weren’t “proactive” enough? Also by “get better” here do you mean improve or a return to normal?

    This is what I’ve read on the prognoses of FIBRO “Most patients with fibromyalgia continue to have chronic pain and fatigue. Despite little change in symptoms in 14 years, two-thirds of patients reported that they were working full time and that fibromyalgia interfered only modestly with their lives.[12] If the patient has a sense of control over pain, a belief that he or she is not disabled, and understands that pain is not a sign of damage, the prognosis is better.[12] Other behaviors associated with better outcomes included seeking help from others, decreasing guarding during examination, exercising more, and pacing activities.[12]”

    http://www.mdconsult.com/das/article/body/402188163-2/jorg=clinics&source=&sp=23772897&sid=0/N/774434/1.html?issn=0095-4543

    Sorry to be negative. I can see where you are coming from, but as a patient, I dislike it when I suspect that that health care provider is spinning the facts to reduce my anxiety. Your statement feels a little bit spin like. I find the best way a healthcare provider can reduce my anxiety is to communicate a clear plan and process for dealing with symptoms. Ex: This is the therapy we have found to be most effective for dealing with this symptom. Try this for x weeks then come back if it has not solved the problem. There are other approaches we can try.

    If I feel I am working within a good process and plan, I can allow myself to trust that plan and focus on other things. I believe this actually supported by psycological research, but I’d have to track down the source.

  17. joebrence9 says:

    I agree 100% that a healthcare practitioner should be involved in the direct care of these patients and that a clear, individualized plan is communicated. That is missing with a video series (or book or any form of non-human device) such as this. A human interaction would likely ellicit more non-specific effects if the interaction is perceived as positive. But that stated, there is alot more “worse” in the snake-oil world.

    There is some research to indicate that understanding “pain”, can help in its management or reduction. Here are some resources to learn more about this concept (again most of these can be downloaded on bodyinmind.org for free):
    Gallagher L, McAuley J, Moseley GL (2013) A Randomized-controlled Trial of Using a Book of Metaphors to Reconceptualize Pain and Decrease Catastrophizing in People With Chronic Pain. Clin J Pain 29(1):20-5.
    Moseley,GL, Nicholas,MK and Hodges,PW (2004) A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain20(5):324-30

    I do suspect that the term “fibromyalgia” is a bit of a nocebo. If the brain suspects a threat, it will respond. So if a term, leads to an expectation that their life is now defined by a “word”, it may respond. I am all for focusing on the management of symptoms—I am not quite sure that giving the actual diagnostic term is helpful. Thats what I was indicating in my response and what you confirmed when you describe “This is what I’ve read on the prognoses of FIBRO “Most patients with fibromyalgia continue to have chronic pain and fatigue. ” Expectations for something, can often lead to something. When a diagnosis is given to a condition such as fibro, it is relatively an educated guess. I am not familiar with any gold reference standard in its detection (if anyone else is, please correct me). So I wouldn’t say anyone is spinning the facts by addressing symptoms and giving you a diagnosis such as “non-specific pain”. Understand what I am saying? I do suspect that when suspecting someone may have something like this, referral to the appropriate specialists should be made so that the symptoms can be addressed in the bio, psycho and social domains.

  18. mousethatroared says:

    I suspect the words depression, lupus and migraine may be a bit of nocebo as well, why not come up with vague names for them as well so that the patient’s expectations or anxiety don’t ascerbated their symptoms?

    If you come up with a new word for fibro, how long before that word will accumulate the negative associations that fibro has?

  19. joebrence9 says:

    Thats the issue. Do we need terms for these vague diagnoses? Do the terms lead to further disability? I suspect if we could devalue the threat of pain, it wouldn’t be the leading cost to our healthcare system. Unfortunately, there is a negative reaction when someone is told they have “fibromyalgia” or “arthritis” or “____”. Potentially, the issue is the term, or maybe its the constant negative portrayal of that term in the media and online. There is this expectation that once you are associated with a diagnosis, you will have pain.

    I am not attempting to be offensive or inconsiderate of individuals who live with chronic pain. I believe we in healthcare aren’t doing a good enough job at understanding how to handle these individuals.

  20. mousethatroared says:

    “There is this expectation that once you are associated with a diagnosis, you will have pain.”

    Actually, I think there is the expectation that once you have a diagnosis you will have a better chance of knowing what treatments will be more effective. That IS generally why we label things, right? So that we can research, diagnose and treat conditions based on their similarities.

    I suspect that the negative reaction to being diagnosed with “arthritis” or “fibromyalgia” is due to the fact that the patient was hoping they would have something much easier to treat. You can change the name all you want, but you are not going to change the reality that the patient has something that does not have an short easy treatment.

  21. mousethatroared says:

    ….Although if avoiding patient anxiety is a goal, maybe tell the doctors to avoid saying things like

    “Well, your symptom is associated with disease X, but your don’t want to have that, disease X is a terrible disease.”

    Really, after a couple of doctors say that to you, it gets a bit disconcerting. :)

  22. Armi Legge says:

    I’m guessing Dual N-Back Training falls under the same umbrella. The New York Times reported on a study using this technique in April 2012: http://www.nytimes.com/2012/04/22/magazine/can-you-make-yourself-smarter.html?pagewanted=all&_r=0

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