The LENS Experience

How your Neurotherapy Treatment Program with LENS will be structured

The LENSk™ Neurofeedback System is a relatively new and not yet widely known treatment modality. Thus, most people entering a treatment program utilizing LENS are understandably curious about what it will entail for them in terms of specific procedures, treatment effects, and the number of sessions necessary to resolve their complaint. This document is designed to answer some of these concerns.

The Evaluation Period

Every treatment program begins with an Initial Consultation, lasting approximately 90 minutes to 2 hours. During this time, an intake interview will be conducted during which information will be gathered about you and your condition. This interview will entail completion of numerous informational forms including a Social/Developmental History, an Informed Consent document, a CNSQ (Central Nervous System Questionnaire, a survey of symptoms and their severity levels), and a Head Injury Locator chart, among others.

Time will also be spent describing the LENS system, the program, and answering your questions and concerns.

Finally, a brain-mapping procedure will be conducted in which brainwave information will be collected from 21 specific sites on the scalp. This information will be processed by computer to provide a "map" or chart of your individual brainwave patterns, and will help us to determine the nature and extent of any brainwave irregularities that may be present, as well as give us an outline for how to proceed with the treatment.

It is important to note that this and all other procedures performed are totally noninvasive and painless, as all brainwave readings are taken using sensors attached to the scalp with only a waxy paste.

Following the brain-mapping procedure a specially-formatted preprogrammed procedure (lasting about 30 minutes) will be administered, designed to deliver a controlled amount of treatment stimulation (using electronic diodes mounted in specially modified goggles and worn on the face) while yielding some additional important diagnostic information. In this session, we are seeking to determine how both the brain itself and your symptoms respond to the particular type of stimulation provided by LENS. This information is crucial in establishing the format of future treatment sessions and the optimal stimulation dosage for your particular circumstances.

In some cases, this "diagnostic/treatment" session may be conducted on the same day as the initial intake, following the brain mapping procedure. However, in most cases, this session is conducted at the next scheduled session.

Completion of the Intake Interview, Brain Mapping, and the "diagnostic/treatment" session brings to a close the Evaluation period of the treatment program. At this time, using an understanding of your history, observations of your brain's reaction to the stimulation, and careful reports of your subjective and symptomatic responses and changes over the week since beginning treatment, it will be possible to project an estimated treatment length for your situation.

The following estimates are based on our experience (some patients have needed fewer sessions, and some occasionally need a few more):

• If your problem came on suddenly (e.g., an accident) after a life of high functioning, and you are comfortable with the longer periods of stimulation, you can expect 10 to 20 sessions.
• If your problem came on suddenly after a life of high functioning, and if you are so sensitive to the stimulation that it needs to be severely limited, you can expect approximately 20 to 40 sessions.
• If you have a lifelong history of multiple problems and are very sensitive to the feedback, you may need more than 40 to possibly over 100 sessions.
• In a very few circumstances such as severe stroke, very severe head or spinal cord injury, or genetic physiological disturbances, the number of sessions can easily be in the hundreds.

Please feel free to ask us about the treatment times we anticipate for you.

Regular Treatment Sessions

The next phase of treatment is a series of individualized sessions (each lasting about 15 to 30 minutes), usually scheduled on a weekly basis, in which brainwave activity will be monitored at from one to seven sites on the scalp, with each of those sites receiving a specified dosage of stimulation via the goggle-mounted diodes. The type and amount of stimulation delivered, and the sites chosen for treatment will depend on the results of the Evaluation period procedures. The session format and dosage may change as the course of treatment progresses as a result of the reactions you may experience during and immediately following the session, as well as in the time period leading to the next session.

Pre-Session Report

Prior to the actual running of each LENS session, we will inquire about your reactions since the previous session over the short-term (12-24 hours after the session) and the long-term (the remainder of the time up to the day and time of the current session). Your reports of your reactions to the treatment are critical to our ability to determine the optimal treatment parameters for you at each session, so we strongly encourage you to be accurate and thorough in your self observations during the time between sessions. If keeping a brief daily log of your symptoms and reactions would not be inconvenient, we urge you to do so. We are especially interested in knowing about any changes that occur in the frequency, intensity and duration of your usual symptom patterns, for better or worse, so that we can tell how the system is affecting you and adjust the stimulus dosage and other treatment parameters accordingly.

In keeping track of your reactions, we suggest that you familiarize yourself with the three major domains, or areas, into which most of the symptoms of Central Nervous System dysfunction fall. They are:

Problems of Force -	energy/stamina (fatigue), sleep patterns, initiative, motivation, perseverance, movement/coordination
Problems of Focus -	attention/concentration, distractibility, cognition, mental clarity, information absorbency/comprehension, memory, sequencing, prioritizing, decision-making
Problems of Feeling -	mood (depression, anxiety), self-concept, panic, hypervigilance, obsessiveness, irritability, rage, explosiveness

The pre-session report is a critical aspect of your treatment regime, and so we stress that you do your best to be attentive to your functioning in the above-referenced domains between sessions. Following are some of the reactions you may experience over the term of your treatment program:

Brief Reactions

On rare occasion, there may be some potential risks of discomfort involved in participating in this research. The stimulation may be too intense at times, and may make you uncomfortable, irritable, tense, and anxious, or fatigued. This rarely happens for more than a second at a time. If this happens, please tell us and the settings on the equipment can and will be changed to make the stimulation less intense to the extent that you are once more comfortable. The primary signs of overdose are reactions of feeling "tired" (fatigued) or "wired" (irritable/anxious), usually occurring during or shortly after the session, or seeing no change in your condition during the week subsequent to the session.

Longer Lasting Reactions

You may experience one- or two-week periods of anger, fear, and irritability during the treatment. You may feel as if you have tremendous energy to do things, or feel very tired. These longer-lasting reactions have especially tended to occur with particular feelings that people have been struggling to control for a long time. While these feelings can be intrusive and bothersome, it has been the experience of previous patients that they are still able to function adequately. At times however, support from your own therapist or physician may be useful and should be relied upon. It has also been observed that the need for many medications often decreases. As the person's neurological efficiency improves, medications remain in the body unused. People often start having side effects from them because of the decreasing tendency of the body to rely on them, and they may no longer need the same level of medication. People being treated with LENS who are also taking prescription medications are instructed to stay in close contact with their physician to monitor their reactions and possibly adjust dosages.

Between Sessions

While many people feel energy, ease, clarity, and happiness after an LENS session, these positive feelings may precede feelings of fatigue, depression, and anxiety between sessions. Those patients "rebounding" from good feelings often feel discouraged and doubtful about their ability to finish treatment. The rebound appears to be the brain's way of struggling to remain in the old, familiar, and dysfunctional state. As people continue with LENS, both the intensity of the good feelings and the unpleasant rebound periods tend to become shorter and less intense until the exaggerated feelings no longer occur. To date there have been no exceptions to this pattern. Instead, people become clearer about the entire range of feelings they have, instead of becoming numb and flat in their emotional responses.

Post-Session Processing

Another important component of the regularly scheduled session is the post-session processing of any reactions or psychological material which may have arisen during the session, or in the week prior to the session. Depending upon your reason for seeking treatment, this component of the session may be totally unnecessary or absolutely essential. As is any other change agent, from psychotherapy to hypnosis to yoga, LENS is a disruptive process, with inevitable ups and downs on the road to eventual improvement. Most patients, especially those who come for treatment of emotional and behavioral disorders or post-traumatic stress, are strongly encouraged to have adjunctive psychotherapy or counseling during the course of their LENS treatment. It is very important to have a support system in place and a person or persons who can help process the emerging and possibly disturbing emotions, memories, dreams, etc. that may arise as treatment progresses. We allow for a brief period of time after each LENS session for such processing, as necessary. However, if you do not presently have a relationship with a psychotherapist at another location, and your case is one which fits the above profile, we want you to be aware that we are also trained and experienced psychotherapists, and can provide psychotherapy as well as biofeedback sessions at this office . Many patients have greatly benefited from sessions which integrate LENS and psychotherapy, and you are encouraged to consider this as an option for your treatment program.

Periodic Re-Assessment

As the course of treatment progresses (between 10 and 20 sessions, depending on the nature of your case) we will conduct periodic re-mapping session, which will allow us to view graphically the progress you are making in terms of changes in your brainwave patterns and movement toward greater balance and flexibility. You will also be asked periodically to complete another CNSQ, which also will help us to chart your progress. As a result of these reassessments, your treatment protocol may be changed, but the basic session format will remain the same until the decision is made to discontinue treatment.

Considerations After Treatment

It will be time to discontinue LENS when you stabilize by achieving and maintaining consistently better functioning. You may, however, become used to the stimulation that LENS provides you, and go into a slump after you discontinue it. The slumps that have occurred have lasted between a few days and a month, and have been less of a problem than those that brought people into LENS treatment. During this period your body will become used to being open to its own internal useful stimulation. Most of those who have received LENS have continued to improve long after LENS has ended. The changes generated by LENS treatment tend to be permanent (as would any other behavior pattern "programmed" into the brain, e.g., reading, riding a bicycle, etc.) unless some new trauma occurs. "Booster" sessions are typically unnecessary, but some of our patients have found it helpful to receive one or a short series of LENS sessions some time after their initial treatment program was discontinued. Generally, it is the patient with the more complex case history and chronic symptoms who is seeking and benefiting from these sessions.

An analogy for how long to continue treatment

Let's say we wanted to teach you how to play "Mary had a little lamb" on the piano. Assume you've never touched a piano before. Say that after 10 lessons, you are finally able to play "Mary had a little lamb" all the way through perfectly without a single mistake. That's great. However, if you were to quit the piano at that point -- because you did it perfectly once - what's the chances that 10 years from now, you could sit down again at the piano and play "Mary had a little lamb." Chances are, you'd probably really struggle to play it. But instead, after you finally learned to play "Mary had a little lamb" perfectly, you came for 10 more practice sessions -- and THEN quit the piano. The chances are that 10 years from now you would be able to play "Mary had a little lamb" and do a very credible job even if you had never touched the piano for 10 years.

This is the concept of overtraining. It's important to overtrain your brain with Neurofeedback, so your brain really "gets it". Once you've made good progress with the training, and achieved some of the changes you want, you probably should do 6 to 10 additional training sessions to help the training to stick -- to give the brain a chance to really "get it".

(Our appreciation to Mike Cohen of the EEG Spectrum Organization for this analogy).

What LENS Will Not Do

• LENS will not make life pretty or make other people wonderful, warm, generous, or fair. Life retains its difficulties on the outside.
• It will not change people's moral and ethical outlook. It will make them more of who they really are, and make it easier for them to be themselves.
• It will not, by itself, make people wiser. It will, however, open them up to the wisdom they have already taken in, and to the wisdom they find around them, or with which they surround themselves.
• It will not make long-used defenses go away easily. This is a disruptive treatment, as is any change agent from yoga to moving a household. People often will feel very confused as old defenses crumble, and their brains have not yet learned how to naturally formulate new and more flexible ways to be and to function in the world. Some people who have been trying not to be angry will find themselves becoming angry - as they really are. However, their anger will finally pass once they let themselves feel what there is to feel, if their life is treating them right.
• LENS will not magically make people easy to work with if they are incredibly complex, difficult, and reactive. People who feel they have a lot "wrong" with them, and who say they have lifelong difficulties, can be successfully worked with, and left very sturdy. However working with these people in the most complex of instances is a delicate task, and may require a long course of treatment (approximately a year).

For more information about LENS, click here. Please feel free to ask further questions at any time. It is important to us for you to be as informed and feel as comfortable with this process as possible.

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