Thursday, November 20, 2008


This is a repeat of a posting from my pediatric blog, OT, Self Regulation and Autism.

I've been using Therapeutic Listening with clients for about a year now. I recently got Samonas sound therapy training, and I have been reading everything in site about Samonas, Therapeutic Listening and other sound programs. I want to know about the technology and how the programs differ from each other.

Over Speakers
One thing that Samonas has that others do not, is a series of disks (the CQ series) that can be played over stereo speakers. One of my colleagues uses them in the school setting with her kids once per week and sees gains.

Web-Based Monitoring
Another feature I like is even more important. The Samonas people will tell you all about the high quality music recorded in pristine settings by joyful musicians.... that's important, but even more so is the feature of web-based monitoring. After clients get their listening CD, they log into a web site every day or so and provide a rating of how it's going. Based on that day's feedback, they are told how many minutes to listen the next day.

To understand why this is important one needs to know that with some other programs, therapists give the one-size-fits-all instruction: 30 minutes, twice per day. There is no room for nuance here. It belies the fact that these therapies truly are powerful, and for people who are sensitive (typically, the people who need them), they can have powerful effects. I have seen adults and children have unwanted emotional reactions at inoportune times.

One can use the Samonas disks without the web log-in. I like the fact, that therapists are being instructed in how to grade auditory therapy ... just as they currently grade their other therapies.

Levels of Intensity
Finally, there are many levels of intensity in the Samonas program. A therapist finds out what level to start a client at by giving them the intro (A.R.T.) CD and monitoring the effects using web-based reporting. Once the client is matched to an intensity level, listening disks are chosen.

There are a myriad of other features, and more to come. I am impressed with the program, and confident that it will serve my clients well.

Involuntary Momevent

I am seeing a client who has a tic that starts at her mid-section and thrusts her head and shoulders outward a few inches. In addition, she constantly touches things, is emotionally volatile and obsesses over having her way. Did I say that these symptoms were compounded by teenage hormones? Not an easy state for a pretty girl.

We had talked about sound therapy and Interactive Metronome (IM). I knew that IM would help with the sensory issues and eventually decrease a lot of the associated anxiety. I know of an IM provider who has Tourettes Syndrome who regularly keeps his symptoms at bay with IM. I wanted to try this approach with my client, but I was worried that the intensity of IM would cause an increase in her obsessive behaviors.

So why not use sound therapy... it would improve overall self-regulation and help her find calm. However, I've seen some amount of passive behaviors with sound therapy. I didn't want her self-esteem to take a nose dive, and really complicate things.

Finally, I suggested to the parents that we do both. And they agreed. Within a couple of weeks, the body tic has substantially diminished. Her overall home behaviors have improved and both parents are beaming. We completed the IM program, and still have a 6 weeks remaining on the sound therapy. My plan is to give her a quick shot of IM every 2 weeks to bolster the initial gains. I'll update more on this later.

Wednesday, November 12, 2008

Musical Emotions

I just read about a number of dual sensory experiences in the book, Musicophilia, by Oliver Sacks. His examples include people who hear colors. He can add this one to the list: a woman who feels in musical notes.

My good friend, Amanda, called me this morning in a state of excitement. Amanda has minor bouts of mania and minor bouts of depression. Another friend of hers once called her the most intense person she ever know. That was before my time with Amanda. She's pretty mellow these days. Although, I guess she has her moments.

And today was evidently one of them. It's been a rough November for her. External events had brought up some emotions, and combined with the dreary Michigan November she succombed to a bit of depression. As a friend, I was keeping a very careful eye on her.

During her call she said, "Last night I listened to some sublime choral music on my stereo. It filled my whole body with feeling. Finally, I couldn't handle any more and turned it off. This morning when I was in the shower, I felt a little funny. Instead of feeling a single emotion or feeling, I had...", -- and here she paused trying to find the words -- "...a whole harmonic range of emotions, arranged just like notes stacked one on top of the other". Then she explained that it was just like the rich choral music she had been listening to.

I got her to slow down long enough to explain it.

She told me that she had seen a visual image (in her inner eye) of about 12 emotions. The feeling of each emotion was represented by a musical note on a staff. The 12 feelings or notes were stacked in a single beat on the staff. She felt the emotions within herself like a rich chord of music -- all at once. Pretty bizarre and very beautiful.

"How did it feel?", I asked, afraid of the answer.
"Just fine.", she said. "Amazing and fine."
"What emotions were there?"
"The deeper notes were fear, sexual feelings, longing, up through greed, compassion, a need to express myself, and on and on. The highest note was joy."
"How do you feel now?"
"Very connected and in harmony with myself. Everything is just perfect."

I talked to her later. It was a momentary experience. It came with a high and then a low, but she did fine. That brain of ours is filled with all kinds of mysteries!

Saturday, November 8, 2008

Physics and the brain

**Meandering-Entry Alert**
This entry talks about replacing depressed thoughts and associations with pleasant ones, creating new associations and memories in the brain that can be the basis for a more pleasant life. It builds off of brain theory (neural networks from a lecture from U. of Mich.) and psychotherapy.

Self Sabotage
My husband, Peter, a psychotherapist, has written a book on self-sabotaging behavior. He says that we subconsciously try to repeat negative experiences - usually left over from earlier times or childhood. It is hard to change our ways. For example, if we are depressed, we will seek out behaviors to reinforce our depression. He says that we have to catch ourselves in the act, and then purposefully change what we do.

The Novelty of Pleasant Associations
I would like to propose that when we feel depression stir, we step back from it, see it for an emotion (that is, don't identify with it, just look at it) for about 10 seconds. It will fade. When it comes back (even in a few seconds), repeat the process. At this point, we should be in a less-depressed state. Now try to find gladness, and look for things to associate it with: a potted plant, art, a person we enjoy. This new memory is novel. It will be taken into the brain, and if it sits there for a few minutes without depression, may stick. Thus we will have associated something in our environment (the plant) with gladness, and with repeated sessions over several days, can take hold in our being.

This method creates a novel experience, a novel association between pleasantness and situations that might have been associated with depression. For example, Michigan is gray in the winter. Without sun, people here tend to get seasonal affective disorder (and the poor economy is no help!). So, what happens, for example, if you go away from Michigan for 5 years? A psychiatrist friend of mine once explained that without the associations of winter events with no sun, seasonal depression will fade. In place of gray skies, different memories will exist and they will override the gloomy ones.

Can one get the sad memories to fade without leaving the gloomy weather? I think so. Read on.

Lecure on Memory
The beauty of living in a (great) college town is the availability of stimulating lectures. Today, Professor Michal Zochowski of the University of Michigan Biophysics department lectured on "Physics and Brain Function". Professor Zochowski creates neural networks in petri dishes. A neural network is a very complex structure that can be "taught" to learn things. That is, information can be input to the network and then retrieved later. The format of the neural network's information is so complex, that you can't figure out what it is doing. For example, if I look on my computer for information I have stored, I can find it. I can see the folders and find the folder it is stored in, open a file in the folder and then find the informaiton. However, this is not possible for information stored in a neural network.

If you try compare the brain's memory and function to a (PC or Mac) computer, the comparison breaks down very quickly. Computers are far to simplistic. However, it is possible (at this point), to use a neural network to model brain function and gain some insight.

Professor Zochowski uses his neural networks to simulate the brain's hippocampus and cortex. The hippocampus is thought of as a "device" that 1) finds interesting (and novel) associated bits of information and 2) keeps alive a memory of the bits and their association so that the cortex can (very slowly) put this into long term memory as a newly learned fact. The cortex acts as a mechanism for creating and storing long-term memories. Together, they take novel information, keep an impression of it alive and then after a while (if the information is interesting enough to be still alive), store it in long term memory and create rich connections so that it is easily found. To test these assumptions of how the brain's memory works, Professor Zochowski programmed his neural networks to mimmick the hippocampus and cortex as stated above. The model duplicated know brain wave formation and function, and so the neural network is a good model for now.

Back to Michigan gloom, memories and making new associations. What does the neural network experiment tell us? Does it support our thesis of replacing sad memories with happier ones? I think so.

The model suggests that by creating a new set of associations and holding them steady for a few minutes, a new memory is made. We need to pay keen attention to the stimulus (the pleasant association) so that it appears to be a novel event. If it is done repeatedly, it will strenghthen and override the old one. With disuse, one hopes that the old memory will fade.

Sunday, November 2, 2008

IM & Depression - Single Case

Carrie is a 35 year old woman who put aside her career several years ago to care for her two children. ages 3 and 6. Her six year old son has autism. Carrie took part in a 10-person study focusing on Interactive Metronome (IM) as an intervention for reducing stress in parents of children with autism. She, like others in the study, spends a great deal of time in doctor’s offices, therapy clinics and in school meetings. Carrie had little time for herself due to the rigors of caring for and supervising her son, which includes moderate assistance with bathing and grooming, hours in the kitchen preparing special foods, and constant supervision for his safety.

As part of the study, Carrie was given a small battery of pre- and post- IM assessments. The primary assessment tool was the Parental Stress Index (PSI), a standardized assessment that measures stress in parents with children 12 years and younger. Stress sources on the PSI are broken into two sections: Questions about the child and his/her characteristics and questions about the parent (including parenting itself).

Other assessments in the battery included the adult/adolescent version of the Sensory Profile and the 6-item IM Survey.

Carrie’s overall pre-score on the PSI demonstrated stress in excess of 4 standard deviations higher than the norm. All components including depression and health demonstrated large contributions to her overall stress levels. She was within 2 standard deviations from the norm in just one area, “isolation” (from peers, family). Previous studies on parents of children with autism indicate “somewhat” higher PSI scores on the child component items. Carrie’s scores are in excess of that.

Carrie's IM Survey scores indicate excellent rhythm & timing, good concentration and focus, fair memory recall and organization skills, and poor multi-tasking and coping skills,. She completed the adult Sensory Profile on the pre-test only and scored as “typical” in all areas.

The IM intervention program was set-up to allow a parent to complete a 25- 40 minute IM session while his/her child was in therapy elsewhere in the clinic. Each parent was expected to do sessions once or twice a week, as schedules permitted, for a total of 15,000 IM claps and taps of the hands, feet and novel combinations of both. It is thought that 15,000 repetitions is enough for the effects of IM to last with time. The program had two characteristics. First, once a parent established competence with IM tasks and had achieved average or better scores ( usually at session 2), he or she was given increasingly larger number of repetitions (up to 1000 repetitions) for both hands. This was usually completed on session 7. Second, starting at session 8, tempos were altered for some or all tasks in each session. A standard tempo is 54 beats/second - just lower than typcial hearbeat (60 beats/second). In session 8, the tempo was lowered to 46 for 200 repetitions and then lowered again to 40 for the remainder of the session. In session 9, the tempo was raised to 64 for 300 repetitions, raised again to 69 for 200 repetitions and then, back to 64, before ending on at a tempo of 54. In session 10, the tempo was lowered to 35 for the entire session. In 11, the tempo was raised to 72 for 400 repetitions, and then lowered to 54.

The rationale for higher tempos was to assist with multi-tasking. The life of the parent of a child with special needs is busy to the point of being overwhelming, and so increased multi-tasking would be a plus. Multitasking was directly measured on the IM Survey and indirectly measured as the competence component of the PSI.

The rationale for lower tempos was to assist with focus and concentration (measured on the IM Survey). In addition, the study team hoped for increased patience, as measured indirectly by acceptability (of the child) on the PSI. In fact, the lower tempos did try the patience of two of our test subjects to the point that they were allowed to forego those tempos. Carrie on the other hand persevered and completed those tasks.

As the program progressed, Carrie visibly relaxed. After 3 sessions, she said that she looked forward to coming, and she arranged for an extra session each week to complete the program faster. After 7 sessions, Carrie observed that she seemed to be “coming out of a fog”. She said that she hadn’t realized that she was depressed and had been so for a number of years. After 7 sessions, she arrived wearing new clothes and said her self-esteem had improved and that she now wanted to look good when in public.

At the end of the program, Carries’ scores for stress had decreased by 3.6 standard deviations – an impressive amount. Her stress scores for non-parenting factors is at the 64th percentile, and within the typical range for all parents. Her overall stress scores remain high, but as we discovered in the study, the life of a parent with a special-needs child is necessarily complex. Carrie’s overall score (86th percentile) is now the second lowest (second best) of our 10 parents.

In an interview six months later, Carrie said that her affect remains positive, her self-esteem is high, and she has good self-confidence. She said that she feels resilient to stress and handles it very well, without moving into bad habits such as binge eating. She said that she now has perspective on her life’s challenges, and she expressed confidence about handling challenges in the future.