Thursday, December 1, 2011

"NORMAL" ROUTINE EEG's ARE NOT ALWAYS NORMAL

“NORMAL” ROUTINE EEG’s ARE NOT ALWAYS NORMAL


EEG SEVERITY INDEX OF TRAUMATIC BRAIN INJURY

Robert Thatcher (Neuro-scientific research)

Routine EEG’s do not always show brain damage although we know that a person might have suffered brain injury after trauma. We refer for EEG investigations with high expectancy and often the EEG shows no abnormality.

The severity of traumatic brain injury in patients is normally judged by emergency hospital admission records, the Glasgow Coma Scale and duration of coma and amnesia. The accurate measuring of the GCS may be in doubt where as the present EEG severity index may facilitate accurate diagnosis of the extent of brain injury by providing an objective and independent measure of the severity of TBI.

There are often reports of headaches, fatigue, impaired memory, reduced concentration and attention, reduced information processing capacity, depression, aggression, anxiety, irritability, sleep disturbances, sexual dysfunction, posttraumatic personality changes, temper outbursts, self centered behaviour, emotional lability and reduced social awareness which are thought to be associated with frontal and temporal lobe damage. The presence thereof can be measured by psychometric assessment but the severity level of the brain damage is still unclear.









Although the Glasgow Coma Scale, the duration of loss of consciousness and duration of posttraumatic amnesia, are valuable clinical predictors of the severity of TBI, there are limitations. The GCS is often not measured in emergency rooms. The duration of loss of consciousness and posttraumatic amnesia is often only a prediction and not necessarily correct.

The routine EEG and MRI are also not sensitive enough to predict the severity level or difference between mild, moderate or severe level of TBI.

A study done by Dr Robert Thatcher had the purpose of developing an objective and quantitative metric of the severity of brain injury by using EEG obtained in the long term post-acute period from 15 days to 4 years post injury. For the purpose of this article, the method of study will not be discussed. (The Journal of Neuropsychiatry and Clinical Neurosciences 2001;13:77-87)

There were significant correlations between emergency admission measures, EEG discriminant scores and 7 neuropsychological tests: Wechsler Adult Individual Scale Revised, Boston Naming Test, Word Fluency Test, attention tests, Wisconsin Card Sorting Test, Wechsler Memory Scale revised and California Verbal Learning Test. (Robert Thatcher et al)

The results of Thatcher’s research indicate that TBI has a long lasting effect on cognitive functioning and that the Q EEG provides a measure of persistent neurological reorganization resulting from the injury.

Patients who present with persistent cognitive and neuro-phychological deficits many months after the injury, do not have access to accurate estimates of the severity of the TBI. The EEG severity index may facilitate accurate diagnoses of the extent of brain injury and provides an objective and independent measure of the severity of TBI. (The Journal of Neuropsychiatry: Patients included in the research: From the Bay Pines Veterans Affairs Medical Center, Bay Pines, Florida and Defense and Veterans Head Injury Program, Washington DC. By Dr R Thatcher).

The TBI Severity Index is an estimate of the neurological severity of injury and should be viewed as an adjunct to the evaluation of the patient. It does not serve as a primary basis for diagnosis.

How do we derive a TBI Severity Index?






STEP 1: Routine EEG

Routine EEG recordings are performed to measure brainwaves and the most prominent purpose of performing EEG’s is to diagnose epilepsy and brain damage. These recordings do not always offer enough information.






STEP 2: Quantitative EEG
The Q EEG can be compared to observing light through a prism. Detail is accentuated which cannot be seen with the naked eye on a routine EEG recording. The Q EEG provides information regarding brain functioning and cognition as compared to a normative or reference database (Thatcher Neuro-Guide). We get information from the Q EEG regarding absolute and relative power, ratio of different frequencies in the brain, coherence or connectivity of the brain, phase lag scores and asymmetry scores.



STEP 3: Derive discriminant scores by importing into NeuroGuide (Dr R Thatcher)

Discriminant scores were accomplished through mathematical procedures described by Thatcher et al.








So a “normal” EEG might be an abnormal Q EEG.

For more information:
Dr. Annemie Peché

0823356133 / 011 6756138 / 0164549302

Sunday, August 22, 2010

COHERENCE: IS YOUR CHILD CONNECTED?

IS YOUR CHILD’S BRAIN CONNECTED?


If our brains are not connected, we cannot function effectively.

What does that mean?

All brain activity is coordinated by neuronal networks. If there is a dysfunction or disruption of one or more neuronal circuits or there is some slowing in the timing of neuronal transmission, a person will have some trouble thinking, learning, remembering, understanding, integrating new information and coping with life.

A person may suffer from over connectivity in the brain or under (poor) connectivity. The following symptoms are indications of poor connectivity of certain brain areas:

• speech problems: leaving out words and phrases: in stead of “I will take the dog for a walk” a person would say “walk dog”; “defily” for “definitely”; battling to find the correct word to describe something;
• general word finding or “lost vocabulary” -“the word is on the tip of my tongue” but the person is unable to utter it. The person may understand a concept but is unable to verbalize thoughts or get a message across.
• What is the disconnection syndrome?
• Asperger and Autistic children can not imitate others because their mirror neurons are not connected.
• When connections in the brain are poor, learning becomes a problem.
• One may not be able to follow instructions through because the information gets lost on the way.
• Poor motivation and procrastination may be due to hypo coherence or poor connectivity.

When a person is over connected or suffers from hyper coherence one can present with the following symptoms:

• A person repeats his actions. Tourette syndrome is a good example – they will repeat a word and or a swearword uncontrollably.
• Obsessive compulsiveness (i.e repeated hand washing) is an example of hyper coherence or over connectivity of certain areas of the brain. They feel forced or driven to repeat actions or have repetitive thoughts.
• Stuttering is another example of hyper coherence. In other words the person is over connected and cannot control his actions.

Hyper or hypo coherence in other words, overly connected or poor connectivity may be found with:
• Traumatic Brain Injury
• The 5 learning disorders
• Stroke
• Autism
• Memory Impairment
• And various psychiatric disorders
• Memory impairment



Remediation
Neurotherapy is a tool utilized to remediate these problems and thereby normalizes brain functioning. Before neurotherapy can be utilized to remediate hyper (over connectedness) or hypo coherence (disconnection), a quantitative EEG (Q EEG) should be performed which shows how much of each frequency range the brain produces in different brain areas relative to a world wide norm. It also indicates hyper and hypo coherence. According to the Q EEG results a program is identified to train the brain to operate more effectively.

Dr Annemie Peché

Tuesday, November 10, 2009

SLEEPING DISTURBANCES

Our brains and specific associative areas in the brain are responsible for cognitive, mental, emotional, social functioning in human beings as well as sleep.

There are 5 normal stages of sleep. Sleep is cyclic through the night beginning at stage 1-5 and REM sleep, before beginning the cycle again, each cycle, between 80-120 minutes.

In wakefulness with the eyes closed, alpha activity (a range of brain waves between 8-12 hz) dominates and is highest in the occipital areas or at the back of the head and with beta dominating over the frontal areas.
1. stage 1: alpha attenuates, becomes irregular and the slower rhythms start to dominate in the EEG. The person becomes very calm and even drowsy.
2. stage 2: this light sleep phase is characterized by sleep spindles or V shape waves over the back (posterior) regions of the brain. These waves are called theta (4-7 hz). The person becomes very drowsy.
3. stage 3: in this stage high amplitude delta waves begin to appear and the person falls asleep.
4. stage 4: more than half of the brain waves are in the delta range (1-2 hz) and the person is fast asleep.
5. REM: rapid eye movement phase in which the subject is usually dreaming and may recall the dreams on awakening.

There are about 200+ diagnosable sleep disturbances of which sleep apnea, narcolepsy, sleep onset problems, sleep maintenance problems and REM sleep disturbances are the most common.

Sleep disturbances are common with ADD (increase in theta activity). There are several reasons for suffering from sleep disturbance such as a reduction of oxygen flow during the day and night. The latter may be due to sleep apnea caused by closing of the airway and although it is less common with children, a family history of sleep apnea may precipitate sleep apnea even with children. Stress and tension, depression, situational circumstances such as problems at home, school and social life and an over aroused right brain may cause sleep onset and sleep maintenance problems. Teeth grinding, sleep walking and sleep talking as well as night mares and night terrors are some of the sleeping disturbances experienced.

A disturbed EEG pattern may also cause sleep disturbances which can be addressed by neurotherapy, through which the brain is trained to produce effective frequencies of brain waves.

THE HIGHLY SENSITIVE CHILD

THE HIGHLY SENSITIVE CHILD

Highly sensitive individuals are people born with a tendency to notice more in their environment, who reflect deeply on everything before acting, who cried lots as newborns and suffered from cholics.

Although their ears, eyes, sense of smell and taste buds may not be better, their way of sensing their environment is more sensitive. Their brains seem to process information more thorough. They seem more affected by pain, medication and stimulants and their immune systems are more reactive and they are more prone to allergies, stomach aches, head aches and upset tummies. Food is normally too spicy and place smells weird. Their whole body is designed to detect what is happing in the outside world. Therefore they get overwhelmed by much more stimulation than their systems allow. They have to create a defense mechanism to protect them from over stimulation and often they are reactive in a less sociable tolerant manner. They won’t enjoy camps, partying and sometimes dating. They avoid being irritated or overwhelmed by resisting new situations and will throw a temper tantrum, have rages and melt downs to protect themselves to these situations.

Many well meaning parents cause tremendous pain not understanding these “difficult children” and treating them totally wrong, causing serious adverse reactions, which snow balls. With gentle and sensitive guidance they can be very cooperative.

As a result of their sensitivity they tend to be empathic, smart, intuitive, creative, careful and conscientious but on the down side they are easily overwhelmed by high volume or large quantities of input experiencing at once. They get over stimulated and are easily upset. Restaurants are too noisy and birthday parties are too busy. They would rather engage in chess, which requires deep cognitive engagement. They will ponder on social dilemmas; focus on “what would happen if..” ; imagining their cat’s thoughts.

They will notice when the bed sheets have been changed. They feel stronger and more intense emotions but they also suffer more when others suffer. They are bestowed with rich inner lives and are normally very conscientious for their age

About 15-20 % people are born highly sensitive and traditionally these people become scientist, counselors, theologians, historians, lawyers, teachers, artists and people in the healthcare profession.

Answer to the following statements to determine whether you or your child is highly sensitive:
Gets startled easily; complains about scratchy clothing (seams in socks or labels in T-shirts); does not enjoy big surprises; learns better from a gently correction than strong punishment; doing mind reading; use mature big/sophisticated words for their age; sensitive to the slightest uncommon odors; has a clever sense of humor; seems intuitive; battles with sleep onset after excitement; does not adjust easily to changes; needs to change wet or dirty clothes often; very inquisitive; tends to be perfectionistic; notices distress in others; prefers quite play; asks provoking and deep questions; sensitive to pain; irritated by noise; notices subtleties (notices changes in appearance or routine); cautious (won’t engage unless situation or safety is checked); feeling of uneasiness with strangers; experience deep routed feelings.
13 or more statements answered yes: probably highly sensitive
No psychometric test is accurate enough to guarantee this diagnosis, however even a few positive statements may assume highly probability of being highly sensitive.

Saturday, July 25, 2009

WHAT CAUSES ADD?

WHAT CAUSES ADD?

Theories have ranged from silly to scientific. Let’s look at a few popular theories:

The bad child

In 19120 Still published an article in the British medical journal Lancet and described children who exhibited symptoms of moral control, mischievousness and destructiveness. These children were born bad. The theory of genetic offer some credibility to this theory. Some children live with a genetic predisposition which is passed down. Regardless of genetics it is important to keep in mind that if the parent does not teach, the child will not learn. Parents cannot change the genetic code but good teaching can alter the behaviour.

The role of the family

Stability at home, predictability, an element of constancy, happiness in the home, marital stability, the parents’ attunement with the child are all important factors. When chaos in the family reaches a certain level, the child is likely to tune it out. They slow down the brain, so that it is less alert, less awake and less aware to environmental stress. The same pattern is followed when a child is yelled at constantly or when parents are verbally abusive. Slow frequency ranges are the essence of ADD. So slowing down the brain is very functional as a defense mechanism.

ADD does not exist

“There is nothing wrong with him, he just needs discipline.” The denial of a syndrome, which needs to be spanked out of a child, is not only offensive but ludicrous. In 1979 Schmitt was of the opinion in his book “The Minimal Brain Dysfunction Myth” was of the opinion that ADD is a fabrication by distressed parents, teachers and physicians.

Poor parenting

ADD kids come from various homes good and bad. Poor parenting can however cause ADD to be like a runaway train. Inadequate parenting may make things worse but good parenting can dramatically alter the course of the ADD child. Poor parenting may result in uncontrollable, disrespectful, undisciplined and neurotic children. The dysfunctional behaviour may be the result of the way the children interpret the world based on how it was presented by dysfunctional parents. There for poor parenting dramatically affect the outcome of ADD children in a negative way, but it is highly unlikely to be the cause of ADD.

Environmental influences

Due to zenobiotic toxins, synthetic substances and pollution in the environment a theory that ADD is caused by environmental factors developed and can not be ignored. It will take a long time to collect all data to get a new understanding of molecular biology, toxicology and human sensitivities and hopefully lead to deeper insight. We are just scratching the surface regarding the influence of sugar, food additives, dyes, preservatives, lead, dioxin, mercury etc and don’t exclude eating habits.

Genetics

Clinicians, teachers, the remedial fraternity and parents have experience of the theory of genetic transmission, which is supported by a number of twin studies by Goodman and Stevenson and Comings. The idea that ADD is agenetic disorder is well grounded in the scientific literature. Meeting with the parents of an ADD kid, it is often obvious were it is coming from and that the parents are undiagnosed.

Brain injury

Brain injury can be structural, when the brain is physically damage and shows up on MRI’s or, or functional where is does not show structural damage but a dysregulation of brain waves cause functional problems. The latter may be more prominent in ADD. When EEG or brainwaves are broken down I specific sites on the head, we see abnormal patterns in ADD patients. Slower frequencies vary from 0,5 to 7 hz and faster frequencies from 15-18 cycles per second. Functional injuries relate to the timing of the brain. Certain functions require production of brainwaves within certain bandwidths. If we go to sleep, the brain should produce slower frequencies. If we write exams we need to produce faster frequencies. A child who needs to concentrate in class will not succeed if he produces slower delta/theta frequencies. The structure of the brain may be good, but on functional level the person will not succeed in finishing the task if the brain is not alert. The term MBD or minimal brain dysfunction was changed to ADD to describe e the nature of the dysfunction.

Brain injury can occur from many different factors. Children suffering from ADD may not report major head injury but jolts, hits, bangs, whip lash could be sufficient to alter the rhythm of the brain. Toxins and nutritional deficiencies, anoxia or interruption of the flow of oxygen to the brain, encephalitis, severe infections, high fever or damage during pregnancy or birth complications may cause brain injury. Heavy metals result in brain injury.

The role of stress

People under stress tend to produce high ranges of beta activity. Although the higher beta ranges are important for vigilance, alertness, concentration and focus, the brain needs to go back to an idling mode to relax, which is the alpha range. Should the brain not adapt or its state flexibility does not bring about relaxation, the brain learns to be hyper vigilant, over sensitive and highly stressed. Children with ADD may zone out if stress or demands are too much and become lethargic and passive as a defense.

Genetic brain injury

Genetic brain injury is carried over from the one to another generation and may play a role in behaviour, personality and cognition.

The main reason for ADD is inefficient brain waves that are produced by the ADD child. One way of treating ADD is to alter the brain waves from too slow frequencies (delta, theta) which cause under arousal and poor concentration and focus as well as too high frequencies, causing tension and hyper activity to frequencies that will help with concentration and other cognitive functions such as sensory motor rhythm.

Wednesday, July 15, 2009

UNDERSTANDING MEMORY

UNDERSTANDING MEMORY

A common misconception of what memory is is that the mind has the ability to make a photograph of experiences. In fact memory is more than what we consciously recall about events from the past. It is the way past events affect future functions.

The brain is composed of spider web neural networks that fires patterns, called a neural net profile. When the neurons in our brain make connections, they fire. If they fire repeatedly, these connections between the neurons strengthen and enhance the possibility of learning. So memory is the repetition of firing of certain neuronal networks. In other words, experience shapes the brain and learning is experience dependent.

The infant brain has an over abundance of neurons with few synaptic connections at birth. The brain learns from implicit memory, which is the first impressions a baby makes from the first day of his life and those remain available to us through out our lives. Implicit memory happens automatically. The baby does not say “oh yes, I remember that toy, it made a loud noise before”, when he has a fright as it happens again.

The brain constantly scans the environment and tries to determine what comes next. It distinguishes between familiar and new information which is the mind’s attempt to “remember’’ the future. When the next moment is anticipated, the brain is ready to handle the environment and helps us to plan for the future.

By the second birthday toddlers have developed a new skill. They talk about recollections of the day’s events. This kind of memory includes knowledge of their world. This development is experience dependent. This kind of memory is called explicit memory.

Working memory is what we are thinking of at a specific moment. Remembering the phone number of a shop you need to call once only, is an example of working memory. You hold on to those digits just long enough to dial the number. There is no rehearsal of the information. Unfortunately information for exam papers is stored as working memory and the information is held onto till after the exam only. There is a time limit to working memory. If working memory persists, you are bombarded with irrelevant information from the past.

How do items become part of long term memory? An example of long term memory is remembering a close friend’s phone number, which should be placed in long term storage. How does this happen? New associations link up with existing memory traces and form new clusters. The new clusters depend on REM sleep stage, which is an attempt to make sense of the day’s activities.

Information has to be encoded into long term explicit memory to last longer but may be affected by trauma. For example, if someone had been in an accident in January. He may retrieve information from October to December, but after that he can’t remember, which is called retrograde amnesia. Why? Retrograde amnesia is information which did not have a chance to be integrated and encoded into the long term explicit memory. The patient involved in the accident will be able to remember old info that had been encoded before the accident.

Remembering and forgetting: Forgetting is an essential aspect of explicit memory. If we remember everything we encoded, our working memory would be flooded and normal functioning will become impaired.

Emotions also play a role in memory. Information with a moderate or high degree of emotional intensity is labeled as important and has a greater chance to be remembered but when we are overwhelmed by emotions and terror, we inhibit because we feel bombarded and confused. If the degree of emotional intensity is too high, we rather forget traumatic information.

Sleep plays an important role in memory. The brain sometimes tries to recollect blocked memory during REM sleep and therefore we have nightmares in order to reorganize traumatic information. Sleep and more important REM sleep, is crucial for memory consolidation.

Memory can also be enhanced by a technique called neurotherapy.

For more information : Dr Annemie Peche’ 0823356133

BORDERLINE PERSONALITY DISORDER

BORDERLINE PERSONALITY DISORDER (BPD)

The popular description of the borderline personality disorder (BPD) focuses on individuals who cannot tolerate routine, are incapable of insight, who are inclined to lead chaotic lives and who have little to no empathy with others. Friends and family suffer with them as they (the people around them) are the targets of rage. They show unpredictable mood shifts and behaviour and the BPD blame people close to them for deliberately causing them pain.

Key characteristics of BPD are
affect dysregulation; which refers to an unusual intensity of emotional responses and a slow return to baseline. The affect is highly variable and they show intense response to environmental triggers. They react to non verbal cues and are quick to read threat. Moods may change from hour to hour. There is a greater possibility of experiencing anger, anxiety and shame. Their moods do not include all emotions equally. Their experience of fear and anxiety reflects a double message, which involves fear of abandonment and rejection on the one hand and fear of merging and getting too close to people on the other hand. They experience an intense need for love vs an intense fear of abandonment. These fears may flow from a history of poor attachment and memories of abandonment. The role of brain functioning is very important, as the memories reactivate the amygdale which is involved with emotional memory. Feelings of losing control, causes regression to memories of rejection. They experience themselves as defective, bad and worthless. This feeling is not built on conscious memories but they are felt and these are created thoughts and feelings of shame. Uncontrolled aggression is the most common defense mechanism to hide behind painful experiences. So, should a BPD become ashamed or tensed, he will project aggression and show rage. Depression is experienced but short lived. They don’t experience continuous low mood. Their coping skills are characterized by acting out behaviour (destructiveness, sexual perverse activity, self destructiveness, cutting themselves, suicide attempts); regression to prior childhood patterns (being late or forcing someone to phone them to wake up in the morning, despite of being able to set an alarm). They often suddenly withdraw and seem inhibited. Passive-aggression such as manipulation and sarcasm occur. They often dissociate from themselves – they may deny that they ever had a feeling of love for someone, whilst they are cross with the person. They tend to project their own feelings onto others – why do you hate me so much?
Impulsivity or disinhibition: sudden outbursts of rage, uncalled for; self destructive behaviour such as substance abuse, promiscuity, addictions (anorexia, bulimia, gambling, shoplifting and excessive spending, self-mutilation) may occur. Self-mutilation or inflicting pain is an attempt to relieve mental pain by inflicting emotional anesthesia. The sight of their own bleeding, bruises or burns allow for an almost orgasmic release. The endogenous endorphins are released into the bloodstream and the brain.
Identity diffusion and interpersonal problems: BPD individuals feel dissociated, empty, bored, lonely which suggest identity disturbance and which impacts all kinds of relationships. Intimate relationships begin with intense emotion, an over connectivity and later brake op the same way with rage and impulsivity. Extreme bonding may also occur – they may invite themselves to a quick cup of coffee, after which one can’t get rid of them or connect with an acquaintance as if they were life long friends.
Cognitive functioning: their thoughts may become distorted. They may experience paranoia. On a different level they may also justify unacceptable behaviour such as stealing.


BORDERLINE DISORDER IN CHILDREN

Borderline pathology in childhood is associated with the same neurophychological abnormalities as seen in adult BPD, showing defects in executive functioning, associated with:
· Impulsivity: They easily become overwhelmed by inner and external pressure and with minimal provocation or anxiety will through fits of rage, loose control and bite others, be destructive and show paranoia. Their life style seems erratic – they are in either hypo- or hypertonic states.
· Anxiety: they show free floating and chronic anxiety; they fear separation; they fear their own disorganization and aggression and need a caring adult to help them regulate their feelings.
· Depression: the negative self image cause negative affect
· Defense mechanisms include fantasy, projection, denial, ritualistic behaviour to ward off negative feelings such as anxiety.
· Disturbed sense of self includes an unstable self-concept including feelings of emptiness and nothingness.
· Interpersonal relationships: they are clinging and focus on adults to gratify basic needs such as love, since they have not introjected love during development , mainly due to an attachment problem. They seem socially isolated and don’t make friends easily.
· Their cognitive functioning is characterized by short attention span, poor spatial orientation and impaired memory. They are capable of logic, although their reality testing is distorted by their expectancy or anticipation of emotional pain or abandonment.

ETIOLOGY – HOW DOES IT ALL START?

This disorder is experience dependent and interactions may play a more important role than dramatic life events. Children can be resilient even in the face of such events. Genetics do play a role so does neurologically based vulnerability. An individual may be born with impaired brain circuitry for modulation of moods and impulsivity. So, psychologically adverse events could amplify personality traits. The quality of attachment is regarded the most important factor. A child’s brain links up to the mother’s brain to learn self-regulatory capacities. Joy, laughs or anger, distancing, early neglect are all experiences that the child internalizes and engraves in his brain (anterior cingulated in the prefrontal cortex that organizes social, emotional and cognitive functions). Absence, lack of attachment or sexual/physical abuse, result in miss-attunement between the child and mother or caretaker. No feedback on the baby’s smiles cause an inner emptiness and leaves the child with no mirror image from which he should experience a self or introject feelings.


The role of the brain: the amygdale involves emotional memory: the insula and anterior cingulate are associated with self image. The insula associate with love or rejection and connects with self awareness. Should a child experience neglect, abuse, abandonment, or sees disgust or despair in the eyes of the caretaker or parent, the insula associates the experience with shame, pain, discomfort and rejection. Should these situations repeat, a post traumatic flashback is engraved in the neuronal loop and the uncomfortable emotion is learnt and becomes part of the daily experience as well as the personality.

TREATMENT PLAN

As BPD accompany symptoms of bipolar disorder, depression, post traumatic stress disorder, ADHD, psychosis, dissociative disorder, eating disorders and substance abuse, it is important to differentiate in order to follow the correct treatment plan. The wrong medication for instance prescribing anti depressants not keeping in mind that their depression is short lived, may make them worse.

The treatment plan should be on multi disciplinary level including psychotherapy, in certain cases medication may play a role, as well as neurotherapy , during which the brainwaves are monitored. Neurotherapy is non-invasive in other words, no impulses go into the brain. How does the training work? Through operant conditioning: this is a process through which the brain gets visual and auditive feedback when it produces productive and effective brain frequencies. When the brain produces ineffective frequencies, in other words, if the brain is either over or under aroused, problems are experienced on behaviour level, cognitive and emotional as well as interpersonal levels. The level of arousal of the brain is normalized or stabilized in order to ward off tension and other negative feelings. Specific focus is placed on the cingulated and amygdale mentioned before.
Annemie Peche’
For more information please phone: 0823356133