Many of us in the treatment community have begun to hear more and more about EEG Biofeedback. We also hear about neurofeedback. Is it the same thing? Different? Is it that thing where you warm up your extremities and feel more relaxed? Why is it suddenly popping up everywhere? If it is evidence based why hasn’t it been readily available before now? Finally, what the heck is it, really? All of these questions and more will be answered in a concise and straightforward manner in the following paragraphs. You need not be a Neuropsychologist to grasp what you’re about to read. Lord knows I’m not!
EEG Biofeedback and neurofeedback are synonymous terms. This treatment modality utilizes audio and visual feedback to guide over and under aroused brainwaves, as well as unstable brainwaves, into a more effective mode of operation. Individuals with symptoms and diagnoses as broad as seizure disorders, ADD/ADHD, substance use disorders, affective disorders, insomnia, hypersomnia, chronic pain and traumatic brain injuries can be effectively and measurably addressed with EEG Biofeedback.
There is frequent confusion between EEG Biofeedback and Peripheral Biofeedback. Peripheral Biofeedback teaches people how to make seemingly involuntary bodily processes-such as body temperature-voluntarily. For instance, an individual with chronically cold extremities can learn to voluntarily warm their hands and feet. In the case of Brainwave training, or EEG Biofeedback, making brain functioning voluntary is never the objective since the learning happens in the brain, not the mind. Clients simply need to focus and relax while the software teaches their brain, the organ, how to better self-regulate. The objective is to train your brain to automatically be more effective and efficient for the task at hand. For example, focus when you need to finish a task. In the case of tension headaches both types of biofeedback can be helpful. They both address the issue in a different way, but with both types of feedback the symptoms can be reduced or alleviated altogether.
The process of EEG Biofeedback begins with an initial evaluation, either through the use of a symptom-based evaluation or Quantitative EEG. With symptoms-based neurofeedback, questions related to over and under arousal, as well as instability, are posed to the client. Clients frequently ask “which leads to more effective treatment, the QEEG evaluation or a bunch of questions?” The answer, efficacy depends on the protocols that each methodology suggests based on their respective evaluation.
Since the landmark UCLA study (published in the American Journal of Drug and Alcohol Abuse in 2005), other reputable institutions have replicated their outcomes using the same Scott/Peniston protocols. The outcomes are always consistent if not better than the original UCLA results: 77 percent of participants who receive neurofeedback in conjunction with a 12-Step program remain abstinent at 12 months, compared to 44 percent of those who didn’t receive neurofeedback, but who stayed in treatment longer.
Following the completion of the evaluation, a protocol is generated determining what sort of treatment will be most helpful for the client. In general, Beta is provided for clients who have either under arousal of the left or right hemispheres, disrupting one’s ability to focus and concentrate. SMR, which is a training of the beta wave at a different frequency, supports calming, relaxation and objectivity. A combination of Beta and SMR treatments creates overall stability of brainwave activity and is particularly helpful for individuals with long-term mental health issues, chronic substance use disorders, head injuries and a history of mental illness in their family origin. Alpha/theta training, frequently utilized for clients with traumatic histories and Axis II Cluster B disorders, creates a distinct feeling of peace and serenity, emotional connection to others and more objective observational skill, all frequently lacking in traumatized individuals. The types of protocols and the manner in which they are applied are summarized below.
|Beta/SMR Protocols Help:
• Better focus and concentration
• More present
• Improves objectivity
• Mood further stabilizes
• More calm and relaxed
|Alpha/Theta Training Assists:
• Less self-absorbed
• More open minded
• Less defended
• More connected emotionally
• Increase peace and serenity
• Have more objective observations
• Access and integrate repressed experiences
Supporting Clients in Residential and Inpatient Treatment with EEG Biofeedback
A challenge for every residential and inpatient treatment center is the client that suddenly glazes over and announces to his or her treatment team that it is time for them to go home – despite the fact that it is only day nine or day whatever of their 30-day program. Sometimes they are glazed and dazed. Sometimes they are highly agitated. But with EEG Biofeedback – at Beacon HouseSM we know within three sessions of atypically heightened alpha amplitude that a client is getting ready to make a dreaded Against Medical Advice (AMA) exit. We know before the client is even formulating his or her exit strategy! And with appropriate intervention we often prevent – and you can too – that AMA before it occurs, with all of the services your center brings to bear – peer support, clinical interventions, a 12-Step meeting, more biofeedback, meditation, everything you’ve got. If you can’t keep them, you can’t help them!
The importance of this information is far reaching and not just a nifty AMA blocking strategy. What this tells us is that our old beliefs regarding “Johnny just hasn’t hit bottom yet” or “Susie just doesn’t want recovery badly enough yet” are absolutely not accurate. The addicted brain responds to treatment strategies with heightened alpha amplitude – a fight or flight reflex. When an individual chooses to leave treatment prematurely and they appear highly agitated or glazed over, they are often quite literally in altered state of mind – in fight of flight – and without an intervention that meets them where they are it will prove ineffective almost every time.
The study below demonstrated the difference between an experimental cohort group receiving EEG Biofeedback during a 12-week residential treatment experience versus a control group in the same treatment center not receiving biofeedback.
UCLA Study. The American Journal of Drug and Alcohol Abuse, 31:455-469, 2005
*Effects of an EEG Biofeedback Protocol on a Mixed Substance Abusing Population* William C. Scott, David Kaiser, etal.
Why Does EEG Biofeedback work on addictions and prevent flight/flight response?
For the addicted brain, the threat of ongoing recovery triggers the survival cortical defensive bypass, but EEG Biofeedback trains the cortex to avoid this reactive state. This causes it to integrate the treatment process more effectively. Essentially, the fight/flight response is soothed.
One’s resistance to the principles in the book Alcoholics Anonymous becomes closer to the nonresistance one would have in following the instructions in a DVD player to set the clock. The unconscious reactions of “not feeling like” reading recovery literature, going to meetings, etc., resolve and there is a greater enthusiasm for recovery activities.
Clients are far less likely to regress into primitive maneuvers in response to effective treatment strategies.
If EEG Biofeedback is evidenced based (It is) Why isn’t it more prevalent?
- Up until three years ago, equipment was not user-friendly – now there is equipment on the market, which is fully automated and highly effective.
- The symptoms-based evaluation process was very difficult to learn and operator-dependent, therefore results were not consistent before automation.
- The QEEG methodology is labor intensive and quite expensive to administer.
- When a technician would leave it would take months to train a replacement. Now with automated symptom-based neurofeedback systems, a new technician can be trained to hook someone up within hours and can become proficient within weeks.
- Equipment and training was cost prohibitive – equipment leases are particularly affordable. Many treatment centers such as Promises have multiple EEG Biofeedback computers at each location in order to provide as many sessions as possible to clients during their residential program stay.
- Training time and costs required a large commitment for a trial – training is now a few short weeks.
- Therapists used to be more computer phobic, and lacked the skills necessary to operate EEG Biofeedback software.
- Many EEG Biofeedback manufacturers were therapists and scientists who lacked business skills.
Frequently Asked Questions
How many sessions does it take?
The broad answer is that it depends on the symptoms. That having been said:
Individuals (children, adolescents and adults) with ADD/ADHD often begin to see results in focus and concentration within five-seven sessions and will frequently conclude treatment in 25 sessions.
Clients with anxiety disorders, unipolar depression and substance use disorders often benefit from a more lengthy course of treatment – often – 40 – 45 sessions show tremendous (and permanent) change.
Bipolar depression, long term, chronic relapsers, migraine suffers and individuals with chronic pain will benefit from an even longer course of treatment. Although improvements will typically be experienced throughout the course of treatment, for these conditions, more really better. Sometimes as many as 75 – 100 sessions have been reported to be helpful.
How long is a session?
Each session is approximately 35 minutes, but beginning sessions are sometimes shorter in duration.
Where do I find a provider?
Go to www.brainpaint.com or www.neurofeedback-services.com for a directory of national and international individual providers, as well as treatment centers and inpatient hospitals that provide EEG Biofeedback. When/if you contact a treatment center, be certain to ask with what frequency a client can receive neurofeedback sessions. Given the short term nature of residential treatment, it is important that clients are availed of as many sessions as possible per week – ideally one session per business day. At Beacon HouseSM (www.beaconhouse.org) clients are provided a session each day of the week. This promotes a culture of receptivity and peacefulness in which the rest of the treatment experience can best be assimilated.
Is EEG Biofeedback covered by insurance?
Yes, however, ask your clinician for more information since they may not take insurance. (Note: insurance companies do not have the word neurofeedback in their database – they exclusively use EEG Biofeedback.)
What’s the average price of a session?
EEG Biofeedback is in the same price range as other therapists in your geographic area. Prices range considerably depending on your geographic location.
Could this work because of placebo effect?
Nope. Placebos do not work on animals, and that is how this field was discovered. Don’t worry, no animals were harmed. As a matter of fact, the cats came running for their session when they saw the researcher arrive. For more information, you can read the book A Symphony in the Brain, by Jim Robbins.
“EEG Biofeedback therapy should play a major therapeutic role in many difficult areas. In my opinion, if any medication had demonstrated such a wide spectrum of efficacy it would be universally accepted and widely used,” Frank Duffy, M.D., Neurologist, Boston Children’s Hospital, Professor, Harvard Medical School.
Dr. Shari Corbitt is the Director of Neuroscience and Senior Clinical Advisor at Beacon HouseSM in Pacific Grove, CA. Beacon HouseSM, a not for profit, Northern California drug rehabilitation center located on the scenic Monterey Peninsula, is devoted to addiction treatment for adult men and women seeking to realize a lifetime without alcohol and other drugs. Beacon HouseSM maintains a commitment to exceptional brain health with the provision of neurofeedback and optimal nutrition. To learn more visit www.beaconhouse.org.
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