Neurofeedback and Addiction Treatment Success are Linked
Neurofeedback or EEG Biofeedback employs our premature biological mechanisms, self-regulation, and homeostasis to educate the brain to be more adaptive, effective, and operative. Neurotherapy can help develop a number of things, including addiction recovery. Inspire Malibu tackles the fundamental issues of addiction called comorbidities (also known as dual diagnosis), and we don’t just emphasize addiction recovery.
The practice of getting sober can be very taxing, and the portions of the brain that warrant a logical answer are circumvented under these tense situations. Resolutions are then constructed upon apprehension. This is predominantly evident in the initial periods of recovery, impairing an addict’s capability to absorb and employ the keys learned in rehab. Neurofeedback helps to develop the reactive brain into one that is interactive.
As well as addiction recovery, Inspire Malibu goes a step further and tackles the core issues of dependence. These fundamental concerns, known as comorbidities or Dual Diagnosis, are handled through our neurofeedback program. It’s imperative to take notice of the motivating problems, as they can create barriers to recovery.
For Example, our program at Inspire Malibu utilizes one on one therapy as well as group therapy, and if someone is suffering from panic attacks or anxiety, it will be difficult for them to participate, thus hindering their recovery. Aiding the healing process of these underlying issues releases the freshly sober to be more present and receptive to the drug and alcohol rehab program. This relates not only to drug and alcohol addiction, it applies to a mired of dependencies.
The American Journal of Drug and Alcohol Abuse, 31:455–469, 2005 Copyright D Taylor & Francis Inc.
ISSN: 0095-2990 print / 1097-9891 online
Effects of an EEG Biofeedback Protocol on a Mixed Substance-Abusing Population
William C. Scott, B.S.W., C.C.D.P.,1 David Kaiser, Ph.D.,2 Siegfried Othmer, Ph.D.,3 and Stephen I. Sideroff, Ph.D.4
1-Neuropsychiatric Institute, University of California, Los Angeles, California, USA and Restorative Technologies,
Santa Monica, California, USA
2-Department of Psychology, Rochester Institute of Technology, Rochester, New York, USA
3-EEG Spectrum International Inc., Encino, California, USA
4-Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA and Moonview Sanctuary, Santa Monica, California, USA
Abstract: This study examined whether an EEG biofeedback protocol could improve outcome measures for a mixed substance-abusing inpatient population. Method. One hundred twenty-one volunteers undergoing an inpatient substance abuse program were randomly assigned to the EEG biofeedback or control group. EEG biofeedback included training in Beta and SMR to address attentional variables, followed by an alpha-theta protocol. Subjects received a total of 40 to 50 biofeedback sessions. The control group received additional time in treatment equivalent to experimental procedure time. The Test of Variables of Attention (TOVA), and MMPI, were administered with both tester and subject blind as to group placement to obtain unbiased baseline data. Treatment retention and abstinence rates as well as psychometric and cognitive measures were compared. Results. Experimental subjects remained in treatment significantly longer than the control group (p<0.005).
Of the experimental subjects completing the protocol, 77% were abstinent at 12 months, compared to 44% for the controls. Experimental subjects demonstrated significant improvement in the TOVA (p<.005) after an average of 13 beta- SMR sessions. Following alpha-theta training, significant differences were noted on 5 of the 10 MMPI-2 scales at the p<.005 level. Conclusions. This protocol enhanced treatment retention, variables of attention, and abstinence rates one year following treatment.
Keywords: EEG, biofeedback, EEG biofeedback, addiction treatment, chemical dependency, alpha-theta, TOVA, MMPI
Alcohol and drug abuse is an ongoing societal and treatment problem (1, 2). While major resources have been employed to study and treat addiction, there has been little significant improvement in the success rate of treatment. Relapse rates remain high, typically over 70% (3–5). Gossop et al. (6) reported 60% of heroin addicts relapsed one year following addiction treatment.
Peniston and associates demonstrated significantly higher abstinence rates with alcoholics when they incorporated EEG biofeedback into the treatment protocol (7–10). Eighty percent of subjects in these experiments were abstinent one-year posttreatment.
EEG biofeedback training is an operant conditioning technique used to reinforce or inhibit specific forms of EEG activity. In the alpha-theta protocol employed by the Peniston studies, low-frequency EEG activity was reinforced. The alpha-theta protocol was first demonstrated to be effective with posttraumatic stress disorder (11).
The efficacy of alpha-theta EEG biofeedback may lie in its ability to allow participants to better tolerate stress, anxiety, and anxiety-eliciting situations, which are particularly evident during the initial phases of recovery. This protocol was shown to significantly lower 13 of the scales of the Millon Clinical Multiaxial Inventory (MCMI), including anxiety, whereas traditional treatment produced decreases in only two of these scales (7). However, questions have been raised in the literature regarding the sample size, sample independence, and methodology in the Peniston et al. studies (12). Furthermore, no controlled studies have been reported that extend these findings to other abused substances.
In addition to the psychological problems that substance abusers face in remaining abstinent, they also experience comorbid conditions that affect cognitive and attentional deficits. These deficits may be acquired from prolonged substance abuse (13–17), but the evidence also points to deficits that predate abusive behavior (18). For example, in one study, approximately 35% of treatment-seeking cocaine abusers met the DSM-IV criteria for childhood attention deficit hyperactivity disorder (19). Also, adult alcoholics report more residual-type attention deficit disorder (ADD) than controls (20). Low cognitive ability also has been shown to predict relapse after treatment at an alcohol treatment facility (21).
EEG biofeedback also has been used successfully to improve attentional, cognitive, and psychosocial functioning, including reductions in impulsivity (22–24). These and other studies have employed a protocol in which beta and SMR frequencies (15 – 18 Hz and 13 – 15 Hz, re- respectively) were operantly conditioned while inhibiting theta frequencies in remediating attentional and cognitive deficits in children and adults with ADD (25–28, 35). Given the relationship between cognitive/attentional impairment and addiction, it would strengthen a treatment model to address these deficits.
In the present study, a beta/SMR EEG biofeedback training regimen was combined with an alpha-theta protocol in the treatment of a mixed substance-abusing population. One expected objective was the enhanced ability of the subjects to focus on the treatment program, reduce impulsivity, and, thereby, increase program retention.
In order to extend the positive EEG biofeedback findings in the alcoholic population, an addict population was selected that included patients addicted to the following primary drugs: heroin, crack/cocaine, and methamphetamine, as well as alcohol.
One hundred twenty-one volunteers from the Cri-Help, Inc. residential treatment program in the Los Angeles area participated in this study. There were 49 females and 72 males. They were 19 to 53 years of age, with a mean age of 32.4. The primary drug of choice reported at admission was 31% heroin, 28% crack cocaine, 26% methamphetamine, 6% alcohol, and 9% other controlled substances; 94% were multiple-drug users.
Subjects determined to have a diagnosed psychotic or personality disorder (based on DSM-IV criteria), or a seizure disorder were excluded. Subjects were randomly assigned to the EEG biofeedback plus conventional treatment group (60 experimental subjects) or the conventional treatment-only group (61 control subjects).
Subjects were provided informed consent before participating in this experiment, approved by the UCLA Human Subjects Protection Committee.
All subjects received treatment based on the Minnesota Model 12-step oriented program described by Stinchfield and Owen (29) supported by group, family, and individual counseling. In addition, the experimental group received 40–50 EEG biofeedback sessions. The control group received additional treatment time equivalent to the biofeedback sessions.
Experimental subjects underwent two sessions of EEG biofeedback training (45 minutes per session) five days a week for four to five weeks. EEG biofeedback was performed on a Neurocybernetics 2- Channel EEG biofeedback system.
In Phase I, experimental subjects underwent 10–20 sessions of Beta- SMR EEG biofeedback in which operant conditioning was used to augment either 15–18 Hz (beta) or 12–15 Hz (SMR) EEG activity. At the same time, training attenuated elevated activity in the 2–7 Hz (theta) and 22–30 Hz (high beta) ranges. Active bipolar electrode placement was at C3-FPZ for beta and at C4-PZ for SMR, based on the international 10–20 system of electrode placement (30).
The starting protocol consisted of beta training 50% of the time and SMR training 50% of the time. These percentages would be altered based on changing symptomatology and TOVA results (31), with inattentive or impulsive profiles resulting in increased beta or SMR training.
After 10 Beta-SMR EEG biofeedback sessions, participants were reassessed with the TOVA. If a participant scored within the normal range (i.e., scores of 85 or above), he or she began alpha-theta training. If the TOVA remained abnormal after the initial 10 Beta-SMR sessions, 5 or 10 additional Phase 1 treatments were administered. It took a median of 10 Beta-SMR sessions with a mean of 13 sessions for the TOVA to normalize for the experimental subjects.
In Phase II, subjects underwent 30 sessions of alpha-theta training. The frequency range for alpha was 8–11 Hz, and for theta, it was 5–8 Hz. The initial sessions were used to train down alpha levels that were above 12 mV (peak to peak), while augmenting theta until there was a ‘‘crossover.’’ This was defined as the point at which the alpha amplitude dropped below the level of theta. Subsequent to the first achievement of crossover, both alpha and theta frequencies were augmented.
Before the initial crossover was achieved, excess EEG activity in the 15–30 Hz range was inhibited. This was intended to reduce muscle tension and to quiet the mind. After crossover was achieved, the 2–5 Hz frequency range also was inhibited. This was intended to discourage the sleep transition during low-arousal states.
Each alpha-theta session began with the subject sitting in a chair with eyes closed. The active electrode was placed at Pz with a left-ear reference (A1). The right earlobe was connected to the circuit ground. Two distinct tones were employed for alpha and theta reinforcement, with the higher-pitched sound used to index the higher-frequency alpha band.
At the start of each session, the technician spent 3–5 minutes reading a script of guided imagery to the experimental subject that dealt with identified essential elements of maintaining abstinence. These included ongoing regular attendance at 12-step meetings, weekly meetings with a sponsor, expanding the individual’s identified comfort zones, and mental exercises dealing with cue extinction and relapse rejection.
After the guided imagery, it was made clear to the subject that the objective of the training did not involve explicit rehearsal of the script during the EEG biofeedback. Subjects reporting previous meditative practices were asked not to use them during the training since meditation has been observed to override alpha-theta reinforcement effects. Following the alpha-theta training, clients were given the opportunity to process their experience.
When it appeared that sleep might be occurring during training, subjects were told prior to their next session to move a limb if they heard the technician say either, ‘‘Right foot, left foot, right hand, or left hand.’’ At points where the subject’s delta activity (2–5 Hz EEG) started to elevate and at their highest amplitudes (indications of sleep onset), the limb commands were given to determine responsiveness. The delta amplitude value at which the subject transitioned to nonresponsiveness was documented. Subsequently, during sessions where the delta was elevating toward nonresponsiveness levels, the feedback sounds were inhibited in order to discourage the sleep transition.
Tests were administered prior to training, after Beta-SMR training (Phase 1), and after alpha-theta training (Phase 2) for experimental subjects and at commensurate points in time for the control group (typically 1, 16, and 46 days into the research program). All subjects had acclimated to the institutional setting for a minimum of 7 days prior to testing. The initial testing was accomplished with subjects and experimenters blind to group placement.
The TOVA was administered to assess attentional and cognitive functions (31 – 33). The Minnesota Multiphasic Personality Inventory (MMPI-2) was administered at the start of the study and again at 46 days.
Patient abstinence was determined by collateral contacts in addition to self-report. Follow-up interviews for this purpose took place at 3-month intervals over a 12-month period. Research subjects gave permission to contact individuals who were intimately involved in their recovery. These individuals were their 12-step sponsors, family members, and those people referring the subject to the program. Subjects who used substances beyond one 4-week window were considered to have fully relapsed. Those whose relapse duration was within a single 4-week window were categorized as a brief relapse (Please see appendix for a procedures flow chart.).
Days in Treatment
The length of stay in treatment averaged 138 days for experimental subjects and 101 days for controls. This difference was significant.