Combining Neurotherapy with Mindfulness Meditation

Training to Foster Wellness During Early Recovery

Ed Pigott, Ph.D., Ron Dawe, Ph.D., Jennifer Alfert, M.A. & Greg Alter, Ph.D.

 

Mindfulness meditation training is designed to increase people’s moment-by-moment self-awareness and acceptance thereby enhancing their personal development and overall wellness.   Mindfulness training has become an essential component for numerous evidence-based treatments including those for eating disorders, ADHD, managing chronic pain, and easing severe symptoms of depression and anxiety.  Mindfulness meditation’s growing recognition as a highly effective treatment is such that it has been incorporated into leading medical centers (e.g., Harvard, Stanford, and Yale) and is taught to all patients at the Menninger Clinic due to its proven effectiveness in helping people learn to better regulate their emotions and sustain positive improvements in their lives.

Due to its growing recognition as a robust intervention, mindfulness training is being introduced into substance abuse treatment facilities.  While this is likely a positive development, teaching clients in early recovery how to sustain focus on their present-moment experience and be self-accepting of it is exceedingly difficult due to their high rates of anxiety, self-loathing, and depressive ruminative thinking.  It takes great effort for people to quiet their mind and focus it on their present-moment experience.   While mindfulness fosters personal growth and transformation, most people who start mindfulness training stop long before experiencing its many benefits.

The present study evaluates the effectiveness of combining rhythmic light and sound neurotherapy (LSN) with mindfulness training to foster wellness in clients during early recovery.   LSN is based on over 70 years of research and takes advantage of our brain’s natural tendency to synchronize with pleasant rhythmic stimulation.  Using an early EEG machine, Adrian and Matthews (1934) were the first researchers to document that having subjects stare at a flickering light changed their brainwave activity.  Toman (1941), followed by Walter and Walter (1949), built on this discovery and found that the hertz (Hz) frequency the light flickered at caused subjects’ same brainwave pattern to grow stronger.   Since these early pioneers, numerous other neuroscientists have documented the ease with which our brains synchronize to rhythmic light stimulation (e.g., Barlow, 1960; Inouye et al, 1979; Nogawa et al, 1976; Townsend et al, 1975).  Neher (1961) found that this same synchronization effect occurred to rhythmic sound stimulation.

While LSN has been found helpful for a variety of behavioral health disorders, it was recently compared to two other evidenced-based treatments in a randomized controlled trial of 113 students with pathological worry (Wolitzky-Taylor & Telch, 2007).  This trial found:

• 12 LSN sessions (three times per week for four weeks) had the highest rate of clinically-significant change after four weeks @ 67% and the same frequency of exposure therapy was second @ 48%;
• LSN resulted in significantly less ruminative worrying than the other two treatments (p < .001); and
• LSN’s treatment gains were maintained in the three-month follow-up despite no further treatment.

Due to its apparent effectiveness in disrupting ruminative thinking, the present study’s intent was to see if LSN could assist clients to learn how to quiet their mind and focus it on their present-moment experience.   

Setting, Intervention, Subjects, & Measures:

The study took place at The Palm Beach Institute (PBI), Florida’s first private substance abuse treatment facility.   All PBI clients attended the hour-long NeuroAdvantage™ Mindfulness Meditation Training (NMT) group three mornings per week for four weeks.   These groups consisted of:

• Teaching one of 12 mindfulness lessons from the  NeuroAdvantage™  Client Workbook;
• A 30-minute LSN session that applied differential hemispheric stimulation using variable frequencies to stimulate the right hemisphere @ 9-11hz and left hemisphere @ 18-20hz to help correct hemispheric asymmetries commonly found in QEEG studies of people with depression and/or ruminative thinking;
• All LSN sessions included a paced breathing tool to help clients learn diaphragmatic breathing;
• Clients listened to mindfulness audio coaching recordings during their LSN sessions; and
• Clients reviewed the prior lesson’s homework & were taught a new mindfulness exercise.

53 clients were administered the Beck Depression Inventory (BDI) and State-Trait Anxiety Index within two days of admission into PBI (typically following detox elsewhere) and on discharge.

Results:

For analysis purposes, clients were separated between those who were highly symptomatic on admission defined as scoring in the moderate to more severe range on the BDI (≥ 17) and those who were less symptomatic.  Of the 53 clients, two-thirds scored in the highly symptomatic range.  Figure 1 presents the pre/post change scores for the BDI and State-Trait Anxiety Index for both PBI’s high and low symptomatic clients.  Both groups showed significant improvement with a 69.7% weighted mean reduction in depression, a 32.3% reduction in State Anxiety, and a 29.1% reduction in Trait Anxiety.

Figure 1

PBI’s highly symptomatic clients’ improvement in Trait Anxiety—usually thought of as a persisting personality trait—is particularly noteworthy.  The average for working adults on this measure is 35 with a standard deviation of 9.  PBI’s highly symptomatic clients averaged 55.9 on this scale following admission (2.3 SD’s above the mean) and 38 on discharge.  These clients’ averaged almost two standard deviations of improvement in Trait Anxiety and by discharge 65.7% scored within the normal range. 

Figure 2 presents the remission and response rates for PBI’s highly symptomatic clients.  23 of 35 (65.7%) had a remission of their depressive symptoms defined as a final BDI score <10 and 32 (91.4%) had a 50% or greater improvement on this measure.  While this study did not have a comparison group, another study found that 43% of clients receiving standard care in a 28-day substance abuse treatment program had a 50% or greater improvement on the BDI (Weiner et al, 2008).

Figure 2

Discussion:

PBI’s clients clearly had a very positive response to their treatment program which included the NMT group three mornings per week for four weeks.   It is not possible to determine how much of the observed improvement was due to other PBI treatment components (which included a strong focus on EMDR treatment in addition to psychiatric services and 12-step programming) OR the individual components of the NMT group which included:

• 12 specialized LSN sessions using the NeuroAdvantage™ Trainer;
• All LSN sessions included training in diaphragmatic breathing to help clients develop the long, graceful breathing cycles that are common in meditation and many relaxation-oriented interventions;

• Clients listening to mindfulness audio coaching recordings during their LSN sessions; and
• 12 mindfulness meditation lessons with an accompanying workbook of homework exercises for clients to complete and then review during subsequent NMT groups.

Despite these limitations, the magnitude of improvement is noteworthy and warrants further investigation.  In addition to dramatic reductions in clients’ self-report of depressive symptoms, PBI’s highly symptomatic clients also averaged almost two standard deviations of improvement in their level of Trait Anxiety.  These reductions in Trait Anxiety should help clients in their early recovery and as Wolitzky-Taylor & Telch’s (2007) research suggests, such improvements will likely endure for three months or more.   While further research is needed, treatment centers that are looking to add mindfulness training to their services should consider the NeuroAdvantage™ Mindfulness Meditation Training program since it combines evidenced-based LSN with mindfulness training and includes a client workbook and group leader manual to ease implementation.

For More Information Contact:

 

Ed Pigott, Ph.D.

Licensed Maryland Psychologist and Principal; NeuroAdvantage, LLC

Phone:  443.812.9497  Email:  ed@neuro-advantage.com

Ron Dawe, Ph.D., LMHC

Executive Director; The Palm Beach Institute

Phone:  561.833.7553  Email: rdawe@pbinstitute.com

References:

Adrian, E.D. & Matthews, B.H. (1934).  The Berger rhythm:  Potential changes from the occipital lobes of man.  Brain, 57: 355-385.

Barlow, J.S. (1960). Rhythmic activity induced by photic stimulation in relation to intrinsical activity of the brain in man. Electroencephalography and Clinical Neurophysiology, 12: 317-326.

Inouye, T.,  Sumitsuji, N., & Matsumoto, K. (1979). EEG changes induced by light stimuli modulated with the subject’s alpha rhythm. Electroencephalography and Clinical Neurophysiology, 49: 135-142.

Neher, A. (1961). Auditory driving observed with scalp electrodes in normal subjects. Electroencephaloqraphy and Clinical Neurophysioloqy, 13: 449-451.

Nogawa, T., Katayama, K., Tabata, Y., Ohshio, T., & Kawahara, T. (1976). Changes in amplitude of the EEG induced by a photic stimulus. Electroencephalography and Clinical Neurophysiology, 40: 78-88.

Toman, J. (1941). Flicker potentials and the alpha rhythm in man.  Journal of Neurophysiology, 4: 51-61.

Townsend, R.E., Lubin, A., & Naitoh, P. (1975).  Stabilization of alpha frequency by sinusoidally modulated light.  Electroencephalography and Clinical Neurophysioloqy, 39: 515-518.

Walter, V.J. & Walter, W.G. (1949). The central effects of rhythmic sensory stimulation. Electroencephalography and Clinical Neurophysiology, 1: 57-86.

Weiner, M., MciLveen, J., Abrams, M. & Pigott, E. (2008).  Neurotherapy as an adjunctive treatment for substance abuse Disorders:  A pilot study.  Therapeutic & Alcohol/Drug Interventions Conference, Las Vegas.

Wolitzky-Taylor, K.B. & Telch, M.J. (2007). Placebo-controlled Trial Investigating Self-Administered Treatment for Pathological Worry. Poster presented at the World Congress of Cognitive and Behavioral Therapies, Barcelona, Spain.