Helps to Decrease Symptoms of Depression & Anxiety
Mental health researchers are discovering that anxiety and depression coexist in people at far greater rates than previously realized. In the recently completed 35-million dollar STAR*D study funded by NIMH, over two-thirds of depressed patients had one or more co-occurring anxiety disorders (Trivedi, et al 2006). The Psychology Today magazine has an excellent article on this topic (http://cms.psychologytoday.com/articles/pto-20031023-000002.html). The article points out that in the majority of cases, the anxieties that people experience in life are the precursor to their symptoms of depression. Unfortunately, most treatments target only one or the other resulting in the full scope of people’s problems simply not being addressed.
NeuroAdvantage™ offers a number of light & sound neurotherapy (LSN) programs designed to decrease symptoms of depression and anxiety as part of an overall treatment plan. Numerous clinical researchers have found that LSN is a robust treatment effective in facilitating profound relaxation and meditative states (e.g., Freedman & Marks, 1965; Richardson & McAndrew, 1990; Thomas & Siever, 1989; Williams & West, 1975).
More recently in a randomized placebo-controlled study comparing 20 LSN sessions to simulated treatment for patients with treatment-resistant depression, Cantor and Stevens (2009) found that improvement only occurred during active LSN treatment with patients averaging a 70.9% decrease in depressive symptoms. When compared to a normative database, quantitative EEG (QEEG) pre/post testing demonstrated that LSN resulted in significant positive changes in cortical regions of the brain associated with improved mood regulation whereas these changes did not occur following simulated LSN. LSN patients also maintained improvement after stopping active treatment when re-assessed one month later averaging an additional 33% decrease in depressive symptoms. This finding supports the observation that LSN often generates enduring effects.
The sustained improvement often resulting from LSN treatment is also seen in a randomized controlled trial of college students with pathological worry (Wolitzky-Taylor & Telch, 2007). In this study 113 students were randomly assigned between LSN, two evidence-based treatments for pathological worry, and a wait-list control group. The researchers originally conceptualized LSN as a placebo intervention but re-conceptualized it as an active treatment following students’ strong positive response to it (Wolitzky-Taylor, 2009). This trial found that 12 LSN sessions (three times per week for four weeks) had the highest rate of clinically-significant change @ 67% with exposure therapy second @ 48%. Furthermore, 65% of the LSN group had clinically-significant treatment gains in the follow-up assessment three months later even though there was no skill-training component as part of the LSN intervention.
This level of sustained improvement is noteworthy since high levels of worrying is often a long-standing personality trait. When enrolled into the study, 31.2% of the students met the criteria for generalized anxiety disorder with lower rates for other disorders (e.g., 18.3% for social anxiety disorder, 11% for specific phobia, 5.5% for panic disorder, 3.7% for obsessive compulsive disorder, and 11% for major depressive disorder). Students’ high-level of sustained improvement strongly supports the durability of LSN treatment gains.
The NeuroAdvantage™ Trainer was designed to take advantage of these various lines of research. Repeated three or more times per week, these Trainer sessions often have the cumulative effect of enhancing overall wellbeing as well as improving the targeted areas of brain functioning.
Beginning in February 2008, NeuroAdvantage and Behavioral Health of the Palm Beaches (BHOPB) initiated a series of studies evaluating the Trainer’s effectiveness for substance abuse clients with co-morbid depression who also often had significant co-occurring anxiety. These early studies validate the Trainer’s potential to improve the outcomes for people with significant symptoms of depression and anxiety.
The first study included 11 Trainer clients and 7 control subjects (Weiner et al, 2008). All subjects were administered the Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), and Rosenberg Self-Esteem Scale (RSES) before and after the LSN intervention. Due to a family emergency, one LSN subject was discharged without completing the post-treatment measures.
LSN was administered in a group therapy format using the NeuroAdvantage™ Trainer’s “Mood Lifter” program five afternoons per week for two weeks. During these 30-minute sessions, the Trainer stimulated the right hemisphere @ 10hz and left hemisphere @ 19hz. This program is designed to help correct hemispheric asymmetries commonly found in Quantitative EEG (QEEG) studies of depressed people by calming their “overly activated” right hemisphere while stimulating the “under activated” left hemisphere. The NeuroAdvantage group also listened to coaching CDs during their LSN sessions. The four CD titles were:
As shown in figure 1, clients receiving BHOPB’s standard treatment services made substantial improvements on each outcome measure and validate the significant improvement clients on average make during their participation in BHOPB’s 28-day residential program. The NeuroAdvantage group though made even far greater improvement on the outcome measures. While this was somewhat expected given the greater depressive symptoms and lower self-esteem the NeuroAdvantage group initially endorsed, the differential magnitude of change was still very substantial. On average, the NeuroAdvantage group’s depression and hopelessness scores decreased by 75% while their self-esteem scores increased by 80%.
Figure 2 presents the percent of the NeuroAdvantage and control group subjects who “greatly improved” as defined by a 50% or more decrease in depression on the BDI and BHS and a 100% or more improvement in self-esteem on the RSES. The difference in “greatly improved” rates at the individual level was very substantial for each measure. This finding suggests that by adding neurotherapy groups to their treatment services, treatment centers will significantly increase the likelihood that every client makes substantial improvement while participating in their programs.
The BHOPB therapist running the NeuroAdvantage treatment group also kept a detailed log of subjects’ self-reports before and after the sessions. An analysis of subjects’ self-report data found:
The therapist also reported that clients consistently reported feeling a sense of inner calmness and serenity following their NeuroAdvantage sessions.
Based on these results, BHOPB made NeuroAvantage groups an essential treatment component for clients identified with co-morbid depression. Figure 3 presents the pre/post BDI scores for 18 clients who received six NeuroAdvantage group sessions combined with audio coaching over two weeks (Weiner et al, 2008). As in the first study, the Trainer stimulated the right hemisphere @ 10hz (to help calm ruminative thinking) and left hemisphere @ 19hz (to activate it and rebalance hemispheric symmetry).
As seen in figure 3 above, after six LSN sessions clients’ made substantial improvement with 13 of 18 (72.2%) having a 50% or greater decrease in their depression as measured by the BDI. Clients also averaged a 34.1 point decrease on the MCMI Major Depression scale after receiving only six Trainer sessions over the course of two weeks.
The slight decreased effectiveness between the first and second depression study may be due to the decreased number of NeuroAdvantage group sessions. The first study had ten 30-minute sessions over two weeks compared to only six in the second study. This hypothesis is supported by the fact that three of the second study’s 18 clients had a 30 to 40% decrease in their BDI scores but failed to meet the ≥ 50% decrease criteria. These clients would likely have met this criteria if they were provided an additional 4 Trainer sessions. Similar to the first study, clients consistently reported feeling an inner calmness and serenity following their NeuroAdvantage sessions as well as reporting other improvements (e.g., decreased anxiety, improved sleep, increased mental focus and concentration, etc.)
Cantor, DS & Stevens S (2009). QEEG correlates of auditory-visual entrainment treatment efficacy of refractory depression. Journal of Neurotherapy, 13: 100-108.
Freedman, S. & Marks, P. (1965). Visual imagery produced by rhythmic photic stimulation: Personality correlates and phenomenology. British Journal of Psychology, 56: 95-112.
Golden, R.N. et al (2005). The efficacy of light therapy in the treatment of mood disorders: A review and meta-analysis of the evidence. American Journal of Psychiatry, 162: 656–662.
Leonard, K.N., Telch, M.J., & Harrington P.J. (1999). Dissociation in the laboratory: A comparison of strategies. Behaviour Research and Therapy, 37: 49-61.
Richardson, A. & McAndrew, F. (1990). The effects of photic stimulation and private self-consciousness on the complexity of visual imagination imagery. British Journal of Psychology, 81: 381-394.
Thomas, N. & Siever, D. (1989). The effect of repetitive audio/visual stimulation on skeletomotor and vasomotor activity. Hypnosis: 4th European Congress at Oxford. London: Whurr Publishers.
Trivedi MH, Rush AJ, Wisniewski SR, et al. (2006). Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: Implications for clinical practice. American Journal of Psychiatry, 163:28–40.
Weiner, M., MciLveen, J., Abrams, M. & Pigott, E. (March 2008). Neurotherapy as an adjunctive treatment for substance abuse Disorders: A pilot study. Therapeutic & Alcohol/Drug Interventions Conference, Las Vegas.
Williams, P. & West, M. (1975). EEG responses to photic stimulation in persons experienced in meditation. Electroencephalography and Clinical Neurophysiology, 39: 519-522.
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.
Wolitzky-Taylor, K.B. Personal communication. March 30, 2009.
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