Patented Technology to Empower the Mind

 

 

Neurotherapy as an Adjunctive Treatment

for Substance Abuse Disorders

 

Ed Pigott, Ph.D., Dennis Marikis, Ph.D., & Greg Alter, Ph.D.
Licensed Psychologists & Principals, NeuroAdvantage, LLC
All Rights Reserved, 2008

 

Background:

 

Substance abuse causes negative changes in the brain.  Mathew and Wilson’s meta-analysis published in the American Journal of Psychiatry (1991) found that whereas drinking alcohol and abusing drugs causes an immediate increase in cerebral metabolism and blood flow, chronic abuse results in decreases in both.  It is unlikely that such negative changes are corrected by abstinence alone, particularly during the early stages of recovery.  For example, Herning and associates’ (2003) found that chronic marijuana abuse resulted in decreased brainwave power resulting in a sluggish brain that persisted even after four weeks of abstinence.

 

Neurotherapy encompasses a variety of drug-free technologies designed to improve brain functioning.  EEG biofeedback (also known as neurofeedback) is the most researched neurotherapy for treating substance abuse disorders.  Neurofeedback teaches people how to strengthen desired brainwave patterns to improve their ability to relax and maintain focused attention as well as develop many other positive mental states.  This learning process takes place by attaching electrodes to people’s scalps and then “feeding back” to them when the strength of desired brainwave patterns increase using an electroencephalography (EEG) machine.

 

Over forty years worth of research has found neurofeedback effective in treating numerous conditions including ADHD, depression, and anxiety disorders among others.  Commenting on this extensive body of research, Dr. Frank Duffy (2000), Professor of Pediatric Neurology at Harvard, writes: "In my opinion, if any medication had demonstrated such a wide spectrum of effectiveness, it would be universally accepted and widely used."

 

Neurofeedback for Substance Abuse Disorders:

 

Starting in the early 1970’s, researchers began evaluating neurofeedback’s effectiveness as an adjunctive treatment for alcoholism (e.g., Twemlow & Bowen, 1976; Twemlow, Sizemore, & Bowen, 1977).  This early research used neurofeedback to teach chronic alcoholics to strengthen their alpha and theta brainwaves (5 to 12 Hz).  High rates of alpha/theta waves are found in skilled meditators and associated with states of profound relaxation, increased spirituality, and heightened suggestibility.  During these sessions, therapists would typically give patients abstinence-oriented hypnotic suggestions and positive affirmations.  Afterwards, patients would discuss their newfound insights while the therapists worked to reinforce long-term attitudinal change.

 

Table 1 presents the key findings from this research.  Summarizing across studies, these researchers found that alpha/theta training:

 

• Reliably strengthened alpha/theta waves;
• Decreased depression and promoted positive personality changes;
• Increased spirituality; and
• Decreased alcohol abuse during follow-up in 67% to 93% of subjects.

 

Table 1

Alpha/Theta Training Outcome Studies Lacking a Control Group

 

 

Peniston and Kulkosky (1989) conducted the first alpha/theta training experiment with alcoholics using random assignment.  Their subjects were inpatients in a VA substance abuse program with histories of chronic alcoholism and multiple past failed treatment attempts.  Compared to the traditionally treated inpatient control group, following fifteen 30-minute alpha/theta training sessions the neurofeedback group (n=10) showed:

 

• Strengthened alpha and theta waves;
• Greater reductions on the Beck Depression Index;
• Substantial positive personality changes (Peniston & Kulkosky, 1991); and
• A dramatically lower relapse rate one year after discharge (20% versus 80% for the control group).

 

Fahrion (1995) conducted the first large controlled study of alpha/theta training for people who abused drugs other than alcohol (e.g., cocaine, marijuana, etc).  The subjects were convicted male felons in a prison-based treatment program who were randomly assigned between the traditional program and the traditional program combined with neurofeedback.

 

The neurofeedback group (n=39) received alpha/theta training sessions for 30-minutes a day, five days per week for six weeks.  Compared to traditionally treated inmates, the neurofeedback group showed higher rates of positive outcomes 6 to 12 months after release from prison as measured by clean urine drug screens and violation-free participation in parole programs (67% verses 53%).  In analyzing the data, Fahrion found that African-Americans were more responsive to alpha/theta training compared to Caucasians and less responsive than Caucasians to the conventional 12-step treatment program.  Fahrion also found that alpha/theta training was more effective for non-stimulant abusing felons and not as effective for cocaine abusers.

 

Scott and Kaiser (1998) evaluated adding beta (12-18 Hz) training to alpha/theta neurofeedback for people who abused stimulant drugs.  Numerous studies have found beta training effective in treating children and adults with ADHD by increasing their ability to concentrate and decrease impulsive behaviors (Hirshberg, 2007).  ADHD has a high co-morbidity rate with substance abuse particularly when the preferred drug is a stimulant (Biederman et al, 1995).  The researchers hypothesized that beta training would enhance concentration while reducing impulsivity and thereby decrease subjects’ likelihood of dropping out before program completion.

 

Scott and Kaiser randomly assigned inpatients in a 45-day substance abuse program between conventional treatment and the conventional program plus neurofeedback (n=48).  The neurofeedback group first received 10 to 20 beta training sessions to improve their cognitive functioning followed by 30 alpha/theta sessions.  Compared to conventional treatment, the neurofeedback group showed:

 

• Significant improvement in their ability to sustain attention;
• Substantial positive personality changes including greater improvements on the MMPI’s depression, hypochondriasis, hysteria, psychasthenia, social introversion, and psychopathic deviance scales;
• Higher treatment retention rates particularly during the initial phase of beta training when stimulant abusers are at greater risk for dropping out; and
• Decreased likelihood of relapse following discharge.

 

Building on this earlier research, Scott and associates (2005) published in the American Journal of Drug and Alcohol Abuse a study evaluating neurofeedback’s effects on a mixed substance abusing population treated in a state-funded 90-day “Minnesota Model” 12-step program.  The researchers randomly assigned subjects between the neurofeedback (N=60) and control group with the control subjects receiving additional therapist time equal to the time spent in neurofeedback training.

 

Similar to their prior study, the neurofeedback group first received 10 to 20 beta training sessions to improve their cognitive functioning followed by 30 alpha/theta sessions.  Compared to conventional treatment alone, the 60 clients randomly assigned to also receive neurofeedback showed:

·          A 41% increase in program completion (76% versus 54% for control subjects);

·          Improved ability to sustain attention and inhibit impulsive behaviors;

·          Decreased rates of anxiety, depression, and psychopathic deviance; and

·          Decreased likelihood of relapse during the 12-month follow-up phase (23% versus 56% for control subjects)

Summarizing across these studies, research has found that neurofeedback training improves substance abuse treatment outcomes by:

 

• Decreasing rates of anxiety, depression, and psychopathic deviance;
• Improving cognitive functioning and the ability to sustain attention;
• Decreasing impulsive decision-making;
• Improving outcomes for minorities (Fahrion, 1995; Kelly, 1997);
• Dramatically improving program completion rates; and
• Decreasing the likelihood of relapse.

 

Given these findings, neurofeedback is an evidenced-based intervention that warrants broad inclusion into substance abuse treatment programs.  Unfortunately while this research is compelling, neurofeedback is seldom used in actual practice because:

                       

• The equipment is expensive typically costing between four and six thousand dollars per machine;

• There is a limited number of trained professionals; and
• Sessions are provided one-on-one versus in the group therapy format common in substance abuse treatment programs.

 

These factors make neurofeedback simply too professional-time intensive and expensive for most treatment centers to implement on a program-wide basis.

 

The NeuroAdvantage™ Solution:

 

NeuroAdvantage, LLC is a neurotherapy technology and professional services company founded by clinical psychologists with over 30 years of cumulative neurofeedback experience.  Our key technology is the NeuroAdvantage™ Trainer.  The NeuroAdvantage™ Trainer enables people to experience the proven effectiveness of neurofeedback—without the hassles of electrodes and at an affordable price.

 

Unlike neurofeedback, the Trainer uses enjoyable light and sound neurotherapy (LSN) to strengthen desired brainwave patterns.  This patented technology 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 repetitive sound stimulation.  In 1999, Frederick and associates found that LSN’s combined rhythmic light and sound stimulation increased the targeted brainwave pattern’s strength by an average of 38.3% in a single session alone.  A white paper summarizing this research is available at: www.neuro-advantage.com/page/851224.

 

Budzynski and associates (1999) took this research a step further.  They compared the effectiveness of academic counseling to 30 LSN training sessions at 14 Hz (beta) for a group of struggling college students.  Their study found that these sessions not only strengthened subjects’ beta waves but that these changes persisted while the students performed challenging mental tasks.  More importantly, in the quarter following treatment termination the LSN students’ GPA improved by an average of .7 points while the comparison students’ GPA dropped by .2 points suggesting that LSN training generated lasting effects.

 

Using a variety of neuro-imaging measurement tools, researchers have discovered that rhythmic light stimulation also increases brain metabolism and blood flow (e.g., Aaslid, 1987; Diehl et al, 1998; Fox & Raichle, 1985; Phelps & Kuhl, 1981; Sappey-Marinier et al, 1992).  LSN’s positive impact on brain metabolism and blood flow helps to correct chronic substance abuse’s negative effects on both (Mathew & Wilson, 1991).

 

Depending on the Hz frequency used, clinical researchers have found that LSN is a robust treatment effective in facilitating profound relaxation and meditative states (Freedman & Marks, 1965; Glicksohn, 1986; Lewerenz, 1963; Richardson & McAndrew, 1990; Sadove, 1963; Thomas & Siever, 1989; Williams & West, 1975) as well as promoting healing for numerous mental and physical conditions including:

 

• ADHD and Learning Problems (Carter & Russell, 1993 & 1994; Budzynski et al, 1999; Joyce & Siever, 2000; Joyce, 2001; Russell, 1997; Russell & Carter, 1997);
• Chronic Fatigue Syndrome (Berg & Siever, 2000; Trudeau et al, 1999);
• Chronic Pain and Fibromyalgia (Boersma & Gagnon, 1992; Siever, 1999);
• Dementia and Cognitive Decline in Seniors (Budzynski & Sherlin, 2002; Tan et al, 1997);
• Depression in Adults and Seniors (Berg & Siever, 2007; Kumano et al, 1996; Tan et al, 1997);
• Headaches (Anderson, 1989; Solomon, 1985);

• Premenstrual Syndrome (Anderson et al, 1997; Noton, 1997);
• Psychosomatic Conditions (Chijiwiina et al, 1993);
• Seasonal Affective Disorder (Berg & Siever, 1999; Siever, 2004); and
• Stroke (Rozelle & Budzynski, 1995; Russell, 1997).

 

Control Cravings, Reduce Depression, and Promote Positive Change:

 

Research has found that for many people LSN triggers a pleasant dissociative state similar to that achieved through deep meditation and/or hypnosis.  Therapeutic dissociation is simply a “disconnect” or interruption in one’s awareness of thoughts and the passage of time thereby rejuvenating the mind.  Kroger and Schneider (1959) found that LSN induced a hypnotic trance in nearly 80% of subjects within five minutes (see figure 1).  In a large well-controlled study published in Behaviour Research and Therapy, Leonard and associates (1999) found that LSN was vastly superior (p<0.0001) in triggering dissociation compared to dot staring, a common hypnotic technique.  The NeuroAdvantage™ Trainer’s ability to rapidly trigger dissociation makes it an ideal tool for disrupting the destructive cravings and ruminative thinking that sabotage for many their road to recovery.

 

Figure 1

 

 

 

Bright light is increasingly recognized for its powerful beneficial effects in relieving depression.  In 2005, the American Psychiatric Association published a consensus panel report finding that light therapy had treatment effects equivalent to antidepressants for non-seasonal depression (Golden et al, 2005).  In 2006, Lam and colleagues found that light therapy was faster acting, and had fewer negative side-effects, than Prozac in treating the depression associated with seasonal affective disorder.  The Trainer combines light therapy’s antidepressant effects with the ability to disrupt ruminative thinking while simultaneously strengthening desired brainwave patterns.

 

The NeuroAdvantage™ Trainer was designed to take advantage of these various lines of research.  Each Trainer enables users to control the light intensity and comes with 18 different LSN sessions.  Repeated three or more times per week, these Trainer sessions have the cumulative effect of enhancing overall wellbeing as well as improving the targeted areas of brain functioning.

 

NeuroAdvantage has developed a special version of the Trainer to help people in recovery.  This version is programmed with alpha/theta and beta training sessions designed to:

 

• Decrease Symptoms of Depression & Anxiety
• Promote Recovery from Trauma
• Help Control Cravings
• Improve Mental Concentration & Focus
• Enhance Pain Management
• Develop Mindfulness Meditation Skills
• Improve Sleep
• Relax the Mind & Body
• Increase the Likelihood of Sustained Recovery

 

To enhance effectiveness, NeuroAdvantage has produced a growing library of audio coaching recordings people listen to during their Trainer sessions.  These recordings cover a variety of topics and use positive suggestions, affirmations, and guided visualizations to help people make desired changes in their lives.  Titles include:

 

• 12-Steps To Recovery Series
• Mindfulness Meditation
• Control Cravings
• Beating the Blues
• Manage Your Pain
• Letting Go of Trauma

• Christian Meditation
• Stop Smoking
• Overcome Avoidance
• Deep Sleep

 

Initial Studies with Behavioral Health of the Palm Beaches:

 

Beginning in February 2008, NeuroAdvantage and Behavioral Health of the Palm Beaches (BHOPB) initiated a series of studies evaluating LSN’s effectiveness for substance abuse clients with co-morbid depression and/or PTSD.  These early studies validate LSN’s potential to improve the outcomes for clients with co-morbid disorders.

 

The first study evaluated LSN’s effects on co-morbid depression and included 11 LSN 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.  The Mood Lifter 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 subjects also listened to coaching CDs during their LSN sessions.  The four CD titles were:

 

• Mindfulness Meditation
• Deep Relaxation
• Step 1:  Acceptance of Powerlessness
• Beating-the-Blues

 

As shown in figure 2, 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

 

  

 

Figure 3 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 its treatment services, BHOPB will significantly increase the likelihood that every client makes substantial improvement while participating in their program.

 

Figure 3

 

 

 

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:

• 9 of 11 improved sleep
• 6 of 11 had pleasant dissociative experiences during their sessions (e.g., sense of floating)
• 6 of 11 increased focus and concentration following the sessions
• 6 of 11 decreased anxiety symptoms
• 6 of 11 increased patience and reported being less irritable with others following the sessions
• 4 of 11 reported decreased or the disappearance of pain following the sessions

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 4 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). 

 

Figure 4

 

 

As seen in figure 4 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 decreased on the MCMI Major Depression scale.  The somewhat 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., improved sleep, increased mental focus and concentration, etc.)

 

PTSD Pilot Study:

 

BHOPB also evaluated the Trainer‘s effectiveness for clients with co-morbid PTSD (Weiner et al, 2008).  Ten clients were administered the Posttraumatic Stress Diagnostic Scale (PDS) and Millon Clinical Multiaxial Inventory (MCMI) before and after BHOPB’s two-week program for PTSD clients.  BHOPB’s PTSD track also includes a psychodrama group and two individual sessions of Eye Movement Desensitization and Reprocessing (EMDR).

 

BHOPB’s PTSD clients had six 30-minute sessions using the Mood Lifter program with audio coaching as well as four 35-minute group sessions using the Trainer’s “Letting Go of Trauma” program.  NeuroAdvantage’s trauma program uses alternating “back-and-forth” light and sound stimulation for 20 minutes while the coaching CD directs the client to first think about a traumatic event and then to focus on the alternating stimulation that is occurring in their “eyes and ears.”

 

The Letting Go of Trauma program takes advantage of research showing that slow, alternating stimulation of the right and left hemispheres with back-and-forth eye movements reduces psychophysiological measures of arousal while decreasing the vividness of traumatic memories and their associated negative emotions that are common in PTSD (e.g., Lee & Drummond, 2008; Barrowcliff, et al, 2003; Van den Hout, et al, 2001).  The resulting “back-and-forth” eye movements that occur in NeuroAdvantage’s trauma program is the same active ingredient accounting for EMDR’s ability to reduce the nervous system’s over-arousal in response to trauma.  The program’s final 15 minutes uses alpha/theta LSN stimulation combined with positive affirmations to minimize any lingering anxiety clients might be experiencing while fostering inner serenity.  The combination of alternating stimulation followed by alpha/theta LSN paired with audio coaching results in powerful healing benefits that include clients’ decreased sensitization to traumatic memories and their associated anxiety, worry, feelings of helplessness, and avoidance behaviors.

 

Figure 5

 

As seen in figure 5 above, BHOPB clients made substantial improvement on each of the outcome measures.  Clients’ PTSD symptoms decreased by an average of 36.4% on PDS Symptom Severity scale and 10.3 points the on MCMI’s PTSD scale after only two weeks.  Clients also decreased by an average of 24.2 points on MCMI’s Major Depression scale demonstrating dramatic improvement on this measure.  Clients’ improvements on the MCMI scales are particularly noteworthy since scale scores below 60 are considered in the normal range.

 

Due to the twice weekly Letting Go of Trauma groups, most PTSD clients had one or two of these groups prior to their first individual EMDR session.  BHOPB’s EMDR therapist has noted dramatically lower levels of arousal during EMDR sessions for these clients compared to those who have not had a NeuroAdvantage trauma group before their first EMDR session.

 

BHOPB and NeuroAdvantage are now designing a follow-up study to directly compare the relative effectiveness of EMDR and the Letting Go of Trauma groups in reducing clients’ over-arousal in response to traumatic memories.  This research is very important due to its potential in enhancing the efficiency and clinical effectiveness of care for substance abuse clients with co-morbid PTSD.

 

After Care:

 

The NeuroAdvantage™ Trainer is portable, affordable, easy-to-use, and includes a paced breathing tool to help clients develop the long, graceful breathing cycles that are common in meditation.  This makes it an ideal tool for clients to use as part of their aftercare recovery plan because it reinforces, and helps them further develop, the skills they learned in acute treatment.  The Trainer is particularly helpful for people working to recover from addictions and cravings.  In addition to its immediate positive impact, the Trainer provides a 22 to 35-minute structured intervention with audio coaching that clients can use whenever they become vulnerable to relapse.

NeuroAdvantage™ professionals provide telephonic coaching to assist clients in maximizing their benefit from using the Trainer and encourage them in following through on their recovery plan (e.g., working with their sponsor; 90 meetings in 90 days; etc.).  The Trainer combined with telephonic coaching supporting clients following through on their recovery plan should increase clients’ likelihood of sustained recovery.  The clients from substance abuse treatment centers who contract with NeuroAdvantage™ receive a $300.00 discount for the Trainer and NeuroAdvantage’s telephonic coaching services.

 

 

For More Information Contact:

 

Ed Pigott, Ph.D.

Licensed Maryland Psychologist and Principal; NeuroAdvantage, LLC

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

 

 

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