Staying sober was always a struggle for David. The Los Angeles resident would enter recovery and seemingly make progress only to succumb to the pull of opiates and cocaine. In the war for control of David’s life, addiction seemed to be winning.
Then something changed. A month ago, during a stay at Promises Treatment Center, David began neurofeedback training. The procedure involves hooking up electroencephalography (EEG) sensors to your head to measure your brain waves. Your brain’s activity is fed back into a computer that then displays brain activity in real time. By seeing and/or listening to your brain waves, you can alter them to resonate at a different — more desirable — frequency, allowing you to regulate your state of mind at will. While neurofeedback has been used to help a range of medical conditions including ADHD and PTSD, it is gaining traction as a complementary treatment for substance use disorders.
After 12 sessions of neurofeedback, David feels that he has the tools to sustain his recovery and battle the ever-present urge to return to drugs.
“I’ve had real bad problems with anger for a very long time, [even] without drug use,” David said. “It’s like being irritable and angry was a big part of who I was. Now, I’m just calm. I’m able to think about things more. I can tell that my thinking, my thought process, has changed; I feel like I lost that thought process, and I’m gaining it back.”
An evidence-based addiction treatment
Research on biofeedback dates to the early 20th century, but neurofeedback was popularized in the 1960s and 1970s. By the early 1990s, it was being tested in trials as a way to help patients with PTSD. In 1993, Bill Scott and Eugene Peniston conducted a landmark study of veterans with PTSD and alcoholism and found that by treating them with neurofeedback, the patients were increasingly able to distance themselves from their trauma. In fact, all of the 24 patients’ PTSD symptoms significantly diminished, and 79% of the vets remained abstinent for the next 12-24 months.
Scott went on to publish the first large randomized controlled trial in the field of EEG biofeedback in 2005. In a study examining the effects of neurofeedback on a mixed substance abusing population (more than one substance), 77% remained abstinent 12 months after treatment compared to 44% of the control group — a near two-fold increase. Scott used these results to create the BrainPaint system — a leading neurofeedback software program that was recently made available for use at addiction treatment centers.
In 2010, British researchers led by Tomas Ros at the University of London provided the first published evidence of neuroplastic changes occurring directly after neurofeedback. After a session of neurofeedback, the scientists observed a change in the function of certain neurons that lasted more than 20 minutes.
How does neurofeedback work?
There are different types of brain waves, and treatment specialists make use of this knowledge when they design the neurofeedback protocols (how the software will interact with your brain during a session). Delta is the slowest frequency and is correlated with sleep. Theta is next, and is observed in meditative states. Alpha is second fastest, and is linked to feeling relaxed, while beta waves have the highest frequency and appear during motor activity.
So, if one were anxious all the time, or struggling with PTSD, neurofeedback would be aimed at achieving a less aroused, or calmer, state. If someone were depressed, they’d want to learn how to coax their brain waves toward a more aroused frequency. While the number of sessions necessary to see results varies among individuals, Michelle Kunzelmann, a neurofeedback specialist at Promises, believes patients should start with two or more sessions per week, with five being best.
Most of her clients notice positive changes within 5-10 sessions, she said. “Once you get past 20 sessions or so, you will really see what kind of benefits you can start to gain, and usually by that time most clients are ready to flip or switch their protocol,” Kunzelmann said.
Three common protocols are beta, SMR and alpha-theta. The beta and SMR protocols are done with eyes open, and are meant to “wake up” and focus the brain, respectively; the alpha-theta protocol is done with eyes closed. “Alpha-theta is very effective with PTSD and addiction,” she said, in that it has a calming effect.
The benefits of neurofeedback for addiction
While neurofeedback is still gaining ground, Promises has been using it for about five years, said Matt Morgan, a treatment specialist based at Promises Malibu. Promises employs the BrainPaint software, mainly because it’s user-friendly. He typically starts clients on it immediately — it can help speed up the process of detox, and it can help keep them in treatment, he says. “It has a tendency to pull them back from the edge.”
During a session, which typically lasts an hour, “the brain is doing all the work.” Before a session, Morgan and his patient will go over the changes the patient may have noticed since the last session — sleeping through the night, for instance — and go over goals for the upcoming session — feeling less irritable, for example. Neurofeedback can help modulate under-arousal — falling asleep, or feeling depressed or weepy — and over-arousal—aggression, heart palpitations and teeth-grinding. Typically, over-arousal problems affect alcoholics, whereas under-arousal issues bother methamphetamine and other stimulant addicts.
Neurofeedback can have a calming effect on the brain, or it can help wake the brain up. “So, it does sort of the same thing [as the drug of abuse], but without the disconnection from the buzz,” Morgan said.
Kunzelmann sees changes in almost everybody she works with, namely improved sleep, sharper focus and better mood. She also notes that it seems to help open people up emotionally. David says he cried during his first session. Now, he’s able to feel and not dwell, he says. “I’m able to think about problems in life without becoming angry, sad or being over-emotional; and then when I’m done, I don’t dwell on [them].”
He also says neurofeedback has helped a lot with one particular symptom of opiate withdrawal: restless legs syndrome. Within five sessions, he says his legs became less tense; he was able to fall and stay asleep longer, too.
Do the benefits last?
The improvements that naturally come with getting sober do, in fact, resemble those reported for neurofeedback. Are you sleeping better because you’re not doing cocaine all night? Are you feeling more connected because you’re in group therapy?
David insists that neurofeedback has been indispensable to solving some of his otherwise intractable problems. He’s gotten sober more than once, but his anger never eased up until he tried neurofeedback.
As for how long it lasts, that can depend on the person and the issue, Kunzelmann said. “Most clients I work with who complain of difficulties falling or staying asleep tend to see improvements early on. I believe those changes stick or save very well.” For things like PTSD, nightmares and/or headaches, “once those issues are improved, they tend to stay improved.” She says most of her clients who do 20-40 or more sessions will tend to keep their results, but some might want to do “touch-up” sessions six months or a year after the initial work “just to get back to where they were.”
There’s an app for that
While both Kunzelmann and David say they wish everyone could experience neurofeedback, the reality is that it’s only available in a small number of treatment centers. However, you never know when there might be “an app for that.” In fact, about a year ago, a Bay Area-based company launched the first meditation app based on neurofeedback, complete with mini-sensors that wire your head to your mobile device.
Personal Neuro Devices, located in San Francisco, partnered with hardware provider NeuroSky, based in San Jose, Calif., to create Transcend, the first meditation app that provides feedback based on directly measured neural activity. With Transcend, meditators can change styles based on recommendations, track progress and confirm that their practice has been effective.
Brain-computer interface technologies are especially important for addiction treatment. “It can be a tool that’s part of a larger therapy,” says Johnny Liu, director of NeuroSky’s developer program. “By understanding [your] overall emotional states, you can learn how to focus, calm yourself” — and with that focus and calm can come not only abstinence, but growth and healing.
Editor’s note: Patient names have been changed to protect their privacy.
By Jeanene Swanson