“EEG Biofeedback therapy should play a major therapeutic role in many difficult areas. In my opinion, if any medication had demonstrated such a wide spectrum of efficacy it would be universally accepted and widely used.” Frank Duffy, M.D., Neurologist, Boston Children’s Hospital, Professor, Harvard Medical School.

A challenge for every residential addiction treatment center is the client that suddenly glazes over and announces to his or her treatment team that it is time for them to go home, despite the fact that it is only Day 9 or day whatever of their 30 day program. Sometimes they are glazed and dazed. Sometimes they are highly agitated. Studies show that the longer the client stays in treatment, the better their outcomes. But how do you help that client who suddenly decides they don’t need treatment?

In the past, the standard reaction to AMAs (leaving against medical advice), was to say, “Susie hasn’t hit bottom yet,” “Joe needs to want recovery more,” and similar statements. The truth is, some of those people might not make it back to treatment because addiction is a powerful, and sometimes deadly, disease. What if there was a way to help these clients focus and overcome the fight/flight response they have while in treatment and in early recovery?

Enter EEG Biofeedback, also known as Neurofeedback. At Promises Treatment Centers, we have made Neurofeedback an elemental part of addiction treatment, and it has been immeasurably helpful for clients who have a tendency to bolt from treatment.

Before we discuss further how Promises uses Neurofeedback, let’s discuss what it is exactly.

EEG biofeedback and neurofeedback are synonymous terms. This treatment modality utilizes audio and visual feedback to guide over and under aroused brainwaves, as well as unstable brainwaves, into a more effective mode of operation. Individuals with symptoms and diagnoses as broad as substance abuse disorders, ADD/ADHD, affective disorders (depression, bipolar, anxiety), insomnia, hypersomnia, chronic pain, and traumatic brain injuries can be effectively and measurably helped with EEG Biofeedback.

There is frequent confusion between EEG Biofeedback and Peripheral Biofeedback. Peripheral Biofeedback teaches people how to make seemingly involuntary bodily processes, such as body temperature, voluntary. For example, an individual with chronically cold extremities can learn to voluntarily warm their hands and feet. In the case of brainwave training, or EEG Biofeedback, making brain functioning voluntary is never the objective since the learning happens in the brain, not the mind. Clients simply need to focus and relax while the software teaches their brain, the organ, how to better self-regulate. The objective is to train your brain to automatically be more effective and efficient for the task at hand.

At Promises, we start Neurofeedback sessions as soon as the client is stabilized after detox. If we see within three sessions atypically heightened alpha amplitude, we know that client is at risk to leave Against Medical Advice. We know before the client is even formulating his or her exit strategy that the flight/fight response is kicking in. With appropriate intervention – peer support, clinical interventions, a 12 step meeting, more biofeedback, meditation, everything we offer – we can help the client relax and focus on treatment. If we can’t get them to complete treatment, we can’t help them.

The importance of this information is far reaching. It proves that old beliefs about needing to hit a worse bottom or needing to want it more are simply not accurate. The addicted brain responds to treatment strategies with heightened alpha amplitude, a fight or flight reflex. The addict wants to use drugs. Treatment is about not using drugs. When an individual chooses to leave treatment prematurely and they appear highly agitated or glazed over, they are often quite literally in an altered state of mind – in fight or flight -and without an intervention that meets them where they are it will prove ineffective almost every time.

A study, “Effects of an EEG Biofeedback Protocol on a Mixed Substance Abusing Population,” by William C. Scott, David Kaiser, et al., and published in the American Journal of Drug and Alcohol Abuse, showed significantly improved treatment outcomes for those clients who received neurofeedback vs. those who did not during a 12-week residential treatment experience.

Why Does EEG Biofeedback work on addictions and prevent fight/flight response? For the addicted brain, the threat of ongoing recovery triggers the survival cortical defensive bypass (“If I don’t get my alcohol/cocaine/Oxy I will die!” might be the false survival message they get), but EEG biofeedback trains the cortex to avoid this reactive state. This causes it to integrate the treatment process more effectively. Essentially, the fight/flight response is soothed. One’s resistance to the principles of recovery becomes closer to the nonresistance one would have in following the instructions to set the clock on a DVD player. The unconscious reactions of “not feeling like” reading recovery literature, going to meetings, etc. resolve and there is a greater enthusiasm for recovery activities. Clients are far less likely to regress into primitive maneuvers in response to effective treatment strategies.

If EEG Biofeedback is evidenced based (It Is) Why isn’t it more prevalent?

Up until 3 years ago, equipment was not user-friendly—now there is equipment on the market, which is fully automated and highly effective. The symptom-based evaluation process was very difficult to learn and operator-dependent, therefore results were not consistent before automation. The QEEG methodology is labor intensive and quite expensive to administer. When a technician would leave it would take months to train a replacement. Now with automated symptom-based neurofeedback systems, a new technician can be trained to hook someone up within hours and can become proficient within weeks.

How many sessions does it take?

The broad answer is that it depends on the symptoms. That having been said: Individuals (children, adolescents and adults) with ADD/ADHD often begin to see results in focus and concentration within 5-7 sessions and will frequently conclude treatment in 25 sessions. Clients with anxiety disorders, unipolar depression and substance use disorders often benefit from a more lengthy course of treatment—often 40—45 sessions show tremendous (and permanent) change.

Bipolar depression, long term, chronic relapsers, migraine sufferers, and individuals with chronic pain will benefit from an even longer course of treatment. Although improvements will typically be experienced throughout the course of treatment, for these
conditions, more really is better. Sometimes as many as 75—100 sessions have been reported to be helpful.

How long is a session?

Each session is approximately 35 minutes, but beginning sessions are sometimes shorter in duration.

Shari Stillman-Corbitt, Psy.D., Senior Executive Director, Promises Treatment Centers, has enjoyed an adventurous career performing both clinical and administrative work. She was most recently Executive Director at TouchStone
Treatment Centers. Her past experience includes Clinical Director of the Indian Health Council, Inc. on the Rincon Indian Reservation in Pauma Valley, CA; Program Director at Casa Palmera, an Eating Disorders and Chronic Pain  Management inpatient treatment facility in San Diego, CA; and Clinical Director at Sierra Tucson. Originally from New York, she earned her Masters and Doctoral degrees from Yeshiva University in New York City. Her areas of specialization include the treatment of addictions, eating disorders, trauma, and personality disorders.