We feature an expert in the mental health and substance use disorder field to answer questions. This issue we talk to Fran Bieganek and Guy Odishaw of Bhakti Brain Health Clinic about using neurofeedback in recovery and mental health.
Q: What is neurofeedback, and what specific changes occur in the brain as a result of undergoing neurofeedback training?
Neurofeedback training is biofeedback for the brain. Neurofeedback employs operant conditioning to train your brain to behave in a more regulated way. During neurofeedback training your brainwave activity is monitored and provided with immediate feedback, through visual and/or auditory cues. When your brain demonstrates regulation, it’s rewarded. The brain responds to the reward by repeating the desired (regulated) brainwave patterns. Over time and continuous repetition, the brain learns how to behave in a regulated manner on its own (without the need for feedback from the training). When the brain regulates symptoms, functional impairment tends to improve.
Q: What are the potential benefits of incorporating neurofeedback into a comprehensive treatment plan for substance use disorders and mental health recovery?
Think of it this way. If a person has a broken ankle and they want to develop endurance skills so they can run a marathon, you wouldn’t recommend they just start running. You would advise them to heal the broken ankle so that they could optimize their training. The same concept applies to neurofeedback. This type of training clears up dysregulated brainwave activity, resulting in optimized brain functioning – for example, better focus, more cognitive flexibility, improved emotion regulation or better sleep quality. Improvements in these areas will facilitate a person’s ability to engage in other therapeutic interventions.
Q: Can you explain the process of conducting a Quantitative Electroencephalogram (QEEG) assessment and how the results are used to inform neurofeedback treatment plans for individuals in recovery?
In our clinic we use both QEEG (quantitative electroencephalogram) and ERP (evoked response potential) to obtain a comprehensive assessment of a client’s underlying brain mechanisms. These assessments allow us to identify brainwave dysregulation that may be causing a particular set of symptoms or functional impairments.
A quantitative EEG is a brain map. It provides valuable insights into resting-state brain activity. This is an electrical measurement, analysis, and quantification of the brainwaves, which control the brain’s tasking mechanism. We first gather the raw EEG data, and then we process it through a normative database, which is a database of healthy individuals’ brainwaves. This gives us a comparison of the client’s brain relative to neurotypical brains.
An Evoked Response Potential measures electrical activity in the brain in response to stimulation of sight or sound. This allows us to measure how quickly the neurons in your brain respond to certain stimulation. ERP complements the QEEG by revealing real-time cognitive processes and brain responses to specific stimuli.
Once we’ve collected the data, we conduct an extensive analysis that will be used to inform us about what interventions we will recommend.
The QEEG and ERP (brain mapping) are just one component of our comprehensive assessment process. We also include a neurocognitive assessment, a mental health diagnostic assessment and genetic testing. This allows us to get a well-rounded understanding of what factors might be contributing to your current level of functioning.
Q: What specific brainwave patterns or abnormalities are typically identified through QEEG assessments?
QEEG assessments give us information about cortical electrical activity in your brain, which can help us identify irregularities in brain functioning. For example, it can show us if brain wave activity is too high or too low in a particular area of your brain, and it can reveal how your brain cells are communicating with each other. Our brain mapping process can reveal brain wave patterns that are associated with functional impairments such as cognitive inflexibility, impulsivity, anxiety, focus and attention issues, as well as many other symptoms.
Q: Which areas of the brain are typically targeted during neurofeedback sessions?
The targeted brain areas in neurofeedback are determined specifically by the analysis of your QEEG assessment. So, neurofeedback sessions are unique to the individual. In our clinic we have equipment that allows us to train full brain networks. For example, the QEEG analysis may show that your reward network is not working efficiently. So, we might target that network with neurofeedback training. In addition to neurofeedback, we also do neurostimulation (transcranial electrical and magnetic stimulation). We also have neuromodulation devices, such as audio-visual entrainment and photobiomodulation (red/infrared light), that you might use at home to supplement your in-clinic training.
Q: What are some common misconceptions about neurofeedback?
Several come to mind. The first is that neurofeedback will change a person’s personality. That is a myth – we are focused on regulating the brain, not changing the qualities that form your distinctive character.
Another misconception is that neurofeedback, as an alternative therapy, can’t be used if someone is taking psychiatric medication. Again, this is not true. As neurofeedback begins to regulate the brain, it’s possible you might be able to reduce dosage, titrate medication use. But it can also complement the mechanisms of medication.
The other misconception is that neurofeedback doesn’t have scientific research to back its efficacy. This is simply not true. A recent search for research on neurofeedback and substance use disorder in Google Scholar produced over 10,000 results. That number points to the prolific nature of the research. A 2023 meta-analysis, including articles selected from a total of 58 databases, provided strong evidence for the efficacy of neurofeedback in treating substance use disorders (SUD).
Q: Can neurofeedback therapy be integrated with other treatment modalities, such as medication-assisted treatment or cognitive-behavioral therapy, to enhance overall outcomes in substance use disorder recovery?
Definitely. In fact, neurofeedback can regulate brain functioning, facilitating other types of therapy. When brain functioning is optimized through neurofeedback training, it’s much more able to do the tasks we might ask of it in cognitive-behavioral therapy or another therapeutic modality. I have seen this firsthand in my psychotherapy practice.
Q: Can neurofeedback therapy lead to lasting changes in brain function and behavior, even after sessions have concluded?
Yes. The research in this area is exciting! Research is showing that changes that occur in the brain during neurofeedback training have long-lasting effects. This makes sense when you consider we are tapping into the brain’s neuroplasticity.
Q: Are there any potential risks or limitations associated with neurofeedback therapy that individuals in recovery should be aware of?
The potential risks of neurofeedback training are minimal. Some people may experience mild, temporary side effects such as mental fatigue (brain training is a workout for the brain!). Another possible side effect is a headache during a training session. We find that when our clients stay well-hydrated during training, headaches aren’t an issue. It’s similar to hydrating while you work out at the gym.
Results with neurofeedback, like any other intervention, can vary from person to person. I don’t necessarily see that as a limitation, but rather a realistic perspective on expectations.
Q: What are some good resources and organizations that people can access to learn more about neurofeedback?
There are two organizations that are engaged in research and oversight of the field of neurofeedback training and neurotherapy.
The International Society for Neuroregulation and Research (isnr.org) is a membership organization. Members come from many countries and various professional disciplines. They all are working on neurotherapy, neurofeedback training and neurofeedback research. The organization supports education and excellence in the field of neurofeedback training and neurotherapy.
Biofeedback Certification International Alliance (bcia.org) is an organization, established in 1981, that certifies neurofeedback practitioners.
And, if you want to read some of the research on neurofeedback, just use the search feature in Google Scholar. It will keep you busy learning for months!
Bhakti Brain Health Clinic has a YouTube channel with lots of informative videos on it, as well. We’d love for you to check it out!
Fran Bieganek, MS, LP, BCN. Fran is a licensed psychologist, Board Certified in Neurofeedback by the Biofeedback Certification International Alliance (BCIA) and an active member of the International Society for Neurofeedback and Research. She has a private psychotherapy practice in Edina, MN and is Co-founder/Co-owner of Bhakti Brain Health Clinic. Fran is also a retired tenured track Professor of Psychology in the Minnesota State College System.
Guy Odishaw, NFP, CST, CTO. Guy is a Healthcare Entrepreneur, Bioelectric Medicine Practitioner is the Founder of Bhakti Wellness Center, Co-founder of the first integrative student health clinics in the country at the University of Minnesota and Co-founder/Co-owner of Bhakti Brain Health Clinic. He is also co-founder of several other wellness clinics.
If you have a question for the experts, or you are an expert interested in being featured, please email phoenix@thephoenixspirit.com.
Last Updated on May 7, 2024