An automated EEG biofeedback system for reducing attention deficits in individuals with substance use disorders has been found to work just as well as a clinician-run system and to provide substantial benefit in a residential treatment setting, according to a joint study from researchers at the University of California, Los Angeles (UCLA) and the University of North Carolina Wilmington.
It is estimated that roughly one in four persons with substance use disorders has an attention issue as well. EEG biofeedback can be used to train people how to self-generate a state of effortless attention—a relaxed, alert focus that increases control over actions associated with addiction. That in turn can translate to an improved ability to make healthy decisions and a greater willingness to be in treatment, according to the authors of the study.
This technique also can provide an alternative to the drugs commonly used to treat attention-deficit disorder (ADD) and attention-deficit/hyperactivity disorder (ADHD), which have the potential to spark addiction or relapse in a population that tends be at greater risk for substance abuse or dependence.
“We wanted to see if a system that was programmed to make a lot of the decisions that a trained therapist would usually have to make would do as well as a therapist-controlled system, with the difference being that a therapist uses judgment to adjust the protocols versus the machine using algorithms,” says study lead author Julian Keith, PhD, professor of psychology, University of North Carolina Wilmington. “They are based on the same kind of decision-making principles the therapist should be using, but it’s possible to actually program them into the machine.”
The study involved 95 participants randomly assigned to one of three groups who either received 15 sessions of BrainPaint automated EEG biofeedback, 15 sessions of Neurocybernetics—a clinician-run system—operated by a therapist with almost two decades experience, or 15 therapy sessions without biofeedback.
In addition to both neurofeedback groups significantly improving results on the Test of Variables of Attention (TOVA), an outcome measure used to diagnose ADD/ADHD, the BrainPaint group stayed 65 days or 71% longer in treatment than the control group. Longer stays in treatment are considered one of the most important determinants of long-term sobriety.
“What was impressive in the study is we showed that neurofeedback did in fact produce large measurable changes in as few as 15 sessions of neurofeedback treatment,” Keith says. The sessions took place in a span of a week and a half.
Addressing attention issues
According to Keith, substance use disorder patients will see better results from treatment if they can first address their attention issues prior to beginning to absorb what they’re trying to learn from treatment.
“Changing behavior generally will require neuroplasticity, and it’s going to require the ability to attend to what it is that’s supposed to be the focus of learning during that time,” he says.
According to David Sack, MD, CEO of Elements Behavioral Health, the company's Promises Malibu facility has had an EEG biofeedback program for four years, and Elements has now integrated neurofeedback at 11 of its treatment centers nationally.
“We have extensive experience with EEG biofeedback in a clinical population with substance abuse and co-occurring disorders,” Sack says.
There are two broad protocols that are typically used with EEG biofeedback. The first is an Alpha-Theta protocol geared toward arousal symptoms to use for patients with anxiety, depression and insomnia. The second is a Theta-Beta or SMR protocol for patients with co-occurring ADHD.
According to Sack, most Promises patients go through the Alpha-Theta protocol after coming off opioids or alcohol where they are excessively aroused, in a reactive emotional state, and being treated for anxiety symptoms or post-acute withdrawal symptoms.
Sack says EEG biofeedback can be particularly helpful during the detox stage when patients are experiencing various levels of discomfort, because it helps decrease withdrawal symptoms.
“Even when you manage [detox] optimally with medicine, it’s very hard for someone to be completely asymptomatic,” he says. “[EEG biofeedback] reduces their muscle spasms, they sleep a little better and they feel like they have some control over their symptoms.”
EEG biofeedback is started for patients as soon as they’re safe to get up and out of bed, Sack says, adding that very few people decline to participate because they experience so much benefit from the first few sessions that they want to continue. Additionally, he says, clients who are not able to participate in group therapy or individual psychotherapy are often very willing to participate in EEG biofeedback.
Promises Malibu has a designated EEG biofeedback technician on staff who has been trained to provide the treatment and to supervise and monitor the procedure. The activity takes place in a designated room.
Sack says EEG biofeedback has helped patients complete treatment with less adjunctive medicine for symptoms of anxiety and insomnia, and has given them the ability to respond to stress better.
He says that although it seems as if EEG biofeedback is promoting higher completion rates, the organization cannot specifically attribute that to the EEG biofeedback.