An advanced version of neurofeedback techniques, which some addiction professionals believe have been underutilized in substance use treatment, is making inroads for a much-watched segment of the population dealing with traumatic brain injury (TBI). Preliminary research results are suggesting that High Performance Neurofeedback (HPN), in which a small signal sent to the brain produces slight fluctuations in brainwaves, can improve neurocognitive symptoms in former professional football players who experienced multiple concussions during their playing career.
Based on pilot study results, up to 100 former National Football League (NFL) athletes will be receiving 24 sessions of HPN and will be evaluated over a period extending one year after treatment. The Carolina HealthSpan Institute functional medicine clinic in Charlotte, N.C., home of the NFL's Panthers, is one of the study sites. According to a neurotherapist at the institute, some of the results seen in pilot research becme apparent rather quickly.
“After 12 sessions, normalization of qEEG (quantitative electroencephalogram) was very obvious,” says Britney Cirullo, who is board-certified in neurofeedback and is also a licensed clinical addiction specialist. “We had a player who had given a '10' self-rating to his trouble sleeping, and he was able to get that down to a 3.”
Cirullo says in regard to neurofeedback's usefulness in addiction services, “Neurofeedback in general is highly underrated as a treatment.”
Advancement in technology
Cirullo explains that in traditional neurofeedback, a patient has his/her brain transformed through participation in an exercise such as a game or a video. The brain is rewarded when it produces less of a problematic wave. The exercises are based on principles of operant learning.
In HPN, electrodes are placed on the person's scalp and a pulsed, extremely low-strength electrical signal is used to generate a slight fluctuation in brainwaves. This somehow allows the brain to reorganize itself out of stuck patterns; Cirullo says the science of why this occurs remains uncertain.
Any interventions that might offer new options for preventing TBI from evolving into a neurocognitive disorder or chronic traumatic encephalopathy (CTE), the condition that has been identified post-mortem in more than 80 former NFL players, would receive a great deal of attention in the athletic world and beyond. There are currently no accepted criteria for diagnosing CTE, the condition that is the subject of the feature film “Concussion,” in a living individual.
The study that is now under way will examine multiply concussed former NFL players with a confirmed diagnosis of dementia or mild or major neurocognitive disorder as a result of TBI. It is believed that a good number of these individuals have possible or probable CTE, believed to be a result of head trauma that leads to disturbed executive function, depression and, in some individuals, suicidal tendencies.
Baseline status will be determined using a number of neurocognitive tests (evaluating memory, focus, reaction time, etc.), self-report questionnaires on health and memory, and medical evaluations that include qEEG readings ande physical examinations. Participants will receive a total of 24 HPN sessions, administered at least twice a week but no more than three times a week. Follow-up measures will be taken after sessions 12 and 24, as well as six months and 12 months post-treatment.
A study summary states, “It is hypothesized that treatment with HPN Neurofeedback for 24 sessions will result in statistically significant improvements in neurocognitive functioning, self-reported symptoms and EEG functional brain metrics.” A crucial component involves determining whether the rapid changes that have been seen in pilot research persist over a longer period.
Neurofeedback and addiction
There is a significant body of research supporting use of traditional neurofeedback techniques in substance use treatment settings. For example, a study published in The American Journal of Drug and Alcohol Abuse in 2005 found an abstinence rate of 77% at 12 months for individuals with polysubstance abuse issues who received 40 to 50 EEG biofeedback sessions, compared with a 44% abstinence rate in a control group. Those receiving the biofeedback also showed significant improvement on an attention test after an average of only 13 sessions.
Cirullo says research to this point has not examined HPN's potential usefulness in addiction treatment. “The person delivering the service would need to be trained in working with people with addictions,” she says.
Cirullo herself has familiarity with both the addiction treatment and medical arenas, having worked in an opioid treatment program prior to joining the Carolina HealthSpan Institute. She offers a noteworthy perspective on differences between the two settings, from her own experience.
“An addiction counselor can feel that they're not making a difference,” says Cirullo. “I felt like I was helping maybe 1 in 10 people in my old job. Here I feel like I'm helping 9 of 10.”