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Clinical Outcomes in Addiction: A Neurofeedback Case Series

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This case series (N = 30) shows the impact of an addiction treatment approach that uses phenotype-basedneurofeedback in an integrated clinical treatment (Crossroads Institute), which combines targeted brain recovery exercises and neurotherapy. We present pre- and post-neurocognitive testing and electroencephalography/quantitative electro- encephalography measures of the phenotype findings in this polysubstance-based addict population. The electroencephalography phenotypes identify two separate drive systems underlying individual addiction: central nervous system overactivation and obsessive/compulsive drives. In addition to sobriety and abstinence, the neurocognitive improvements documented are particularly impressive. Background According to a survey by the National Institute on Drug Abuse (NIDA), addiction is characterized by compulsive cravings, drug seeking, and drug use, which persist in the face of consequences (Substance Abuse and Mental Health Services (SAMHSA), 2006). For many, addiction is a chronic condition, with relapses occurring even after long periods of abstinence. Relapse rates are quite strikingly similar to rates for other chronic medical illnesses such as asthma. Like any chronic illness, addiction treatment generally requires repeated and persistent intervention to extend the time between relapse as well as to diminish the relapse severity and duration. Through treatment, people with drug addiction can lead productive lives. The U.S. Substance Abuse and Mental Health Services Administration states that chemical dependency, along with associated mental health disorders, has become one of the most severe health and social problems facing the United States. In the United States, 12.5% of the population has a significant problem with alcohol or drugs, with 40% of these individuals having a concurrent mental/nervous disorder (the so-called dual diagnosis). The medical costs are approximately 300% higher for an untreated alcoholic than for a treated alcoholic. About 70% of addicts are employed, with their addiction contributing substantially to absenteeism, turnover costs, accidents/injuries, decreased productivity, increased insurance expenses, and even workplace violence. Costs related to addiction include those related to violence and property crimes, prison expenses, court and criminal costs, emergency room visits, health care utilization, child abuse and neglect, lost child support, foster care and welfare costs, reduced productivity, and unemployment. Of Americans aged 12 years or older, 22.5 million need treatment, but only 3.8 million people receive it (SAMHSA,
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Clinical Outcomes in Addiction: A Neurofeedback Case Series
Gunkelman, Jay;Cripe, Curtis, PhD
Biofeedback; Winter 2008; 36, 4; ProQuest Psychology Journals
pg. 152
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
... Targeted treatment variables focused on remediating deficiencies observed in participants' cognitive control, memory, attention, and executive function. Neurobehavioral imbalances were addressed using an advanced form of a CRT employing a BCI method to influence CRT training activities based on the cognitive information processing strength of each imbalance in real-time [15,21,26]. ...
... The CRT training method used in this study was implemented through a set of training tools composed of a collection of working memory and executive function activities, routinely employed by the primary author in clinical settings to address brain-based deficiencies, called the NeuroCoach program (NTLGroup Inc., Scottsdale) by clients and staff [21,26]. Each activity was designed to develop cognitive functional capacity within a chosen cognitive ability (e.g., auditory working memory capacity, impulse control on go/no-go tasks, or cognitive flexibility with variations of modified Stroop activities) and to develop resilience when encountering stress. ...
... Resiliency was enhanced by demanding greater performance under a larger, more demanding cognitive load based on varying working memory load demands and performance in conjunction with changing response time constraints. In addition, an EEG BCI interface was used to monitor and adjust cognitive loads based on previously identified EEG protocols of addictive drive mechanisms and working memory cognitive load, both of which were used to influence activity presentation [21,26,28,29]. ...
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Up to 80% of individuals seeking treatment fail in their attempts at sobriety. This study investigated whether 1) a cognitive remediation therapy (CRT) program augmented with a brain-computer interface (BCI) to influence brain performance metrics would increase participants' self-agency by restoring cognitive control performance; and 2) that ability increase would produce increased sobriety rates, greater than published treatment rates. The study employed a retrospective chart review structured to replicate a switching replication methodology (i.e., waitlist group) using a pre-test and post-test profile analysis quasi-experimental design. Participants' records were organized into treatment and non-treatment groups. Adult poly-substance users were recruited from alcohol and other drugs (AOD) use outpatient programs and AOD use treatment centers in the United States. Participants volunteered for pre- and post-testing without treatment (n = 121) or chose to enter the treatment program (n = 200). The treatment group engaged in a 48-session BCI/CRT augmented treatment program. Pre- and post-treatment measures comprised 14 areas from the Woodcock-Johnson Cognitive Abilities III Assessment Battery. An 18-month follow-up assessment measured maintenance of sobriety. After testing the difference for all variables across time between test groups, a significant multivariate effect was found. In addition, at 18 months post-treatment, 89% of the treatment group maintained sobriety, compared to 31% of the non-treatment group. Consistent with addiction neurobehavioral imbalance models, traditional treatment programs augmented with BCI/CRT training, focused on improving cognitive control abilities, may strengthen self-control and improve sobriety rates.
... Multi-case studies by Koberda J L in Traumatic Brain Injury (TBI) and Cerebrovas-cular Accident (CVA) patients showed that 10 sessions of LZNFB training are effective in the rehabilitation of cognitive problems, headache, dizziness, and depression (Koberda, 2015;Lucas Koberda & Stodolska-Koberda, 2014). Also, LZNFB is an effective method in treating alcohol and SUD and can yield even faster and more effective results than traditional or two-channel neurofeedback (Gunkelman & Cripe, 2008;Lucas Koberda & Stodolska-Koberda, 2014). ...
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Background: Previous studies have shown that conventional neurofeedback and cognitive modification treatments have led to numerous psychological improvements in patients suffering from substance use disorders. However, effectiveness of LORETA (Low-Resolution Brain Electromagnetic Tomography) Z score neurofeedback (LZNFB) and Cognitive rehabilitation therapy on reducing of opioid craving has yet to be investigated. Thus, aim of the present study was to compare effectiveness of LZNFB and Cognitive rehabilitation therapy with methadone maintenance treatment (MMT) in reduction of craving in patients with opioid use disorder.
... Multi-case studies by Koberda J L in traumatic brain injury (TBI) and cerebrovascular accident (CVA) patients showed LZNFB effectiveness in rehabilitation of in cognitive problems, headache, dizziness and depression after 10 sessions of training (Koberda, 2015;Lucas Koberda & Stodolska-Koberda, 2014). Also LZNFB is an effective method in treating alcohol and substance use disorder and is able to accomplish even faster effective results than traditional or two-channel neurotherapy (Gunkelman & Cripe, 2008;Lucas Koberda & Stodolska-Koberda, 2014). ...
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Full-text available
Background: Previous studies have shown that conventional neurofeedback and cognitive modification treatments have led to numerous psychological improvements in patients suffering from substance use disorders. However, effectiveness of LORETA (Low-Resolution Brain Electromagnetic Tomography) Z score neurofeedback (LZNFB) and Cognitive rehabilitation therapy on reducing of opium craving has yet to be investigated. Thus, aim of the present study was to compare effectiveness of LZNFB and Cognitive rehabilitation therapy with methadone maintenance treatment (MMT) in reduction of opium craving in patients with opioid use disorder. Methods: Thirty patients with opioid use disorder undergoing MMT were randomly assigned into three groups: LZNFB with MMT, Cognitive rehabilitation with MMT (as experimental groups), and MMT alone Control group. The LZNFB and Cognitive rehabilitation groups received 20 and 15 sessions of treatment, respectively. The three groups were assessed using a number of questionnaires as well as Dot-Probe Task at pre-test, post-test, and one-month follow-up. Results: The results showed that both experimental groups accomplished significantly greater reduction in opium craving than MMT alone group at post-test and follow up (P<0.05). The LZNFB with MMT group showed higher decrease in opioid craving than the Cognitive rehabilitation with MMT group. In addition, Cognitive rehabilitation group experienced greater improvement on attentional bias towards craving cues than LZNFB with MMT group at post-test and follow up. Finally, LZNFB with MMT group and Cognitive rehabilitation with MMT group got higher scores on the recovery assessment scale than MMT alone group at post-test and follow up. According to results of this study, LZNFB training is more effective than Cognitive Rehabilitation in decreasing of craving and improving quality of life in addiction to opioids. Conclusion: The findings of the current study provided preliminary support for the effectiveness of LZNFB and Cognitive rehabilitation on reduction of opium craving, improvement of attentional bias towards craving cues and quality of life among Iranian opioids use patients.
... Electroencephalogram (EEG) based NF is not only used in the optimal performance field [15][16][17][18][19][20][21] it is also used for the treatment of various neurological and psychological disorders [17,22] such as attention deficit hyperactivity disorder (ADHD), autism, stroke rehabilitation, depression, anxiety, stress, obsessive compulsive disorders, epilepsy, schizophrenia, and pain [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. A variety of NF training protocols has been applied for optimal peak performance and for treatment of neurological disorders. ...
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Neurofeedback (NF) training has been used for the treatment of neuropathic pain. This paper presents the results of assessment of the learning ability of five patients having neuropathic pain. The following two types of baselines were adopted: Baseline 1 refers to power on Day 1 in PreNF state; and Baseline 2 refers to power recorded on each training day in PreNF state. The result of the study demonstrated that not only the baseline its selection is also important to demonstrate the validity of training protocol. It was also found that Baseline 2 can be used to define cut-off time for training (when training should be stopped). All five patients can be classified as learner and alpha band was found to be most relevant for NF training.
... These brain-phenotypes, subtypes of mental health disorders describe symptom and behavioral manifestations of regional brain over-arousal, under-arousal, or instability. (Gunkelman & Cripe, 2008;Amen, 2015). In PTSD, dysregulation of three intrinsic connectivity networks are identified: The Central Executive Network (CEN), the Salience Network (SN), and the Default Mode Network (DMN). ...
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