the neuroscience of addiction · for neurofeedback, evaluating the patient’s self -report on...
TRANSCRIPT
About The Florida House Experience
Established in 2001 as a sober-living facility in Deerfield Beach, Florida,The Florida House Experience is now a full-service facility, offering one of the only medically integrated programs in the country. Our mission is to provide integrated, modern day addiction treatment at the highest quality, so every patient has the opportunity for a better life.
We employ a team of highly qualified, licensed medical and clinical professionals to assist you throughout your recovery. Your medical doctor, psychiatrists, clinicians, and case managers will work in partnership in order to solve the underlying issues fueling your addiction, and create a comprehensive treatment plan that works best for you. Furthermore, patients’ care plans are continuously being assessed, even during treatment, so that proper adjustments are made in accordance to changing needs.
In addition to the personalized medical care we provide, we offer multiple components of out-patient care for our patients after their recovery. We strive to provide our patients with a well-rounded recovery strategy, and in order to do this, we address multiple areas of life – not just the addiction itself. With our treatment, patients are able to establish important goals of recovery and incorporate those goals into their lives through a guided process that will give them the highest chance of treatment success and get them on the right path towards a happy and healthy future!
Biofeedback/Neuro TestingBiofeedback
The first few sessions of Biofeedback are an “introductory” tothe NeuroRehab Team, the services the team provides, and thetechnology being used in treatment today. Typically, (as is thecase for detox/residential), patients will be put in the BioBed® for “Biofeedback,” which will assist in relaxing and calming the patient by teaching them breathing exercises in order to regulate his/her breathing and heart-rate. Mental calming will begin as a result of the patients’ physical calming being taught.
Biofeedback/Neuro TestingNeuropsychological Testing
After several sessions (some more, some less) of Biofeedback inthe BioBed®, patients will be scheduled for Neuropsychologicaltesting. Testing is used as a means to “close in” on potential targetsfor neurofeedback, evaluating the patient’s self-report on cognitive,physiological, and executive memory, and emotional health-relatedsymptoms the patient may be experiencing. After testing iscomplete, patients are then educated on the use and benefit ofquantitative electroencephalogram (qEEG), going into detail asto how the procedures work, what to look for, how to interpretthe results, etc.
What is gEEG/gEEGGuided NeurofeedbackWhat is qEEG?
Quantitative electroencephalogram (qEEG) uses a head cap coveredin 19 sensitive electrodes to map your brain and allows our team ofspecialists to track your treatment progress during your stay with us.After selecting the best portions of the recording, an analysis is run tolook for areas of dysregulation, which are areas of the brain that are actingthe furthest away from a “normal” brain. We determine whether thoseareas produce too much or too little activity, the quality of communicationbetween different areas of the brain, and the efficiency of the brain to“shout out” for resources.
What is gEEG/gEEGGuided NeurofeedbackqEEG-Guided Neurofeedback
Once admitted to our residential treatment program, our patientsundergo a complete neuro-psychological evaluation so that we candetermine what the most effective treatment plan for them will be. Ourevaluation takes into account functionality of specific regions of the brainthat are affected by drug and alcohol usage. After recording the initialqEEG, the analysis reveals areas of interest which are significantly moredysregulated than the comparative normal brain. These areas are thefocus of the Neurofeedback training.
Neurofeedback is tailored to each individual. The goal of Neurofeedbackis to retrain the brain to regulate the areas of greatest dysfunction.For example, because of immense amount of research that has beenconducted on the brain, we can target symptoms such as addictio(focus, planning, judgment, multi-tasking, etc). After targeting theaffected areas of the brain, the neurofeedback training can then guidethese dysregulated areas to behave more like the normal brain.
Campus LifestyleWe take pride in our well-maintained campus and off-campus housing. Daily housekeeping ensures that every individual is as comfortable as possible during their stay. In addition to our state-of-the art facilities, we offer modern residences for men and woman. We can assure that our patients will receive the optimal rest and relaxation they will need throughout their stay. To add to therelaxing lifestyle and environment we create for our patients, we also offer many other amenities to ensure your journey to rehabilitation is as smooth as possible. These luxury programs and activities include:
► Acupuncture► Massage therapy► Smoking cessation► Physical trainers
► Gym► Massage therapy► Yoga► Family program
Further Reading:1.Thatcher, R. W., Biver, C. J., & North, D. M. (2003).Quantitative EEG and the Frye and Daubertstandards of admissibility. Clinical EEG andNeuroscience, 34(2), 39-53.
2. Thatcher, R. W., Walker, R. A., Gerson, I., &Geisler, F. H. (1989). EEG discriminant analysesof mild head trauma. Electroencephalographyand clinical neurophysiology, 73(2), 94-106.
3. Thatcher, R. W. (2000). EEG operant conditioning(biofeedback) and traumatic brain injury. ClinicalEEG and Neuroscience, 31(1), 38-44.
4. Craig, A. D. (2009). How do you feel—now? theanterior insula and human awareness. Naturereviews neuroscience, 10(1).
5. Coburn, K. L., Lauterbach, E. C., Boutros, N. N.,Black, K. J., Arciniegas, D. B., & Coffey, C. E. (2006).The value of quantitative electroencephalographyin clinical psychiatry: a report by the Committeeon Research of the American NeuropsychiatricAssociation. The Journal of neuropsychiatry andclinical neurosciences, 18(4), 460-500.
6. Thatcher, R. W., Biver, C. J., & North, D. M. (2004).Z score EEG biofeedback: technical foundations.Applied Neurosciences Inc.
7. Collura, T. F., Guan, J., Tarrant, J., Bailey, J., & Starr,F. (2010). EEG biofeedback case studies using liveZ-score training and a normative database. Journalof Neurotherapy, 14(1), 22-46.
8. Thatcher, R. W. (2010). LORETA Z scorebiofeedback. Neuroconnections, December, 9-13.
9. Thatcher, R. W., & Lubar, J. F. (2009). History of thescientific standards of QEEG normative databases.Introduction to quantitative EEG and neurofeedback:Advance theory and applications, 29-59.
qEEG & Neurofeedback Brain Training
Dr. Karen Dodge, PhD, MSPH MSWFlorida House Institute for Addiction Medicine & NeuroRehabilitation
What is a qEEG? A qEEG (quantitative
Electroencephalography) is a computer-generated analysis of EEG data compared to a normative database of age-, handedness-, and gender-matched controls
The analysis yields standardized (i.e. z-scored) variations from the average represented by the normative database of controls; ages from 2 mos-82 years. (N=727)
What is normal?
Phenotype and Genotype
If you don’t give a qEEG to everyone, who should it be recommended to?
This should be based on judgment, but some recommendations of situations to be considered are:
• Anxiety• ADHD• Chronic Pain• Epilepsy• Headaches in Adults• Repetitive Compulsive
thoughts and behaviors• Mood Disorders• PTSD
• Addiction• Long, difficult
psychiatric/medical history with little response to many medications
• Suicidal depression• TBI’s
Process of qEEG Analysis, Evaluation and Diagnostics
Fig. 1 – Example of conventional EEG (left) and qEEG (right) . Absolute Power- Brainpower available w/in a frequency at each site. Amplitude/Strength of Frequency. Microvolts squaredThe conventional EEG includes examination and marking of EEG traces and events. The qEEG (right)includes the Fast Fourier Transform (top right) and normative database Z scores (bottom right).
Brain Map: Anxiety before and after Neurofeedback
LORETA Horizontal Sagittal Coronal
Dysregulatedareas can be overactive (red) or underactive (blue)
The degree of dysregulation allows the tailoring of personalized NF training protocols
LORETA & 3D Brain-Surfer
Brodmann Areas Defined by Korbinian Brodmann, published in
1909. 45 areas in humans segregated by cyto-
architecture using cell body and endoplasmic reticulum staining methods. Functions are localized to individual hemispheres or bilaterally.
Modern methods of brain scanning (fMRI, PET, MEG) have elucidated networks of these Brodmann Areas (BAs)
These networks are the treatment targets of qEEG Neurofeedback
Simply, neurofeedback is a method for allowing patients to understand their brain activity through some medium (e.g. lights, sounds, video etc.….)
This understanding allows a patient to manually change their brain activity based on received feedback in the form of lights, sounds, pictures…
This modulation of brain activity results in the regulation of activity in different Brodmann areas across bands of Hz (1-30).
Using the tools of neurofeedback, patients’ brains can be mapped to isolate particular Brodmann areas that are dysregulated at specific bands of Hz.
This allows the personalization and tailoring of protocols to suit the patient for their particular pathology
A normative database is employed to describe the deviations of patients’ brain activity from healthy normals. This is the difference between EEG and qEEG.
What is Neurofeedback? How does it work?
How does NFB Work?
Is qEEG NF Better than other NF Methods?
• qEEG NF uses 19 electrode leads all around the head to record and monitor brain activity • Older methods ala Peniston and Scott used less
than 5 leads• qEEG NF trains specific Brodmann Areas at select
frequency ranges (e.g. Delta, Theta, Beta)• Older methods train frequency ranges globally all
across the brain; far less sensitive and specific• qEEG NF employs a normative database to know
exactly where, how, and to what degree a patient’s dysregulation is. Older methods do not.
How Important is it to Combine qEEG with Neurofeedback?
• QEEG reports provide information about what areas of the brain and in which frequency ranges a patient is showing dysregulation
• The resolution of LORETA allows for high spatial resolution when mapping a patient’s brain. This combined with qEEG yields tremendous sensitivity and specificity in treating patients
Location of some of the regions in the human brain that are affected by alcohol, including the mesolimbic and mesocortical dopamine systems (which includes the ventral tegmental area [VTA], nucleus accumbens, and prefrontal cortex), amygdala, striatum, and hippocampus.
Signaling systems using the neurotransmitter glutamate also may undergo adaptive changes that contribute to AOD dependence. According to Kalivas and O’Brien (2008), adaptive changes in glutamatergic systems that transmit signals from various brain regions (e.g., the cortex, amygdala, and hippocampus) to the striatum are responsible for compulsive drug-seeking behavior in dependent people.
NEURONS AND AXONS
Neurotransmitter Distribution in the Central Nervous System Functions Affected Drugs That
Affect It
Dopamine Midbrain, Ventral tegmental area (VTA), Cerebral cortex, Hypothalamus
Pleasure and reward Movement, Attention, Memory
Cocaine, Methamphetamine, Amphetamine. In addition, virtually all drugs of abuse directly or indirectly augment dopamine in the reward pathway
Serotonin Midbrain, VTA, Cerebral cortex, Hypothalamus
Mood, Sleep, Sexual desire, Appetite
MDMA (ecstasy), LSD, Cocaine
Norepinephrine Midbrain, VTA, Cerebral cortex, Hypothalamus
Sensory processing, Movement, Sleep, Mood, Memory, Anxiety
Cocaine, Methamphetamine, Amphetamine
Endogenous opioids (endorphin and enkephalin)
Widely distributed in brain but regions vary in type of receptors, Spinal cord
Analgesia, Sedation, Rate of bodily functions, Mood
Heroin, Morphine, Prescription painkillers (Oxycodone)
Acetylcholine Hippocampus, Cerebral cortex, Thalamus, Basal ganglia, Cerebellum
Memory, Arousal, Attention, Mood
Nicotine
Endogenous cannabinoids (anandamide)
Cerebral cortex, Hippocampus, Thalamus, Basal ganglia
Movement, Cognition and memory
Marijuana
Glutamate Widely distributed in brain Neuron activity (increased rate), Learning, Cognition, Memory
Ketamine, Phencyclidine, Alcohol
Gamma-aminobutyric acid (GABA)
Widely distributed in brain Neuron activity (slowed rate), Anxiety, Memory, Anesthesia
Sedatives, Tranquilizers, Alcohol 36
Heroin Signature• More than 70% of heroin addicts in early abstinence show
low-voltage background activity with diminution of alpha rhythm, an increase in beta activity, and increased low-amplitude delta and theta waves in central regions1
• Concurrent with cocaine- and alcohol-using subjects, abstinent heroin-dependent subjects show enhanced high beta power2
• Spectral power and event-related potentials relate to abstinence length3
• Considerable to full normalization of EEG power in heroin ex-addicts has been seen after 3 months4
1) Olivennes et al. 1983; Polunina and Davydov 20042) Franken et al. 2004; Costa and Bauer 1997; Herning et al. 1994b; Rangaswamy et al. 2004; Roemer et al. 19953) Shufman et al. 1996; Bauer 2001a; Polunina and Davydov 20044) Bauer 2001b, 2002; Costa and Bauer 1997
Methamphetamine• Methamphetamine-addicted patients
exhibit significant power increases in delta and theta bands1
• These findings align with conclusions that methamphetamine abuse causes psychomotor slowing and frontal executive deficits2
• Increased theta power is correlated with response time and reduced accuracy3
1) Newton et al. 2003, 20042) Kalechstein et al. 20033) Newton et al. 2004
How long is a typical session?
Is it important to combine the EEG with clinical data?
• The qEEG is a statistical report, so it should correlate with pencil-and-paper measures reported by the patient
• The clinician should also note if a client reports a symptom that doesn’t appear to correlate with the qEEG, which is a possibility.
Do qEEG’s improve client compliance?
• According to several clinicians, the qEEG adds credibility and has improved client motivation to stick with the neurofeedback program.
• Neurofeedback training enhances patients’ longevity in most intervention modalities particularly with our pt. population as was documented in a RCT performed in 2005 at UCLA with a primary SUD sample of approx. 200 pts (Scott 2005)
References Apkarian, A. V. Functional magnetic resonance imaging of pain consciousness: cortical networks of pain critically depend on what is implied by “pain”. Curr. Rev. Pain 3, 308– 315 (1999). Buzsaki, G. (2006). Rhythms of the Brain, Oxford Univ. Press, New York. Cannon, R., Lubar, J., Thornton, K., Wilson, S., & Congedo, M. (2005) Limbic beta activation and LORETA: Can hippocampal and related limbic activity be recorded and changes visualized using LORETA in an affective memory condition? Journal of Neurotherapy, 8 (4), 5-24. Cannon, R., & Lubar, J. (2007). EEG spectral power and coherence: Differentiating effects of Spatial–Specific Neuro–Operant Learning (SSNOL) utilizing LORETA Neurofeedback training in the anterior cingulate and bilateral dorsolateral prefrontal cortices. Journal of Neurotherapy, 11(3): 25-44. Cannon, R., Lubar, J., Sokhadze, E. and Baldwin, D.
References John, E. R., Prichep, L. S. & Easton, P. (1987). Normative data banks and neurometrics: Basic concepts, methods and results of norm construction. In A. Remond (Ed.), Handbook of electroencephalography and clinical neurophysiology: Vol. III. Computer analysis of the EEG and other neurophysiological signals (pp. 449-495). Amsterdam: Elsevier. Lubar, J., Congedo, M. and Askew, J.H. (2003). Low-resolution electromagnetic tomography (LORETA) of cerebral activity in chronic depressive disorder. Int J Psychophysiol. 49(3):175-185. Luria, A. The Working Brain. Penguin Press, London ISBN 0 14 080654 7 Thatcher, R.W., North, D., and Biver, C. Evaluation and Validity of a LORETA normative EEG database. Clin. EEG and Neuroscience, 2005b, 36(2): 116-122. Thatcher, R.W. and Collura, T. Z Score Biofeedback and New Technology. International Society of Neuronal Regulation Annual Meeting, Atlanta, GA, September 16-21, 2006. Thatcher, R.W., North, D., and Biver, C. Self organized criticality and the development of EEG phase reset. Human Brain Mapp., Jan 24, 2008a. Thatcher, R.W., North, D., and Biver, C. Intelligence and EEG phase reset: A twocompartmental model of phase shift and lock, NeuroImage, 42(4): 1639-1653, 2008b. Thatcher, R.W. and Lubar, J.F. History of the scientific standards of QEEG normative databases. In: Introduction to QEEG and Neurofeedback: Advanced Theory and Applications, T. Budzinsky, H. Budzinsky, J. Evans and A. Abarbanel (eds)., Academic Press, San Diego, CA, 2008. Thatcher, R.W., North, D., Neurbrander, J., Biver, C.J., Cutler, S. and DeFina, P. Autism and EEG phase reset: Deficient GABA mediated inhibition in thalamo-cortical circuits. Dev. Neuropsych. (In press, 2009).