Neurofeedback and Counseling as Integrative Treatment

Transcription

1 2015 Singapore Asia s First Neurofeedback Conference 8th 10th January 2015, Singapore Expo Convention and Exhibition Centre Neurofeedback and Counseling as Integrative Treatment Prof. Dato Dr See Ching Mey Division of Industry and Community Network Universiti Sains Malaysia

2 I. INTRODUCTION (cont.) Over the last decade, medical view of the brain has changed and neuroplasticity is universally accepted. Brain changes at any age and continuously creates new neurons throughout life.

3 I. INTRODUCTION (cont.) Neuroscience accepts interrelation between central nervous system, autoimmune system, socio-emotional, physical and mental wellbeing. We are living in an age dominated by pharmaceutical approaches to treating brain.

4 I. INTRODUCTION (cont.) Neurofeedback Emerging as a bold new nonchemical alternative. It is non-invasive as it is a brain exercise. It provides information about the type and intensity of brain waves generated. It organizes the brain to function better in the context of the mental health and wellness.

5 I. INTRODUCTION Neurofeedback It is based on operant conditioning by using positive reinforcement / rewards to train the brain. It gives greater personal command for long term mental, physical and emotional health.

6 II. ROLE OF NEUROFEEDBACK IN TREATING MENTAL DISORDERS (cont.) Introduction Counseling can be effective when combined with neurofeedback (Goodwin and Montgomery, 2006). Psychologists/Counselors can integrate neurofeedback into the counseling model as treatment for mental disorders.

7 II. ROLE OF NEUROFEEDBACK IN TREATING MENTAL DISORDERS (cont.) Technological innovation has found a way to manage brain s deterioration, bolster and create new neural connections leading to targeted behavioural changes. This discovery has led to engineered computer programs that helps patients to reduce distinct normal brain states and foster brain changes without adverse effects.

8 II. ROLE OF NEUROFEEDBACK IN TREATING MENTAL DISORDERS (cont.) An individual s reaction to events around him/her affects the strengths and resilience of every system in the body, strengthening or weakening the ability to repair, regulate and resist disease. Thus, many physical and emotional conditions stem from the mind and brain, hence, training it into better health is important.

9 II. ROLE OF NEUROFEEDBACK IN TREATING MENTAL DISORDERS (cont.) Neurofeedback enables patients to alter his / her brain wave to improve health, well-being and performance. The three step processes are : Becoming aware of a brainwaves response. Learning to control the response. Transferring control of the response to day-to-day living. Brain s own self-regulating ability is used to resolve brain s dysregulation.

10 II. ROLE OF NEUROFEEDBACK IN TREATING MENTAL DISORDERS (cont.) Neurofeedback treats the symptoms of mental disorders, instead of the causes. Counseling explore the causes. Neurofeedback helps patients avoid drugs with side effects. Integration of counseling and neurofeedback enhances treatment process resulting in speedy recovery.

11 II. ROLE OF NEUROFEEDBACK IN TREATING MENTAL DISORDERS (cont.) Neurofeedback and Anxiety Anxiety is characterized by excessive and uncontrollable worrying and the presence of specific symptoms that include muscle tension, irritability, sleep disturbance and feeling keyed up or on edge. Helping patients to calm themselves mentally and physically is an effective solution to treat anxiety. Neurofeedback trains the brain to reduce anxiety and increase calmness (Nauert, 2012).

12 II. ROLE OF NEUROFEEDBACK IN TREATING MENTAL DISORDERS (cont.) Brain training decreases medication usage, and increases quality of life. It trains patients to moderate their response to stress so that anxiety occurs less frequently. With training, the brain will consistently maintain healthier patterns.

13 II. ROLE OF NEUROFEEDBACK IN TREATING MENTAL DISORDERS (cont.) Neurofeedback and Insomnia Insomnia means difficulty in falling asleep or staying asleep for a period of time during the night (Roth, 2007). Neurofeedback works on areas of the brain that allow and regulate sleep. The brain is trained by rewarding it to sleep and thus create healthier patterns. Research showed significant post treatment improvement for a group of 12 adults with primary insomnia (Hammer et al., 2011).

14 II. ROLE OF NEUROFEEDBACK IN TREATING MENTAL DISORDERS (cont.) Neurofeedback and OCD OCD is having recurring, unwanted thoughts, ideas or sensations (obsessions) that make the person feels driven to do something repetitively (compulsions) (Horwath and Weissman 2000). Neurofeedback helps patient regulate themselves better. With multiple sessions, it leads to permanent changes and benefits (AboutNeurofeedback, 2012).

15 II. ROLE OF NEUROFEEDBACK IN TREATING MENTAL DISORDERS (cont.) Findings of neurofeedback treatment on patients with OCD (Hammond, 2003): Reduction in symptoms. Did not struggle to stop repetitive behaviours and thoughts. Minds were quieter and calmer. Recorded successful treatment of neurofeedback on OCD (Hammond, 2005).

16 II. ROLE OF NEUROFEEDBACK IN TREATING MENTAL DISORDERS Neurofeedback and Depression Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest (Rupke, Blecke et al. 2006). Neurofeedback focuses on re-training the brainwave pattern identifying and reversing the frontal brainwave asymmetry that causes depression. It produces significant change without the use of medication (Hammond, 2013).

17 III. ROLE OF COUNSELING IN TREATING MENTAL DISORDERS (cont.) Mental Disorder Mental Disorder is a result of disorganization of personality, mind, and emotions. It impairs normal psychological and social functioning of an individual. Assessment of Mental Disorder comprises a combination of affective, behavioural, cognitive and perceptual components.

18 III. ROLE OF COUNSELING IN TREATING MENTAL DISORDERS (cont.) Counseling Counseling : Psychologist/Counselor works with the client to understand his / her thinking in order to find solution (Rupke, Blecke et al., 2006). Counseling has therapeutic characteristics such as listening, empathic understanding, building relationship of trust, gaining insight, and building on strengths and wellness, awareness of environment, culture and self shape the individual.

19 III. ROLE OF COUNSELING IN TREATING MENTAL DISORDERS (cont.) There are many models, approaches and techniques in counseling. Cognitive Behavioural Therapy Some Counseling Approaches Choice Therapy Gestalt Therapy Behavioural Therapy Psychoanalysis Therapy

20 III. ROLE OF COUNSELING IN TREATING MENTAL DISORDERS (cont.) Cognitive Behavioural Therapy CBT is a talking therapy that help manage a person s problems by changing the way he/she thinks and behave. It is problem-focused and goal-directed at addressing and challenging problems (Freeman and Oster, 1999). CBT focuses on examining the relationship between thoughts, feelings and behaviours (Renaud, 2014).

21 III. ROLE OF COUNSELING IN TREATING MENTAL DISORDERS (cont.) CBT treatment includes breaking down the problems to smaller parts in order to clearly see the connection and how it affects an individual. A pattern in their thinking is identified and the psychologist/counselor works with the patient to improve the thinking pattern.

22 III. ROLE OF COUNSELING IN TREATING MENTAL DISORDERS (cont.) Behavioural Therapy Behavioural Therapy is a treatment that helps change potentially self-destructing behaviors (Cuijpers, Smit et al. 2010). Focuses on human behaviours and eradicate unwanted behaviours. Behaviour is learnt and therefore can be unlearned via therapy.

23 III. ROLE OF COUNSELING IN TREATING MENTAL DISORDERS (cont.) Psychologist/Counselor focuses on thoughts / feelings that lead to the behaviour to understand it on a deeper level (Hayes 2004). Past is acknowledged to learn the root of the unwanted behaviour. The therapy focuses on present behaviour and ways to rectify it.

24 III. ROLE OF COUNSELING IN TREATING MENTAL DISORDERS (cont.) Psychoanalysis Psychoanalysis is treating mental disorders that could be a result of past personal experiences, early childhood and dreams (Channel, 2008). The therapy helps the patient to take control by tracing the root of the behaviour and understanding how it has developed over time, then, constructively use ways to mould their present life.

25 III. ROLE OF COUNSELING IN TREATING MENTAL DISORDERS (cont.) It is based on the principle that our present is shaped by our past (Channel, 2008). Hurtful experience remains in the unconscious and subconscious mind, influencing present behaviour. This can lead to problems related to self esteem, personality, relationships and work.

26 III. ROLE OF COUNSELING IN TREATING MENTAL DISORDERS (cont.) Choice Therapy Choice therapy believes that all human beings have the same behaviour system, yet, how they use it to meet their needs create the differences (Glasser, 1998). It is based on the principle that we are driven by our genes to satisfy five basic needs: survival, love and belonging, power, freedom and fun.

27 III. ROLE OF COUNSELING IN TREATING MENTAL DISORDERS (cont.) Choice Therapy Patients are guided to make choices and control their behaviour. The therapy focuses on helping the individual to take ownership of his/her actions and direct his/her own lives (Burke, 2012).

28 III. ROLE OF COUNSELING IN TREATING MENTAL DISORDERS Gestalt Therapy Gestalt therapy focuses on developing patient s personal responsibility by gaining insight of his/her behaviours and emotions (Fagan & Shepherd, 1970). The psychologist/counselor guides the patient to explore, understand, be aware and gain insights to his/her needs, or let them recede into the background.

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30 IV. CASE 1: PATIENT DIAGNOSED WITH ANXIETY PATIENT GENDER AGE DIAGNOSIS A FEMALE 42 GENERALISED ANXIETY DISORDER (GAD) Appeared calm on the outside, but patient complained that her brain never stopped thinking. Patient complained of worrying, being fearful, restless and had negative thinking. High brainwave activity in the right frontal lobe of the brain.

31 IV. CASE 1: PATIENT DIAGNOSED WITH ANXIETY Counseling Counseling Approach Used: CBT and Behaviour Therapy. CBT : Challenged her irrational thinking and explored ways to handle and manage people. Behaviour Therapy Trained breathing and relaxation techniques.

32 IV. CASE 1: PATIENT DIAGNOSED WITH ANXIETY Neurofeedback Neurofeedback trained the patient to decrease the level of activation, and release middle/low frequency of brain wave instead of high frequency (Jacobs, 2013). Patient s output aligns with the finding from Braintrain (2014), whereby patient experienced significantly improved sleep patterns, better concentration, less worries and fear and reduced muscle tension.

33 PROTOCOL P4 Delta: Improve sleep

34 NEUROFEEDBACK SESSION Month Session Treatment Protocol June Session 1 Session 5 July Session 6 Session 10 T6 Delta, F7 F8 Delta, August Session 11 Session 12 P4 Delta, T3 T4 Delta September Session 13 Session 16 Total sessions 16 *** P4 & T3 T4 Delta protocol was alternated based on the symptoms she was displaying at the time.

35 FINDINGS (16 Sessions of Neurofeedback and 6 Sessions of Counseling) Presenting Problem Outcome Constant worrying Able to challenge her irrational Negative thinking Emotional when she was dealing with people at home and at her workplace thinking Able to manage her worries Able to manage her emotion while dealing with people Running thoughts resulting Able to control outburst of in her inability to fall asleep emotion Can fall asleep and stay asleep for 6-8 hours

36 IV. CASE 2: PATIENT DIAGNOSED WITH INSOMNIA PATIENT GENDER AGE DIAGNOSIS B FEMALE 48 INSOMNIA Patient complained of fatigue, unable to focus in work, mood disturbances and a lot of running thoughts. Increased level of beta activity during sleeponset period and early sleep stages.

37 IV. CASE 2: PATIENT DIAGNOSED WITH INSOMNIA Counseling Counseling Approach Used: CBT and Behaviour Therapy. CBT : Helped the patient to focus on things that happened throughout the day, checked and changed the thinking and emotion. Behaviour Therapy : Used imagery and relaxation technique.

38 IV. CASE 2: PATIENT DIAGNOSED WITH INSOMNIA Neurofeedback Plays a role in maintaining an awake state and, conversely, help the brain sleep. Theta training : Suitable for patients having difficulty in initiating sleep. Delta training : Benefits patients who has problems maintaining sleep (Diaz, Sloot et al. 2012).

39 PROTOCOL F2 Beta : Improve motivation

40 NEUROFEEDBACK SESSION Month Session Treatment Protocol Session 1 Session 7 T3 T4 Delta, P4 Delta, F2 July August Session 8-16 Total sessions Beta, F3 Beta 16 *** F2 Beta was alternated with F3 Beta starting from Session 6-16.

41 FINDINGS (16 Sessions of Neurofeedback and 3 Sessions of Counseling) Presenting Problem Outcome Tired after waking up Using the techniques trained in the Fatigue all day counseling session, she is able to fall Could not focus nor into sleep and sleep through the night concentrate Mood disturbances without waking up Felt rested in the morning Able to focus and go about her daily activities Cheerful

42 IV. CASE 3: PATIENT DIAGNOSED WITH OBSESSIVE COMPULSIVE DISORDER PATIENT GENDER AGE DIAGNOSIS C MALE 72 OBSESSIVE COMPULSIVE DISORDER (OCD) Patient complained of obsessive thoughts and compulsive behaviour that caused anxiety.

43 IV. CASE 3: PATIENT DIAGNOSED WITH OBSESSIVE COMPULSIVE DISORDER Counseling Counseling Approach Used: CBT and Behaviour Therapy. CBT : Used assignments to help the patient to work through the obsession and compulsiveness. Behaviour Therapy : Train thought stopping and relaxation techniques.

44 IV. CASE 3: PATIENT DIAGNOSED WITH OBSESSIVE COMPULSIVE DISORDER Neurofeedback Overactive brainwaves at the frontal lobes caused patient to have OCD symptoms (Jacobs, 2013). Delta training at frontal lobe lowers down beta and hi-beta in order to reduce anxiety and obsessive thoughts.

45 PROTOCOL T3 Fz Delta: Reduce obsessiveness

46 NEUROFEEDBACK SESSION Month Session November Session 1 Session 5 Treatment Protocol F3 Beta, T4 Delta, Dec ember Session 6 Session 11 Total sessions 11 T3 Fz Delta

47 FINDINGS (11 Sessions of Neurofeedback and 3 Sessions of Counseling) Presenting Problem Outcome Fear of contamination or Reduced fear of contamination dirt Having things orderly and Able to walk away if things are not orderly and as he wants it to be the way he wanted it to be Noted unwanted repetitive Unwanted repetitive thoughts Aggressive or horrific thoughts and able to challenge the irrational thoughts Able to pause and review thoughts about harming aggressive or horrific thoughts himself or others about harming himself or others

48 IV. CASE 4: PATIENT DIAGNOSED WITH DEPRESSION PATIENT GENDER AGE DIAGNOSIS D FEMALE 41 DEPRESSION Patient complained of feeling low in spirit, persistent feeling of sadness and loss of interest. Other symptoms displayed by patient are feelings of hopelessness, worthlessness, helplessness, restlessness, and thought of suicide.

49 IV. CASE 4: PATIENT DIAGNOSED WITH DEPRESSION Counseling Counseling Approach Used: Psychoanalysis Therapy. Psychoanalysis Therapy : Hypnotherapy to resolve unfinished businesses of her past.

50 IV. CASE 4: PATIENT DIAGNOSED WITH DEPRESSION Neurofeedback Neurofeedback moderates depression and mitigates anxiety as well as rumination (Hammond, 2005). Brain training focused more on the patient s frontal and temporal lobes.

51 PROTOCOL F2 Beta : Improve motivation F3 Beta: Reduce depression

52 NEUROFEEDBACK SESSION Month Session August Session 1 Session 2 Treatment Protocol F3 Beta, T4 Delta, September Session 3 Session 9 October Session 10 Session 16 Total sessions 16 T3 F2 Delta

53 FINDINGS (16 Sessions of Neurofeedback and 5 Sessions of Counseling) Presenting Problem Outcome Less motivated to do Able to occupy herself with tasks beneficial activities Running thoughts Able to control her running thoughts Annoyed by past and Resolved unfinished business and present family issues Sad feelings with suicidal thoughts inner conflict Become calmer when she deals with family members. Does not get annoyed easily No more suicidal thoughts

54 V. CONCLUSION Patients with mental disorders experience relief using various treatment models such as medication, psychotherapy / counseling, traditional medicine and neurofeedback. Neurofeedback and counseling can be an option for patients who does not respond well to medications. Neurofeedback provides opportunity for the patient to optimize brain functioning and counseling provides face-to-face therapy to find solutions.

55 V. CONCLUSION (cont.) The patient can choose their treatment approach after discussing with their psychologist/counselor. Combination of two treatment services (neurofeedback and counseling) works best towards recovery. Therefore, it is concluded that integrating counseling and neurofeedback is an effective integrated treatment model.

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