11/2/2015. Neurofeedback Treatment of Severe and Suicidal Depression. Victims of Untreatable Depression. BCIA Webinar 15-8:

Transcription

1 Neurofeedback Treatment of Severe and Suicidal Depression BCIA Webinar 15-8: November Presented by Dennis A. Romig, PhD, BCN Director, Brain Improvement Center Austin, Texas Special Acknowledgement to Dr. Angelo Bolea Dennis Romig, PhD and Angelo Bolea, PhD 1 Victims of Untreatable Depression Dennis Romig, PhD and Angelo Bolea, PhD 2 Dennis A. Romig, PhD, BCN Brain Improvement Center.com dromig@sidebyside.com Austin, Texas Psychologist and Director of the Brain Improvement Center, Group private practice treating clients using Neurofeedback, other Biofeedback, and cognitive behavioral treatment (CBT): Traumatic Brain Injury (TBI) and Post-Concussion Syndrome (PCS) Depression Anxiety Attention Deficit Disorder (ADD) and other psychological problems Current President of the Biofeedback Society of Texas Co-Program Chairman of the Association of Applied Psychophysiology and Biofeedback (AAPB) 46 th Annual Scientific Meeting in Austin, Texas in March, 2015 How Texas Veterans Benefit from Neurofeedback. Invited to give a presentation and demonstration at the Texas Capitol to the Texas Governor s Staff, Texas House Staff, Texas Senate Staff, Austin, TX (Resulted in additional state appropriations for neurofeedback treatment of military veterans) Bolea, A., Romig, D. & Romig, L. (2012). Heal Your Brain and Body: Think and Speak the Positive. Performance Research Press: Austin, TX. And Bolea, A., Romig, D. & Romig, L. (2012). How to Have Brain Healing Sleep. Performance Research Press: Austin, TX. Brainimprovementcenter.com Dennis Romig, PhD and Angelo Bolea, PhD 3 1

2 Webinar Objectives 1. Suicidal depression can be successfully treated with neurofeedback 2. How to assess the brain waves for the best starting methods 3. The three parts of depression that the Quadrant Brain Model treats 4. Prototype methods for each part of depression 5. Recommended Adjunctive Methods to treat Depression Dennis Romig, PhD and Angelo Bolea, PhD 4 BCIA Webinar Outline Suicidal and Severe Depression Treatment Results using Dr. Angelo Bolea s Quadrant Brain Approach Overview of Research on 20 Successful Clients with Suicidal or Severe Depression First Depression Case Presentation- A : Postpartum Depression Second Depression Case Presentation- J : Post-Concussion Syndrome Depression Improvement in Sleep as a path to decreasing D Adjunctive Methods to Support Neurofeedback Your Questions and Ideas Dennis Romig, PhD and Angelo Bolea, PhD 5 Research Basis for Bolea Quadrant Model for Successful Neurofeedback 1. Hospitalized Long Term Schizophrenic Patients Treatment success with 70 chronic inpatient schizophrenic patients, most with head injuries and depression symptoms, were successfully discharged. Two year follow-up showed improvements were sustained. Angelo Bolea, Ph.D., Neurofeedback Treatment of Chronic Inpatient Schizophrenia. Journal of Neurotherapy, (1), Dennis Romig, PhD and Angelo Bolea, PhD 6 2

3 2. Successful Treatment of 25 Consecutive Clients with Post Concussion Syndrome using Neurofeedback The results of a study of 25 consecutive clients with Post-Concussion Syndrome brain injuries were presented. The diagnostic characteristics of the clients were described including the number of head injuries, the presence of psychological trauma, the variety of symptoms at intake, and the length of time between head injuries and onset of symptoms. Of the 25 clients, 21 were completely rehabilitated, while the other 4 clients went from total disability to only partial disability. The neurofeedback protocols and the adjunctive treatments that were found most useful were presented. The principles for which adjunctive modalities to use based upon the severity and co-morbidity of symptoms were outlined. Successful Treatment of 25 Consecutive Clients with Post Concussion Syndrome using Neurofeedback and a Variety of Adjunctive Interventions. Angelo Bolea, PhD & Dennis Romig, International Society of Neurofeedback Research 2014 Annual Conference, San Diego (Video available through ISNR) Dennis Romig, PhD and Angelo Bolea, PhD Neurotherapy Treatment Results for Suicidal and Severe Depression 20 Consecutive, Sequential Clients Average Number of Sessions to Immediate Positive Results: 3.4 Primary Physician Referrals. Example Documented Immediate Positive Results: Slept Better, calmer, did not binge eat, mood is better, cleaned house, thinking better. Felt much better. Was able to accomplish much at home. Went off all 3 different medications. Feels positive. Nice to family. Felt better every day after 1st session up to Monday. Happier, less. Able to calm husband down in argument. Owner at work said it was good to have me back. Thinking and memory are better. Better mindfulness. Dennis Romig, PhD and Angelo Bolea, PhD 8 Neurotherapy Treatment Results for Suicidal and Severe Depression 20 Consecutive, Sequential Clients Average Number of Total Treatment Sessions for Depression: 12.6 Example Documented Positive Results in Client s Life: Able to return to job after 7 sessions. Physician remarked client looked better than in five years. Fewer headaches. I m a lot happier human being. Decreased sleep meds. I am doing better than I ever have in my life. Able to see own responsibility in problem. Felt better than she had in years. Not in the fog she d been in for a long time. Discontinued anti-depressants. Slept much better, good focus, calmer, felt optimistic, got and held a job. More optimistic than in whole life. Almost afraid to admit it, but I feel great. Seems like a miracle. I am experiencing happiness I have not felt since I was a child. Dennis Romig, PhD and Angelo Bolea, PhD 9 3

4 3. Neurotherapy Treatment Results for Suicidal and Severe Depression 20 Consecutive, Sequential Clients Average Number of Total Treatment Sessions for Depression: 12.6 All Clients able to return to work, education, and/or family responsibilities 19/20 Depression symptoms gone at conclusion of treatment. Off of all psychotropic medicine 95% Success Angelo Bolea and Dennis Romig. Immediate and Follow-up Success of Neurofeedback Treatment for 20 Severely Depressed Clients: Quadrant Brain Theory and Application, International Society of Neurofeedack Research Annual Conference, Carrolton, Texas 2013 (Video available from ISNR) Dennis Romig, PhD and Angelo Bolea, PhD 10 Comparative Relapse Rates for Different Treatments of Depression Treatment 1 Year Relapse Rate Prescription Drugs 50% Cognitive Behavior Therapy and Other Counseling Therapy 29-30% Expected Relapse Rate Bolea Romig Quadrant Brain Based Neurofeedback (n= 20) 30-50% 5 % Dennis Romig, PhD and Angelo Bolea, PhD 11 Neurofeedback increases white brain matter pathways and volume of Grey Matter,Dr. Mario Beauragard, ISNR 2011 Dennis Romig, PhD and Angelo Bolea, PhD 12 4

5 Two Major Principles of Biofeedback Success 1. The client understands how biofeedback works 2. The client is motivated to do the biofeedback training Dennis Romig, PhD and Angelo Bolea, PhD 13 First Depression Case Presentation Outline of A : Post-Partum Depression Presenting Depression Symptoms and Situation Interview Assessment Summary Quadrant Brain Spectral Assessment Summary What I did and Why I did it A s Treatment Results Dennis Romig, PhD and Angelo Bolea, PhD 14 A s Presenting Depression Symptoms and Situation 1. A, mother of 3 children, who was not feeling well went to a physician in a rural community 2. Physician prescribed anti-depressant medication 3. Few weeks later it was discovered that A was actually pregnant. 4. Had rough pregnancy and child was born three months premature. A visited hospital frequently to see infant 5. The day the infant was brought home, A was suicidal and refused to pick the infant up. Dennis Romig, PhD and Angelo Bolea, PhD 15 5

6 Head Injury and Other Health History: A Age : 29 Education and Training: High School Occupation: Mom Head Injuries: One head injury as 4 year old, left eye with golf club Three car accidents as a child Serious Illnesses like Strep Throat, Mono, Epstein-Barr s, Serious Sinus Staph infection of pelvic inflammation 2003 Interests and Hobbies: Reading, Cooking (Past), and Singing in Church Dennis Romig, PhD and Angelo Bolea, PhD 16 Client Education and Assessment 1 st Meeting Agenda (2 Hours) My Interaction Style Teaching, Respectful, and Side by Side 1. Stories of Successful Clients 2. Parts of the Brain have different functions 3. Client Frequencies and Desired Levels of Energy (microvolts) 4. How do you think Brain Wave Biofeedback can help you? - Client Goals 5. History: Mono/Childhood Strep; head injuries; sleep; traumatic experiences; psychotropic medications Dennis Romig, PhD and Angelo Bolea, PhD 17 Client Education and Assessment 1 st Meeting Agenda (2 Hours) Continued 6. Any questions? 7. Assessment at brain Sites. Print out assessment at each site and go over average scores. Client sees brain wave imbalances that correspond to Client Goals 8. Do abbreviated Neurofeedback Protocol on right side, left side, and right side 9. Write down results and show client results 10. Schedule Next Session Dennis Romig, PhD and Angelo Bolea, PhD 18 6

7 Critical Clinical Conditions Successfully Treated with Select Biofeedback Modalities Skill Stream Motor: Supplementary motor: movement get ready for movement SENSORY Leg & Foot Neck Remembering how it Shoulder feels to do it Associations must be some connection Hand Face Jaw Abdomen Associations what is it connected to Something is Happening Energized High Arousal Emotional Ridge Dennis Romig, PhD and Angelo Bolea, PhD 19 Brain Training Assessment Summary- A 1. What would you like to have improved? Depression, focused on death. Anxiety and Panic. No food for two days. Waking up hourly and rocking self to sleep 2. What challenging life events or psychological difficulties have you had? Newborn came home after 3 months in NICU and I started having anxiety. 3. Any substance abuse? Tobacco 4. Who are some of your relatives or friends who have had a positive impact on you? Mom, husband, mother and father-in laws, people at church 5. What would you like to do when your brain is trained the way you want? I just want to be involved in life. Take care of family and home. Dennis Romig, PhD and Angelo Bolea, PhD 20 The Three Parts of Depression that the Quadrant Brain Model Treats 1. Lack of positivity 2. Lack of Get up and Go, Weighed down with Foggy thinking 3. Continuous worry and anxious thoughts Dennis Romig, PhD and Angelo Bolea, PhD 21 7

8 Brain Wave Training Frequencies for Assessment Name of Frequency Delta/Theta Brain Waves Foggy Brain Waves. Sleep and Twilight brain waves. Frequency Settings Usual Training Goals with One Herz (Hz) Sensor (in microvolts) 2-5 Hz Less than 6-8 Less 3:1 theta/ beta/smr ratio Right Side Brain Alpha Brain Waves Calming and Optimism brain waves Left Side Brain Alpha Brain Waves Worry and Distractibility brain waves SMR (Sensory Motor Rhythm) Brain Waves Get up and go brain waves Beta Brain Waves Clear thinking Fast Beta Highly vigilant, Anxious (Inflammation?) 8-12 More than Less than 4-5 Less than left side Beta in frontal area. Equal to Beta in left side parietal More than More than or Less Dennis Romig, PhD and Angelo Bolea, PhD 22 The Three Parts of Depression that the Quadrant Brain Model Treats 1. Lack of positivity: At Cp4 and/or P4 the Bf ( Hz) is Higher than Alpha (8-12 Hz). Alpha > Bf at least 2 microvolts 2. Lack of Get up and Go, Weighed down with Foggy thinking: At Cp4 and/or P4 and/or Fc3 and/or F3 and/or Fp1 the DT is over the 3:1 ratio with SMR (13-15). get up and go is too low especially relative to the DT (2-5Hz) brain waves 3. Continuous worry and anxious thoughts: Left frontal alpha is higher than left frontal Beta (16-22Hz) Dennis Romig, PhD and Angelo Bolea, PhD 23 EEG Brain Wave Assessment Summary Name: A Date: Average Levels of Brain Waves in Improvement Goals Microvolts Right Side of the Brain FP2 DT 13.5 B 5.9 A 5.9 BF 6.4 SMR 2.9 F4 DT 11.3 B 6.6 A 6.5 BF 6.6 SMR 3.1 T4 DT 6.6 B 16.9 A 6.9 BF 24 SMR 4.6 P4 DT 7.7 B 6.5 A 7.3 BF 6.9 SMR 2.7 CP4 DT 11.3 B 9.2 A 11.8 BF 12.2 SMR 3.9 Lower Bf Lower Bf Lower DT Dennis Romig, PhD and Angelo Bolea, PhD 24 8

9 Dennis Romig, PhD and Angelo Bolea, PhD 25 EEG Brain Wave Assessment Summary Name: A Date: Average Levels of Brain Waves in Improvement Goals Microvolts Left Side of the Brain FP1 DT 30.3 B 8.1 A 10.2 BF 8.5 SMR 4.8 F3 DT 11.4 B 5.7 A 6.7 BF 6.2 SMR 3.8 T3 DT 6.9 B 5,3 A 5.0 BF 5.7 SMR 3.3 P3 DT 11.3 B 7.2 A 13.0 BF 5.2 SMR 3.5 FC3 DT 11.1 B 6.2 A 7.7 BF 5.6 SMR 3.4 Brain Improvement Center, Austin, Texas Dennis Romig, PhD and Angelo Bolea, PhD 26 Initial Therapy Training Session () Initial Assessment Level For one or more microvolts of improvement from previous level Date Brain Sites Inhibit/Lower Ave. Microvolts Reward/Raise Ave. Microvolts 7/17 Assessment Cp4 Bf 6.1 (12.2) A 8.1 (11.8) DT 8.1 (11.3) SMR 2.7 (3.9) Fc3 Bf 4.4 (6.2) SMR 3.2 (3.8) DT 10.7 (11.1) SMR 3.1 (3.8) Cp4 Bf 6.1 (12.2) A 7.8 (11.8) Dennis Romig, PhD and Angelo Bolea, PhD 27 9

10 A s Neurotherapy Results After 2 hour Assessment and Neurotherapy she jumped up, grabbed her husband, rushed home, and picked up her infant. At the beginning of second Neurotherapy session two days later, I asked, How is your brain doing? A replied, Doing better overall with a smile on her face. A completed 12 sessions of Neurotherapy. Commented, My brain feels better. Managing household and 4 children. Husband called a few weeks after A started Neurotherapy and said, I have seen so many positive improvements in A. Can I come in for some of this for myself? No relapse after 2 years. Dennis Romig, PhD and Angelo Bolea, PhD 28 How did A get such good improvement so rapidly? Dennis Romig, PhD and Angelo Bolea, PhD 29 Psychological and Behavioral Functions of Each Quadrant Dennis Romig, PhD and Angelo Bolea, PhD 10

11 Neurotherapy Protocol to Improve Optimism and Get-Up-and-Go Phase 1. One Sensor Site Inhibit Reward Time CP4: BF: hz Alpha: minutes hz DT: 2-5 hz SMR: hz 4-5 minutes FC3: A. BF: hz SMR: hz 4-5 minutes B. DT: 2-5 hz SMR: hz 4-5 minutes C. Alpha: 8-12 hz Beta: hz 4-5 minutes CP4: BF: hz Alpha: 8-12 hz 3-5 minutes Phase 2. Shift to Fp1 after Fc3 DT/Smr balance improves. Do Fp1 DT/Smr for 1-2 minutes the first two times. (Watch client.) Then increase Fp1 to 3-4 minutes. Use one Sensor first then shift to two Sensors using protocol on next page when there has been 80% or more improvement in balance at any site. Dennis Romig, PhD and Angelo Bolea, PhD 31 Neurotherapy Protocols to Improve Optimism and Get up an Go Phase 3: Two Sensors Do only following sites where improvement is needed Site Inhibit Reward Time CP4 P4 A. BF: hz Alpha: 8-12 hz 4 5 minutes B. DT: 2-5 hz SMR: hz 4 5 minutes FC3 F3 A. BF: hz SMR: hz 4 5 minutes B. DT: 2-5 hz SMR: hz 4 5 minutes C. Alpha: 8-12 hz Beta: hz 4 5 minutes F3 FP1 A. DT: 2-5 hz SMR: hz 4 5 minutes B. Alpha: 8-12 hz Beta: hz 4 5 minutes CP4 P4 BF: hz Alpha: 8-12 hz 3 5 minutes Dennis Romig, PhD and Angelo Bolea, PhD 32 EEG is the Missing Link in the assessment and treatment of concussions and other head injuries. Andrew Lozen, M.D. Neurosurgeon Medical College of Wisconsin Diagnostic Neuroimaging Course July, 2015 Dennis Romig, PhD and Angelo Bolea, PhD 33 11

12 Concussions and other head injuries set off a cascade of brain changes that over time increase post concussion syndrome (PCS) symptoms, including sleep disorders and depression. The PCS symptoms can emerge from 1 week to as long as 30 years after the injury. Second head injury and/or illness and/or psychological trauma increase symptoms and their intensity. Dennis Romig, PhD and Angelo Bolea, PhD 34 Second Depression Case Presentation Outline of J : Post Concussion Syndrome Quadrant Brain Spectral Assessment Summary Presenting Depression Symptoms and Situation What I did and Why I did it J s Treatment Results Dennis Romig, PhD and Angelo Bolea, PhD 35 Brain Training Assessment Summary J 1. What would you like to have improved? Motivation, depression, not optimistic; waiting for other shoe to drop 2. What challenging life events or psychological difficulties have you had? First husband verbally and emotionally abusive. Mom died in Had mono in Any substance abuse? No 4. Who are some of your relatives or friends who have had a positive impact on you? Friends, daughter-in-law, and people at church 5. What would you like to do when your brain is trained the way you want? Find joy again. Dennis Romig, PhD and Angelo Bolea, PhD 36 12

13 EEG Brain Wave Assessment Summary Name: J Date: Average Levels of Brain Waves in Improvement Goals Microvolts Right Side of the Brain FP2 DT 21.8 B 5.0 A 8.0 BF 7.8 SMR 4.4 F4 DT 14.5 B 6.1 A 7.8 BF 12.9 SMR 5.3 T4 DT 6.4 B 5.8 A 5.8 BF 9.8 SMR 4.0 P4 DT 13.9 B 6.2 A 11.6 BF 7.0 SMR 7.0 CP4 DT 10.1 B 6.2 A 14.4 BF 5.5 SMR 8.7 Dennis Romig, PhD and Angelo Bolea, PhD 37 EEG Brain Wave Assessment Summary Name: J Date: Left Side of the Brain FP1 DT 30.0 B 6.5 A 11.0 BF 11.1 SMR 6.2 F3 DT 9.1 B 7.7 A 13.2 BF 9.4 SMR 8.9 T3 DT 8.3 B 6.9 A 12.3 BF 7.0 SMR 8.2 P3 DT 9.3 B 6.9 A 11.4 BF 7.3 SMR 7.9 FC3 DT 14.3 B 7.5 A 10.2 BF 6.7 SMR 6.6 Dennis Romig, PhD and Angelo Bolea, PhD 38 Interview Assessment Summary J June 8: J reported that she struggles with depression and fear. Sleeps a lot. No motivation. Sick a lot. Feels depleted of energy. Has been on anti-depressant medications. Stated that she has had mild depression for some time, but the depression has become severe the last three months. June 13: Told her husband I questioning her about having a head injury. He replied, Yes, you were in the automobile accident with your sisters in February, A whiplash from a rear end collusion. Countercoup Fp1 Dennis Romig, PhD and Angelo Bolea, PhD 39 13

14 Initial Three Therapy Training Sessions Initial Assessment Level Date Brain Sites Inhibit/Lower Ave. Microvolts Reward/Raise Ave. Microvolts 6/8 No difference From assessment 6/10 No difference From assessment Report from Husband 6/13 CP4 Bf 7.1 (6.8) A 8.5 (14.4) Dt 11.4 (10.1) SMR 6.4 (8.7) F3 Bf 7.2 (9.4) SMR 6.6 (8.9) A 9 (13.2) SMR 7 (8.9) DT 14.9 (9.1) SMR 9.1 (8.9) FC3 DT 7.8 (9.3) SMR 7 (8.9) Cp4 Bf 7.7 (6.8) A 8.8 (14.4) 7/4 Fp1 F3 DT 11.5 (30) one sensor SMR 3.7 (6.2) Dennis Romig, PhD and Angelo Bolea, PhD J s Neurotherapy Results June 16, 2011 Amazing how much better I feel. Got more done in the last 2 days than you can believe. July 18, 2011 Reports she is more alert and has more focus. July 27, 2011 Reports she is less anxious and stressed August 1, 2011 Big difference in being optimistic. Immediate memory is better. August 22, 2011 Discontinued anti-depressant last week. When I woke up the lights were brighter, sounds were clearer. More aware. August 29, 2011 Reports having less joy without anti-depressant. September 5, 2011 Weepy. No anti-depressants for three weeks. Reports that when she reads, she can comprehend better. J has improved so much that she can reduce from once a week treatment to once every two weeks. Dennis Romig, PhD and Angelo Bolea, PhD 41 J s Neurotherapy Results continued October 11, 2011 Great Sleep. Warm bath with Epson salt October 31, 2011 Sleep is better. Energy level is higher. Able to complete housework tasks and other projects December 12, 2011 Energy has improved. Sleep is so much better. This is the best Christmas present ever. March 20, 2012 Feel better than in years. Not in the fog I have lived in for so long. Improved reading comprehension. Discontinued Treatment, J referred her husband, her son, her daughter-in-law and a friend January 28, 2013 Tune up session I have never felt better in my whole life. It is wonderful. Total number of sessions : 25 No relapse after 3 years Dennis Romig, PhD and Angelo Bolea, PhD 14

15 Symptoms Caused by Poor Sleep Depression +Anxiety = Dizziness and/or Vertigo +Stress and Fatigue= Irritability + Anxiety = Poor Memory + Anxiety =Fatigue +Stress and Fatigue = Headache Lack of Concentration and Focus Dennis Romig, PhD and Angelo Bolea, PhD 43 Symptoms Caused by Depression Poor Sleep Lack of Motivation Anxiety Poor Memory Dennis Romig, PhD and Angelo Bolea, PhD 44 Neurotherapy Protocol to Improve Sleep Slow Down Breathing Rate to 9 Breaths per minute or less before start. Site Inhibit Reward Eyes Open Eyes Closed CP4 BF hz Alpha 8-12 hz 2 minutes 2 minutes DT 2-5 SMR minutes P4 BF 25-35hz Alpha 8-12 hz 2 minutes 2 minutes PO4 BF hz Alpha 8-12 hz 2 minutes 2 minutes O2 BF hz Alpha 8-12 hz 2 minutes 2 minutes FC3 Alpha 8-12 Beta minutes P4 BF Alpha 8-12 hz 2 minutes 2 minutes Dennis Romig, PhD and Angelo Bolea, PhD 45 15

16 Improve Positivity and Energy (Depression) Cognitive Behaviors Biofeedback Neurofeedback (EEG) Think 4 positive Paced Breathing thoughts after 1 negative thought Do activities that are fun Be around positive people Exercise 30 minutes Get a good night s sleep Heart rate variability biofeedback Increase optimistic brain waves (A 8-12 Hz at CP4, P4, P6) and Reduce anxious brain waves (BF Hz) Increase get-upand-go brain waves (SMR Hz) Reduce sleep brain waves (DT 2-5 Hz at CP4, FC3, and FP1) Dennis Romig, PhD and Angelo Bolea, PhD 46 Improve Sleep (Sleep Disorders) Cognitive Behaviors Biofeedback Neurofeedback (EEG) Rest 2 hours before bed No screen time 2 hours before bed Warm bath or shower 30 minutes begore bed No conflicts when tired, hungry, or sick Paced Breathing, 5-6 breaths per minute, eyes closed com/ RESPeRATE-Ultra- Pressure Hypertension- Reduction Smart phone ap- Breathe2Relax Interrupted sleep: Reduce anxious brain waves, increase optimistic brain waves, eyes open and eyes closed CP4, P4, PO4, 02 Sleep onset problem: Reduce sleep brainwaves (DT 2-5 Hz), Increase get-upand-go brain waves (SMR Hz) Dennis Romig, PhD and Angelo Bolea, PhD 47 Dennis Romig, PhD and Angelo Bolea, PhD 48 16

17 Dennis Romig, PhD and Angelo Bolea, PhD 49 Contact : Angelo S. Bolea, PhD Clinical and Consulting Neuropsychologist Annapolis, Maryland Dr. Bolea@Verizon.net Dennis A. Romig, PhD Psychologist Brain Improvement Center 9506 San Diego Road Austin, Texas (512) dromig@sidebyside.com Dennis Romig, PhD and Angelo Bolea, PhD 50 17