Neurofeedback: Building a Network of Care
This is a hopeful time for mental health as we are seeing a movement towards research and delivery of interventions that support a person centered, recovery model. Our commitment at New Pathways is to build a network of care that provides evidence based and phase oriented treatments for trauma and to support “real world” research on how these interventions work.
One way that we are growing our network of care is through our neurofeedback program and participation in the Neurofeedback Advocacy Project (NAP).
The goals of NAP are aligned with the social work values of New Pathways - service, collaboration, equity, accessibility, and community. We share our vision for participating in this project and how we hope it will support our goal of creating an integrative network of care for people recovering from trauma and overwhelming stress.
What is Neurofeedback?
Neurofeedback, or EEG biofeedback, is a non-invasive technology-based therapy that has been around for a number of decades. The therapeutic application of neurofeedback has been used for conditions such as concussions, ADHD, addictions, trauma, as well as peak performance for musicians, athletes, and business leaders.
Neurofeedback uses a brain computer interface (BCI). This interface detects electrical brain activity in real-time and trains the brain to respond to a defined frequency that is calming and stabilizing for the nervous system. While it sounds complex, the simple goal of neurofeedback is to reduce symptoms that are interfering with one’s ability to function in daily life through nervous system regulation.
Advances in technology and the availability of computers have made it possible for neurofeedback to be more widely available to health professionals. As we will discuss, the real challenge for neurofeedback is the training, supervision and delivery of services by skilled professionals within a network of care.
Neurofeedback and Psychotherapy for Trauma: Enhancing Regulatory Capacity
“Any way that you end up living in fear means a loss of quality of life. It's just difficult to address this only through therapy.” Sebern Fisher
One of the reasons we have adopted neurofeedback at New Pathways is because it supports a phased model for the recovery of PTSD and complex trauma. In this model there are three phases for treatment: 1) safety and stabilization, 2) confronting, working through, and integrating traumatic memories, and 3) reconnection, growth and restoration.
Clients seeking trauma therapy inevitably present with symptoms of nervous system dysregulation and need to start with the stabilization of symptoms which can be both physiological or psychological in nature. Phase one therapy includes psychoeducation about trauma recovery, increasing resources for well being, and learning self regulation strategies. It can also involve lifestyle changes and medication, as needed.
According to the polyvagal theory, trauma therapy is dependent on a “neuroception” of safety. Neuroception refers to the nervous system’s ability to detect threat without conscious awareness, whether it be in the environment or within one’s internal experience. But in order to feel safe, one has to know what safety feels like in the body, not just as a concept. This is a challenge for those who have grown up in unsafe and unpredictable environments and the default setting of the nervous system is to be on guard.
The goal of therapy is to offer a corrective experience of feeling safe and supported with the presence of a consistent, caring other. For those suffering from complex trauma, therapy may not be sufficient to dampen the fear response enough for them to benefit from therapy. Trauma therapist and neurofeedback expert Sebern Fisher advocates for a brain-informed treatment, not just by learning about the brain, but by working with it directly through neurofeedback. Neurofeedback enhances the work of therapy by helping to stabilize and regulate the brain circuits, thereby changing one’s ability to feel safe in the world and engaged in everyday life. Sebern Fisher’s work has inspired many therapists, like ourselves, to adopt neurofeedback as an adjunct to psychotherapy in the recovery of trauma.
To date, there has been limited research on neurofeedback for trauma, but emerging research is promising. A recent study led by Bessel Van Der Kolk and colleagues demonstrated improved trauma scores for those receiving neurofeedback compared to treatment as usual. Future research will depend on the commitment of dedicated clinicians who can collaborate with academic researchers in real world settings to demonstrate the efficacy of neurofeedback therapy in the treatment of trauma.
Challenges to Building Services and Accessibility for Neurofeedback
There are many challenges to offering neurofeedback as an adjunct service for trauma therapy. Even though it has been around for several decades and dedicated therapists report it to be an essential part of their practice, it is not widely offered in private and agency settings. It is helpful to understand some of the reasons why.
One reason for the low adoption rate amongst therapists is the technological and scientific nature of this intervention, which differs from the softer skills of counseling. Neurofeedback requires training in technical procedures and a foundational understanding of brain science that is not widely taught in the social work and counseling profession. The initial costs of setting up a neurofeedback clinic are much higher than a therapy practice, which has historically low overhead costs. Increasing popularity of online therapy has also contributed to lower overhead. . In addition, neurofeedback requires a long term commitment to ongoing learning and supervision in clinical skills on neuroscience informed therapy. This can be challenging for therapists at any stage of their career and will be appealing to those who are drawn to innovation and challenge.
Another barrier to offering neurofeedback services is the integration of this treatment into a continuity of care for mental health. Dr. Tom Insell (the former director of the National Institute of Mental Health) writes that we are in a mental health crisis not because we lack resources, but because the system is fragmented and poorly coordinated. Even with research studies of neurofeedback, the success of this treatment will depend on how it is integrated with skilled trauma therapists and mental health professionals.
Currently, most neurofeedback services are offered in private practice clinics for individuals who can pay out of pocket or have health care benefits to pay for the services. The financial barrier limits access to many marginalized and underserved populations who need neurofeedback and integrated trauma services the most.
Neurofeedback Advocacy Project
This year (2022) New Pathways signed onto the Neurofeedback Advocacy Project (NAP) as part of our commitment to developing neurofeedback services as an adjunct to trauma therapy.
NAP was founded by psychologists Dr. Matt Fleischman and Dr. Henry Kaiser in Oregon who are both dedicated to the cause of raising awareness and accessibility of neurofeedback.
The mission of NAP is “to implement neurofeedback in agencies working with underserved and vulnerable populations and to track results on the client, agency, and healthcare system”. New Pathways qualified as the first Canadian group to participate in the project because of our commitment to improving services for trauma recovery through research, program development, and clinical support.
By participating in NAP, we are also contributing to real world research that demonstrates the results of treatment and cost savings in health care settings by using NAP’s results tracking system. Dr. Fleischman reports that through the project many publicly funded agencies are adopting neurofeedback as a regular service because of client retention. Agencies are reporting an no show rate as low as 4% compared to the usual no show rate of 30-50% for other treatments. Clearly the clients are finding enough benefit to keep returning to treatment which is a very reliable measure of treatment efficacy.
As mentioned, one of the biggest barriers to expanding services for neurofeedback is access to training and equipment. NAP is able to provide training and supervision to therapists at a fraction of the cost compared to usual treatment. This enabled us to hire a postgraduate social work intern, create a second neurofeedback room, and expand our services to see more clients at a lower cost.
Future Plans: Growing Our Network of Care
Our goal at New Pathways is to make neurofeedback more accessible through collaboration and training with researchers and clinicians who are dedicated to providing integrative and neuroscience informed therapies for the treatment of trauma. Since opening the clinic at the beginning of the pandemic, demand for services has grown. Through the partnership with NAP, we have added two new therapists to our neurofeedback therapy team and have begun developing a program to improve access to services and outreach to the community.
By offering neurofeedback training and supervision, we are able to offer low treatment to a limited number of qualifying clients who are working with a trauma program or therapist as their primary source of ongoing support. This program is designed to support phase one of trauma therapy by providing a foundation of nervous system regulation that will help stabilize clients, enough to participate in more intensive trauma therapy.
In order for this service to be successful, we will be looking to collaborate with trauma therapists and health care professionals who could identify clients who would benefit from neurofeedback as part of their overall recovery plan.
Therapists who are interested in learning more are invited to register for our newsletter to receive more information, fill out the form below!
