One of the biggest challenges in psychotherapy is knowing how long it may take clients to make lasting changes. For some people a few sessions is enough to help them through a difficult time. For others with deep-seated issues that stem from adverse experiences in early childhood, change through talk therapy can take years. Fortunately, psychotherapists now have a new tool available to us that to help facilitate change more quickly: EEG neurofeedback.
Just over two years ago I picked up the book Neurofeedback in the Treatment of Developmental Trauma: Calming the Fear-Driven Brain by Sebern Fisher, an accoplished psychodynamic therapist who worked for years with severely traumatized and neglected children and adults. In her book she described how EEG neurofeedback, or brain training, helped her work with clients who were suffering from a lifetime of being in a fear driven brain. For some people, talk therapy is just not enough as the brain is so strongly wired from childhood to be on guard for threat and feeling unsafe.
Mindfulness has become so popular in the past few years and is now made relevant to almost everything – parenting, business, driving, sports, art, lying in bed, walking, swimming, sex, eating …. just about anything. The word is so ubiquitous that it runs the danger of not meaning much any more.
Yet, as someone who has found meditation and awareness practices to be central to my well being and my clinical practice, I need to keep sifting through the hype and asking myself, what is it really all about?
At it’s core, mindfulness is simply a practice of being aware with an “open focus”. We hold whatever is in our present moment experience with a sense of knowing what is. This can be directed to our inner experience or our perception of what is happening around us. With mindfuln awareness we become a little less identified with our sense of self, and life feels much lighter. At least, this is my experience of it.
When I teach mindfulness in my clinical practice or in groups, I always have to start with finding out what people know about the practice and how it has helped them. Inevitably, because there is so much information about mindfulness, there is a range of experiences and inaccurate perceptions about what mindfulness is, especially as it pertains to mental health.
A common statement I hear from people is, “I tried it but it didn’t work for me.” This is unfortunate as many who are seeking relief for their mental health may be discarding a tool based on inaccurate perceptions of what mindfulness is and how it can be relevant to helping them. Instead of throwing the baby out with the bath water, I hope to address some of these misperceptions that I commonly hear and clarify what we are talking about when we talk about mindfulness for mental health:
1. Mindfulness is meditation
First and foremost, mindfulness is not synonymous with meditation. Meditation is simply a tool to practice this kind of awareness. It provides the container for us to experience this present moment awareness and it helps us to transfer this awareness to our daily lives in all that we do. Also remember, that not all meditation practices are mindfulness meditation. Meditations can use imagery or evoke a particular feeling or state which is not the same as being open to what is here in the present moment. It is important to make the distinction that mindfulness is not meditation and not all meditations are mindful.
2. Mindfulness is relaxation
Another common myth is that mindfulness is relaxation. It is understandable that people are attracted to mindfulness because there might be a promise of feeling calm and relaxed. However, this is not goal and intention but certainly a desired outcome for many of us who experience too much stress in our lives and for those suffering from anxiety and depression. The benefit of being aware of our experience is that it gives us information about what needs to be changed. If we are stressed and anxious, then we may become aware that we need to let go of muscular tension, slow down thoughts, breathe a little deeper, and that may help to let go of stress. However, the first step is to be aware of what we are feeling which may at first feel quite unpleasant. It may take some time and patience with the practice to feel more balanced and at ease especially if the nervous system is constantly revved up.
3. Mindfulness is cessation of thoughts
Just as we cannot every stop breathing, we can never stop our minds from thinking. It is not uncommon for people to think they cannot meditate because they keep having constant thoughts. Mindfulness helps us see thoughts from an observer perspective, but we can never stop the thoughts from happening. Awareness helps us to get less identified with thoughts and also see the thoughts as they are happening. This perspective also can help us be less identified with unhelpful thoughts that lead to anxiety and depression.
4. Mindfulness is a special state
Sometimes we go into meditation with an expectation of going into a special state. Indeed, in groups we may hear of one participant feeling blissed out, while others feel like a failure for just going over their mundane to do list or feeling overwhelmed with anxiety. With mindfulness we just acknowledge what is without preference, whether it be a blissful or anxious state. People who are struggling with addiction may be somewhat susceptible to this belief as it may be seen as a drug free alternative to spacing out or escaping.
5. Mindfulness is attention control
Lastly, mindfulness is not about attention control although we use practices to focus our attention on what is. The breath is a common point of focus we use to train the attention on the present moment. However, the end goal is not to just control attention but to stabilize the mind. Once we have given time to keep returning attention to the breath, we become much more aware of how the mind works and the tendencies to get pulled into anxious thoughts and rumination.
This list of myths does not get to the actual practice and insights that emerge from engaging in mindful awareness. My hope is that addressing the myths will help people to approach this practice with an open and curious mind rather than with set expectations from the barrage of information out there. It is only through engaging in the practice, ideally with the support of an instructor and group, that people can make sense of mindfulness as a tool for managing their stress and mental health.
In future blogs I will expand on the practices as we address them in the MAST program.
A great, short video that addresses the myths of mindfulness can be found in Andi Puddicombe’s TED talk, It Only Takes 10 Minutes a Day.
How does neurofeedback help to heal from trauma? People who suffer from trauma have a range of symptoms including anxiety, depression, hypervigilence, flashbacks, emotional reactivity, sleep disturbances, etc. From a neurofeedback perspective we can understand that all of these symptoms are disturbances in the resting state of the brain, otherwise known as the “default mode network.” Neurofeedback helps by teaching the whole brain to be in a good resting state so the whole system (body/mind) can calm down.
The Othmer method of neurofeedback treats trauma in two stages. The first stage addresses physiological regulation of the body through Infra Low Frequency Training. The second stage is working with deeper states and processing with a training called Alpha Theta. It is important that enough time is spent on stabilization before addressing deeper states as the body needs to feel safe enough to process the held memories of trauma.
First Stage: Infra Low Frequency Training
After doing an extensive 2 hour intake assessment to understand each person’s nervous system, we come up with a plan for training over a period of 20 sessions to start. In the first stage of treatment, the brain is trained at a frequency of .1 or lower. This is done by watching a video screen of a movie or game for a duration of 30-40 minutes with sensors of the head that pick up electrical activity of the brain. A sophisticated computer program takes that information and feedbacks information through changes in the signal from the monitor, giving your brain the information it needs to track a very low frequency.
Each person’s brain has an optimal low frequency that lets them feel calm and focused. In the first few sessions of ILF training we find that optimum frequency through a process called optimization. Through the 20 sessions we add training sites in the brain to address different symptoms of trauma. This is a gradual and collaborative process and requires a lot of attention to tracking how one feels during and in between sessions. It requires a lot of commitment and patience for both therapist and client as it takes time to get the protocol just right for each person. The overall result is a much more calm and regulated nervous system.
Second Stage: Alpha Theta Training
The first stage of ILF training can take more than the initial 20 sessions. Each person is very different and the progress in treatment can depend a lot on the nature and severity of the trauma; other compounding factors such as diet and substance use; and whether people are integrating neurofeedback treatment with traditional talk therapy to address the experience of trauma and recovery. All of these factors will impact on the progress of neurofeedback.
Once we know that the nervous system is regulated enough that people can feel relatively calm and resilient we can consider adding deep state training. By this time people feel they have more energy, can sleep through the night, recover more easily from life stressors, and feel more present and engaged in their lives.
Alpha theta training trains the brain in a very different way from ILF training. In this training the eyes are closed and we are induced into a deep relaxed state, usually in an inclined position with blankets to keep one comfortable. Alpha theta works with deeper parts of the brain (brainstem) by releasing cortical control. With the eyes closed our brains can go into an alpha and theta stage which means there is a dominance of these frequencies in the whole brain. Alpha waves are 8-13 Hz and are dominant when we are in an awake and relaxed state. Theta waves are slower (4-7 Hz) and are present before the very slow delta waves of sleep. In a theta state the brain produces more images and memories that can be processed.
Alpha theta training is often done with an induction to guide people into an internally focused, relaxed state. We may start with a short guided meditation to relax the body and mind and to settle into the training. It can also be helpful to set an intention or affirmation to help release traumatic memories and learned habits, and start to integrate new ways of being. This part of the practice can be very helpful in planting the seed for change that can happen through alpha theta training.
Alpha Theta training may be introduced before 20 sessions of ILF or after. Once people are introduced to this training they can choose whether they integrate it with ILF or shift into only doing Alpha Theta training.
Third Stage: Integration
The third stage of treatment for trauma is one that should be addressed through the whole process but becomes more important as the nervous system is regulated. This is the stage of integration and processing the meaning of trauma and recovery. While neurofeedback takes away the necessity of only using talk therapy for the recovery of trauma, it is still important to integrate psychotherapy in order to understand what it means to live without trauma. Often people experience a lot of grief for the years that they have suffered and how much they lost through this experience. They may also start to have a very different sense of self that can be very disorienting. All of these issues can be addressed through talk therapy.
Neurofeedback is not meant to be a stand alone treatment for trauma but one very powerful tool that can enhance and support the different treatments that support recovery of the whole person in body, mind and spirit.
Why is it so difficult to slow down, calm the busy mind and relax the body? This is one of the most common problems I hear about in my practice and for most of us the answer has to do with our addiction to busy lifestyles and constant engagement of our minds. The pace of our lives may be difficult to change but there are practical tools to help train the brain to slow down when needed.
One tool that I recommend and practice myself is the practice of Yoga Nidra, a guided meditation that promotes a deep state of relaxation. Research shows that a 30 minute practice of Yoga Nidra can equal 2 hours of restorative sleep and it is a relatively simple practice to learn. It just takes a commitment to making the time in one’s day.
Yoga Nidra and the Brain
Yoga Nidra works at the level of our brain waves by decreasing high beta frequencies (busy mind), increasing in alpha frequencies (relaxed state), and then guiding to a deeper dream like state with increased theta frequencies.
An interesting study in Copenhagen demonstrated this shift in brain wave activity by looking at the electrical activity of participants with an EEG during a Yoga Nidra practice. They found that the whole brain was in a relaxed state, similar to sleep for the duration of the meditation, and there was an increase of theta activity (11%) while the alpha activity did not decrease significantly (2%). This shows that the meditative state of Yoga Nidra is different from sleep in that the brain is still conscious and alert while allowing for a slowing down of thoughts and increase in images of a dream like state. It is in the space that rest and restoration can happen at the level of the whole nervous system.
Healing for Mental Health
Yoga Nidra comes from an ancient Tantric practice of yoga and has been adapted more recently for modern times and for mental health conditions such as anxiety, depression and trauma. One of the reasons that Yoga Nidra is effective for mental health problems such as trauma is that is promotes long term changes in the brain through neuroplasticity, the brain's ability to establish new synaptic connections and set new neural pathways for healing and self regulation. Research on Yoga Nidra fro trauma, for example, has shown a significant decrease in symptoms of PTSD including reduced rage, anxiety and emotional reactivity. A 2014 study with veterans 2014 published in the International Journal of Yoga Therapy “showed significant decreases in negative thoughts of self-blame and depression." Richard Miller, the creator of iRest, has adapted Yoga Nidra for PTSD and has conducted research with combat veterans, homeless people, domestic violence survivors, and other traumatized populations with very good results.
How does it work?
Yoga Nidra is essentially 10 practices in one. There is a sequence of steps that guides one from the busy mind state to a deeper and deeper state of relaxation. All of the steps may be practiced or just a few, depending on how much time one has to practice. These 10 steps are adapted from Richard Miller’s modern version of Yoga Nidra.
Step 1: Initial Relaxation
In this step we prepare for Yoga Nidra by lying down in a comfortable position in a room with little distractions. This is traditionally done in savasana or corpse pose with legs and arms extended, eyes closed and a blanket to keep the body warm. We take some time to settle the body and mind and shift to an inner awareness by letting the body be supported and relaxed.
Step 2: Setting of Intention for this Practice
In Yoga Nidra we make an intentional shift to acknowledge that we are doing this practice for the next 30 minutes and reflect on the attitude we are taking towards ourselves and this practice. We let everything else go, as best we can, and take a stance to welcome our experience as it comes and let the teacher’s words become our own words that guide us to a deeper state.
Step 3: Sankalpa or Heartfelt Desire
We now move beyond setting the intention for this particular practice and reflect on our heartfelt desire for our lives. This is very personal and is expressed in present moment language. Some examples of a sankalpa are “I am at peace”, “I am healthy in my body and mind”, “I have caring relationships in my life.”
Step 4: Finding an Inner Resource
This step is very important for people who suffer from anxiety and trauma and may feel unsettled and unsafe by paying attention to their inner experience. The inner resource can be a place, person, or image of something that evokes a feeling of safety and comfort in one’s life. We hold this image to evoke the feeling of safety and know that we can come back to this place at any time.
Step 5: Body Rotation
The mind is now guided to the specific sensations in throughout the whole body. This can be done fairly quickly so the mind has to keep moving attention to the direct sensations as they occur and is less easily distracted by random thoughts.
Step 6: Breath Awareness
The focus of attention now becomes the breath and the physical sensations of breathing. This can be done by counting the breath cycles backwards to help maintain focus of the mind.
Step 7: Opposites – Feelings, Emotions, Beliefs
This step moves beyond this direct physical experience to incorporate particular sensations (cold/hot, heavy/light), emotions (happy/sad, hurt/loving), and deep seated beliefs (I am worthy/unworthy) and how they are held in the body. We pay attention to opposites, moving from one to the other and then holding both.
Step 8: Joy – Visualization
The next layer of our experience to explore is the bliss state. In Richard Miller’s iRest practice he invites a feeling of pleasure, joy, or love. One may also be guided to particular images and visualization that can evoke deeper feelings of well-being.
Step 9: Witnessing – Observe Yourself
As we come towards the end of the practice we let go of any particular focus and just observe the self as a witness. We become aware of the part of self that can just observe the self and all the experiences that emerge in the present moment.
Step 10: Integration
The last step is to slowly emerge from the deep inner experience and return to a waking state. We set an intention to integrate Yoga Nidra into our daily lives and be more alert and relaxed in our waking state.
Here is a guided Yoga Nidra practice to try. It is recommended to try this practice on a regular basis to help the brain and body integrate the state of deep relaxation over time.
24 minute Yoga Nidra practice
For an introduction to Richard Miller's iRest practice try out these guided meditations:
Rachael Frankford, MSW, RSW is a clinical social worker in private practice. This blog is to share musings on mental health and about the intersection of mindfulness, neuroscience, and psychotherapy.