Feature - Retraining the Brain
For Andy Godin, 20 years as a combat engineer on missions to Cyprus, Croatia, Bosnia and Herzegovina, Macedonia and Kosovo had taken its toll. Returning to Canada to serve as a warrant officer responsible for more than 40 military and civilian personnel, he says he ended up in such dire straits he was at the end of his military career “just counting pencils.”
“Soldiers are trained to be task-oriented with the mission before all else,” says Godin. “With that singular focus, stuff piles up only to explode later. When my service ended, I had no idea what the hell everything else was. Normal life was strange.”
Godin was diagnosed with post-traumatic stress disorder (PTSD), an anxiety disorder that is often accompanied by deadened or volatile emotions, flashbacks, nightmares, depression, anxiety, rage, insomnia and substance abuse. In recent years, as more becomes known about the disorder, the military has taken further steps to support soldiers with PTSD or operational stress injury with counselling and peer-support groups.
After Godin was diagnosed, his doctor, psychiatrist Dr. Janet McCulloch, suggested neurofeedback, a treatment that measures and affects brain activity. “I thought it was something out of a ‘sci-fi’ novel, but I had not much else going for me. I was desperately ill,” says Godin.
Godin says neurofeedback has “cut the edges off the bad times” and although sometimes he can still feel negative emotions coming on, he now can pick up the signals and is able to “slow it all down before going off the deep end again.”
In Kingston, treatment of post-traumatic stress disorder is changing in a remarkable way. Nestled in behind the HSBC Bank on Princess Street, the Kingston Institute of Psychotherapy and Neurofeedback (KIPN), operated by psychiatrists Dr. Janet McCulloch and Dr. Linda Beckett, has been utilizing the technology of biofeedback in a 21st-century application, offering a type of fitness workout for the brain.
In the clinic’s seven training rooms, patients relax in recliner chairs as technicians fasten electro-encephalogram wires to various points on the scalp and ears to “capture” brainwave patterns, which are fed to a computer. That information is then displayed back to patients as they listen to music and watch fractals displayed on a screen. When the computer detects turbulent brainwave patterns, the patient will hear sounds akin to the needle-skipping sound of static on old-fashioned vinyl records.
“When the patient hears this static, they are alerted to the turbulence and automatically adjust their patterns,” says Dr. Janet McCulloch. “It is not unlike if you are driving along on the highway and you drift into the rumble strips and automatically correct your lane orientation.”
This new approach is the result of recent neuroscience research that shows brainwaves can be altered through practice and repetition. “We no longer see the brain as hard-wired in a way that is permanent. Now, the brain is seen as a neuroplastic organ, capable of changing its own pathways and structure,” says McCulloch.
According to Dr. Linda Beckett, the brain is amazingly adaptable. Researchers have found that for any given situation, the brain exhibits a normal brainwave pattern. Healthy and regulated nervous systems will react with the appropriate patterns. A person experiencing a variety of psychological or circumstantial difficulties may not have a regulated brainwave response, something called dys-regulation. Neurofeedback addresses problems of brain dys-regulation, an underlying cause of many complaints.
“We no longer see the brain
as hard-wired in a way that is
permanent. Now, the brain is
seens as a neuroplastic organ,
capable of changing its own
pathways and structure.”
Dr. Janet McCulloch
“The brain can learn to make adjustments to improve its own performance. When it learns to self-regulate, its efficiency, health, stability and performance improve,” says Beckett. “We are seeing growing numbers of our patients exert more control over focus, attention, impulsiveness, blood pressure, improved sleep, making for better lives, better relationships.”
Many of the clinic’s military and civilian clients are recovering and coping better with a number of psychiatric conditions, of which PTSD is one. Nearly 400 patients pass through the clinic doors weekly, seeking help for anxiety, depression, panic or obsessive compulsive disorders, as well as children referred to neurofeedback for attention deficit hyperactivity disorder (ADHD). Since opening, the clinic has treated more than 40 people with PTSD.
It was nearly three years ago in their separate practices that McCulloch and Beckett started using neurofeedback with some of their patients who were struggling to recover from severe and prolonged manifestations of PTSD and other psychiatric disorders. Many were veterans or soldiers on medical leave.
When many of their patients began to respond, they and another colleague did a small pilot study exploring the use of neurofeedback for military PTSD. The study showed that neurofeedback significantly reduced symptoms. With promising results, the two physicians and a young Queen’s University graduate, Alex Legnini, set up a small clinic in modest premises on Fraser Street three years ago and began offering neurofeedback to a growing number of patients. Legnini now acts as KIPN’s chief executive officer and has designed the space and infrastructure for the clinic. He talks about his grandfathers, both of whom fought in the Second World War, and is proud to be part of a process that helps soldiers and their families.
The move to the larger Princess Street premises happened two years ago and now, with 10 employees and some 1,200 patients later — not all veterans — neurofeedback is garnering new attention across North America, with the Kingston clinic the largest centre offering the treatment.
McCulloch says she’s seen neurofeedback help more people in the course of one year than what she was able to do in 25 years of medical practice.
“At a certain point in my medical career, I had many patients who weren’t getting better, just trudging along, staying stuck, but not living. A colleague in Kingston, Dr. Heather Pearson, introduced me to this system and it was easy to see the improvements when this group began neurofeedback training at my office.”
Beckett says neurofeedback therapy fits well with her philosophy of medical practice “not believing or thinking people need to be fixed by me... In my practice, I prefer to promote wellness, support healing, ease a journey through problem issues and help heal psychological issues or psychiatric conditions, with support, understanding and sometimes medication. Neurofeedback fits with my philosophy and is helping many of my patients, some of whom are now off their medications and leading happier lives,” she says.
Sessions last between 35 to 55 minutes depending on the type of therapy and protocol prescribed. Before each session and again at six- to eight-week intervals, patients fill out questionnaires about their emotions, sleep and indicate whether or not certain symptoms are occurring or improving.
“The first thing most people notice is a distinct improvement in energy,” says Beckett. “And after a few sessions, people report feeling more focused, calm and centred. Soon they are telling us they are less bothered by doubts and insecurities and some of their upsetting thoughts are easing or disappearing. Essentially, neurofeedback is a brain fitness system.”
KIPN uses eight systems and software, each licenced from the Zengar Institute Inc. of British Columbia, which has more than 2,000 units in use in Europe, Australia, Canada and the United States.
Cost for patients is not covered by Ontario Health Insurance Plan (OHIP), though Veterans Affairs Canada covers the session fee for veterans with PTSD or operational stress injuries. There is a sliding fee scale at the clinic for other patients whose extended health benefits do not cover the costs of the therapy and the clinic offers free treatment for veterans’ family members. Veterans Affairs has also funded the cost for some veterans to be provided with home systems.
“Provincial health plans require extensive evidence-based research for therapies to be approved for coverage,” says Beckett. “Currently we are in process of gathering data for publication on some 1,200 patients who have been treated with neurofeedback so perhaps we will see OHIP and other plans accept this therapy for coverage.”
“At a certain point in my
medical career, I had many
patients who weren’t getting
better, just trudging along,
staying stuck, but not living.
A colleague introduced me to
this system and it was easy to
see the improvements when
this group began neurofeeback
training at my ofice.”
Dr. Janet McCulloch
Dave Manryk is a retired veteran with more than 30 years’ service in deployments around the world, experiences that eventually drove him to despair and left him suicidal. One day on the way to work at the base here in Kingston, he cracked and says he “just wanted to put [his] car into the river.”
He called his military superior, was hospitalized and eventually was referred to a Guelph, Ontario-based institution for PTSD therapy. Yet when he returned to Kingston, despite being in peer-group support and psychiatric counselling, he was “bouncing all over the place, still grasping at straws.”
“Because of PTSD, I was isolated, angry, smoking two or more packs of cigarettes a day, high blood pressure and blood sugars and with horrible relationships,” says Manryk. “One day, Dr. McCulloch suggested I try neurofeedback and frankly, I was just desperate because life was so terrible.”
Manryk says after six or eight sessions he began to notice significant changes, seeing his agitation, anger and aggression diminish.
“People in my therapy group recognized the changes. And I was more settled in my thoughts so I could see my own signals when I was sliding again into distress. I could use all the ‘tools in my psychiatric toolbox’ to deal with my emotions,” he says. “I don’t care if I do this for the rest of my life. It is not invasive. It is not painful. And I am even off my antidepressant medications. My blood pressure is down. Neurofeedback saved my life.”
After Rick Gould spent 34 years with five different classifications in the Canadian Forces, he says in 2004 his PTSD “came out sideways.” At the time he was chaplain to soldiers returning from Rwanda.
“I was hospitalized with compassion fatigue after Rwanda, was suicidal on mood suppressants and finally was released from the forces in 2006. I completed a master’s degree despite the mess I was in and yet was still suicidal,” he says. “Then in desperation, I decided to try neurofeedback because I trusted Dr. McCulloch and her ideas for my treatment.”
Gould rallied. And he became one of the first veterans to be approved by VAC to purchase his own $7,000 system, which he now uses daily.
“I can still be triggered and have intense feelings, but now I can recognize and change my reactions to things. Without neurofeedback, I would be dead right now,” he says. “My gratitude is bottomless for the changes that have come to my life.”
McCulloch and Beckett have high hopes for the long-term acceptance of neurofeedback by the wider medical community and by government health plans.
“That Veterans Affairs Canada has recognized and now funds neurofeedback for PTSD is an enormous vote of confidence in this therapy,” says McCulloch. “During and after the two World Wars, there were enormous advances made in surgery, neurosurgery and general medicine, which carried over to the rest of the population. I hope this happens with neurofeedback. If the medical innovations that are used to treat these wounded soldiers can help us to advance treatment of mental illness, we will have made something good from the horror of this war.”
McCulloch also sees practical and realistic factors for use of neurofeedback therapy. “The numbers of people whose lives are affected by mental illness is too high. Psychotherapy and medications have helped many patients and will continue to do so,” she says. “But with neurofeedback we can help more people more quickly and with less expense. That makes sense to me.”