How Neurotherapy is Utilized In Recovery

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A Wise Mind Presented by Sabino Recovery S1 Ep 4

On the latest episode of A Wise Mind Presented by Sabino Recovery, host Sam Zimmer and Neurotherapist Andréa Copeland discuss the world of Neurotherapy, specifically the role of neuroplasticity in recovery, neurofeedback, and how it is utilized at Sabino Recovery and the benefits to using Neurotherapy in the treatment of trauma and addiction.

Episode Transcript:

Sam Zimmer: Welcome back to the A Wise Mind podcast presented by Sabino Recovery. Today, we have the pleasure of talking to Andréa Copeland, our talented neuro therapist, and she heads up our whole brain mapping and neurofeedback wing here at Sabino Recovery. Good morning, Andréa.

Andréa Copeland: Good morning. Thank you for having me.

Sam Zimmer: Of Course! No, it’s my pleasure. And I think a lot of people listening are gonna be really interested in, in what you have to say. Um, we were talking before we started recording, how sort of skeptical I was when I first got to Sabino, I was like, what the heck is brain mapping and neurofeedback? It’s pretty cool how we do it for new employees though, you know, since we’re so small, new employees get the chance to experience everything we have to offer. Here they go through a typical week of what it’s like to go to groups and individual sessions. So like we were talking about, I was like, what the heck is brain mapping and neurofeedback here on my schedule? I was a little bit skeptical.

And when I met with Andréa, she explained it very, very well. And I was definitely able to learn about what kind of benefits and stuff. So that’s what we’re going to talk about today.

Andréa Copeland: Looking forward to it.

Sam Zimmer: Yeah. Um, so brain mapping and neurofeedback, can you just speak a little bit about, you know, what that is and kind of like what it entails and

Andréa Copeland: Yeah. So brain mapping is always our initial session here. Every resident is provided with this service. So when a resident comes in, I will meet with them. Initially, we will place a fitted cap. 20 different sensors onto the scalp. What we’re doing is we’re recording the electrical activity right on the cortex.

And so what the brain map is going to do is it’s going to give us information about each one of our frequencies. And so we can break that down a little bit later in the series here, but that would be Delta, theta, alpha, a few different betas, and gamma. And what we’re looking for is any dysregulation from the norm.

And so we’re looking at standard deviations from the norm, of course, based on what we see in that brain map, it’s going to give me information on how to set a protocol for neurofeedback training. And it’s also going to give the team information and what direction to kind of lead the treatment planning.

So from the brain map, we’ll start the neurofeedback training. And basically what neurofeedback training really is. It’s a tool where we’re using QEG technology or EEG technology, rather, to help stabilize the central nervous system. And with that, we can really help an individual become more regulated so that they can really get the most out of treatment.

Yeah. I mean, that’s really the simplest way to explain neurofeedback in a nutshell. So actually, you know, I’ll add to that with the technology, what the resident is actually seeing is both auditory and visual feedback. And that is what is helping to create those new neural pathways to help stabilize the nervousness.

So when somebody gets their initial brain map back, it’s something that’s kind of like they can see in black and white, so to speak on, on the computer screen.  Right. So what does it show up? What does it show up as to them? Yeah, so it’s quantifiable information and so they’ll have a visual map of their brain.

And so there’s little topographic maps or little heads for each frequency and each site that we’re looking at. So again, those, those 26. What we’re going to look at there is how far they are from the norm. And they’re based on colors. So anything in white is going to be optimal. Anything in green, yellow, orange, or red is going to be over aroused, which means the brain is locked into that state, or really kind of stuck in that frequency.

If we see anything in our lighter greens or blues, the brain is deficient or not moving into that frequency as often as we want the entire goal is that we should be able to move in and out of all of our frequencies at. Based on the task at hand, but for many reasons, for different experiences, such as trauma, whether that’s emotional, whether that’s physical, like a traumatic brain injury, if we’ve used substance use, our brain is going to now rewire.

Um, I tell our residents, our brain is our dumbest smartest organ, and it’s really just trying to help us, but sometimes we get stuck and we need to remind the brain how to move back into a more optimal frequency. You’re back to homeostasis.

Sam Zimmer: So what kinds of diagnoses are associated with those different colors? Is that something that you can kind of see? 

Andréa Copeland: Right now QEG is just a tool. We don’t really use it as a diagnostic tool. We’re really looking at it in terms of dysregulation and a symptom. So what characteristics are coming out based on this dysregulation and really we can see anything? Obsessive intrusive thoughts to sleep issues.

Of course, this is not related to sleep apnea. We do have sleep studies for that. We can see, um, lower mood. We can see the anxiousness that may be coming in. We can see attention issues. There are a variety of different areas that we can look at, even if a person is more treatment-resistant that can give us an idea of how to guide that treatment plan.

Sam Zimmer: I remember, you know, our conversations, throughout the time we’ve been working together, when somebody is showing up red they’re overactive, they’re kind of always in that fight or flight and it can be. It’s not a diagnostic tool like you said, but it’s associated when someone’s showing up red in that way to like trauma.

Andréa Copeland: Right. It can be definitely. So it’s really dependent on the frequency if someone’s over aroused and those really fast frequencies. We know they’re stuck in that fear-driven brain. And so it’s, it’s going to take even myself a different approach to work with that individual because there’s a lot of trust that needs to be built.

They really need to quote-unquote, buy into neurofeedback and know that they’re the ones that are training their brain now.

Sam Zimmer: And seeing that, sorry, seeing that brain map initially can be a really positive tool to help them buy in because it’s like. You know, in this field, it’s really hard for someone to see any kind of quote-unquote proof staring them in the face that says, okay, I do have these issues.

And you know, with that information, you know, it’s obviously really beneficial for you and the rest of the clinical team in terms of how do we start treating this person? Um, regardless of what we do as staff, there needs to be that willingness and buy-in. So when somebody sees their brain map and they’re showing up extremely red or blue, whatever end of the spectrum, I imagine it probably has a really strong effect in sort of investing them in their treatment.

Andréa Copeland: Right. It really does. And I’m really glad you brought this up because not only can it show people areas where they may be a little bit avoidant or not wanting to do. On the other end of the spectrum, it really validates a lot of individuals because often people who’ve experienced trauma have been told, why can’t you snap out of this?

Why don’t you just meditate away? And why meditation is absolutely beneficial. Sometimes people need all hands on deck and they, they do need more help than just, um, meditation on their own. So often residents can come in and it isn’t uncommon for them to cry and to say, this is exactly what I’ve been feeling inside.

This is exactly what I’ve been telling people. And now it’s validated with the scientific information with this evidence that I actually feel this way. And one step further. Now they’re going to have the tools to retrain their brain because it’s not just looking at it and saying what is the neurofeedback helping to stabilize?

Sam Zimmer: So what a great segue. So retraining their brain. So how does that process take place?

Andréa Copeland: Yeah, that’s one of my favorite parts. I love brain mapping, but neurofeedback is really amazing because it is the individual that is now using this feedback to help retrain their brain. It is all about them.

They are the one that is making that change. So the resident will come in for 10 sessions of neurofeedback. How many sessions they can fit in in a 35-day stay. If they’re here longer, then of course we’ll add more. But when a resident comes in, we place sensors on top of the scalp and the areas of the dysregulation.

They now are looking at a big monitor, a big TV screen, and they’re looking at a video game. And what that video game is, it’s just that visual feedback. It’s an exact mirror image of their brain. They’re also wearing headphones where they’re getting auditory information. Which is in the form of beeps. So we’re using operant conditioning.

These beeps, I call our little brain treats. And just as an example, say, someone comes in, and just as a basic example, they want to work on their sustained attention. When they’re focused on the game, the game starts to play just, just by way of their focus, because what we’re doing is we’re most likely decreasing a slow wave, potentially increasing effects.

So their brain is asked to do a lot, but they can do it. So again, when they’re focused, the game plays. When they’re distracted, the game will completely stop. And that’s just enough information for our brain to say, oh, what was I doing? What was I thinking about? Okay, the game stopped. What do I need to do?

And either they’ll talk in their head to their game or they’ll pay attention. They’ll focus on a spot and they’ll get it to move it. Now on my side, I’m seeing their brainwaves’ lifetime. So I can often see when a person’s checked out before they even realized they’re checked out. If they need more coaching, I can pause it and kind of call them back.

But really we’re doing this in rounds. And so each round of five minutes, I’ll stop and I’ll check in depending on how many beeps they’ve received, I will increase the threshold. So I’ll make it a little bit harder. And I tell people I’m kind of like their brain personal trainer and they’re the athlete, right?

They’re the person in the gym and really what’s happening next is that they’ve now increased the threshold. It gets a little bit harder. They’ll now need to adjust to make that gameplay again. 

Sam Zimmer: Yeah, because I remember when, when I went through a neurofeedback exercise, um, just to give the listeners a little context.

So I was looking at the TV screen and there was a race car on a racetrack and the better I focus the faster and straighter the car went and then either I got distracted or I think maybe you turned up the level of difficulty or something, but the car veered off to the side and started to slow down.

Andréa Copeland: So if that were to happen to somebody, as you said, and you pause the game and kind of were to coach them up, what are some of the ways that you do that? I’ll just ask them. What were you thinking about, right. And sometimes they’ll say I have no idea. I didn’t even realize I wasn’t paying attention until the game stopped.

And then they’ll start to notice how many times they check out just in that five-minute time span. And it’s just that small amount of feedback that’s bringing them back to the game. Um, sometimes, you know, maybe an individual will get hot and that can actually create this disconnect. Or maybe they’re thinking about what they’re going to eat at lunch later, or processing something from an earlier session.

We can talk about that and then we can bring them back to the game.

Sam Zimmer: So can you talk a little bit about like the real-world application of that? So obviously we’re doing this for a reason and I know it’s all centered on the theory of neuroplasticity which is, in a sense retraining the brain. I’m sure you can explain it a little bit more intelligently than that.

Um, so the things that you’re teaching them, it’s it’s to teach them how to regulate their brain. And how they’re feeling and their emotions when they leave our program and go back to the real world. Right?

Andréa Copeland: Right. Pretty much. I mean, with neuroplasticity, the brain has this ability to change and adapt.

And with neurofeedback, what we’re doing is we’re giving feedback. Essentially to create these new neural pathways or these new connections. So when we’re giving information and giving them positive feedback on those new neural pathways, those old pathways will start to close. So it’s not that people have to walk around and okay, I’m the car driving the game or I’m the game driving the car, um, throughout their day-to-day. But the idea is that now these new neural pathways have new connections formed where the new tools are placed on top of that. And so they’re just a lot more regulated to be able to handle those day-to-day stressors.

So, but it isn’t uncommon for a resident to say, I was thinking about making the dolphin swim. When I was really stressed out, I put myself back in that game, which is a really cool tool.

Sam Zimmer: The dolphin game. Yeah. So I’ve heard a lot, I’ve heard a lot of great feedback. I haven’t yet been able to experience that. So maybe I’ll have to bug you about that.

But, um, but yeah, no, I really like what you said. Cause a lot of people, when they come in here, you know, the reason they’re coming in here is because when they get really anxious or they get triggered. Their first line of defense, what their brain is telling them is go to the liquor store or self-harm or any number of maladaptive coping mechanisms.

So what you’re accomplishing with our residents is retraining their brain so that when they leave, it’s okay. I’m not going to the liquor store when I get anxious. It’s okay. I’m going to employ like a breathing exercise that I learned while I was at Sabino or one of the many tools that somebody learns here.

Andréa Copeland: Right. So it can give them a pause. So instead of feeling that dysregulation at such intense levels, it’s a lot more manageable. So prior to people coming in, if they have really intense anxiety, right, their mind isn’t thinking they are just knowing, I want to get out of this discomfort. And what’s the first thing I can do to get out of this discomfort?

Now, the discomfort is not as intense. It’s much more manageable and people are able to sit in that because they know it’s not going to last.

Sam Zimmer: So how many sessions of neurofeedback and how many brain maps does somebody do while they’re in typical stay here at Sabino?

Andréa Copeland: Yeah. Here at Sabino, they’ll have an initial map, 10 sessions within that 35 day stay for the period.

Um, and then they’ll have a post brain map. And then we get to actually sit side by side and look at the initial map and the post map. One of my favorite parts. It’s really, really exciting for people to see those changes happening, especially for individuals that can often be really hard on themselves and say, I’m not making enough progress or it’s not moving fast enough.

They can see there is a visual change here. Now, as far as those 10 sessions go, often when you read about neurofeedback, you’ll see people need 30, 40, 50 plus sessions. One, that can depend on the dysregulation, but two that’s really based on an outpatient setting. So here at Sabino, the fact that they have so many other modalities daily, they’re coming to neurofeedback actually three to four times a week.

And they’re really enclosed in this safe space. So they don’t have the outside stress of work, a family, of running their kids around. They’re only focused on themselves. So within those 10 sessions, people often see pretty big changes. Um, again, not just the neurofeedback is helping to change the brain.

It’s everything that they’re doing here at Sabino. It’s really, really fortunate that people are able to use this modality in a residential setting. 

Sam Zimmer: Right. Because my understanding is that you do things a little bit differently than like you were alluding to. What most people do on an outpatient basis, as far as like your process, can you speak a little bit more to that?

Andréa Copeland: Yeah. In an outpatient setting, because people are so busy, they typically drop in once to twice a week and changes can be seen, but they’re hard to sustain. So when you’re doing it three to four times a week here, you can sustain those changes. You can really get hit the ground running. There’s often other devices that I use as well.

So it may not just be strictly neurofeedback. We may be using pen. We may be near infrared light. We may be using heart rate variability. It all is dependent on what the resident’s needs are and what they’re able to really tolerate. Um, just a typical session can be 20 minutes, but sometimes our residents only need five minutes and then we’ll do 10 minutes of heart rate variability training. Um, it, again, it’s really dependent on what that client needs day by day session by session.

Sam Zimmer: Yeah. Yeah. Just like everything else here at Sabino. Yeah. Um, so as far as like outpatient, is that something that you recommend, is that something that people are open to and what does that process look like?

Andréa Copeland: Yeah. So once we look at the post brain map and really how an individual resonates or connects with the neurosis. We’ll talk about aftercare, so that can look many different ways. Either they can continue sessions on an outpatient basis. I will help them find a practitioner who uses similar devices, who knows how to read a brain map and they can continue their training.

That way I will collaborate with that practitioner. They can do remote training, which really came out during COVID. It was one of the. The fortunate things that we have available to us is that now people can train at home with a practitioner. We can connect via zoom. We can control the entire software from our side while we’re seeing what’s going on on their side.

Or they can use different home training devices without a practitioner, something a lot more simplified, which is not necessarily neurofeedback per se, but something like audio, visual, entrainment, binaural beats, isochronic tones, um, meditation feedback. That’s just, it is measuring your brainwaves, but it’s a little bit different from neurofeedback.

Sam Zimmer: Well, however, keep the ball rolling and keep the progress happening. And that reminds me of something that I’ve been wondering. Cause I’m sure a lot of people get confused like I was about remembering the feedback, but also there are so many different modalities out there. One of the ones that we utilize here is EMDR and it, you know, can be following a light.

It can be, you know, tapping or buzzers, so I’m sure some people are a little bit confused as to the difference between brain mapping, neurofeedback, and other modalities like EMDR. So can you speak a little bit to that?

Andréa Copeland: Yeah. I feel like EMDR and neurofeedback really work well together because the end goal is still the same to help regulate with neurofeedback. We have specific protocols. There’s one called the alpha-theta protocol, excuse me, as well as the Penn Dustin protocol. And they’re, they’re very similar, but what can happen is that once a resident is more stabilized, we can move them into these alpha-theta states. And in that state, we have more access to the subconscious where they can really access memories.

And this is more so like seeing the memory on a screen. It’s not anything that’s retraumatizing, they’re not replaying it. They’re just gathering information. And now that they’ve been able to gather those memories, they can take it into a modality like EMDR, where they can now reprocess. That’s what the R and EMDR stands for is that they’re not able to reprocess that memory.

So we have some talented practitioners here that offer EMDR and they can either have that scheduled back-to-back neurofeedback and EMT. Or even the next day, depending on what the resident is looking for.

Sam Zimmer: Gotcha. So that actually is a great segue into something I think is really important. Um, you know, how you collaborate with the rest of the clinical team, you know, the folks that are doing the EMDR primary therapist, family therapist, um, because we are so small, obviously we’re able to collaborate like that and communicate in real-time, just so everyone’s on the same page.

So what are some of the things that you see? In your time with the residents that is, I guess, important to share with their therapist, their family therapist, and the rest of the clinical staff.

Andréa Copeland: Yeah. So we have a wonderful staff here and we have weekly treatment team meetings. And so during those meetings, I will often talk about their brain map and sometimes we can see if a person is really trapped or locked into those slower frequencies. They’re having a hard time, really, um, learning new information. They are having a hard time remaining present. They could experience something called flooding. And so that type of information I can take to the team and say, you know, they may not be appropriate for these modalities right now, or if they are, maybe they shouldn’t close their eyes without some more stabilization, because that’s where we’re seeing a lot of flooding happen. As part of the brain map I didn’t mention, we are recording the electrical activity, 10 minutes, eyes open and 10 minutes eyes closed so we can see what’s happening in both of those states there.

If somebody is performing really well in neurofeedback, we can take that to the team and say, Hey, I think they’re ready for X, Y, and Z modalities. And so we can get them scheduled for that a lot sooner. 

Sam Zimmer: That’s what I love so much about it is because, you know, when somebody sees you their first week here, we’re able to find out what’s going to work for them, or at least have a much better idea of what’s going to work for them right off, right off the bat, as opposed to hitting our head against the wall with somebody trying X, Y, and Z before figuring out that it was something else.

Yeah. So if I’m somebody who’s never done brain mapping and neurofeedback, and I’m coming to see you for the first time, what can I expect throughout that first week or two?

Andréa Copeland: Yeah. So, um, the first part is you’ll, you’ll walk in, we will set you up with a nice fitted cap that has 20 different sensors under there. I always let our individuals or our residents know that we use a blunt point syringe filled with gel, and that gel is placed into every one of those sensors, which is just going to help amplify. It’s going to conduct and amplify the frequency so that we can see the brainwaves directly on the screen.

This is the really cool part because it’s the first time you get to see your brain. So you’re actually looking at your brain’s lifetime. Often the residents are biting down, blinking, swallowing, thinking different thoughts, just so that they can see how their brainwaves move. And then I move that screen away.

I don’t want them to get distracted and all watch that for the initial recording, which is eyes open 10 minutes. You are instructed to think about whatever comes up. There’s no prompt. There’s no, no way to be. You’re just going to sit there while I record for the first time. Now a question I get asked a lot is that people will say, well, what if I’m having the best day of my life?

Or what if I’m extremely depressed this day? We are taking. A million, well, not a million, but, um, uh, quite a big sampling rate of what is going on in the brain. So snapshots. And so we’re seeing the default mode of the brain. You can come in on your best day, on your worst day, and we’re still really going to see the baseline where that person is at that default.

So after that initial 10 minutes, eyes open recording, I will then ask them to close their eyes for 10 minutes. If an individual is getting sleepy, I’ll have to call their name. And I can see that based on what their frequencies are doing. We don’t want anyone to fall asleep during that session, once they are done, they will be jelled.

Um, they’ll have to go take a shower, wash their hair out, and then they’ll come back a few days later and we’ll sit down and we’ll go over that initial brain map with them. And that’s where I discussed the different color, coordinated topographic maps. After we go over that brain map, then we’ll have their first session.

And that’s where the video games come in. Um, they’ll have the sensors placed once again, this time we’re not using gel, so they’re much more excited to come in and see. Um, and then they’ll start playing video games. So this is one of the modalities where an individual can come in and they can tell me as much of their day as they want or as little of their day.

They don’t have to talk and process. It is hard work, like going to the gym, but it’s fun also. So we make it fun.

Sam Zimmer: That’s all I’ve heard from people. Um, you know, they’re walking over to your building to do brain mapping neurofeedback. They got a little skip in their step because they know they’re coming to see you and I’ve experienced it too.

It’s like playing video games with your mind, you know? So I imagine that’s probably a nice, nice break in the action. Cause obviously, you know, when somebody comes to Sabino and is dealing with going through all their intense stress, things can definitely be difficult. Um, but you know, like you said, they don’t have to talk to you about all of that stuff.

They can kind of just go through their brain calisthenics and you know, it’s still hard work, but it’s also a lot of fun too. So really glad that we have you here at Sabino Recovery. Um, and thank you so much for taking the time to talk with us today. Thank you to our listeners. Thank you for listening to A Wise Mind podcast presented by Sabino Recovery. To listen to more episodes, just search A Wise Mind, presented by Sabino Recovery on your chosen podcast platform.

We discuss topics that can be difficult to process on A Wise Mind. There is no shame in seeking help. For resources or to find someone to talk to please visit the links in the description below.

How Neurotherapy is Utilized In Recovery

Apr 18, 2021

Mental Health

Shara Turner, LPC, MSC, NCC, NARM

A Wise Mind Presented by Sabino Recovery S1 Ep 4

On the latest episode of A Wise Mind Presented by Sabino Recovery, host Sam Zimmer and Neurotherapist Andréa Copeland discuss the world of Neurotherapy, specifically the role of neuroplasticity in recovery, neurofeedback, and how it is utilized at Sabino Recovery and the benefits to using Neurotherapy in the treatment of trauma and addiction.

Episode Transcript:

Sam Zimmer: Welcome back to the A Wise Mind podcast presented by Sabino Recovery. Today, we have the pleasure of talking to Andréa Copeland, our talented neuro therapist, and she heads up our whole brain mapping and neurofeedback wing here at Sabino Recovery. Good morning, Andréa.

Andréa Copeland: Good morning. Thank you for having me.

Sam Zimmer: Of Course! No, it's my pleasure. And I think a lot of people listening are gonna be really interested in, in what you have to say. Um, we were talking before we started recording, how sort of skeptical I was when I first got to Sabino, I was like, what the heck is brain mapping and neurofeedback? It's pretty cool how we do it for new employees though, you know, since we're so small, new employees get the chance to experience everything we have to offer. Here they go through a typical week of what it's like to go to groups and individual sessions. So like we were talking about, I was like, what the heck is brain mapping and neurofeedback here on my schedule? I was a little bit skeptical.

And when I met with Andréa, she explained it very, very well. And I was definitely able to learn about what kind of benefits and stuff. So that's what we're going to talk about today.

Andréa Copeland: Looking forward to it.

Sam Zimmer: Yeah. Um, so brain mapping and neurofeedback, can you just speak a little bit about, you know, what that is and kind of like what it entails and

Andréa Copeland: Yeah. So brain mapping is always our initial session here. Every resident is provided with this service. So when a resident comes in, I will meet with them. Initially, we will place a fitted cap. 20 different sensors onto the scalp. What we're doing is we're recording the electrical activity right on the cortex.

And so what the brain map is going to do is it's going to give us information about each one of our frequencies. And so we can break that down a little bit later in the series here, but that would be Delta, theta, alpha, a few different betas, and gamma. And what we're looking for is any dysregulation from the norm.

And so we're looking at standard deviations from the norm, of course, based on what we see in that brain map, it's going to give me information on how to set a protocol for neurofeedback training. And it's also going to give the team information and what direction to kind of lead the treatment planning.

So from the brain map, we'll start the neurofeedback training. And basically what neurofeedback training really is. It's a tool where we're using QEG technology or EEG technology, rather, to help stabilize the central nervous system. And with that, we can really help an individual become more regulated so that they can really get the most out of treatment.

Yeah. I mean, that's really the simplest way to explain neurofeedback in a nutshell. So actually, you know, I'll add to that with the technology, what the resident is actually seeing is both auditory and visual feedback. And that is what is helping to create those new neural pathways to help stabilize the nervousness.

So when somebody gets their initial brain map back, it's something that's kind of like they can see in black and white, so to speak on, on the computer screen.  Right. So what does it show up? What does it show up as to them? Yeah, so it's quantifiable information and so they'll have a visual map of their brain.

And so there's little topographic maps or little heads for each frequency and each site that we're looking at. So again, those, those 26. What we're going to look at there is how far they are from the norm. And they're based on colors. So anything in white is going to be optimal. Anything in green, yellow, orange, or red is going to be over aroused, which means the brain is locked into that state, or really kind of stuck in that frequency.

If we see anything in our lighter greens or blues, the brain is deficient or not moving into that frequency as often as we want the entire goal is that we should be able to move in and out of all of our frequencies at. Based on the task at hand, but for many reasons, for different experiences, such as trauma, whether that's emotional, whether that's physical, like a traumatic brain injury, if we've used substance use, our brain is going to now rewire.

Um, I tell our residents, our brain is our dumbest smartest organ, and it's really just trying to help us, but sometimes we get stuck and we need to remind the brain how to move back into a more optimal frequency. You're back to homeostasis.

Sam Zimmer: So what kinds of diagnoses are associated with those different colors? Is that something that you can kind of see? 

Andréa Copeland: Right now QEG is just a tool. We don't really use it as a diagnostic tool. We're really looking at it in terms of dysregulation and a symptom. So what characteristics are coming out based on this dysregulation and really we can see anything? Obsessive intrusive thoughts to sleep issues.

Of course, this is not related to sleep apnea. We do have sleep studies for that. We can see, um, lower mood. We can see the anxiousness that may be coming in. We can see attention issues. There are a variety of different areas that we can look at, even if a person is more treatment-resistant that can give us an idea of how to guide that treatment plan.

Sam Zimmer: I remember, you know, our conversations, throughout the time we've been working together, when somebody is showing up red they're overactive, they're kind of always in that fight or flight and it can be. It's not a diagnostic tool like you said, but it's associated when someone's showing up red in that way to like trauma.

Andréa Copeland: Right. It can be definitely. So it's really dependent on the frequency if someone's over aroused and those really fast frequencies. We know they're stuck in that fear-driven brain. And so it's, it's going to take even myself a different approach to work with that individual because there's a lot of trust that needs to be built.

They really need to quote-unquote, buy into neurofeedback and know that they're the ones that are training their brain now.

Sam Zimmer: And seeing that, sorry, seeing that brain map initially can be a really positive tool to help them buy in because it's like. You know, in this field, it's really hard for someone to see any kind of quote-unquote proof staring them in the face that says, okay, I do have these issues.

And you know, with that information, you know, it's obviously really beneficial for you and the rest of the clinical team in terms of how do we start treating this person? Um, regardless of what we do as staff, there needs to be that willingness and buy-in. So when somebody sees their brain map and they're showing up extremely red or blue, whatever end of the spectrum, I imagine it probably has a really strong effect in sort of investing them in their treatment.

Andréa Copeland: Right. It really does. And I'm really glad you brought this up because not only can it show people areas where they may be a little bit avoidant or not wanting to do. On the other end of the spectrum, it really validates a lot of individuals because often people who've experienced trauma have been told, why can't you snap out of this?

Why don't you just meditate away? And why meditation is absolutely beneficial. Sometimes people need all hands on deck and they, they do need more help than just, um, meditation on their own. So often residents can come in and it isn't uncommon for them to cry and to say, this is exactly what I've been feeling inside.

This is exactly what I've been telling people. And now it's validated with the scientific information with this evidence that I actually feel this way. And one step further. Now they're going to have the tools to retrain their brain because it's not just looking at it and saying what is the neurofeedback helping to stabilize?

Sam Zimmer: So what a great segue. So retraining their brain. So how does that process take place?

Andréa Copeland: Yeah, that's one of my favorite parts. I love brain mapping, but neurofeedback is really amazing because it is the individual that is now using this feedback to help retrain their brain. It is all about them.

They are the one that is making that change. So the resident will come in for 10 sessions of neurofeedback. How many sessions they can fit in in a 35-day stay. If they're here longer, then of course we'll add more. But when a resident comes in, we place sensors on top of the scalp and the areas of the dysregulation.

They now are looking at a big monitor, a big TV screen, and they're looking at a video game. And what that video game is, it's just that visual feedback. It's an exact mirror image of their brain. They're also wearing headphones where they're getting auditory information. Which is in the form of beeps. So we're using operant conditioning.

These beeps, I call our little brain treats. And just as an example, say, someone comes in, and just as a basic example, they want to work on their sustained attention. When they're focused on the game, the game starts to play just, just by way of their focus, because what we're doing is we're most likely decreasing a slow wave, potentially increasing effects.

So their brain is asked to do a lot, but they can do it. So again, when they're focused, the game plays. When they're distracted, the game will completely stop. And that's just enough information for our brain to say, oh, what was I doing? What was I thinking about? Okay, the game stopped. What do I need to do?

And either they'll talk in their head to their game or they'll pay attention. They'll focus on a spot and they'll get it to move it. Now on my side, I'm seeing their brainwaves’ lifetime. So I can often see when a person's checked out before they even realized they're checked out. If they need more coaching, I can pause it and kind of call them back.

But really we're doing this in rounds. And so each round of five minutes, I'll stop and I'll check in depending on how many beeps they've received, I will increase the threshold. So I'll make it a little bit harder. And I tell people I'm kind of like their brain personal trainer and they're the athlete, right?

They're the person in the gym and really what's happening next is that they've now increased the threshold. It gets a little bit harder. They'll now need to adjust to make that gameplay again. 

Sam Zimmer: Yeah, because I remember when, when I went through a neurofeedback exercise, um, just to give the listeners a little context.

So I was looking at the TV screen and there was a race car on a racetrack and the better I focus the faster and straighter the car went and then either I got distracted or I think maybe you turned up the level of difficulty or something, but the car veered off to the side and started to slow down.

Andréa Copeland: So if that were to happen to somebody, as you said, and you pause the game and kind of were to coach them up, what are some of the ways that you do that? I'll just ask them. What were you thinking about, right. And sometimes they'll say I have no idea. I didn't even realize I wasn't paying attention until the game stopped.

And then they'll start to notice how many times they check out just in that five-minute time span. And it's just that small amount of feedback that's bringing them back to the game. Um, sometimes, you know, maybe an individual will get hot and that can actually create this disconnect. Or maybe they're thinking about what they're going to eat at lunch later, or processing something from an earlier session.

We can talk about that and then we can bring them back to the game.

Sam Zimmer: So can you talk a little bit about like the real-world application of that? So obviously we're doing this for a reason and I know it's all centered on the theory of neuroplasticity which is, in a sense retraining the brain. I'm sure you can explain it a little bit more intelligently than that.

Um, so the things that you're teaching them, it's it's to teach them how to regulate their brain. And how they're feeling and their emotions when they leave our program and go back to the real world. Right?

Andréa Copeland: Right. Pretty much. I mean, with neuroplasticity, the brain has this ability to change and adapt.

And with neurofeedback, what we're doing is we're giving feedback. Essentially to create these new neural pathways or these new connections. So when we're giving information and giving them positive feedback on those new neural pathways, those old pathways will start to close. So it's not that people have to walk around and okay, I'm the car driving the game or I'm the game driving the car, um, throughout their day-to-day. But the idea is that now these new neural pathways have new connections formed where the new tools are placed on top of that. And so they're just a lot more regulated to be able to handle those day-to-day stressors.

So, but it isn't uncommon for a resident to say, I was thinking about making the dolphin swim. When I was really stressed out, I put myself back in that game, which is a really cool tool.

Sam Zimmer: The dolphin game. Yeah. So I've heard a lot, I've heard a lot of great feedback. I haven't yet been able to experience that. So maybe I'll have to bug you about that.

But, um, but yeah, no, I really like what you said. Cause a lot of people, when they come in here, you know, the reason they're coming in here is because when they get really anxious or they get triggered. Their first line of defense, what their brain is telling them is go to the liquor store or self-harm or any number of maladaptive coping mechanisms.

So what you're accomplishing with our residents is retraining their brain so that when they leave, it's okay. I'm not going to the liquor store when I get anxious. It's okay. I'm going to employ like a breathing exercise that I learned while I was at Sabino or one of the many tools that somebody learns here.

Andréa Copeland: Right. So it can give them a pause. So instead of feeling that dysregulation at such intense levels, it's a lot more manageable. So prior to people coming in, if they have really intense anxiety, right, their mind isn't thinking they are just knowing, I want to get out of this discomfort. And what's the first thing I can do to get out of this discomfort?

Now, the discomfort is not as intense. It's much more manageable and people are able to sit in that because they know it's not going to last.

Sam Zimmer: So how many sessions of neurofeedback and how many brain maps does somebody do while they're in typical stay here at Sabino?

Andréa Copeland: Yeah. Here at Sabino, they'll have an initial map, 10 sessions within that 35 day stay for the period.

Um, and then they'll have a post brain map. And then we get to actually sit side by side and look at the initial map and the post map. One of my favorite parts. It's really, really exciting for people to see those changes happening, especially for individuals that can often be really hard on themselves and say, I'm not making enough progress or it's not moving fast enough.

They can see there is a visual change here. Now, as far as those 10 sessions go, often when you read about neurofeedback, you'll see people need 30, 40, 50 plus sessions. One, that can depend on the dysregulation, but two that's really based on an outpatient setting. So here at Sabino, the fact that they have so many other modalities daily, they're coming to neurofeedback actually three to four times a week.

And they're really enclosed in this safe space. So they don't have the outside stress of work, a family, of running their kids around. They're only focused on themselves. So within those 10 sessions, people often see pretty big changes. Um, again, not just the neurofeedback is helping to change the brain.

It's everything that they're doing here at Sabino. It's really, really fortunate that people are able to use this modality in a residential setting. 

Sam Zimmer: Right. Because my understanding is that you do things a little bit differently than like you were alluding to. What most people do on an outpatient basis, as far as like your process, can you speak a little bit more to that?

Andréa Copeland: Yeah. In an outpatient setting, because people are so busy, they typically drop in once to twice a week and changes can be seen, but they're hard to sustain. So when you're doing it three to four times a week here, you can sustain those changes. You can really get hit the ground running. There's often other devices that I use as well.

So it may not just be strictly neurofeedback. We may be using pen. We may be near infrared light. We may be using heart rate variability. It all is dependent on what the resident's needs are and what they're able to really tolerate. Um, just a typical session can be 20 minutes, but sometimes our residents only need five minutes and then we'll do 10 minutes of heart rate variability training. Um, it, again, it's really dependent on what that client needs day by day session by session.

Sam Zimmer: Yeah. Yeah. Just like everything else here at Sabino. Yeah. Um, so as far as like outpatient, is that something that you recommend, is that something that people are open to and what does that process look like?

Andréa Copeland: Yeah. So once we look at the post brain map and really how an individual resonates or connects with the neurosis. We'll talk about aftercare, so that can look many different ways. Either they can continue sessions on an outpatient basis. I will help them find a practitioner who uses similar devices, who knows how to read a brain map and they can continue their training.

That way I will collaborate with that practitioner. They can do remote training, which really came out during COVID. It was one of the. The fortunate things that we have available to us is that now people can train at home with a practitioner. We can connect via zoom. We can control the entire software from our side while we're seeing what's going on on their side.

Or they can use different home training devices without a practitioner, something a lot more simplified, which is not necessarily neurofeedback per se, but something like audio, visual, entrainment, binaural beats, isochronic tones, um, meditation feedback. That's just, it is measuring your brainwaves, but it's a little bit different from neurofeedback.

Sam Zimmer: Well, however, keep the ball rolling and keep the progress happening. And that reminds me of something that I've been wondering. Cause I'm sure a lot of people get confused like I was about remembering the feedback, but also there are so many different modalities out there. One of the ones that we utilize here is EMDR and it, you know, can be following a light.

It can be, you know, tapping or buzzers, so I'm sure some people are a little bit confused as to the difference between brain mapping, neurofeedback, and other modalities like EMDR. So can you speak a little bit to that?

Andréa Copeland: Yeah. I feel like EMDR and neurofeedback really work well together because the end goal is still the same to help regulate with neurofeedback. We have specific protocols. There's one called the alpha-theta protocol, excuse me, as well as the Penn Dustin protocol. And they're, they're very similar, but what can happen is that once a resident is more stabilized, we can move them into these alpha-theta states. And in that state, we have more access to the subconscious where they can really access memories.

And this is more so like seeing the memory on a screen. It's not anything that's retraumatizing, they're not replaying it. They're just gathering information. And now that they've been able to gather those memories, they can take it into a modality like EMDR, where they can now reprocess. That's what the R and EMDR stands for is that they're not able to reprocess that memory.

So we have some talented practitioners here that offer EMDR and they can either have that scheduled back-to-back neurofeedback and EMT. Or even the next day, depending on what the resident is looking for.

Sam Zimmer: Gotcha. So that actually is a great segue into something I think is really important. Um, you know, how you collaborate with the rest of the clinical team, you know, the folks that are doing the EMDR primary therapist, family therapist, um, because we are so small, obviously we're able to collaborate like that and communicate in real-time, just so everyone's on the same page.

So what are some of the things that you see? In your time with the residents that is, I guess, important to share with their therapist, their family therapist, and the rest of the clinical staff.

Andréa Copeland: Yeah. So we have a wonderful staff here and we have weekly treatment team meetings. And so during those meetings, I will often talk about their brain map and sometimes we can see if a person is really trapped or locked into those slower frequencies. They're having a hard time, really, um, learning new information. They are having a hard time remaining present. They could experience something called flooding. And so that type of information I can take to the team and say, you know, they may not be appropriate for these modalities right now, or if they are, maybe they shouldn't close their eyes without some more stabilization, because that's where we're seeing a lot of flooding happen. As part of the brain map I didn't mention, we are recording the electrical activity, 10 minutes, eyes open and 10 minutes eyes closed so we can see what's happening in both of those states there.

If somebody is performing really well in neurofeedback, we can take that to the team and say, Hey, I think they're ready for X, Y, and Z modalities. And so we can get them scheduled for that a lot sooner. 

Sam Zimmer: That's what I love so much about it is because, you know, when somebody sees you their first week here, we're able to find out what's going to work for them, or at least have a much better idea of what's going to work for them right off, right off the bat, as opposed to hitting our head against the wall with somebody trying X, Y, and Z before figuring out that it was something else.

Yeah. So if I'm somebody who's never done brain mapping and neurofeedback, and I'm coming to see you for the first time, what can I expect throughout that first week or two?

Andréa Copeland: Yeah. So, um, the first part is you'll, you'll walk in, we will set you up with a nice fitted cap that has 20 different sensors under there. I always let our individuals or our residents know that we use a blunt point syringe filled with gel, and that gel is placed into every one of those sensors, which is just going to help amplify. It's going to conduct and amplify the frequency so that we can see the brainwaves directly on the screen.

This is the really cool part because it's the first time you get to see your brain. So you're actually looking at your brain's lifetime. Often the residents are biting down, blinking, swallowing, thinking different thoughts, just so that they can see how their brainwaves move. And then I move that screen away.

I don't want them to get distracted and all watch that for the initial recording, which is eyes open 10 minutes. You are instructed to think about whatever comes up. There's no prompt. There's no, no way to be. You're just going to sit there while I record for the first time. Now a question I get asked a lot is that people will say, well, what if I'm having the best day of my life?

Or what if I'm extremely depressed this day? We are taking. A million, well, not a million, but, um, uh, quite a big sampling rate of what is going on in the brain. So snapshots. And so we're seeing the default mode of the brain. You can come in on your best day, on your worst day, and we're still really going to see the baseline where that person is at that default.

So after that initial 10 minutes, eyes open recording, I will then ask them to close their eyes for 10 minutes. If an individual is getting sleepy, I'll have to call their name. And I can see that based on what their frequencies are doing. We don't want anyone to fall asleep during that session, once they are done, they will be jelled.

Um, they'll have to go take a shower, wash their hair out, and then they'll come back a few days later and we'll sit down and we'll go over that initial brain map with them. And that's where I discussed the different color, coordinated topographic maps. After we go over that brain map, then we'll have their first session.

And that's where the video games come in. Um, they'll have the sensors placed once again, this time we're not using gel, so they're much more excited to come in and see. Um, and then they'll start playing video games. So this is one of the modalities where an individual can come in and they can tell me as much of their day as they want or as little of their day.

They don't have to talk and process. It is hard work, like going to the gym, but it's fun also. So we make it fun.

Sam Zimmer: That's all I've heard from people. Um, you know, they're walking over to your building to do brain mapping neurofeedback. They got a little skip in their step because they know they're coming to see you and I've experienced it too.

It's like playing video games with your mind, you know? So I imagine that's probably a nice, nice break in the action. Cause obviously, you know, when somebody comes to Sabino and is dealing with going through all their intense stress, things can definitely be difficult. Um, but you know, like you said, they don't have to talk to you about all of that stuff.

They can kind of just go through their brain calisthenics and you know, it's still hard work, but it's also a lot of fun too. So really glad that we have you here at Sabino Recovery. Um, and thank you so much for taking the time to talk with us today. Thank you to our listeners. Thank you for listening to A Wise Mind podcast presented by Sabino Recovery. To listen to more episodes, just search A Wise Mind, presented by Sabino Recovery on your chosen podcast platform.

We discuss topics that can be difficult to process on A Wise Mind. There is no shame in seeking help. For resources or to find someone to talk to please visit the links in the description below.

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