COUNSELLING: AN INTEGRATED APPROACH FOR TREATING MENTAL ILLNESS - - PowerPoint PPT Presentation

NEUROFEEDBACK AND COUNSELLING: AN INTEGRATED APPROACH FOR TREATING MENTAL ILLNESS (A CASE STUDY)

JOACHIM LEE SAC CLINICAL COUNSELLOR & CLINICAL SUPERVISOR, CLINICAL HYPNOTHERAPIST, NEUROFEEDBACK PRACTITIONER 22 JULY 2016

BACKGROUND TO CASE

Kate, 55, married with 4 adult children

DIAGNOSIS-SYMPTOMS-PSYCHOTROPIC DRUGS

PSYCHOTROPIC DRUG CONSUMPTION

Fluvoxamine 50 mg Depression -SSRI Diazepam 10 mg Anxiety Haloperidol 1.5 mg Anti-psychotic / Treatment of mania Benzhexol HCI 2 mg Antispasmodic-Pakinsonism Fluanxol 20 ml Anti-psychotic CarbamaZepine 200 mg Anticonvulsant

• Diagnosed 30 years ago
• Consumes 10 prescribed drugs

daily

• Suffers from severe drug side

effects, i.e. body stiffness, slow movements

• Psychiatric symptoms actively

present

• Has developed immunity to

Psychotropic drugs

• Requires monthly counselling

sessions

CONSIDERATIONS FOR NEUROFEEDBACK (NFB) PROTOCOL WITHOUT QEEG

NFB Considerations were based on:

• Research Literature
• Clinical Experience
• Treatment Targets and Goals
• Excluded two common protocols on NFB literature:
• Sebern Fisher Bliss Protocol - Training Theta and Reward Alpha at Cz
• Hammond’s Protocol-inhibit slow Alpha & Theta, Reward Beta at Fp1

& F3

MY THEORETICAL ORIENTATION: AN INTEGRATED APPROACH

Neurofeedback

• Protocol Bi-weekly

Sessions

Counselling

Counselling sessions involved:

• Psychotherapy (Strength and

Strategic based)

• Hypnotherapy

CZ Delta C3 Delta C3 SMR C3 – C4 SMR C3 – C4 Delta

CLINICAL CONSIDERATIONS – MULTIPLIER EFFECT

Change Objectives Control Objectives Ability to discriminate Anxiety Management Ability to develop higher levels of ambiguity Suicidal Ideations Ability to develop internal locus of control Self Harm - OD

NFB TREATMENT TARGET

• Adjunctive Tool for Training Brainwaves for Self-Regulation
• Stabilize Delta Brainwaves at Cz
• C3-C4 Sensory Motor Rhythm (SMR)

NEUROFEEDBACK SESSIONS

Session No. Observations/Self Reporting Treatment Protocol 1-4 Irritated by the consistent pauses in the music Cz Delta 5-6 Reported to be calmer and pleased with the session C3 Delta 7-12 Was motionless –Decreased in High Beta brainwaves C3 SMR 13-19 High Beta Increased and drop in SMR – Reported to be preoccupied with the trigger problem without affective symptoms C3-C4 SMR 20 Came in being triggered by a crisis (SUD=9) At end of session, SUD=5 C3-C4 Delta

CLINICAL OUTCOMES

Pre-NeuroFeedback Post-NeuroFeedback Frequent Preoccupation with Trigger Problems Decreased in number of preoccupations Flooded with emotions – leading to Outpatient admittance for Fluanxol Intravenous Reported ability to contain negative affective states Low Tolerance to Ambiguity Shared examples (via counselling) of incidences where she was able to tolerate uncertainties Mental Processing Style-Emotional Frame Reported and observed ability to process information from a Cognitive Frame Over dependent on External Validation Able to slow down and listen to self for validation

CONCLUSION

• Clinical evidence that current mental states can be shifted and new mental

states reinforced via immediate feedback despite being on numerous psychotropic drugs

• Frequent training in a specific mental state improves self-regulation
• Clinical support through counselling increases internal wellness

LIMITATIONS OF NEUROFEEDBACK

• Without QEEG – dependent on clinical assessment/experience of therapist
• Cost – unaffordable for low and middle income clients
• Requires 30 sessions and more
• NFB for Mental Health – requires multi- disciplinary team

THANK YOU

• Website: http://psychliving.com/
• joachimlee2007@gmail.com
• +65 91705091