Integrating Neurofeedback Into Psychedelic-Assisted Therapy
How brain training can enhance the therapeutic impact of psychedelics.
KEY POINTS
Psychedelic-assisted therapies involve preparatory and integration sessions as part of the process.
Neurofeedback and NeuroMeditation can be used during the preparation phase to help develop openness, acceptance, and surrender.
Neurofeedback and NeuroMeditation can be used during the integration phase to train desired brain states and/or reinforce "afterglow" effects.
Interest in psychedelic-assisted therapies* (PAT) has increased dramatically in the last few years, and for good reason. The evidence suggests that clinical use of Psilocybin (magic mushrooms), MDMA, and Ketamine can be effective for treatment-resistant depression, as well as PTSD, addictions, end-of-life anxiety, and obsessive-compulsive disorder (see Andersen et al., 2020 for a review). However, it is important to recognize that these benefits are attained within contexts that provide specialized preparation for the psychedelic experience, active support during, and structured integration sessions for follow-up. The point is that the psychedelic experience itself is only one piece of the therapeutic approach.
Although it is tempting to view psychedelics as the latest “magic bullet” to permanently solve personal problems and mental health conditions, it is probably more accurate to think of them as medicines that induce a state of increased brain plasticity. This neuroplasticity facilitates new ways of thinking, feeling, and behaving for those who use it medicinally (Carhart-Harris & Friston, 2019). With this understanding, it becomes increasingly important to 1) prepare the brain/nervous system for the shift experienced during a psychedelic session, and 2) to take advantage of the increased flexibility created by the experience. In addition to incorporating targeted psychotherapy, it can also be helpful to include mental state training in the form of neurofeedback and neurofeedback-guided meditation. Below, I will describe ways that we are using these modalities in both the preparation and integration phases of PAT.
Preparation Phase
Having positive psychedelic experiences is associated with specific psychological and emotional states including absorption, openness, acceptance, and surrender. Negative experiences are more common in persons who tend to be low in openness and surrender and/or high in preoccupation, apprehension, or confusion (Aday, et al., 2021). Consequently, it is important to offer preparatory sessions with a trained guide to facilitate the desired states and minimize the undesired ones. This is referred to as establishing the “Set” or mindset for the experience. These preparation sessions are used to assess a client for appropriateness/readiness, clarify their intentions, manage their expectations, outline the process, and discuss any fears or concerns they might have about working with psychedelic medicines. In addition, this time is important for establishing trust and rapport before entering into a psychedelic state which can feel very vulnerable.
Neurofeedback and neurofeedback-guided meditation (i.e., NeuroMeditation) can assist in the preparation phase by teaching state awareness and mental flexibility. In these practices, the client receives immediate feedback about their brainwave patterns connected to specific states of consciousness. This feedback is typically in the form of auditory or visual changes on a computer screen. Neurofeedback used in conjunction with meditative practices can help the client increase awareness of internal states and learn to intentionally navigate these states of consciousness. As preparation for a psychedelic experience, this type of “inner work” can be a valuable addition. In fact, neurofeedback-guided meditation practices can be used to assist in the development of each of the aforementioned beneficial mental qualities/states (absorption, openness, acceptance, and surrender), thereby increasing the likelihood of a positive and productive psychedelic experience.
Integration Phase
As mentioned earlier, the psychedelic experience appears to generate a state of temporary mental flexibility, allowing new ways of perceiving self and others, and our relation to the world. This can be an optimal time to shift maladaptive patterns of thinking, feeling, and behaving, and practicing new patterns. It is as if, the nervous system is more malleable during this time period. Consequently, a series of integration sessions with a trained guide is recommended in the weeks and months following the psychedelic experience. These sessions are designed to facilitate active processing and synthesizing of the experience to help the client identify and enact steps toward implementing insights gained. Traditional neurofeedback as well as NeuroMeditation can aid in this process in (at least) two ways. Neurofeedback, by its nature, is designed to shift maladaptive patterns in the nervous system. If these patterns are identified in the Intake/Preparation phase of this work, they can be targeted with neurofeedback in the integration phase when there is more openness to change, potentially increasing the efficiency of the process. Also, it is possible to use neurofeedback (and NeuroMeditation) to encourage continued flexibility in the nervous system. This can be done by using neurofeedback to train the brain to maintain the post-psychedelic state. This process is essentially teaching the nervous system to remain open as well as sustaining the “afterglow” often experienced following a psychedelic session.
As research continues to explore best practices for psychedelic-assisted therapies and as these approaches become more widely available, it will be important to continue to examine the safest, most reliable, and effective ways to integrate therapeutic protocols for optimal benefit. The addition of neurofeedback and NeuroMeditation to the preparation and integration phases of PAT’s is one of the most recent contributions to this process and is already being incorporated into some psychedelic-assisted therapy training programs (e.g., MIND Academy).
References
Aday, J.S., Davis, A.K., Mitzkovits, C.M., Bloesch, E.K., & Davoli, C.C. (2021). Predicting reactions to psychedelic drugs: A systematic review of states and traits related to acute drug effects. ACS Pharmacol. Transl. Sci. 4, 424, 435.
Andersen, K.A., Carhart-Harris, R., Nutt, D.J., et al., (2020). Therapeutic effects of classic serotonergic psychedelics: A systematic review of modern-era clinical studies. Acta Psychiatr Scand 143: 101-118.
Carhart-Harris, R., & Friston, K. (2019). REBUS and the anarchic brain: Toward a unified model of the brain action of psychedelics. Pharmacol Rev 71: 316-344.