ALPHA-THETA NEUROTHERAPY AS A MULTI-LEVEL MATRIX OF INTERVENTION
A chapter from the
Textbook of Neurofeedback, EEG Biofeedback, qEEG and Brain Self Regulation
edited by Rob Kall and Joe Kamiya
ALPHA-THETA NEUROTHERAPY AS A MULTI-LEVEL MATRIX OF INTERVENTION
Nancy E. White, Ph.D. and Karinn Martin, M.S.W.
The Enhancement Institute Houston, Texas
Alpha-Theta Neurotherapy, has been found in clinical practice, as in the original work of Elmer and Alyce Green and further developed by Eugene Peniston and described in his original research, to reduce or eliminate alcoholic craving while simultaneously addressing mental, emotional, physical and, at times, spiritual dimensions of alcoholism and surrounding issues. The Peniston protocol of Alpha-Theta Neurotherapy is treated as a multilevel matrix by addressing multiple diagnoses of affective disorders, anxiety, post traumatic stress disorders, personality disorders and some somatic complaints while simultaneously addressing the chemistry of addiction.
The methodology of the Peniston protocol involves pre and post treatment testing using the Minnesota Multiphasic Personality Inventory (MMPI-2) and the Millon Clinical Multiaxial Inventory II (MCMI-II), thermofeedback training to attune autogenic responses, the development and use of imagery with respect to both the process and the desired outcome, and a prescribed regimen of EEG Neurofeedback using specific neurological training sites. The patient is encouraged to practice a post treatment regimen of regular meditation with imagery of desired outcome along with periodic "booster" sessions if indicated. One year of periodic follow-up is advocated to monitor the progress of the patient.
The previous high recidivism rates of alcoholics with multiple diagnoses (comorbidity) may stem from failure to adequately address underlying psychological disorders in the treatment process. The Peniston protocol facilitates the release of deep unconscious material while the patient is in a predominant theta brainwave state. While the etiology of comorbidity is unknown, it could be related to neurochemical imbalances that may either precede, succeed or coincide with alcoholism. One of the reasons for the Peniston protocol's success may be related to this possibility, since both alcoholism and emotional conditions may be considered in terms of neurochemical transactions. Use of prescription drugs to alleviate symptoms, while necessary in certain cases, may be ineffective and contraindicated in other cases and could be double-edged: it may lead back to the dependence on the drug of choice and/or create conflict with programs demanding abstinence.
Four case studies from the files of The Neurotherapy Center are presented as examples of the presenting problems and their degree of resolution. The authors then present the theories of Colin Wilson (Chronic Trauma), Stanislav Grof (COEX Systems), Bruce Perry (effects of prolonged "alarm reactions"), Rossi and Cheek (state-dependent learning and memory) expanded by Cowan, and Alyce and Elmer Green (Beyond Biofeedback), among others, to help rationalize the exceptional effectiveness of the Peniston protocol in treating multiple disorders with accompanying addiction. A final discussion expands these ideas and brings in the experiences of actual patients, noting the "letting go" that accompanies access to slow brainwave states, ultimately allowing entry into a nonlocal reality (outside of linear space and time). Within this nonlocal reality, one's awareness of self becomes distinct from the conscious ego and one may experience "inner guidance" by means of which, frequently in a dream or "vision," one may release unconscious material, heal psychic wounds and subsequently experience a change in one's phenomenal world. The authors see the ability to promote these outcomes, and the power of the protocol, in effect, as resting in training the patient to enter and hold a deep slow brainwave state simultaneously with intention of a desired outcome. Implied is the possibility that cogent intent, held in the slow brainwave state, can produce shifts in neurochemistry.
INTRODUCTION AND BACKGROUND
In March of 1989, when Eugene Peniston's and Paul Kulkosky's research was published in Medical Psychotherapy, it may have heralded a major shift in the future course of therapy for addictions. Their research amplified the prior work of Elmer and Alyce Green, Dale Walters, Margaret Ayers, Barbara Brown, Joe Kamiya, Les Fehmi, Tom Budzynski and others over the past twenty plus years. The Peniston Protocol created a multilevel matrix approach which could simultaneously treat the multiple diagnoses of affective disorders, anxiety, post traumatic stress disorders, personality disorders, some somatic complaints and addiction (Peniston, 1989, 1990, 1991) comprising the horizontal axis with the unconscious, the physical, emotional, mental, spiritual and transpersonal forming the vertical axis. Computerized EEG feedback, a therapeutic relationship and the imagery of desired outcome, interfaced technology with compassionate personal contact. This protocol worked concurrently on overlapping addictions and the underlying psychological state.
Figure 1. The Peniston Protocol creates a multilevel matrix of intervention with its horizontal axis of diagnoses & presenting problems & its vertical axis of levels of the Self & Self connected to All That Is.
The April, 1991 issue of Men's Health magazine commented on a study reported in the Journal of the American Medical Association
"Why do many alcohol or drug addicts repeatedly sober up, only to relapse? They may be suffering from underlying preexisting mental illness, including manic-depressive and anxiety disorders, depression and schizophrenia.
"A recent study conducted by the Federal Alcohol, Drug Abuse and Mental Health Administration and published in the Journal of the American Medical Association (JAMA) points up the futility of repeatedly detoxifying addicts without addressing their mental problems. Researchers also find that psychological treatment is useless while a mentally ill person is abusing drugs or alcohol. The answer appears to be tackling the symptom and the underlying cause simultaneously."
As many as 30% of all individuals treated for chemical dependency and 50% of all individuals treated for psychiatric/psychological disturbances may be suffering from both a chemical problem and mental illness (Continuum, 1993). JAMA states that among those with an alcohol disorder the lifetime prevalence of at least one other mental disorder was 70%. The highest comorbidity rates are for affective, anxiety, and antisocial personality disorders (Regier, 1990).
Dual diagnosis patients are difficult to treat and have high recidivism rates according to an article by Wolpe, Gorton, Serota, and Sanford in Hospital and Community Psychiatry, January, 1993. Levy and Mann reported in the Journal of Substance Abuse Treatment in 1988: "Dually diagnosed patients have problems beyond alcoholism that complicate recidivism; problems in regulating thought, affect, and behavior; poor self-esteem; and low frustration tolerance among others" (Continuum, 1993).
From a scientific perspective, the etiologic mechanisms underlying these high rates of comorbidity remain undiscovered. Common neurotransmitter systems have been identified for some mental and addictive disorders. For example, dopamine system dysfunction has long been considered a factor in certain forms of mental illness and dopamine-mediated psychological reward and reinforcement functions have been demonstrated more recently to be related to substance abuse (Ritz, 1987). The system for producing and distributing serotonin also has been critical to the understanding and treatment of affective disorders (Goodwin, 1973), and decreased serotonin metabolite levels have been found in the more aggressive and impulsive population of young male alcoholics (Ballenger, 1979). Evidence also suggests that certain mental disorders such as affective and anxiety disorders may precede the development of substance abuse problems, although there is increasing argument that certain mental disorders are actually the result rather than the cause of substance abuse disorders (Schuckit, 1988). It is difficult to ascertain which came first, the addiction or the mental illness, or were they born hand in hand through some imbalance in the neurochemistry (Blum, 1991) and/or core trauma?
It is not uncommon for addicts to present depressive symptoms prior to addiction and, if not that, they may have feelings of worthlessness and guilt about what they have created out of their chronic addiction. The recovering addict is often anxious. Suicidal ideation, especially in the addict detoxing from cocaine, is also encountered. Recovering individuals often report that they feel worse than they did when they were using. Their behavior is still addictive with the major change being that they are no longer using their drug of choice. Often they exhibit personality disorders.
One way of treating this problem of dual diagnosis, or perhaps multiple diagnosis, has been to give the patient drugs. The presence of medication can interfere with the treatment of addiction. Addicts may have come in with the desire to get off drugs and not to use anymore, but use the prescribed medication as an excuse to sabotage their treatment. Perhaps pleased to not have to go chemical free, the addict could assume that since the doctor prescribed medication that the doctor must agree that he or she can't live chemically free in order to function. Any regularly prescribed medication could lead to this thinking process. So, addicts may rationalize that, since they can't live chemically free, they may as well take their drug of choice rather than the prescribed chemical (Reilly, 1989; Sweben, 1993).
There are considerations concerning medication in another direction as well. Compliance with an aftercare program is strongly associated with improved outcomes, lowering the recidivism rate. A strong support system is an important factor (in recovery), yet many twelve step groups such as A.A. (Alcoholics Anonymous), C.A. (Cocaine Anonymous) and N.A. (Narcotics Anonymous) view the use of even essential psychotropic medications as "using" or not remaining substance-free. This leads to conflict with sponsor and/or group support and possibly damaging compliance with the prescribed drug regimen. Many times these patients simply return to the former situation, which often leads to a return of their addiction and mental/emotional symptoms. (Continuum, 1993; Erickson, 1991).
We are not speaking against medication; sometimes it proves to be the best way of handling the multiple diagnosis problem. If there is an effective way to promote what appears to be more permanent healing and recovery without medication, however, we would prefer it.
At The Neurotherapy Center we have found that the Peniston Protocol of Alpha/Theta neurofeedback has allowed us to affect addictive craving directly and to simultaneously address physical, emotional, mental and, sometimes, spiritual levels of the disease. Since emotional problems, as well as addictive craving, may ultimately be explainable in terms of neurochemical transactions, by extrapolation we can speculate that the protocol works to alter the nature of some of these transactions in a lasting way; but this has yet to be proven. Even though the exact mechanisms by which this breakthrough protocol works are not yet known, the method is producing a high level of positive clinical results. For example, a recent survey of several of the leading practioners using Alpha-Theta Neurotherapy estimates that the success rate of outpatient treatment is in the range of 60 to 70%, while the inpatient success rate is in the range of 70 to 80% (Walters,1994). We wish to present a method of treating with this multileveled matrix of healing and to offer actual case studies as examples of achievable outcomes. Later in the Chapter we offer some ideas, based on some leading theories, as to what may make the Peniston protocol so effective.
Our treatment incorporates the protocol developed by Peniston (1989, 1990, 1991), with allowances made for our outpatient clinical setting, and is developed in the following paragraphs. The outpatient model we have developed leaves the Peniston protocol virtually intact. Imagery, while following the guidelines of the protocol, may be directed more to a patient's specific needs and presenting problems. A minimum of four treatments per week is indicated, scheduled to recognize to the extent possible the demands of the patient's outside life. Severe cases may receive two treatments per day, with a minimum three-hour interim between treatments, up to four days a week. The accelerated pace may continue just for the first several weeks of treatment or may last the entire time. Adjunctive treatment may be called for in certain cases, such as individual psychotherapy and/or CES treatments. When we treat an addict from another city we help them find living arrangements conducive to sobriety - often a halfway house that understands our program - and assist them in joining a support group, either one of our own or another. We also conduct random drug and alcohol testing on addicts during the course of treatment.
Intake and Assessment
The initial phase of assessment utilizes the Peniston procedures which involve:
1. Pre-treatment psychological testing: Patients complete The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and The Millon Clinical Multiaxial Inventory II (Millon II) prior to beginning the treatment.
2. Medical history
3. Addiction history
4. Neurological conditions including any head trauma history
5. Personal history
(with emphasis on any mental, emotional or physical trauma, particularly in childhood)
6. Needs and goals of the patient assessed
7. Explanation of the program
8. Patient commitment to the program
Patients complete the MMPI-2 and the Millon II and fill out a personal, medical and addiction history, a neurological checklist and completes a quantative EEG prior to beginning treatment. We then meet with the patient to review the outcome of these assessments. At this time an overview of the EEG brainwave training is explained. The needs and goals of the patient are assessed and any mental, emotional or physical traumas of childhood are discussed.
The Peniston protocol begins with four to six thirty-minute sessions of thermal biofeedback-assisted autogenic training. The subject is instructed to sit in an Alpha chair (manufactured by Sensory Environment Engineers) and to relax with eyes closed. These chairs are used to accelerate/heighten the patient's auditory stimuli and create a feeling of environmental security. The Alpha chair is a cushioned egg-shaped chair with strategically placed speakers wrapping their sounds around the occupant. A temperature sensor is attached to the middle finger of the subject's dominant hand, collecting data received by a J&J I-330 instrument. Autogenic phrases are presented to the patient by way of an audio tape. Individuals who are auditorily non-responsive are assisted in creating effective visualizations for themselves instead. The patient is taught deep rhythmic breathing techniques to induce relaxation of the body and to quiet the mind. A training criterion of warming the hands to between 94 and 96 degrees Fahrenheit is established.
Following the thermal training but prior to the brainwave training, one session is devoted to the clarification of the patient's goals and imagery is constructed to represent the patient's desired outcome. An alcohol rejection scene is developed relevant to the patient's previous drinking behavior (Peniston, 1989; Fahrion, 1992). The patient is shown a picture of delta, theta, alpha, and beta brainwaves with an explanation of the state of consciousness that predominance of each of these brainwaves represents. Next he or she is instructed to visualize initially increasing the amplitude of their alpha brainwaves and is told that at some point during the feedback sessions that the alpha amplitude will usually begin to recede and the theta amplitude will rise. The exception to this instruction would be the patient who initially has very high alpha amplitude, in which case the alpha audio feedback will be turned off and they will be instructed to visualize increasing the amplitude of the theta brainwaves from the beginning of the feedback sessions. The next task includes the visualization of one's hypothalamus gland in the center of the brain and requesting that it optimally balance the production of neurotransmitters. The patient is then assisted to create an image of his/her ideal self as he/she wants to be, handling in a positive way the important personality and social issues in his or her life. Next the patient is told, "Let yourself sink down to a state just before sleep without going to sleep." The final step is a directive to the subconscious stating, "Please bring to me anything out of my past that I may need to see or experience for my healing," and then, lastly, giving the simple command of "DO IT!"
The patient is then given 24 to 26 sessions of alpha-theta EEG feedback, a total of 30 sessions overall although additional sessions may be indicated for some individuals. The most common schedule is four sessions of brainwave training per week with a duration of 45 minutes to an hour each which incorporates 30 minutes of active feedback. The patient is instructed to differentiate the alpha and the theta audio feedback tones. The patient sits in a semi-darkened room, in a comfortable reclined chair with the eyes closed and is generally left alone during the active feedback period. The clinician remains nearby in order to make any threshold changes (explained further below) that might become necessary, or to handle any problems. The process of the patient is not interrupted during the feedback session but with a few patients who were inclined to go to sleep, the clinician was available to lightly tap them on the arm to bring them back from sleep. The clinician might suggest that the patient incorporate, "Tell your unconscious mind to keep you awake during the session."
While there are a number of good computerized EEG systems on the market, we have been using the CapScan Prism Five (CapScan Corporation) to monitor the EEG and provide harmonic auditory feedback. The feedback is presented from the left occiput (Green, 1977, Peniston, 1989). Three active, user defined, bandpass filters are set at theta (4-8 Hz), alpha (8-13 Hz) and beta (13-26 Hz). Auditory feedback is provided for alpha and theta independently when brainwave frequency exceeds thresholds. A concurrent bar graph is shown on the screen during the patient's alpha-theta training experience. At the end of each session, a statistical analysis and graph is produced of the mean amplitudes of theta, alpha and beta and is reviewed with the patient.
Earlobes, forehead and scalp are cleansed with alcohol and rubbed with Omni Prep and White Signa Cream used to reduce electrode resistance prior to applying the monopolar electrodes. Electrodes are then placed on FP1, FP2, O1, O2 (International 10-20 placement, Jasper, 1958) and a ground electrode placed midway between FP1 and FP2 and reference electrodes placed on both earlobes. The electrodes are held in place by velcro and a headband.
Electrode impedance is checked before recording begins and electrodes are reapplied accordingly for an impedance of less than 5,000 ohms. Thresholds for alpha and theta are set in order to provide feedback, triggered if the occipital (O1) alpha or theta go above these preset thresholds. Thresholds are adjusted appropriately throughout treatment maintaining approximately 70% feedback. The initial increase of alpha amplitude seems to enable the subject to release physical and mental tension, whereby a deeper, or theta, state of mind surfaces. As the alpha state deepens, the individual lets go of the waking ego state, thus evoking the "window" to the subconscious as theta becomes dominant.
The desired ratio of theta amplitude over alpha amplitude is 2:1. While most alcoholics have low amplitude alpha, we have found that some exhibit high amplitude alpha initially. In these cases, since the original software had no capacity to set an inhibit or to support ratio training, the alpha feedback was eliminated or set above the patient's average amplitude in order to avoid reinforcing excessive alpha production. When the patient begins to produce a predominance of theta brainwaves, a "crossover" occurs (theta at a higher amplitude than alpha). Once crossovers begin to occur regularly, perceptual and behavioral shifts become evident, cravings diminish or disappear and abreactions related to repressed subconscious material emerge. These abreactions seem to emerge naturally in approximately 40 to 60% of the patients with no coaxing from the clinician except the previously stated suggestion, "Please bring me anything of my past that I may need to see or experience for my healing."
At the beginning of the session, as the electrodes are being placed on the patient's head, any relevant issues are processed that may have come up since the last brainwave training session. At the end of the session, the clinician is available to process any abreactions or experiences that the patient had during the session. The clinician listens, not interpreting but allowing the patient to find their own insights. (As a general rule, the patient is not interrupted during the feedback.) The patient is then asked to fill out a post treatment session form which inquires as to their experience during the session. This writing seems to assist the patient in returning to normal waking consciousness (beta dominant) and helps them to integrate whatever experience they had during the session. It also provides a record for them and us to follow their progress.
POST TREATMENT PROGRAM
The patient is administered a second MMPI-2 and Millon-II post treatment to determine levels of change. The changes are noted and discussed with the patient. The post treatment interview involves the review of the patient's preset goals, assessment of changes in the person's attitude, behavior and perceptions and recommendations for the future. Such recommendations may include extension of treatment, periodic "boosters", twelve step groups, and the continued practice of entering the slow-wave (theta) state with the intention of a desired outcome. Follow up phone calls are made at 3, 6 and 12 month intervals.
This multi-modal neurotherapeutic approach seems to address the many dimensions of the individual who, while in treatment for addictions, often exhibits multiple mood disorders, personality disorders and/or somatization disorders. We have found this EEG brainwave training to facilitate the simultaneous integration of the patient's mental, emotional, physical and, at times, spiritual dimensions. The far reaching effects of this treatment are more easily appreciated by examining case studies.
Case Study 1 - B.K.
We have found that nearly all our patients that are treatment resistant and/or high risk present with multiple diagnoses. B.K. is a good example. She was a 43 year old female referred to us by her A.A. sponsor. The sponsor reported to me that this woman had been sober for about two years until she had slipped about two months prior. She was active in AA but was craving alcohol and the sponsor said she had done all she knew to do and hoped that we could help.
When she came in for her first appointment it was obvious that she would be a difficult, if not impossible, case for more traditional psychotherapy. She had an eating disorder and was obese; she was experiencing frequent panic attacks; she was self mutilating, depressed and often had suicidal ideation. She also had migraine headaches. The most difficult aspect of her case was that she was emotionally phobic. She was unable to express any feelings and would panic, become immobilized, dissociate or leave and get drunk when pressed to face any situation that was emotional. She came from an alcoholic family. Her sister is an alcoholic; her mother, a nurse, died of alcoholism; her father, a doctor, now senile, is also an alcoholic. Her mother's brother froze to death on the porch at age 19 when he came home drunk and his family would not let him in the house. She knows that her father's father was alcoholic and believes that her mother's father may have been an alcoholic also. Our assumption is that there is a genetic component to her alcoholism. (See figure 2.)
Figure 2. Genogram depicting the multigenerational family of B.K.
Her initial testing with the MMPI-2 revealed an anxiety disorder or dysthymic disorder within a schizoid personality. Both of the diagnoses fit our clinical impression of her. Her testing also showed a possible schizophrenic disorder. The results of the testing with the Millon II revealed her as quite elevated on borderline personality, compulsive and dependent scales, all of which also fit our impression of her.
She agreed to treatment using Neurotherapy. After the sixth session, she experienced abreactions during the session and was having auditory hallucinations but desired to continue with the feedback sessions. She began having flashbacks and on the fifteenth session she experienced a flashback and realized that she had been sexually abused in the crib, presumably by her father. She recognized this as the probable core of her lifelong problems (Ross, 1989; Grof, 1985; Perry, 1992). She experienced many flashbacks of incest and physical abuse by her alcoholic mother and father. She had lived her life as a victim (her own and others'), yet when she had the flashback of the crib abuse, her adult self appeared in the room and said in a booming voice, "How dare you!" This was a "Resource Self" that had not appeared in her life before.
Using the Neurotherapy, we have found that this phenomenon of the Resource Self occurs with many female cases who have experienced sexual abuse. The adult self will enter the flashback and say "How dare you!" or "Don't you ever do that again!" and rescue the child. An inner resource is reclaimed. The patient is never fully the victim again. This has been a spontaneous occurrence emerging from some part of the self and not programmed by us.
B.K. completed the treatment with a total of 30 sessions. She was retested (See figure 3). The MMPI-2 showed no clinical diagnosis on Axis I and personality disorder NOS on Axis II. There was a major drop in the depression scale from 81 to 53. She was no longer suicidal. She showed the same shifts on the Millon II with the dysthymia scale dropping from 102 to 34. Borderline dropped from 86 to 70, which also fit our impression of her. Perhaps most noteworthy was her pre Millon II score of 71 on the schizoid scale denoting her unwillingness to process any emotional content. Her post score of 00 on this scale suggested that she could be emotionally available for further therapeutic treatment. The elevation of histrionic on the post treatment Millon II, may be perceived as a positive developmental step also suggesting she was now not so blocked to her emotions. She was still slightly high in psychopathic deviance on the MMPI-2 scale. We often see this scale remaining slightly high after EEG feedback training which could be related to creativity and independence. She came in for five booster sessions during the first year when she felt stressed and sensed that she was losing some of her inner peace and connection to herself.
After the completion of the Neurotherapy program, she had no craving for alcohol and was able to face her emotions. She then went through our PAIRS program which is an intense 120 hour group program extending over four to five months, attended by couples and singles. The focus is predominantly on the relationship with one's self. It is a very emotional experience and our belief is that she could not have gone through this if she had not completed the EEG feedback training.
She was called for follow up and after three years she is still doing very well. We recently saw her at a lecture and she came up to speak to us. She looked wonderful. She was still overweight but was no longer bingeing on food and she has remained sober. She has a good relationship with her husband and is doing well on her job. She thanked us again and said, "I owe it all to you."
Case Study 2 - M.M.
An interesting 35 year old male (M.M.) came in for therapy in December of 1990. He was a bright, attractive professional. During the course of the first meeting, he remarked that he smoked marijuana every day. He was told that if he wanted his therapy to be effective he would have to stop. He commented that he couldn't and spoke of his inpatient experience two years prior. He had gotten high the afternoon he got out of treatment.
Figure 3. Pre/Post testing graphs of the MMPI-2 (top) and the Millon II of B.K.
He had begun drinking at age 13 and drank to get drunk every weekend. He began smoking marijuana at age 14. By age 15, he had a goal to try every psychoactive substance at least once and studied the Physician's Desk Reference (PDR) to be sure he didn't miss anything. He had had uppers, downers, heroin, amphetamines, LSD, cocaine, quaaludes, and so on. As far as he knows, he accomplished his goal with the exception of the drug "ecstasy." He would go to Mexico to buy drugs to sell and would test them by shooting a small amount in his vein and could quickly tell the quality by the taste in his mouth. If it was good, he would buy it. By age 22 until he began his treatment, he had had drugs and/or alcohol almost daily.
When M.M. left his inpatient treatment and immediately relapsed, he realized he could not stay off drugs and so he concocted his own therapy which consisted of heavy doses of $320 per ounce marijuana every day. Nothing else would suffice. Every other weekend he would take crack cocaine for several days until his body would collapse. This was the state he was in when he came in for therapy. He was depressed. His wife had put him out of their house and he was living alone in an apartment.
There were multiple addictions throughout several generations of his family. He had had a difficult childhood with a controlling, demanding father who beat him and a depressed mother who felt helpless in her situation with her husband.
Fig. 4. Genogram depicting the multigenerational family of M.M.
He smoked his last joint the day after Christmas on December 26, 1990. He then came in for the Neurotherapy which he completed in early March of 1991. Upon completion, he had no craving. Both his MMPI-2 and his Millon II show remarkable changes. On the pre Millon II, narcissistic, antisocial, aggressive/sadistic and borderline conditions are almost off the scale. The improvement can be seen in the post test which fits our clinical impression of him. His dysthymia scale went from 82 to 11 on the Millon II and depression scale went from 72 to 47 on the MMPI-2.
Figure 5a. Pre/Post testing graph of the MMPI-2 of M.M.
He moved back in with his wife and his children and is successful in his professional practice. He is active in an AA program. On his one year follow up, he reported that he had had the best Christmas he had ever experienced. His parents and sister had come to visit and had brought him a gold key chain to celebrate his year of sobriety.
At eighteen months, he was in a highly stressful situation and relapsed for several days. He immediately came in for six boosters and left feeling good. (It has been our experience that patients completing the Neurotherapy program, should they relapse, are more likely to quickly return for boosters and continue abstinence.) It has now been more than four years since his original treatment and, except for his brief relapse, he is doing well and experiences no craving.
Figure 5b. Pre/Post testing graph of the Millon II of M.M.
Case Study 3 - K.H.
The next study is K.H., a 28 year old female. She came in for individual therapy subsequent to a suicide attempt. She and her husband were both drunk and she attempted to jump out of the car moving at 55 mph on a freeway. When she sobered up, she was frightened of her behavior and was aware she needed help. Her diagnosis included alcoholism, PTSD (post traumatic stress disorder), dissociative disorder, depression and she was experiencing frequent and severe panic attacks. She had an abusive relationship with her alcoholic husband.
When she came in, she was told that she must stop drinking. She looked with dismay and said, "I don't think I could stand the pain of my life without alcohol." She was encouraged to try the Neurotherapy treatment which, in her desperation, she agreed to do.
Upon examination of her genogram, it was obvious she was from a multigenerationally addicted family. K.H. realized she had been an active alcoholic since her father began giving her beer when she was one and one/half years old. Her childhood had been very difficult. She was neglected and was even sent home from school as being dirty. Her alcoholic father had died when she was seven. Her mother remarried a friend of her brother's who subsequently sexually molested her.
At age twelve, she was raped by a friend of her brother's. She became pregnant and had an abortion. She was also sexually abused by this brother. During this period of her life she began seriously abusing alcohol. She was gang raped her first year of high school. She spoke of herself as "a piece of shit."
Figure 6. Genogram depicting the multigenerational family of K.H.
Depressed, suicidal and craving alcohol, she began the Neurotherapy program. After two weeks, she was amazed she had been able to go without alcohol. She did not remember having gone a day without alcohol in many years. She had one beer several weeks after starting the Neurotherapy program but felt so sick the next day that she said she did not think she would ever have another drink. (This was probably the "bone sick flu" that Eugene Peniston speaks of and will be discussed later.)
During the program, she had many flashbacks. At one point she saw the face of her rapist just in front of her. In this deep theta state, without the resistance of the waking ego, her adult resourse self was able to facilitate rapid integration of these past traumas and began to feel much better about herself. She is no longer suicidal or depressed and has had one minor panic attack in the three years since treatment. Her PTSD (post traumatic stress disorder) seems to be resolved. She still has the problem of an alcoholic husband, does not live in a supportive environment and has refused to go to AA, but has managed to maintain her own sobriety. She has enrolled in graduate school and plans to get her masters degree and teach science to high school students. She is enthusiastic and thinks her life experience will help her to have more compassion and understanding for her future students. Her self esteem has risen considerably and she has commented that, even though she loves her husband, she knows she will have to divorce him when she completes graduate school. She plans to move away from this city and stated that she thinks too much of herself to live in the environment with a drunken husband for the rest of her life. This was a long way from her earlier self-deprecating definition of herself as "a piece of shit."
She has now been sober for three years. She has no craving and no desire to drink. Her dysthymia scale on the Millon II dropped from 79 to 24. This is a scale where we see major drops with most of our patients. Borderline personality dropped from 76 to 62. We often see improvements in the borderline scale after treatment, which generally fits our clinical observations. Her post treatment Millon II shows improvement but the self-defeating and passive-aggressive scales are still quite high.
Her MMPI-2 shows considerable change. On the pre treatment test seven of the ten scales were elevated. In the post treatment test, she is within normal limits and is only slightly elevated on the paranoia scale. Again, the depression scale dropped from 72 to 58. Her ego mastery went from 74 to 49. She comes in for individual therapy sporadically and is continuing to feel better about herself and her life.
Figure 7. Pre/Post testing of the MMPI-2 (top) and the Millon II of K.H.
Case Study 4 - M.B.
This attractive 30 year old female (M.B.) had been referred to our office three years prior. Her life was quite dysfunctional but she came for only three appointments in 1988 and then we did not see her again until she appeared in March of 1991. Her life was in shambles. She was depressed and suicidal and she had recently attempted to overdose on sleeping pills. She had smoked marijuana daily for six years along with frequent use of alcohol. As her mother had been, she was addicted to prescription drugs, particularly speed. She had had a recent automobile accident and was in a state of anxiety. She was acting out sexually and had three abortions that year. She had a panic disorder, dissociative disorder and PTSD. She had a bipolar disorder, her depression was interspersed with mania. She had a dysfunctional relationship with her fiance, which was close to breaking up. She had rage attacks which, among other things, were contributing to the destruction of the relationship. This was the impetus that brought her back to therapy. She was highly intelligent, yet unable either to focus mentally or to concentrate and she had had to drop out of law school. She was having as much difficulty physically as she was emotionally. She had gained weight, was chronically fatigued and had asthma, allergies and anemia. She had a sleep disorder, hypoglycemia, and dizziness. She was taking diet pills in an attempt to lose the weight she had gained.
Her parents divorced when M.B. was three months old. Her father, a lawyer, was wild and irresponsible and she was raised by her paternal grandparents in a home that was chaotic and dysfunctional. Her mother, that she remembers having seen only once after the divorce, later died of an overdose of heroin.
Figure 8. Genogram depicting multigenerational family of M.B.
M.B. was quickly able to raise the temperature of her hand to 95 degrees and to maintain it at that level. She moved to the EEG training by the third session. Her imagery was simple. She imagined herself at the beach as "calm, natural, stronger, rejuvenated, and with a broader perspective of life." She then imagined her work and relationship as "calm, thinking before responding, and expressing feelings appropriately." She then imagined a drug rejection scene and ended with seeing herself as she wished to be. During the training, while in the theta state, she had flashbacks to her chaotic childhood and experienced her crying and terror. Much of this was experienced in the "witness" state of consciousness. Due to the issue of childhood sexual abuse, she requested a change to a female therapist after which she was able to process her abreactions more effectively.
She had a total of 30 sessions, two of thermal biofeedback and 28 sessions of EEG training with alpha/theta feedback. This was over a period of approximately eight weeks. She has since married her fiance, a medical student who was very skeptical of the treatment, but who now thinks it was a miracle. She has gone back to law school and additionally is conducting her own international business. She has no craving for drugs or alcohol.
In a six month follow up, M.B.'s comments were, "Being able to enter a deeper state has helped me in a variety of areas. I have lost thirty pounds and have a desire to get back to running. I was previously so lethargic. I am clearer thinking and feel so much more mentally focused. I have a healthier personality. My depression is gone. If I begin to feel down, I get myself relaxed and I handle the situation well. I use the visualization. I can take rejection better (a previous problem for her) and I accept it. I am physically healthier than I have ever been in my life. Previously, I wasn't taking care of my life." She is no longer on any medications.
Figure 9a. Pre/Post testing results of the MMPI-2 of M.B.
Figure 9b. Pre/post testing results of the Millon II of M.B.
THE POWER OF THE PROTOCOL
Thermal Biofeedback - Self Mastery
It is our belief that the Peniston protocol in its entirety is the power of this therapy. In our clinical setting, we are delighted with our outcome and do not wish to break the protocol into pieces for examination but recognize that for purposes of research it may be advantageous to attain further information about its many aspects. To examine the parts of the protocol and the power of each, we look first at the thermal biofeedback with autogenic training which leads one to experience a sense of self mastery of an aspect of the autonomic nervous system that heretofore most believe is out of conscious control. It reduces stress and readies the body/mind system to go to the deeper levels in preparation for the "theta state of consciousness" and, in the field of biofeedback, it has long been recognized that this self mastery brought with it feelings of personal empowerment. We are preparing the proper psychophysiological environment where awakening can occur (Wuttke, 1992).
Educating and Programming the Conscious and the Subconscious
Next we visually educate our patients with the nature of brainwaves and relative states of consciousness as a preparation for the desired performance of the conscious and the subconscious mind.
Showing our patients a model of the brain, we explain in layman's terms the neurotransmitter system and the optimum balance of this system and believe that this offers them a program and a picture for the subconscious mind to follow. We co-create with the patient an alcohol rejection scene or other appropriate rejection scene and end with seeing oneself as one wishes to be. "Programming the unconscious" (Green & Green, 1986) was explored in the late 1960's by Dr. Elmer Green, who revealed that he had modified an approach to changing life patterns that he had excerpted from the ancient Yoga sutras: Hold the image of change firmly in mind as you quiet down both physiology and thought processes, and then release it without attachment (Cowan,1993). With this aspect of the protocol we agree with Jon Cowan who states, "From the viewpoint of learning and memory, the repetition of intentional images or visualizations is quite different from a series of guided imagery experiences. It is much more likely to reinforce learning and produce the overlearning of the particular response that is important in creating personal change." Dr. Deepak Chopra (1993), author and endocrinologist, tells us that imagery creates intention and intention automatically seeks fulfillment.
Altered State - The Nonlocal Reality
We believe that the imagery is very important but that the strength of this therapy lies within one's ability to enter and be held in a deeply altered state with intention of desired outcome. We live in a world that rewards the state of consciousness that we will refer to as the "beta state." It is predominately narrowly focused, rational, linear, more interested in "doing" than "being," and productive, but, due to the narrow focus, is limited in its perceptions of reality. It gains its wisdom and insight predominately from the five senses. It is a world of objects. Sole reliance on this method of brain function inherently activates the ego self (adapted self) with its fears, anxious thoughts, need to be in control and "hold on." We rock between pleasure and pain. Even when we are in the pleasure, we fear the loss of the pleasure, putting us back into the pain. The state of consciousness where the brainwave pattern is predominately low alpha and theta is more openly focused and attention is divided among multiple objects (Fritz & Fehmi, 1982). As we move the predominant brainwave frequency into the lower realms, there is a surrender or "letting go" of control. We move into an emptiness of space where we are conscious and aware but not aware of being aware until we return to the thinking mode. It is here that we encounter the nonlocal reality where we transcend ordinary space and time as we know it, a world behind the scenes that is beyond the world of objects and persons.
In the "normal" or usual state of consciousness, in both our internal perception and our external perception, we experience ourselves as existing within the boundaries of our physical body and are confined by the usual spatial and temporal boundaries. We vividly experience our present situation and our immediate environment. We recall past events and anticipate the future. In the training with feedback tones of a computerized EEG, as the patient obtains deep alpha and theta states, there appears to be a disidentification with the ego self which includes the physical body. "After several minutes of a lot of alpha and theta I began to feel quite disassociated from the sound, as though out there was all the activity, and my brain was completely passive. With this feeling came the disassociation with my body..." states J.H. in Beyond Biofeedback (Green & Green, 1977). Subjects consistently experience a sense of ego-lessness, a "pure being state." They have no consciousness of a body or their life "drama". They frequently experience a sense of being "pure energy." Light and colors are experienced by some, contributing to a profound sense of well-being and inner peace. One woman experienced gold and purple swirling in the center of her forehead bringing with it a feeling of joy and ecstasy.
Figure 10. In the "beta state" of consciousness we rock between pleasure and pain. As we lower the brainwave frequency, there is a letting go and surrender in the "alpha state" moving into the "Void" or deep "theta state."
Dr. Larry Dossey (1993), speaking about the nonlocal reality, refers to this void that is encountered in the deep theta state as follows: "Paradoxically, this void becomes the fullness that gives rise to everything in the visible, phenomenal world. Modern physics seems to echo this vision. For example, in devices called cloud chambers, we can easily see subatomic particles appearing out of the void and disappearing back into it - the mysterious transformation of energy into visible matter and matter into invisible energy. Science, therefore, clearly shows us that the void, whatever else it may be, is not nothing."
Several of our patients have experienced the sensation of being "out of their body." There is, distinctly, a double recollection of two bodies. One is sitting in the chair with eyes closed in a deep state of consciousness hearing the tones of the machine as it rewards the attainment of the preset thresholds of alpha and theta. The "other" self is floating on the ceiling observing the self in the chair. With this state comes inner peace and the awareness that one is not solely his or her body bringing with it the appreciation that one is more than one's body.
It is not unusual for some patients to experience an "inner guidance." This takes many forms, on a continuum from deep insight to the sense of another being or animal appearing to them. One middle aged professional man, who had not had any prior experience of the transpersonal realm, experienced a guide that he referred to as his "Higher Power" which appeared in different guises. Initially his guide appeared as a hawk and then as a snake. Frequently, the guide appeared as a native American who told him he was his great, great, great grandfather (who was known to have been an American Indian). The hawk took him on his wings and soared out into the cosmos. From there, the hawk pointed out the earth to him and then the pinpoint that was his home. He explained to him the insignificance of his local reality in comparison to the vastness of the cosmos. No sooner than he had absorbed this idea, he was quickly propelled to the earth where he was taken to the microcosm world of the earthworm. It was then explained to him the significance and importance of all things. Truth is often found in paradox.
This same man had had a difficult relationship with his father for most of his life. They were not close and he didn't understand his father and his coldness. During the session, he was taken back before his birth and back in time where he was shown the conditions of his father's childhood and the conditions of his father's relationship with his father (the patient's grandfather). He returned to normal waking consciousness with a new understanding and compassion for his father. Stanislav Grof (1985) tells us, "Sometimes the regression appears to go even further and the individual has a convinced feeling of reliving memories from the lives of his or her ancestors, or even drawing on the racial and collective unconscious." Elmer Green (1977) describes theta training as a path to access planetary consciousness.
One female patient was taken by an angel to her father's deathbed where she was able to heal old wounds and say several things she had not been able to say to him when he was living. She returned with a deeper sense of inner peace. For those who experience an "inner guidance," they express a major shift in perception about their lives and environment.
A recurrent phenomena observed by many patients and our staff is the dynamic interconnections between the individual's inner experiences during the neurotherapy and changes in their phenomenal world. It has not been unusual to find that as our patients change during this therapy that other family members change, often without contact as in the case of one woman who had come from out of town and lived with her son during the duration of the therapy. She and her husband had had a very difficult and dysfunctional relationship and, even though she was in her sixties, she was contemplating divorce at the time of her arrival at our office. When she returned to her home, she found that her husband had experienced a positive personality shift. This had seemed to occur simultaneously with her neurotherapy and did not appear to be solely in response to her on the level of the five senses. Again Grof (1985) speaks of change in others congruent with the changes in the individual during the therapy sessions and happening quite independently and not explained in terms of conventional linear understanding of causality. The persons involved may be hundreds or thousands of miles away at the time with no physical communication between the persons involved. For explanation we could turn again to physics and a famous mathematical formula, known as Bell's theorem (1964) that holds that the reality of the universe must be nonlocal; in other words, all objects and events in the cosmos are inter-connected with one another and respond to one another's changes of state (Sheldrake, 1981, 1988; Herbert, 1985; Chopra, 1989).
While in the "theta" state, the subject frequently connects with the "Witness Consciousness." The subject appears to be transported into a suspended, objective state wherein he/she experiences an observing self. "With training you eventually develop the ability to consciously observe and witness internal and external stimuli, without judging or thinking" (Wuttke, 1992). A verse from an ancient Indian Upanishad describes this beautifully: "A man is like two doves sitting in a cherry tree. One bird is eating of the fruit while the other silently looks on." The bird who is the silent witness stands for that deep silence in everyone, which appears to be nothing at all when in reality it is the origin of intelligence (Chopra, 1989). This dimension of self is able to experience and perceive a "bigger picture" of the original trauma. This state of mind enables the patient to perceive from a larger domain and experience less judgment and more acceptance. This capacity to elevate beyond the pain of the original trauma allows the person to release and discharge the prior unexpressed emotional pain. There seems to be carryover when the patient returns to "normal" waking consciousness. One lives more in a state of acceptance of what is rather than how one wishes it to be, more able to "let go" of unwanted thoughts and feelings.
The "Resource Self" seems to be another aspect of the "Witness Consciousness" although there is a different quality to the experience. Whereas the "Witness Consciousness" could be defined more as an "Observing Self" that watches with interest and without judgment, the "Resource Self" is experienced as the personal adult self available to the child being abused in the abreactive flashback situation and becomes "her" champion and rescuer as in the case of B.K. In essence, the individual incorporates the "inner parent" for reparenting/rescripting his/her life.
This deeply altered state of consciousness that we term the "theta" state may also produce an "Inner Healer" that targets somatic issues, strengthens the immune system and, otherwise, physically energizes the subject. M.W. was referred to us for brainwave training by a psychiatrist who had prescribed a regimen including Prozac and Activan. At the beginning of the program, pre-testing with our psychometric instruments indicated a probable schizophrenic disorder or an anxiety disorder in a paranoid personality. He had dropped out of college and was on total disability for Epstein Barr Virus. Presenting symptoms included severe anxiety attacks, depression, sleeplessness, low energy levels, and cognitive impairment. After the Neurotherapy program, post-testing revealed the patient to be within normal limits: there was no clinical diagnosis. He returned to college and his academic performance had returned to normal, depression and anxiety symptoms had vanished, the symptoms of Epstein Barr Virus had disappeared and there was a marked positive change in interactions with family and friends. The attending psychiatrist discontinued all medications.
Further, as relating to addiction, Chopra (1989) states, "Meditation may be a powerful therapeutic tool, allowing the body to get unstuck from the disease. Meditation researchers caught on to this potential in the late 1960's when they discovered that many college-age meditators who used alcohol, cigarettes, and recreational drugs spontaneously quit their habit within a few months of beginning to meditate. We can call this getting unstuck from an old level of consciousness. In terms of neuropeptides, it may be that the meditation freed up certain receptor sites by offering molecules that were more satisfying than alcohol, nicotine, or marijuana....We are no longer in doubt about the fact that invisible wisps of thought and emotions alter the fundamental chemistry of every cell." This may be the neurochemical shift that creates the "bone sick flu" that Peniston speaks of. When many patients have been thoroughly trained in this protocol, if they relapse, they experience bone, joint and muscle aches and sometimes fever, with the symptoms resolving spontaneously in about two days (Cowan, 1993). The body seems to reject the drug or alcohol substance as toxic.
The possibility exists that if we could create a structured meditation program for a patient, that over a period of time we would see these deep shifts in personality and beha
This "Inner Healer" appears to be re-organizing the physiology during immersion in the theta state. The body relaxes and lets go of resistances during theta state of consciousness and, we hypothesize, then has the opportunity to move toward homeostasis. Patients experiencing the following syndromes and physical conditions, in addition to their presenting problems, have reversed their conditions through the alpha-theta training: migraines, chronic headaches, Epstein-Barr virus, Chronic Fatigue Syndrome, Vertigo (as related to Meuniere's Disease), Angina, Hypertension, chronic pain, and TMJ problems. As the case studies presented earlier have indicated, somatization disorder is diminished. Chopra (1989) tells us that the body is fluid enough to mirror any mental event. Dr. Candace Pert (1993), formerly Chief of the Section on Brain Biochemistry at the National Institute of Mental Health, refers to the entire mind-body system as a "network of information," shifting the emphasis away from the gross level of matter toward the subtler level of knowledge. Pert prefers to use the term "bodymind." She theorizes that the neuropeptides and the receptors of the body are the biochemical correlates, the material manifestation, of emotions. Our body knows our secrets and our sorrows and is a mirror of our emotions. As we release these old patterns, the neurochemistry seems to change and our bodies heal and change.
These expressions of the brain/mind system, the "Resource/Witness Self/Inner Healer" consistently seems to produce a state of balance in the psychological domain as well as in the physiological state. This internal self-regulation process appears to address multiple systems of the beingness simultaneously.
Patient - Therapist Relationship
Further, we believe that the self of the therapist is an important element in the success of this powerful therapy. "The art of psychotherapy... insists that what goes on inside the therapist, the artist, is crucial to the whole enterprise," Bugental (1987) states. Others, such as Dr. Edgar Wilson, have found brainwave synchrony between healer and patient at the time of peak effectiveness (Cowan, 1993). Fahrion (1993) found that interpersonal synchrony was highest during healing, especially in alpha frequencies between left occipital areas of the practioner and the patient. In a deeply altered state the patient seems to be more sensitized to the environment and, we assume, to the energy and attitudes of the therapist. A nonlocal connection seems to be formed, a rapport is created and trust of the therapist seems crucial.
The quality of the relationship with the therapist and the "self" of the therapist seems to be a significant component during the abreaction/catharsis. The therapist's empathy and sensitivity to the patient's emotional healing experience during the highly charged, vulnerable experience of the theta state is important to create the atmosphere of trust needed for the patient's willingness to "let go." Female subjects who have been sexually abused consistently request a female therapist for support, bonding and trust in order to move through the cathartic process.
The therapist's own level of personal evolvement in the psychological, mental and spiritual domain and his or her trust of the process of the healing that is taking place and lack of fear of the abreactions is sensed by the patient and is an important component. In their inner healing journey, the patient will not be able to face and heal what the therapist fears. The patient is more likely to block or reject any spiritual or transpersonal experience if they sense a lack of acceptance from their therapist.
IN SEARCH OF COMMON DENOMINATORS
Explaining the remarkable personality shifts that we see in people who experience thirty-plus sessions of alpha/theta training with EEG feedback can only be conjecture at this point. Could there be common denominators, threads that run through all these many symptoms and disorders?
An explanation for the wide-ranging power of this protocol might be found in the realm of state-dependent learning and memory (Rossi & Cheek, 1988) or state-context learning and retrieval (Cowan, 1993). The predominant waking brainwave frequency of children under the age of six is in the four to eight hertz range associated with theta in adults. As we mature, our average brainwave frequencies get faster (Duffy, Iyer, & Surwillo, 1989). In adulthood these lower frequency waves are usually associated with reverie and hypnogogic imagery. They occur in the transitions from wakefulness to sleep.
"The highly emotional experiences of early childhood, and the (often mistaken) decisions which stem from them, are learned and stored as modification of the slower background frequencies that were activated at that t