USING
NEUROFEEDBACK TO CORRECT THE INCORRIGIBLE
George
von Hilsheimer & D.A. Quirk Page -
George
von Hilsheimer Douglas A. Quirk*
ABSTRACT
Quirk learned to apply Mary Cover Jones' method
of desensitization to psychotics despite Wolpe's self-reported inability to
make Reciprocal Inhibition Therapy (RIT) work with psychotics. Von Hilsheimer
suggested that he monitor stress by GSR and Quirk developed a library of
lantern slides to substitute for verbal statements in the hierarchies of
stressful stimuli. He automated this method and named it SCARS (Stimulus
Conditioned Autonomic Response Suppression)
Quirk then applied the same methods and Sterman's EEG biofeedback training
(increasing SMR at C-3/C-4) in a pilot study of 40 matched pairs of jailed
felons; and in a larger pilot study of 110 matched pairs. From 1970 through
1995 Quirk trained 2776 felons by this combined method (temperature, GSR and
EEG)
15% were rearrested in the 3 years following release. This compares well to
the range of rearrest in studies summarized by Alter et al (1996) - 42 % to
78%.
INTRODUCTION
ICTAL AND SUBICTAL DYSFUNCTION
Two of Quirk's colleagues, North and Breen, liked a method of scoring the
Bender-Gestalt published in a book by Hutt. However, the Bender figures
weren't really adaptable to the Hutt method. So North and Breen created new
figures and called the test the Diagnostic Differential Test (DDT). Quirk took
a course in administering the DDT and became expert at its interpretation.
One of the neurologists on staff who used Doug as a consultant gave him a list
of 10 patients whose serial EEGs eventually demonstrated epilepsy but who did
not have seizures. He was asked what test to use to figure out how to
recognize them more reliably than with the EEG. Doug found a file into which
he had put the DDT's those individuals' had taken. Quirk had considers those
particular DDT's as uninterpretable.
About the same time Quirk had been wandering around the halls at McGill on a
trip to Montreal and had a casual conversation with a psychologist who told
him of some work he had been doing with pigeons demonstrating that when an
ablation was made in the region of the brain's septum the pigeons that had
been trained to respond to angular signs were post operation unable to
differentiate the angles from curves.
The performance of his 10 puzzling patients on the DDT indicated that they
couldn't handle angles as well as they could handle curves. So Quirk decided
that he had found an indicator of deep diencephalic epilepsy. The first 70
patients he found with this sign on the DDT were all diagnosed by a
neurologist as epileptic. All but one had typical seizure spindles on the EEG.
Quirk applied the DDT to a large number of arsonists, assaultists and rapists.
Forty per cent of the serious arsonists, 30% of assaultists, and 25% of
rapists demonstrated the sub-ictal sign on the DDT. This last group, the
rapists with anomalous DDT performance, also demonstrated visible anomalies of
the temporal lobe in CAT scans.Quirk's insight that a great deal of
maladaptive behavior might be epileptoid was reinforced by Jonas in ICTAL AND
SUBICTAL NEUROSES, and by Alvarez in NERVES IN COLLISION.
Quirk
moved from Queen Street Hospital to the Clark Psychiatric Institute in Toronto
around 1965 where he continued work using the SCARS GSR biofeedback we had
earlier developed refining the process by which SCARS works.
Quirk was a pioneer in the use of volunteer workers in psychotherapy and most
of the procedures he used were administered through automatic equipment
monitored by volunteers. In his setting the doctoral level staff were free to
diagnose and order treatments which worked.
BARRY
STERMAN
In 1970 Quirk went to a meeting in Boston and heard Barry Sterman talk about
his work with cats and human epileptics. Doug had lunch with Barry and on
Sterman's recommendation bought an Autogen 120a EEG feedback device
From the Clark Quirk moved to the Ontario Correctional Institute (OCI) where
he has spent more than 20 years improving an excellent facility. OCI had the
lowest recidivism rate in the Western World.
In several years the OCI was recognizedby professional correctionists as the
"best" correctional facility in North America
CRIMINALS
IN JAIL
Quirk completed two preliminary studies of recidivism among OCI felons who had
been discharged. He compared 55 pairs of high risk felons half of whom were
treated by temperature biofeedback, by SCARS and by Sterman's EEG method and
half of whom received only counseling. These violent felons demonstrated the
subictal pattern on the DDT (viz., they didn't handle visual angles as well as
visual curves) and on the EEG. The treatment of the 55 felons included
volunteer administered temperature biofeedback training; SCARS GSR training;
and EEG training of the sensorimotor rhythm at C-3 and C-4 as described by
Sterman. These felons received 33 half-hour sessions of training. Subsequently
he trained another group of 55 pairs of felons
Two years after his initial study of 55 pairs of felons 22 or 40% of the
treated felons had been arrested again. Two years after the second study of 55
pairs of felons 11 or 20% of the treated felons had been rearrested. This rate
of recidivism compared to 85% and 65% rearrested among the matched felons who
were not treated by biofeedback. In other words, 60% and 80% of the treated
felons were still free, while only 15% and 35% of the untreated felons had
managed to remain outside of prison.
Quirk treated 150 more felons using the same method of SCARS and SMR
neurotherapy, matched with felons receiving only counseling. We have been
unable to verify the data on recidivism in this last study.An intriguing
finding is that recidivism is a function of the number of training sessions.
Half as many felons who were treated for 16 sessions were successful at
remaining out of jail as were those who received 32 sessions. There is some
effect of training even in a few treatment sessions.
In a careful study of 260 young violent prisoners Quirk was able to
demonstrate that it is possible significantly to reduce recidivism from using
relatively inexpensive, volunteer applied techniques. In an earlier study of
150 women whose average time on a closed ward had been 9 years Quirk
demonstrated that 128 could safely be discharged after using inexpensive,
volunteer applied biofeedback technique.
Quirk's elegant combination of several hypotheses implies that our own success
using milieu therapy to remediate a different population of young felons may
be enhanced by structuring our own assessments more elegantly in terms of a
similar hypothesis as to the nature of the disorder which leads adolescents
into treatment centers. These EEG responsive disorders appear to have a common
characteristic in that they seem mediated through the physical structures in
the diencephalon within which the limbic system functions. These disorders may
be a special form of partial seizure with complex symptomatology.
BIOFEEDBACK
IN PRODROMELESS PSYCHOSIS:CAN YOU FIX PATIENTS WHO GIVE NO WARNING?
INTRODUCTION
We
are here concerned with the applicability of biofeedback treatment to some
major disorders in which there appear to be no observable and no conscious
prodromes to cue re-institution of learned corrective habits.
In
some conditions, pain (e.g., migraine) or an aura (e.g., some cortical
epilepsies) signals the need to activate self-regulatory behaviour which has
been trained into a person by biofeedback. In contrast to migraine and grand
mal epilepsy certain psychomotor seizures give nowarning at all, indeed the
patient may not even know that he has hada seizure when it is over. In these
conditions the afflicted person is unlikely to be aware of any cues that
signal the imminent onset of a deep brain subictal foci causing bizarre
behavior. These seizures used to be known as psychomotor, or templar lobe
epilepsies.
PARTIAL
COMPLEX SEIZURES
Today
they are more likely to be called partial complex seizures (a shorthand which
arised from Partial Seizures with Complex Symptomatology, [PSCS]). These
subictal foci typically do not result in the motor seizures of cortical
epilepsies; but, they are sometimes associated with dangerous criminal
automatisms, or with the emergence of symptoms of some schizophrenias. In
undertaking biofeedback treatment of these latter conditions, it may be
necessary to adopt a different training procedure from the self-regulatory
'informational' feedback most commonly used as biofeedback.
In
one study the present writers tested for deep-brain partial and complex
seizures in the various types of offenses encountered in one year's admissions
to a correctional treatment facility. We found that 40% of the arsonists, 30%
of the assaultists and 25% of the rapists were subject to deep-brain paroxysms
-- perhaps mediated by accessory activation of reinforcement, rage and/or sex
centres of the drive centre.
By
way of contrast, fewer than 2% of the remaining 'garden varieties' of less
dangerous offenders exhibited this deep-brain epileptic syndrome. In several
other studies we found that there was a consistent and strong relationship
between strong emotional reactivity or weak emotional control and dangerous
criminal actions.
BEHAVIOURAL
CHARACTERISTICS
There
are several reasons for selecting dangerous criminal offenders and
schizophrenics as the subjects for the present study. The first obvious reason
is the importance of these two types of conditions in society and in clinical
psychological practice.
The
second obvious reason is that both of these conditions pose particular
problems for therapeutic intervention, and thus warrant study in the context
of any emerging technology. A third reason is that criminals and
schizophrenics have been found in many studies to demonstrate anomalous
psychophysiological measures. These physical measures of psychological
processes might be susceptible to modification by means of biofeedback
treatment.
THE
RELEVANCE OF CUES
Most
conventional biofeedback training involves relatively continuous feedback
tracking changes in the physiological responses being monitored. One point of
view concerning the efficacy of such training is that the treated conditions
are associated with detectable stimuli, and that these stimuli serve as cues
to arouse the subject to reinstate the learned self-regulatory behaviour.
Cuing stimuli might include prodromes such as pain in migraines, aura in
epilepsies, the characteristics of settings such as a classroom or a verbal
text in attention deficit or dyslexia, or even just the passage of time in
meditation training, sleep regulation or chronic pain control.
It
seems likely that most conditions possess some readily perceived cues that
might be used to activate learned corrective behaviour.
PARTIAL
COMPLEX SEIZURES
Some
conditions are such that it would be extremely difficult for the subject to
achieve such a conscious awareness of the cue as to be able to trigger a
trained therapeutic response. This difficulty is probably most true in the
cases of complex partial seizures and of psychotic disorders.
It
is generally agreed that some deep-brain complex partial seizures are
facilitated by alcohol ingestion. In these cases the act of drinking an
alcoholic beverage might serve as a cue if the corrective biofeedback training
were to be undertaken in the context of drinking. Failing this, the use of
alcohol would come to serve as a cue only if the subject undertakes the
necessary anticipatory training on her own. Otherwise, the patient has to rely
on some other kind of cue.
The
most common prodrome in deep-brain complex partial seizures seems to be
heightened intensity of emotional arousal -- perhaps sometimes due to
associated activation of the Olds and Milner 'drive centre'. The difficulty
encountered by most people in using strong emotional arousal as a cue for
behaviour is that emotional arousal tends to distract attention from conscious
cortical self-regulatory habits. High emotional intensity tends to disengage
the subject from such moderating habits. Distracted attention and
disengagement is intensified by alcohol, by recreational and medical drugs,
all of which are often involved in scenes of intense emotionality.
Stated
differently, emotional arousal is mostly pretty confusing and, if intense
emotion activates any habits, the habits engaged tend to be ones which were
learned early in life and are relatively rigid habits in contrast to the more
recently learned adaptive and regulatory habits. The patient learned to be
disruptive as a child, what the therapist is ableto train in the adult is
often weak and ineffective.
ISN'T
IT A DISEASE? You Can Treat It And Cure It!
In
1967 von Hilsheimer published IS THERE A SCIENCE OF BEHAVIOR? reviewing
particularly the success of replication therapies among the behavior
therapies. Quirk had already been demonstrating the utility of our automated
GSR biofeedback method with psychotic patients. By 1971 Quirk had dramatically
demonstrated the effectof temperature and GSR training on schizophrenics who
had beenin hospital for 2-45 years (average 9).
Both
of us remarked that a consistent problem occured when working with dangerous
criminals and with young patients whose early delinquency later proved to be a
prodrome for psychosis. This problem was the absolute absence of a prodrome
for destructive explosive episodes of behavior.
Clinicians
of great intuitive skill were helpless when it came to a type of criminality
for which no one had a solution. The common rate of recidivism in correctional
institutions in the United States was generally believed to be 98% within two
years of discharge. Prisons are so bad that it could be said that we were
failing to criminalize only 2% of the juvenile population enrolled in our
higher institutions of learning (correctional institutes). It happened that
this general belief (even general in the correctional professions) was not
true, but that is another essay (Alter op cit).
ANOTHER
METHOD FOR REHABILITATING CRIMINALS: EEG
Joe
Kamiya's extention of Shagass' earlier demonstration that
electroencephalographic (EEG) activity could be altered and deliberately
shaped by feedback of that activity, launched EEG biofeedback as a clinical
reality. Kamiya's demonstration also suggested that the electrical activity of
the brain is just a kind of behaviour that can be trained like any other.
Let's phrase that in another way. We can condition the electrical activity of
the brain. If this is true then any recognizable feature of the EEG whether it
is pathological or healthy, desired or undesired can be changed. If behavior
is associated with EEG activity then behavior can be changed by changing the
EEG.
The
recognition that brain activity is direct maleable was the seed from which
grew Forester's habituation training for triggerable epileptics and Sterman's
conditioning of sensorimotor rhythm (SMR) to inhibit epileptic seizures. EEG
conditionability also made it possible to normalize learning performances of
people exhibiting attention deficiencies and hyperactivity. But how widely
might this idea be applied? (1) Some epilepsies, whose focus lies in the deep
recesses of the old brain, are variously referred to as partial seizures with
complex symptomatology (PSCS) or "complex partial seizures". These
are non-convulsive seizures, or paroxysmal events, sub-ictal states, or
seizure equivalents.
These
deep-brain seizures have features that make them difficult to recognize.
They
are hard to recognize, first, because sub-ictal states are seldom associated
with convulsions; partial seizures do not cause dramatic losses of
consciousness; the complex symptoms do not seem to have prodromes or even
periodic unusual events that might suggest the need for a specific
investigation (see Spiers, Schomer, Blume and Mesulam, Chapter 8,
Temporolimbic epilepsy and behavior, in Principles of Behavioral Neurology,
Mesulam, F.A. Davis Co., Philadelphia, 1985; Jonas, Ictal and SubIctal
Neurosis and also see Alvarez, Nerves in Collision).
Second,
these sub-ictal neuroses are not readily diagnosed by means of the EEG, partly
because they are not easily triggered, as the cortical epilepsies can be
triggered, by means such as photic stimulation or hyper-ventilation.
Third,
the sub-ictal states or epileptic equivalents often seem to be accountable as
behavioural derivatives of the developmental and social history of the
criminal. Which is to say the victims often seem just to be bad boys with a
long consistent history of bad behavior arising in a bad neighborhood with
other bad boys.
Fourth,
the behaviours associated with these sub-ictal states tend to distract the
observer because they are intense, gruesome, unappetising and usually criminal
activities. The underlying disorder is simply ignored. If the epileptic
discharge in these seizures involves the Olds and Milner 'drive centre', the
person may exhibit uncontrolled paroxysms of rage, sexual drive, hunger,
satiety, alcohol use or other excitant automatisms such as fire-setting. The
individual may seem perfectly normal in just a few seconds after the explosion
of aberant behavior.
It
is not too surprising that when you examine people in prisons that you find
that the correctional population contains relatively large numbers of people
exhibiting this paroxysmal syndrome; but it is the criminality, rather than
the pathology of the behaviour which is most likely to attract the observer's
attention.
If
Barry Sterman's procedure for SMR training of the EEG is effective in treating
some epilepsies, we thought it would be interesting to discover whether or not
it could be used in these deep-brain partial and complex seizure states to
modify their future criminal conduct. If their criminality could be reduced
then the value of Sterman's method would be substantially greater than mere
neurology suggested. In SMR treatment, the training feedback tends to be
discontinuous and contingent on SMR occurrences -- that is, it is operant
training, rather than self-regulatory training. Consequently, if SMR training
reduces criminality, we reasoned that the SMR learning could be said to have
become a stable new habit requiring no maintenance exercises. We could detect
no recognizable prodrome in these cases to serve as a cuing stimulus to
re-activate any learned self-regulatory strategy. So this self-sustaining
response is exactly what we needed.
Of
course the issue did not seem to us to be quite as simple as that. Clinical
experience with offenders exhibiting complex partial seizures suggested that,
whether or not it served as a recognizable prodrome, emotional arousal did
appear to function as a triggering eventfor seizure equivalents in these
people. There is a subclass of criminal which is floridly emotional and that
emotionality is almost always associated with grotesque and extreme acting
out.
If
our observation was accurate and if we were to achieve a stable corrective
habit by means of SMR training, it seemed necessary also to ameliorate the
intensity of emotional arousal as part of the treatment. Accordingly, we
applied the same SCARS method we had used with chronically hospitalized
schizophrenic women to our criminal males. That is we included discontinuous
and contingent training of the GSR at the same time we were using the EEG to
train SMR. Von Hilsheimer'sexamination of the records after Quirk's death
indicates that every singlefelon who received EEG training had first been
trained in the SCARS method of GSR training. Aside from a few pilot cases
where rather weak effects were achieved, we did not perform a formal
investigation of the effects of SMR training alone on criminality.
Later,
von Hilsheimer (1977) was to discover that his stringently diagnosed
population of criminal psychopaths eventually emerged as chronic psychotics
and proved to be the most resistant of all populations (including brain
injured and chronically mentally ill patients) to the markedly good effects of
the milieu and behavior therapy program he demonstrated (ibid).
We
have already discussed the development of the method of training a group of
chronic schizophrenic patients with a GSR training program suggested by some
observations Mednick had made about the characteristic GSR activity recorded
in schizophrenia and in individuals with varying burdens of ancestral
schizophrenia. GSR modulation training was used with these subjects under the
general hypothesis that catastrophic autonomic nervous system reactions are
reflected in the GSR and are centrally associated with the maintenance of
active symptomatic schizophrenia. The results we obtained after a three year
follow-up interval justify the view that the arousal of anxiety, which was
modified in the treatment program, may be more of a causal factor (rather than
an effect) in schizophrenic symptomatology. The results also hold out some
hope that some schizophrenic symptoms are susceptible to suitably designed
biofeedback training. Moreover, theresults with our criminal population
suggests that a less intense but similar anxiety system is at the root of the
criminial character and thatcorrection of criminals demands reduction of their
autonomic arousaland especially reduction of their physiologically determined
anxiety.
CRIMINAL
OFFENDERS
In
our first pilot study with offenders, the subjects were 77 incarcerated
criminal offenders all males, mostly displaying the most dangerous types of
offenses, who gave evidence on the DDT of deep-brain epileptic events.
Presumably their deep subictal events were underlying their excitement-seeking
actions, their 'blind' rages, their excessive sex drive and other derangements
which were involved in their criminal conduct.
STERMAN'S
SENSORI-MOTOR RHYTHM (SMR)
By
the time we were ready to work intensively with criminals Quirk had heard
Sterman give a paper at the 1970 Biofeedback meeting in Boston. He had
discussed Sterman's procedures with him and both of us had obtained an
Autogenic Systems 120a electroencephalometer feedback instrument and had begun
training a variety of subjects to produce sensori-motor rhythm activity (SMR).
EEG activity istypically described as delta, theta, alpha, beta (for 1/2-3,
4-7, 8-13, >13). The biofeedback professional adds to this nomenclation the
term SMR deriving from Sterman's discovery that while 13 Hz is dominant
through the brain, training 13 along the Fissure of Roland results in
resistance to epileptic seizure - even that produced by toxins such as
hydrazine (an normally infallible producer of seizures of fatal intensity).
The amplitude of 13 Hz is notoriously small in epileptics over the
RolandicFissure (aka Sensorimotor Strip or sulcus centralis).
We
began to train SMR using the 120a Autogen version of the EEG. All of our
subjects were also trained to produce an increase in skin resistance (GSR) and
skin temperature using the SCARS method we had developed a decade before and
used with a wide variety of scores of subjects, including our hospitalized
female chronic patients.
NO
PRODROME
It
is worth repeating that EEG anomalies are notfrequently observed in patients
with these deep-brain sub-ictal or complex-partial ictal events. It is also
worth repeating that no recognizable warning events tend to occur. In fact,
neurological lore is that this kind of seizure requires an average of six
nocturnal extended EEG runs in an awake subject using nasal pharyngeal leads
where the electrodes are placed close to the base of the brain up through the
nose and the pharynx.
The
fact that the subject has no EEG anomalies means that the therapist cannot
depend on training which suppresses unwanted signals in the EEG. It also means
that the subject cannot establish a cue to aid him to learn how to enhance his
SMR or to normalize his GSR.
DEPENDENT
VARIABLES
During
the training phase of these studies on felons, the behaviour subjected to
operant training was sensorimotor rhythm (SMR) in the EEG, the temperature
recorded at the left index finger, and the galvanic skin resistance (GSR). In
all of the studies of felons, both of these responses were recorded and
shaped. This is unlike the work with the chronic hospitalized psychotic
patients who were only trained by GSR and temperature.
SMR
was recorded on an Autogenic Systems 120a electroencephalo-meter. Since
absolute SMR values were less of interest than changes in the strenghth of the
signal at 13 Hz, we placed the electrodes at C3 and C4. The limits we adopted
and set in the equipment to represent SMR activity were 12 to 14 Hz between 10
to 30 microvolts.
It
should be remarked that these values for amplitude (10-30 uV) will appear to
be high to those who use equipment manufactured in the 1990s. An equivalent
amplitude limit on contemporary equipment would be closer to the 2 to 10
microvolt range. We restricted the amplitude in this way in order to limit
equipment response to high amplitude artifacts in the low frequencies.
The
120a Autogen EEG does not have an Inhibit command, so that so-called
'inhibits' have to be all of that activity which is excluded by the setting
for reinforcement. The 120a is supplied with verniers, that is knobs which are
infinitely adjustable, and so lend themselves to the behaviorist technique of
'shaping'. We shaped the frequency down from a window opened to 10 Hz through
16 Hz and slowly moved the verniers to a setting of 12 Hz through 14 Hz, viz.
13 Hz. The amplitude remained fixed thoughout training. I have been slightly
flabbergasted to receive telephone calls asking me to explain what I mean by
"shaping". One shapes the behavior from broad limits to narrow. The
dolphin is rewarded for lifting his head from the water, then for lifting
higher, andall the way up, then backward and finally for a flip.
"Shaping" is the fundamental principle of learning theory and
technique.
We
now call the method, using temperature biofeedback training, GSR feedback
training (in Mary Cover Jones' model of successively more stressful stimuli)
and EEG training of the SMR, "Quirk's modification of Sterman's (1970)
neurotherapy". An aside to those of you who bill insurance, when the
insurance officer says "experimental" look horrified and say
"1970!??".
The
feedback used by Quirk was a frequency modulated whistle that occurred
discontinuously and contingently upon this SMR activity; the machine will also
utter a white "shhhhhh" sound and this option was used by von
Hilsheimer.
In
the typical case, the percent of the time in which this SMR activity occurred
tended to average around 10% during the first few half-hour training sessions,
and to rise to 45% to 55% during the last training sessions. I should say that
today I urge practitioners to shape the behavior so that the client is
achieving more than 85% feedback success. This arises from the consensus of
the practitioners I have sampled. GSR was recorded on a locally constructed
treatment unit. A digital display changes in thousands of ohms of skin
resistance. The SCARS procedure described above was followed in exactly the
same manner as with the hospitalized schizophrenic females. However, by the
time we began working with felons, computer technology had become more
economical and user friendly and instead of slide projections, in the more
recent studies (1985 onward) computer graphics were used rather than projected
pictures from slides. Any GSR increase ('less arousal') of 1K or more
automatically (a) entered the new GSR value in a memory chip for comparison
between chip and meter, and (b) changed the slide the subject was watching or
advanced the picture by computer. The slide contents represented areas of
emotional arousal selected for each subject from her responses to a fears
survey schedule. More individualization was available once the pictures were
computerized. Video feedback (slide change) was provided discontinuously and
contingently depending upon successive increases in skin resistance. In the
typical case, GSR values tended to be in the range 50K to 100K. As reported by
Mednick, and consistent with our own experience in widely varying treatment
environments with widely varying populations diagnosed as schizophrenic, the
BSR of criminals was consistenly closer to that of normals than was the BSR of
schizophrenics. The latency of change, the depth of change, and the lenghth or
sluggishness of time to change was markedly less in felons than in
schizophrenics.
The
shape of graphed GSR change was sinusoidal especially in contrast to the
graphs of schizophrenics. The more schizoid the characteristics of the GSR,
the more severe the behavior and less positive the response of the felons to
treatment.
We
remarked that schizophrenics and felons tended to normalize their GSR/BSR
values as well as the intensity of response in the last treatment sessions.
The GSR values during the last treatment sessions tended to vary from 150K to
550K ohms.
I
should also remark here that I am continually being asked that
ifschizophrenics have such a high BSR in contrast to normals, "why do
wetrain it up?" The real reason I do it is that Quirk told me to do so;
and that for more than 40 years I have enjoyed success doing so. The
BSRcontinually normalizes and comes down when you continue to train it up.At
least that is true in all the clients I have observed in all that time.
Presumably an increase in ohms of resistance is an increase in the comfort of
the organism. Why such highly uncomfortable and dysphoric humans as
schizophrenic patients should have such enormously highskin resistance is
really unanswerable.
The
dependent measures for the main effects of the studies of felons were
re-occurrences of condition relevant behaviour during an eighteen month
follow-up interval after discharge. Offenders were followed up through their
cumulative justice system offense records a year and a halfafter release from
the sentences in which they were treated.
Results
(1)
The justice system records of the offenders accepted into this biofeedback
treatment programme were reviewed an average of a year and a half after
release from their treatment sentences. Of the 17 offenders who received 0 to
4 half-hour training sessions (i.e., essentially no treatment), 65% had been
re-convicted of criminal offenses. Of the 10 who had received 34 or more
half-hour training sessions, only 2 or 20% had been re-convicted of criminal
offenses. Intermediate amounts of training were found to be associated with
intermediate recidivism rates. Among these subjects, neither follow-up
interval nor age were related to recidivism rates.
STUDIES
SUBSEQUENT TO THE PILOT STUDY
The
death of the senior author (Quirk) in December of 1997 after he completed a
second draft of this paper, and read my third draft, made impossible our plans
for a leisurely reporting of a long (25 year) series of studies done with
SCARS and Quirk's Sterman treatment of a large (nearly 3000) number of jailed
felons.
From
1970 until his retirement in 1995 Quirk continued to work at the Ontario
Correctional Institute near Toronto, Ontario with the daily collaboration of
his colleague at the OCI, Reg Reynolds. Those of us with more mobile staff may
envy the fact that Reynolds and Quirk had lunch together every working day for
more than 20 years. Quirk and Reynolds did significant work on Cognitive
Behavior Therapy with felons; and Quirk carried out the EEG studies
essentially enjoying the benign neglect of his nominal superiors. Reynolds is
Quirk's executor and has been most helpful in organizing and mining Quirk's
papers.
From
1970 through mid 1995 Quirk used the DDT method of examining felons,
appointing them for EEG and SCARS training. The actual work of training was
done by volunteers, including correctional guards, college students,
housewives and others.
In
a series of reports to the Corrections officials Quirk indicated that the
three year recidivism rate from the biofeedback unit (using these techniques)
had never been more than 45%, and in some groups had fallen to 15%. Overall,
among nearly 3000 felons trained by Quirk's volunteers, the rate of recidivism
was consistently close to 15%. In every comparative group, the rate of success
of the biofeedback group was significantly superior to the results in the
Ontario Correctional Institute (OCI) in groups which did not use biofeedback.
It should be noted thatthe OCI was generally known as "the best jail in
North America".
If
you consider the violent crimes which the felons trained by Quirk would have
committed and did not because of their training at OCI the Quirk Sterman
protocol has saved thousands of lives.
Discussion
It
was our intent originally only to discuss the results of the initial pilot
study and then go on to the 25 year record which followed this study. The
original study did suggest that even some prodromeless conditions would be
susceptible to biofeedback interventions using appropriate applications.
Adequate results will be obtained if the training is structured to foster the
establishment of a new and stable habit to respond in healthy ranges of
appropriately selected physiological responses. Lasting and self strengthening
resistance to symptoms may be possible.
In
these studies, the physiological responses monitored were considered to be
operant responses and the responses were subjected to reinforcements to shape
new habits independent of voluntary control or understanding. It is assumed
that the habits thus developed might well be self-strengthening since, if
properly selected, they should eventuate in self-reinforcement by enhancing
the efficiency of the person's functioning.
The
other issue this report reflects is the physiological responses we monitored
and trained. In many conditions, there is a recordable physiological response
that varies with the symptoms. It is probably relevant only to the preferences
of the particular investigator whether it is the physiology or it is the
behaviour drives, that controls or causes the other. Regardless of the
'causal' relationships involved, treatment might be effected by trained
modification of the most convenient response to monitor. It is often easier to
monitor the physiological response, and by training changes in the
physiological reaction we may be able to change the symptoms of the patient.
Why else would we do it? Oddly enoughin psychology sometimes whe change a
response just to see if we cantrain it. Fortunately, the results here
indicated that we were obtaininga more useful result. Modifying the skin
resistance changed the behavior - either the felons didn't commit more crimes,
or at least theyweren't caught and arrested doing them.
In
the second study we talked about in this paper deep-brain epilepsy was
detected in a subset of relatively dangerous offenders. In spite of the fact
that EEG anomalies were not readily detected among these subjects for
treatment modification, under the hypothesis that Sterman's method for SMR
training offers a general treatment for epilepsy, we tried using Sterman with
these offenders after we had done GSR training. We obtained stable and large
effects which reduced the subsequent criminal behaviour of our felons.
Finally
since study began 25 years of successful treatment of 2776 violent felons who
had sub-ictal indications on a paper and pencil test, the DDT. The conclusions
we drew are vital and indicate that the combination of temperature, GSR-SCARS
training forming Von Quirk's Sterman method for EEG training are robust and
effective training methods which have immediate relevance for today's
population of criminals and mental health patients.
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D.
Quirk died after working on two drafts of this paper, and reading a third.
George von Hilsheimer is responsible for the form of the final draft. Canadian
spellings, e.g. "behaviour" and "centre" and a few
circumlocutious paragraphs have been left intactin memory of Quirk. Editors
and readers are asked to forgive this sentimental touch.
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