Neurofeedback can improve addictions treatment outcomes and lead to improved results when utlized as a companign therapy or as a stand alone therapy. One widely used neurofeedback process is called the "alpha-theta protocol" or the Peniston protocol, which was based upon the researcher Dr. Eugene Peniston who refined and researched it. The technique actually goes back to the Menninger Clinic and previous work by Elmer Green, Dale Walters, and Steve Fahrion over thirty years ago.
Background
Alcohol and drugs are psychoactive substances. They act in the brain, and their effects represent changes in neurological functioning. It is possible to learn to control one's brain states from within, without drugs and alcohol. In this way, addictions can be overcome without a lifetime of struggle and craving. Neurofeedback (also called EEG biofeedback) trains the brain to modulate its level of activity, to become more or less activated according to the needs of the individual. Some addictions, such as alcoholism, often involve brain over-activation. In these cases it can be helpful to teach the brain to quiet down, become less activated. In other cases, for example in people with ADHD who abuse amphetamines, the brain is under-activated and needs to learn to speed up.
Alcoholism
It has been found that many alcoholics, and some other addicts, are deficient in alpha and theta waves. These types of brainwaves are associated, respectively, with a relaxed, alert state and a state of reverie and intense imagery. These alcoholics are cortically hyper-aroused and find it hard to relax and imagine.
Evidence shows pretty clearly that this pattern of hyper-arousal is present before a person becomes alcoholic, although alcoholism itself eventually exacerbates it, reducing alpha and theta even more. This is a condition of anxiety, inability to relax; a chronic state of excess tension. Drinking alcohol temporarily increases the amount of alpha and theta waves and reduces cortical arousal. This is associated with alcohol-produced euphoria. It can even look as if these alcoholics are made more normal when they drink! After a few hours, of course, the good feeling wears off as the basic pattern of low alpha/theta and increased fast beta comes back. The person is more anxious and tense than before.
Research has shown that success in alcohol treatment is worse for those alcoholics who have the least alpha and theta activity, and the most beta. This finding supplements the discovery that alcoholics as a group have less alpha and theta and relatively more beta than non-alcoholics. That is, alcoholics form a continuum, with the most cortically hyper aroused (those with less alpha and theta) showing worse outcomes than others who are less hyper aroused.
Neurofeedback for alcoholism, and some other addictions, is a process of teaching the client first to increase the amount of alpha waves, and then to increase theta. The person progresses into a relaxed, then dreamy and hypnogogic state. Eyes are closed, and they receive feedback via sounds presented through headphones. Usually a reclining chair is used, a blanket is offered to increase comfort and the sense of security and the room is darkened or a light-preventing mask is used.
While in the hypnogogic theta state the client is asked to do visualizations picturing refusal to drink (or to do drugs) and abstinence from alcohol and other substances. In the many clients who also suffer from post-traumatic conditions the hypnogogic state facilitates the re-experiencing of traumatic memories in a setting that allows them finally to be processed and remembered in normal ways and places in the brain. Spiritual experiences often accompany the reprocessing of old memories.
Recreational
A second subset of addicts is cortically under-aroused and need to activate their brains. Cocaine and methamphetamine users, for example, are different from most alcoholics - in some ways 180 degrees apart. Those who prefer speed often show high amounts of theta to start, and so need a different protocol, at least at the beginning.
Although this is a different pattern from alcoholism, we see the same effort at self medication here: amphetamines reduce slow wave activity (theta and low alpha waves) and increase beta. This is rewarding for the sluggish, under activated brains of the cocaine and amphetamine users.
Steve Fahrion describes the alpha/theta experience as one of "exploration and discovery" in contrast to a process of "active coping." The latter focuses on increasing faster brainwaves called "SMR" and "beta" that characterize quiet focus and concentration.
Current Research
William Scott and David Kaiser, in California, are currently engaged in three-year follow-up as part of a large study comparing state-of-the-art addictions treatment with the same program augmented by neurofeedback. A clinical vignette will help to understand the experience:
"About halfway through his process, a Vietnam veteran experienced a vision of hovering over himself while replaying every tour and battle he remembered and some he had forgotten. He states that he felt safe because he was only witnessing the experience rather than reliving it. It appears that he processed the events under a low-arousal state where they could be re-stored as past memories, rather than current ongoing trauma."
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