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Long-Term Follow-Up of a Clinical Replication of the Peniston Protocol for Chemical Dependency
Abstract
Introduction. This study is a long-term follow-up of an early replication of the Peniston EEG biofeedback (EEG-BFB) Protocol for chemical dependency (Peniston & Kulkosky, 1989, 1990).Method. This clinical trial included 16 chemically dependent adult participants treated with the Peniston Protocol in a university outpatient clinic between 1993 and 1995. Ten participants were probationers classified as high risk for rearrest. Treatment effects were assessed using pre/posttreatment measures (Beck Depression Inventory, Minnesota Multiphasic Personality Inventory-2) and long-term follow-up of abstinence and rearrest rates. Probationer rearrest rates were compared to an equivalent probation sample (n = 24) that did not receive EEG-BFB.Results. Initial Beck Depression Inventory scores indicated mild/moderate depression but were significantly reduced posttreatment to within normal limits. Substantial differences were noted posttreatment on 7 Minnesota Multiphasic Personality Inventory-2 clinical scales suggesting less psychopathology following treatment. Long-term (74–98 months) follow-up indicated that 81.3% (n = 13) participants were abstinent. Rearrest rates and probation revocations for the probationer subgroup were lower than the comparison group (40% vs. 79.16%).Conclusion. This study provides evidence of the durability of Peniston Protocol results over time but has the usual limitations of a clinical trial with a small sample, nonrandomized, and uncontrolled design. Implications for further research are discussed including the relevance of recent modifications to the Peniston Protocol and qEEG–based protocols in treating substance abuse.
... (alcohol, 5 years follow-up). According to four studies, the efficacy of neurofeedback exceeds that of current treatment methods in this area after a follow-up period of 1 -5 years ( Burkett et al., 2005;Callaway & Bodenhamer-Davis, E., 2008;Quinn et al., 2004;Trudeau, 2000). After completion of conventional forms of substance abuse treatment, 65 -70% of patients take (any amount of) alcohol or drugs again within the first year ( McKay et al., 1999). ...
... Two large studies in Texas (Callaway & Bodenhamer-Davis, 2008) showed quite remarkable results. One study was done within the state corrections system, the other with addicted homeless people (95% of whom were crack cocaine addicts). ...
... The best empirically supported neurofeedback protocol is the Peniston protocol with the Scott and Kaiser modifications (Bodenhamer-Davis & Callaway, 2004;Callaway & Bodenhamer-Davis, 2008;Scott et al., 2005;Sokhadze et al., 2008). Several slightly different versions of this protocol exist. ...
... Several other studies using the Peniston Protocol and its modifications reported cases with positive clinical effects (Bodenhamer-Davis & Calloway, 2004;Burkett, Cummins, Dickson, & Skolnick, 2003;Callaway & Bodenhamer-Davis, 2008;DeBeus, 2007;DeBeus, Prinzel, Ryder-Cook, & Allen, 2002;Fahrion,Walters, Coyne, & Allen, 1992;Finkelberg et al., 1996;Kelly, 1997;Skok,Shubina, Finkelberg, Shtark, & Jafarova, 1997). These studies indicate that this applied psychophysiological approach based on the alpha-theta biofeedback protocol is a valuable alternative to conventional substance abuse treatment, A critical analysis of the Peniston Protocol is discussed at length in previous reviews (Trudeau 2000, Trudeau et al., 2009Sokhadze et al., 2013). ...
... Using these criteria and based on the studies reported to date, the Peniston Protocol can be classified as probably efficacious when combined with a rehabilitative treatment modality in treating subjects with long-standing alcohol dependency. This classification is based on the original randomized and controlled study of the Peniston Protocol (Peniston & Kulkosky 1989 and multiple observational and uncontrolled studies that preceded and followed that study (Burkett et al., 2003(Burkett et al., ,2005Bodenhamer-Davis & Calloway, 2004;Callaway & Bodenhamer-Davis, 2008;DeBeus, 2007;DeBeus et al., 2002;Fahrion, 1995;Fahrion et al., 1992;Finkelberg et al., 1996;Kelly, 1997;Saxby &Peniston,1995;Skok et al., 1997). ...
... Several other studies using the Peniston Protocol and its modifications reported cases with positive clinical effects (Bodenhamer-Davis & Calloway, 2004;Burkett,Cummins, Dickson, & Skolnick, 2003;Callaway & Bodenhamer-Davis, 2008;DeBeus,2007;DeBeus, Prinzel, Ryder-Cook, & Allen, 2002;Fahrion,Walters, Coyne, & Allen, 1992;Finkelberg et al., 1996;Kelly, 1997;Skok,Shubina, Finkelberg, Shtark, & Jafarova, 1997). These studies indicate that this applied psychophysiological approach based on the alpha-theta biofeedback protocol is a valuable alternative to conventional substance abuse treatment, A critical analysis of the Peniston Protocol is discussed at length in previous reviews (Trudeau 2000, 2005, Trudeau et al., 2009Sokhadze et al., 2013). ...
... Using these criteria and based on the studies reported to date, the Peniston Protocol can be classified as probably efficacious when combined with a rehabilitative treatment modality in treating subjects with long-standing alcohol dependency. This classification is based on the original randomized and controlled study of the Peniston Protocol (Peniston & Kulkosky 1989 and multiple observational and uncontrolled studies that preceded and followed that study (Burkett et al., 2003(Burkett et al., ,2005Bodenhamer-Davis & Calloway, 2004;Callaway & Bodenhamer-Davis, 2008;DeBeus, 2007;DeBeus et al., 2002;Fahrion, 1995;Fahrion et al., 1992;Finkelberg et al., 1996;Kelly, 1997;Saxby &Peniston,1995;Skok et al., 1997). ...
Substance use disorders (SUDs) are among the most common psychiatric conditions, resulting in serious behavioral impairments and cognition decline. Acute and chronic drug abuse, drug dependency and drug withdrawal result in significant alteration of the electroencephalogram (EEG). EEG biofeedback has been used in the treatment of alcohol and mixed substance abuse in residential inpatient populations. More recent outpatient approaches have used quantitative EEG (qEEG) guided neurofeedback, neurofeedback (NFB) integrated with motivational interviewing and LORETA neurofeedback. A recent review of the state-of-art of qEEG and NFB in SUD and earlier reviews have detailed the efficacy ratings and clinical uses of NFB for SUD. In these reviews NFB is rated "probably efficacious" as an add-on (adjunct) treatment to other therapies, namely 12-step programs and/or cognitive behavioral therapies, or other types of psychotherapies or residential programs. Neurofeedback is not yet validated as a stand-alone therapy for addictive disorders and cannot yet be considered a mainstream therapy for addiction. Many persons with SUD have comorbid conditions that need to be considered in designing a treatment plan that incorporates neurofeedback. These include mental conditions such as depression, posttraumatic stress disorder, and attention deficit hyperactivity disorder that may require separate neurofeedback treatment for those specific conditions either preceding neurofeedback treatment for addiction, or incorporated into it. This approach may require separate assessments during the course of therapy to determine response and the need to change protocols or seek other treatments, i.e., medication or psychotherapy, to integrate into the treatment plan update.
... Several other studies using the Peniston Protocol and its modifications reported cases with positive clinical effects (Bodenhamer-Davis & Calloway, 2004;Burkett, Cummins, Dickson, & Skolnick, 2003;Callaway & Bodenhamer-Davis, 2008;DeBeus, 2007;DeBeus, Prinzel, Ryder-Cook, & Allen, 2002;Fahrion,Walters, Coyne, & Allen, 1992;Finkelberg et al., 1996;Kelly, 1997;Skok,Shubina, Finkelberg, Shtark, & Jafarova, 1997). These studies indicate that this applied psychophysiological approach based on the alpha-theta biofeedback protocol is a valuable alternative to conventional substance abuse treatment, A critical analysis of the Peniston Protocol is discussed at length in previous reviews ( Trudeau 2000, Trudeau et al., 2009Sokhadze et al., 2013). ...
Pathological addictive states, including alcoholism and excessive food consumption, cause a serious social problem in Siberia. Alpha-theta brainwave training, as proposed by Peniston (1989), was used for rehabilitation of 32 alcoholic and overeating subjects, in a study conducted in 2 cities in Siberia: Kemerovo and Novosibirsk. Training ranged from 14 to 16 sessions and was accompanied by massive antialcoholic or antiovereating suggestions and visualization techniques. At the end of treatment, most of the patients had obtained a steady aim at sobriety and psychological attachment for training. They indicated improvement of their psychological state, as evidenced by lowered unmotivated anxiety, sense of kinesthetic comfort, and even light euphoria.
Viele Forscher haben schon vor langer Zeit herausgefunden, dass sie Funktionen ihres Körpers und ihres Gehirns mithilfe von Rückmeldungsmechanismen beeinflussen können. Bereits vor 70 Jahren zeigten Jasper und Shagass (1941), dass die klassische Konditionierung des EEGs möglich ist, indem sie den Berger-Effekt (► Kap. 1) mit einem auditiven Stimulus verknüpften.
Among the many resources available for the therapeutic handling of patients under treatment for the use of psychoactive substances, there are several Integrative and Complementary Health Practices (ICHPs) such as meditation, music therapy, and many techniques of laying-on of hands that have been gaining more and more prominence in this specialized area of care.
A person’s different mental states are under the control of the brainwaves which occur at various frequencies and can be measured in cycles per second or hertz (Hz) by electroencephalography (EEG) techniques (Hammond 2011). These EEG bands are delta, theta, alpha, beta, and gamma. Gamma is a very fast EEG activity, that is, above 30 Hz. This activity is associated with intensely focused attention and in assisting the brain to process and bind together information from different areas of the brain. Beta is small, relatively fast brainwave (above 13–30 Hz) associated with a state of mental, intellectual activity and outwardly focused concentration. This is basically a “bright-eyed, bushy-tailed” state of alertness. Activity in the lower end of this frequency band (e.g., the sensorimotor rhythm or SMR) is associated with relaxed attentiveness.
Excused one time to a more philosophical and theoretical approach to understand Yoga in its original context and not mistaken with exercise.
Drug dependence is understood as a complex disorder associated with biological, emotional, and social factors. Consequently, an individual might develop dependence as a result of the interaction of those factors or even one of them alone, which favors the repetitive use that leads to dependence.
Viele Forscher haben schon vor langer Zeit herausgefunden, dass sie Funktionen ihres Körpers und ihres Gehirns mithilfe von Rückmeldungsmechanismen beeinflussen können. Schon vor 70 Jahren zeigten Jasper und Shagass (1941), dass die klassische Konditionierung des EEGs möglich ist, indem sie den Berger-Effekt (Kap. 1) mit einem auditiven Stimulus verknüpften. Die Geschichte der Entwicklung von Biofeedback und Neurofeedback verlief zweigleisig: Auf der einen Seite entfaltete sich das Alpha-Training und entwickelte sich in eine eher humanistisch-psychologische Richtung, während SMR- und Theta-/Beta-Training sich in neurophysiologisch-medizinischen Ansätzen wieder fanden.
The treatment of addictive disorders remains based on short- and long-term strategies that employ and integrate various individual and group-based therapeutic interventions, case management, residential structure, values-based programs, cognitive behavioral therapies, pharmacological interventions, motivational techniques, and other methods. Addictive disorders are complex and associated with other comorbid conditions, and it seems unlikely that a simple and single approach will satisfy the needs of patients. This chapter is addressed to the clinician that has limited experience with the techniques to be described, and is meant as an introduction to the topic. It is important to point out that neurofeedback is used as an add-on treatment to other therapies, namely 12-step programs, and/or cognitive behavioral therapies or other types of psychotherapies or residential programs. Neurotherapy is not validated as a stand-alone therapy for addictive disorders. Secondly, it is important to point out that many persons with substance use disorders have comorbid conditions that need to be considered in designing a treatment plan that incorporates neurotherapy. These include conditions such as MTBI or ADHD, which may require separate neurofeedback treatment for those specific conditions either preceding neurofeedback treatment for addiction, or incorporated into it. There are also conditions such as affective disorders and anxiety disorders that occur commonly in substance use disorders that may respond well to neurofeedback protocols for addictive disorders. These conditions may require separate assessments during the course of therapy to determine response and the need for changing protocols or adding other treatments, i.e., medication or psychotherapy to integrate into the treatment plan.
The present study was carried out to examine the efficacy of alpha/theta neurofeedback (NF) with a new visual paradigm in a cohort of alcohol use disordered (AUD) patients (n = 25) treated in an Austrian therapeutic community center. The experimental study design focused on changes in absolute and relative resting EEG band power as well as in clinical variables, including depression (Beck Depresion Inventory [BDI-V]), psychiatric symptoms (Brief Symptom Inventory [BSI], coping (Freiburg Questionnaire on Coping with Illness [FKV-lis]), psychotherapy motivation (Therapy Motivation Questionnaire [FPTM-23]), sense of coherence (Sense of Coherence Scale [SOC-13]), posttraumatic growth (Posttraumatic Growth Inventory [PPR]), and alcohol cravings (Alcohol Craving Questionnaire [ACQ]). For measuring training effects, participants were randomly allocated to 2 groups: an experimental group (EG, n = 13) and a control group (CG, n = 12). Patients in EG received 12 sessions of visual NF training over a period of 6 weeks to enhance alpha (8-12 Hz) and theta (4-7 Hz) frequency band power in addition to the standard treatment program of the rehabilitation center. Participants in CG received no additional NF intervention. The multivariate analysis of covariance (MANCOVA) showed a change by trend in absolute alpha and theta power in the EG. Even though no MANCOVA effects were found in the clinical scales, AUD patients reported increasing control of their brain activity during the course of NF. However, changes in several clinical scales (BDI-V, BSI, FKV-lis, PPR) from pre- to posttest were observed only in the EG contrary to the CG. The findings of this pilot study provide first evidence for the practicality and effectiveness of visual short-term NF as an additive intervention in the therapeutic community.
The theta-over-alpha frequency crossover seen in alpha-theta neurofeedback, considered an important factor in the treatment's success, has had little definitive research. this study examined 182 alpha-theta session graphs from 10 subject case files for interactions between frequency band activity and subject reports of imagery or biographical memories during crossovers, as well as treatment outcomes. Statistical analyses revealed significantly more reports of imagery/memories during crossover conditions having specific spectral, amplitude, and duration characteristics. Imagery reports were more likely to occur during crossover activity of 1 microvolt or more, lasting at least 3 minutes, and including 3.75μv of 15-20 Hz beta. The defined therapeutic crossover condition also was significantly related to better treatment outcome measures.
Alpha/theta (a/t) neurofeedback training has in the past successfully been used as a complementary therapeutic relaxation technique in the treatment of alcoholism. In spite of positive clinical outcomes, doubts have been cast on the protocol's specificity when compared to alternative relaxation regimes. This study investigated the basic tenet underlying the a/t training rationale, that accurate a/t feedback representation facilitates the generation of these frequency components. Two groups of healthy volunteers were randomly assigned to either (a) real contingent a/t feedback training or (b) a noncontingent mock feedback control condition. The groups were compared on measures of theta/alpha (t/a) ratios within and across training sessions, as well as activational self-report scales after each session. The contingent a/t feedback group displayed significant within-session t/a ratio increments not evident in the mock control group, as well as higher overall t/a ratios in some but not all of the training sessions. No differences were found between the groups in terms of subjective activational phenomenology, in that both groups reported significantly lower levels of activation after training sessions. The data demonstrate that irrespective of considerations of clinical relevance, accurate a/t neurofeedback effectively facilitates production of higher within-session t/a ratios than do noncontingent feedback relaxation.
This study examined whether an EEG biofeedback protocol could improve outcome measures for a mixed substance abusing inpatient population.
One hundred twenty-one volunteers undergoing an inpatient substance abuse program were randomly assigned to the EEG biofeedback or control group. EEG biofeedback included training in Beta and SMR to address attentional variables, followed by an alpha-theta protocol. Subjects received a total of 40 to 50 biofeedback sessions. The control group received additional time in treatment equivalent to experimental procedure time. The Test of Variables of Attention (TOVA), and MMPI, were administered with both tester and subject blind as to group placement to obtain unbiased baseline data. Treatment retention and abstinence rates as well as psychometric and cognitive measures were compared.
Experimental subjects remained in treatment significantly longer than the control group (p <0.005). Of the experimental subjects completing the protocol, 77% were abstinent at 12 months, compared to 44% for the controls. Experimental subjects demonstrated significant improvement on the TOVA (p<.005) after an average of 13 beta-SMR sessions. Following alpha-theta training, significant differences were noted on 5 of the 10 MMPI-2 scales at the p<.005 level.
This protocol enhanced treatment retention, variables of attention, and abstinence rates one year following treatment.
Electroencephalographic (EEG) biofeedback has been employed in substance use disorder (SUD) over the last three decades. The SUD is a complex series of disorders with frequent comorbidities and EEG abnormalities of several types. EEG biofeedback has been employed in conjunction with other therapies and may be useful in enhancing certain outcomes of therapy. Based on published clinical studies and employing efficacy criteria adapted by the Association for Applied Psychophysiology and Biofeedback and the International Society for Neurofeedback and Research, alpha theta training-either alone for alcoholism or in combination with beta training for stimulant and mixed substance abuse and combined with residential treatment programs, is probably efficacious. Considerations of further research design taking these factors into account are discussed and descriptions of contemporary research are given.
This chapter discusses the theories of the effectiveness of alpha-theta training for multiple disorders. Alpha-theta neurotherapy has demonstrated that causing the brain to generate theta activity daily over a period of time seems to have enormous benefits, including boosting the immune system, enhancing creativity, and triggering or facilitating “integrative experiences leading to feelings of psychological well-being.” The protocol seems to transcend the patient's lack of motivation to change, initial incapacity to create internal visual imagery, and disbelief in the effectiveness of the treatment. Frequently, a patient's experience and results far exceed the goals targeted. Alpha-theta EEG state of arousal seems to create a link to a subconscious realm where a wider vision of the self without its ego adaptations is contacted. This link may be associated with concepts of context and state-dependent learning and memory. Besides overcoming the problem presented, the treatment appears to evoke in the patient more general, adaptive shifts in behaviors, attitudes, relationships, health, mental processing, job performance, and creativity. A large number of psychiatric diagnoses appear to respond to this treatment. Furthermore, it is speculated that when the conscious mind enters the EEG range of theta and “surrenders” to what some call the “mind field,” the brain system is enabled to go through a dramatic and profound reordering process. In addition to the theories of the effectiveness of alpha-theta training discussed in this chapter, it is the experience of such a spiritual connection that is a major healing force behind the extraordinary healing so often seen with this training.
This chapter explains neurofeedback in the treatment of addictive disorders. It has long been clear that alcoholism is associated with poor synchrony and deficient alpha EEG activity. Further, alcoholics have been shown more likely to increase the amount of alpha activity after consumption of alcohol. Taken together, these findings suggest that those with a predisposition to alcoholism have deficient alpha activity and are especially vulnerable to alcohol's capacity to produce an electroencephalographically measurable reinforcing state of increased slow-wave activity. The chapter discusses alpha-theta neurofeedback therapy and neurofeedback for addiction and PTSD. The chapter presents a schematic of the therapeutic procedures employed in the Peniston and Kulkosky brain wave neurofeedback therapy (PKBNT) for alcoholism and PTSD. The first step before using the Peniston and Kulkosky therapy involves psychiatric assessments and collection of personal data. These data include chronological age (years), alcoholic and/or PTSD history (years), prior hospitalizations (number), social position (Hollingshead's two-factor index), and intelligence quotient (Shipley Institute scale).
Publisher Summary
The chapter presents a brief integration of biofeedback of the electroencephalogram (EEG) with the field of neuroimaging as well as introduction of non-Gaussian distributed statistics in the form of modern nonparametric statistics. There has been a veritable explosion in new discoveries in the field of neuroscience during the last 10 years. It has resulted in the rapid growth of a new discipline called functional neuroimaging, which embodies the ability to measure four dimensional biophysical brain processes related to many aspects of normal and pathological brain function, including perception and cognition. The evidence of the growth is the commonly reported high spatial and temporal resolution of EEG that yields 3-D current sources capable of being coregistered with PET using spherical and/or realistic head models as determined by conventional Magnetic Resonance Imaging (MRI). The MRI-based spectroscopic methods measure biophysical processes related to the concentrations of organic and nonorganic compounds found in the bioenergetics of cells and the membrane contents of cells. A biophysically based MRI integration to EEG is a welcome arrival because it harkens a measurable linkage between membrane and molecular biology and the electrogenesis of the EEG.
This three year follow-up study presents the treatment outcomes of 19 Dine' (Navajo) clients who completed a culturally sensitive, alpha/theta neurofeedback training program. In an attempt to both replicate the earlier positive studies of Peniston (1989) and to determine if neurofeedback skills would significantly decrease both alcohol consumption and other behavioral indicators of substance abuse, these participants received an average of 40 culturally modified neurofeedback training sessions. This training was adjunctive to their normal 33 day residential treatment.According to DSM-IV criteria for substance abuse, 4 (21%) participants now meet criteria for “sustained full remission”, 12 (63%) for “sustained partial remission”, and 3 (16%) still remain “dependent” (American Psychiatric Association, 1994). The majority of participants also showed a significant increase in “level of functioning” as measured by the DSM-IV Axis V GAF.Subjective reports from participants indicated that their original neurofeedback training had been both enjoyable and self-empowering; an experience generally different from their usual treatment routine of talk-therapy and education. This internal training also appeared to naturally stimulate significant, but subtle, spiritual experiences and to be naturally compatible with traditional Navajo cultural and medicine-ways. At the three-year follow-up interview, participants typically voiced that these experiences, and their corresponding insights, had been helpful both in their ability to cope and in their sobriety. From an outside perspective, experienced nurses also reported unexpected behavioral improvements during the participant's initial training. Additionally, administrators and physicians generally found the objective feedback and verification quality of neurofeedback protocols compatible with their own beliefs.An attempt has also been made to conceptualize the outcome analysis of this study within both a culturally specific and universal socio/bio/ environmental context.
This study investigated the treatment outcome of males dependent on crack cocaine participating in an inpatient treatment facility in which electroencephalographic operant conditioning training (EEG-OC) was added to the treatment protocol. Eighty-seven men were assessed twelve months after completion of the EEG portion of the program. Follow-up procedures of urinalyses, self-report measures, length of residence, and scores on a measure of depression were obtained and showed significant changes after treatment. The addition of EEG-OC to crack cocaine treatment regimens may promise to be an effective intervention for treating crack cocaine abuse and increasing treatment retention.
A controlled case study was conducted of effects of EEG alpha and theta brainwave training with a recovering alcoholic patient who experienced craving and fear of relapse after 18 months of abstinence. Training consisted of six sessions of thermal biofeedback to increase central nervous system (CNS) relaxation. Effects were documented with pretreatment and post-treatment personality testing, 20-channel digitized EEG evaluations both under relaxed conditions and under stress, minute-by-minute physiologic recordings of autonomic and EEG data during each training session, blood pressure, and heart rate indications taken both during relaxation and under stress, and by clinical observation.
Results replicated those of a previous controlled study with chronic alcoholic patients not abstinent prior to treatment. New findings include post-treatment indications of more relaxed CNS functioning under stress, and of reduced autonomic activation both during relaxation and under stress. Brain-mapping indications of anxiety associated with painful cold-pressor stimulation were seen only in the pretest readings; at post-test the brain map indicated pain-associated EEG activity in the contralateral somatosensory area, but no apparent anxiety-associated EEG activity.
At 4 months post-treatment the patient's wife and colleagues report the patient appears to function in a more relaxed way under the impact of stress, and he reports no longer experiencing craving for alcohol.
Overall, support is provided for the possibility that alpha and theta brainwave training may be a useful intervention for the abstinent alcoholic experiencing stress-related craving and fear of relapse.
Research studies focusing on the psychometric properties of the Beck Depression Inventory (BDI) with psychiatric and nonpsychiatric samples were reviewed for the years 1961 through June, 1986. A meta-analysis of the BDI's internal consistency estimates yielded a mean coefficient alpha of 0.86 for psychiatric patients and 0.81 for nonpsychiatric subjects. The concurrent validitus of the BDI with respect to clinical ratings and the Hamilton Psychiatric Rating Scale for Depression (HRSD) were also high. The mean correlations of the BDI samples with clinical ratings and the HRSD were 0. 72 and 0.73, respectively, for psychiatric patients. With nonpsychiatric subjects, the mean correlations of the BDI with clinical ratings and the HRSD were 0.60 and 0.74, respectively. Recent evidence indicates that the BDI discriminates subtypes of depression and differentiates depression from anxiety.
A multiple stepwise regression analysis was used to study the predictive value of a number of social and cultural variables for the Personal Orientation Inventory scores before and after treatment with EEG biofeedback training in a severely addicted inpatient alcoholic population ( n = 67). Pretreatment high self-actualization scores are best predicted by white, well-educated patients whose relationship with family is good and for whom community-support structures are available. However, at post-treatment religious attitude became the major predictor in most scales. The significance of these findings is discussed with respect to the selection and rational prescription of treatment of alcoholic patients with EEG biofeedback.
An alpha-theta brainwave biofeedfack training program was applied as a novel treatment technique for chronic alcoholics. Following a temperature biofeedback pretraining phase, experimental subjects completed 15 30-min sessions of alpha-theta biofeedback training. Compared to a nonalcoholic control group and a traditionally treated alcoholic control group, alcoholics receiving brainwave training (BWT) showed significant increases in percentages of EEG record in alpha and theta rhythms, and increased alpha rhythm amplitudes. Alcoholics receiving BWT showed a gradual increase in alpha and theta brain rhythms across the 15 experimental sessions. These experimentally treated alcoholics showed sharp reductions in self-assessed depression (Beck's Depression Inventory) compared to the control groups. Alcoholics receiving standard medical treatment (abstinence, group psychotherapy, antidepressants) showed a significant elevation in serum beta-endorphin levels at the conclusion of the experiment. This neuropeptide is an index of stress and a stimulant of caloric (e.g., ethanol) intake. Application of brainwave treatment, a relaxation therapy, appears to counteract the increase in circulating beta-endorphin levels seen in the control group of alcoholics. 13-month follow-up data indicate sustained prevention of relapse in alcoholics that completed alpha-theta brainwave training.
Used the Beck Depression Inventory (BDI) and Hamilton Psychiatric Rating Scale for Depression (Hamilton, 1960) to assess the levels of depression presented by 76 male and 29 female alcoholics. To estimate overall depression from the self-report and clinical instruments, the Z scores for both measures were summed. Correlations then were calculated between the composite scores and the alcoholics' background characteristics. Self-reported prior suicide attempts, severity of the current drinking problem, and being white were associated positively with depression. A stepwise multiple-regression analysis indicated that the self-reported occurrence of a prior suicide attempt was the only meaningful correlate. A combined cut-off score analysis of the BDI and Hamilton ratings indicated that 33.3% of the sample was moderately to severely depressed. The more depressed alcoholics were also more likely to have described previous suicide attempts.
To examine the relationship between alcohol use and cocaine relapse.
Ninety-eight cocaine-dependent male patients in aftercare were followed for 6 months following completion of an intensive outpatient rehabilitation program (IOP). Past and current alcohol dependence was assessed at entrance into aftercare, and drinking behavior prior to cocaine relapse and "near miss" episodes was assessed at 3- and 6-month follow-ups. Data on cocaine and alcohol use throughout the follow-up were also obtained.
Patients who had never met criteria for alcohol dependence and those with current alcohol dependence had worse cocaine outcomes (cocaine use on 10% and 7% of the days in the follow-up, respectively) than those with past alcohol dependence (cocaine use on 3% of the days in the follow-up), although alcohol dependence status no longer predicted cocaine use outcomes when cocaine use in IOP was controlled. Alcohol use in 4 of the first 5 follow-up months significantly predicted cocaine relapse status in the next month after cocaine use in IOP and alcohol dependence diagnosis at baseline were controlled. Patients who experienced cocaine relapses were much more likely to report drinking before the onset of the episode than those who had "near misses," particularly on the day of the episode (40% vs. 6% at 3 months; 62% vs. 0% at 6 months). Alcohol did not appear to be a factor in the relapses of cocaine patients with no history of alcohol dependence, even though they did report drinking on 5% of the days in the follow-up.
Relapse prevention efforts with cocaine abusers who have histories of alcohol dependence should include interventions designed to reduce drinking.
Five papers by Peniston and colleagues, which constitute the basic literature for alpha-theta EEG biofeedback treatment for alcoholism and posttraumatic stress disorder, are reviewed. As a result, we raise three questions: (a) Are the samples studied independent? (b) What was the clinical status of the participants prior to treatment? (c) What treatment did the participants actually receive? In seeking answers to these questions we aim to strengthen the database for neurofeedback with specific procedural information so that claims of efficacy can be tested and accepted or rejected on an objective basis.