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The Evolution of a Trauma Protocol Over a Quarter Century

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Abstract and Figures

We present what has emerged in our clinician network as a comprehensive neurofeedback strategy to resolve trauma syndromes. The historical development is presented, albeit from our own parochial perspective. The initial point of departure was the Alpha-Theta protocol targeting psychological resolution. Preliminary stages of brain training serve to enhance the subsequent success of the Alpha-Theta experience. These targeted physiological regulation in various ways. Over time, the primary burden shifted ever more toward the physiological resolution aspects of the therapy. PTSD came to be understood fundamentally in terms of a model of physiological dysregulation. This monograph relates how the comprehensive strategy emerged. Some case reports and group data are presented in support of the therapeutic strategy.
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The Evolution of a Trauma Protocol Over a Quarter Century
Siegfried Othmer, PhD and Susan F. Othmer, BA
The EEG Institute, Los Angeles
This monograph is an augmented and updated version of our book chapter titled Evolution of Alpha-
Theta Training Over a Quarter Century. This is Chapter 13 in Alpha-Theta Neurofeedback in
the 21st Century: A Handbook for Clinicians and Researchers (Expanded Second Edition),
Antonio Martins-Mourao and Cynthia Kerson, editors, Foundation for Neurofeedback and
Neuromodulation Research, Murfreesboro, TN, pp. 317-344 (2017). We present what has emerged in
our clinician network as a comprehensive neurofeedback strategy to resolve trauma syndromes. The
historical development is presented, albeit from our own parochial perspective. The initial point of
departure was the Alpha-Theta protocol targeting psychological resolution. Preliminary stages of
brain training serve to enhance the subsequent success of the Alpha-Theta experience. These targeted
physiological regulation in various ways. Over time, the primary burden shifted ever more toward the
physiological resolution aspects of the therapy. PTSD came to be understood fundamentally in terms
of a model of physiological dysregulation. This monograph relates how the comprehensive strategy
emerged. Some case reports and group data are presented in support of the therapeutic strategy.
The Peniston Studies: Opening to a New Era
Our EEG Institute staff in Los Angeles has been involved with Alpha-Theta training since the
early nineties, after becoming acquainted with the work of Eugene Peniston. Up to that time we had
been working with SMR/beta training exclusively, ever since our entry into the field in 1985. In
those early days, we had absorbed the prevailing wisdom of the field that alpha training had been
thoroughly discredited in academic research. This sentiment was so well established that Peniston’s
presentation at the AAPB meeting in Washington, DC in 1990 encountered considerable resistance
from the old-timers. Nevertheless, that presentation was so compelling that it launched numerous
clinical initiatives within the biofeedback community, ours among them.
Peniston had simply applied the Alpha-Theta protocol to his treatment-resistant alcoholics
among Vietnam era veterans. The protocol had been developed at the Menninger Foundation by the
research group led by Elmer Green and his wife Alyce Green, starting in the late sixties. The
protocol combined temperature training for autonomic nervous system regulation with the
promotion of alpha and theta band activity in the EEG by means of a reinforcement paradigm. This
was intended to promote entry into states that facilitate psychological resolution and emotional
growth. In his first study, Peniston achieved sustained sobriety in his ten experimental subjects,
whereas his ten controls, who received only another round of the standard treatment program at the
Fort Lyons Veterans facility, all relapsed within the subsequent 18 months.
This kind of success was simply unprecedented in addictions treatment, and that was sufficient
to evoke skepticism all by itself. But that was not all. Peniston had also demonstrated substantial
improvements in personality variables within the treatment cohort with the MMPI. The MMPI had
not typically been used as a change measure for a number reasons, among them the expectation that
these personality variables were relatively stable. So skeptics had yet another reason to reject the
findings. Peniston’s results are shown in Figure 1 for the treatment cohort. The controls showed
essentially no change.
Over the next several years, Peniston followed up his first study with two replications that
supported his early results. He acknowledged that his findings applied more to recovery from
PTSD rather than to alcoholism in any generality, so PTSD became the designated target. But once
there was blood in the water, the sharks continued to circle. Other clinicians came to the rescue
with their own supportive data, and among them was our own group.
Figure 1. Pre-post MMPI data for Peniston’s treatment group of ten participants. Controls
showed essentially no change. HS: Hypochondriasis; D: Depression; HY: Conversion hysteria; PD:
Psychopathic deviate; MF: Masculinity/Femininity; PA: Paranoia; PT: Psychasthenia; SC:
Schizophrenia; MA: Hypomania; SI: Social Introversion.
The CRI-Help Study at EEG Spectrum
We developed the Alpha-Theta training capability for our NeuroCybernetics system in 1992,
and in 1994 the opportunity opened up to do a large-scale controlled study, now known as the CRI-
Help study. This likely remains the largest and most extensive controlled study ever undertaken in
Neurofeedback Group
Pre-training Post-training
biofeedback or neurofeedback. CRI-Help, a large residential treatment center in North Hollywood,
sponsored the research and funded the study. There were 121 participants in two groups. Bill Scott,
who was conducting Alpha-Theta sessions at our clinic in Encino, California, supervised the
clinicians who guided the actual training sessions. David Kaiser was responsible for the study
design. We saw this study as yet another replication of the Peniston Protocol, but Peniston himself
demurred on our insertion of SMR-beta training in place of the temperature training element. We
knew what we were bringing the table. We did not know what we might be giving up by dropping
the temperature training aspect. In retrospect, we were caught in a cognitive bias, with an emphasis
on taming impulsivity and enhancing pre-frontal inhibitory control. The well-regulated brain, we
assumed, is better able to exercise good judgment, thus paving the way for mastery over addiction.
Indeed, we were rewarded for our efforts with a normalization of TOVA CPT scores and
improved retention in the program. Relapse prevention was successful at the 70+% level (after 1
year) for a population that was generally more impaired than Peniston’s veterans had been (Scott,
Kaiser, Othmer, & Sideroff, 2005). And there were nice improvements in the MMPI, which
buttressed Peniston’s claims. These are shown in Figure 2. But when participants were asked, at 3-
year follow-up, to what factors they attributed their ongoing success in retaining sobriety, they
mainly gave credit to their continued participation in group. Clearly, they still had to work at
remaining abstinent, which meant that most of them were still contending with a physiological
dependency at some level. We had not solved the problem of addiction categorically. The Alpha-
Theta training had helped with the resolution of trauma syndromes where that had been an issue,
and they were in better mental health status as judged by major improvements in their MMPI
scores. But any acquired physiological drug dependency could still retain its grip. Liberation from
drug cravings was certainly something we observed, but we could not count on it in the general
Figure 2. MMPI Data for the experimental and control cohorts in the CRI-Help Study. Seven clinical
scales showed significant improvement; five showed significant treatment interaction (shown with
Development now had to take place on another front, because the Alpha-Theta training was
sufficiently mature technologically that it was accomplishing all that could be expected of it.
Alpha-Theta has an experiential purpose rather than a brain-training objective. It merely provides
the entry portal to our deeper, disengaged states, and gentle cueing with respect to alpha- and theta-
dominant states is all that is required. That does not pose major technical challenges, so there was
no obvious technological path forward.
Entry into deeper states is mainly a matter of removing impediments. Our central executive
insists on its own priorities without reprieve. It will command the stage whenever it is given a
chance. The Alpha-Theta process deposes the central executive for a spell; it silences the verbal
scold that we carry around in our brains, the rule-maker, the bossy left hemisphere. Harsh self-
judgment is silenced for the moment. The result can be a wholesome encounter with the core self.
What follows is a breaking of boundaries internal and external, an enlargement of one’s affective
scope. There may be a healing of fractured relationships as they are simply re-envisioned. There is
likely to be a healing of traumas as these are re-framed experientially by being revisited in a benign
context. This experience separates the physiological response from the recall of the event, and
allows it to be recommitted to memory as a historical memory like any other. On the basis of an
apprehension of connectedness, there is the envisioning of a wholesome life going forward.
The Alpha-Theta experience is therefore best seen as a remedy for the grip of trauma rather than
for addictions per se. Traumatic memories are whole-body memories, unitary phenomena in which
the re-constitution of the memory trace extends into the peripheral physiology. Trauma memories
are state-stamped rather than date-stamped. Recovery by Alpha-Theta is a psychological process,
but it is one that is crucially dependent on what happens at the physiological level. That aspect,
however, remained somewhat obscure, and needed further clarification. Such clarity was not
available to us at the level of model understanding or of theory at the time. It came through further
development of the clinical approach, which then allowed our understanding to evolve.
The further evolution took place on the SMR-beta portion of the protocol. In the CRI-Help study
we had employed our first iteration beyond the then-standard “C3beta-C4SMR” protocol, which
involved 1518 Hz reinforcement on the left sensorimotor cortex (C3-T3) and 1215 Hz
reinforcement on the right (C4-T4). We modified the left-hemisphere training to introduce a frontal
bias, and the right-hemisphere training to introduce a parietal bias. The new placements were C3-
Fpz and C4-Pz. The training effects were distinctly stronger than before. The state of affairs at this
juncture was captured in a chapter for a psychiatry textbook on addictions treatment (Othmer, S. &
Steinberg, 2010). The (augmented) content is most readily accessible in a monograph available on-
The Journey to Low Frequency
The discovery of high frequency-specificity of the SMR-beta training prompted exploration of
the entire EEG band, eventually leading to the very lowest frequency that was accessible with a 3-
Hz bandwidth, namely 03 Hz, with a 1.5 Hz center frequency. The clinical strategy was to start
out with our standard bands of low beta and SMR and then to find the optimum response frequency
(called the ORF) for each client. Clients distributed themselves over the entire spectrum, but more
clients ended up preferring the lowest frequency than any other. By the time we were well along in
this process, hardly anyone optimized at our old standard frequency of 1518 Hz, where we had
trained everybody over many years! The brain had been doing the best that it could with the
information we provided at the standard frequencies, but that was not its own preference when we
finally started paying attention to that issue.
The pile-up at the lowest frequency, which was well-established by 2004, was an invitation to
explore even lower frequencies, the range below 0.1 Hz that is referred to as the infra-low
frequency (ILF) region. Such low frequencies needed to be trained differently, in a signal-following
manner, which meant the abandonment of any operant conditioning aspect of the feedback design.
Thresholds lose their meaning in this context.
We initiated the exploration of the frequency range down to 0.05 Hz in 2006, and it was not long
before we observed the same pattern as before: clients favored the lowest frequency, and they did
so by an even larger margin than before. We needed to press on to lower frequencies, and on each
occasion the pattern then repeated. For a substantial fraction of our clients, the favored frequency
was always the lowest available. Work at such low frequencies does present technical challenges,
however, and the invasion of new frequency space posed new clinical challenges as well. In
consequence, this process of development has continued systematically to the present day, more
than 10 years later, at a pace of about one decade in frequency space per year during the early
At the same time, a shift occurred in the priority being given to right-hemisphere placements.
The right-parietal placement migrated from C4-Pz to T4-P4 for stronger effects. This protocol was
more lateralized, and it brought the temporal site back into the picture. This became a priority for
nearly every client. Sometimes we never got around to the left hemisphere placements at all by the
time the client was ready to graduate out of the program. The subjective experience of the right-
parietal placement was a profound and pervasive sense of calm, particularly in those who were
most in need of it. We had finally found a way to calm the seas of a profoundly dysregulated
The use of the term dysregulation in this context bears further discussion. The medical use of the
term tends to imply a physical basis for the condition, the standard preoccupation of medicine. The
assumption is implicit that if the medical cause is removed, then the dysregulation status resolves
as well. Whenever “medicine is dealing with conditions where the failure of good regulation is
itself the issue and no physical cause is suspected, the patient is referred to a psychiatrist. This is
the turf where we find ourselves presently: facing conditions where dysregulation itself is the core
concern, and no underlying medical cause is necessarily implied. In such cases, self-regulation
constitutes the categorical remedy. Once the dysregulation status is resolved by means of a self-
regulation process, there is no residue for the field of medicine to address. The divide between
software and hardware failures in computers comes to mind as a good-enough’ analogy.
With the progression deep into the ILF region, our success in re-regulating a severely
dysregulated physiology mounted. The driver had always been our most challenging clients, after
all, the ones where the lowest frequency was not low enough. At the same time, however, the role
of volition in the feedback process was now precluded. The low-frequency signal moves sluggishly
and is relatively featureless. There is no way for volition to engage. There is no better or worse.
The signal simply is what it is, and it only makes sense to the brain that is producing it, and only
while it is producing it. It carries no meaning for the individual, and in fact it has no meaning for
the brain either except in the immediate context as an event in real time. The brain experiences the
signal; it does not merely observe it.
We had arrived at a process that could be understood purely at the neurophysiological level.
This is a matter of the brain engaging with a correlate of its own behavior. How the brain responds
to that signal is entirely its own affair. The clinician’s role is to observe the status changes and to
discern implications for guiding the training. The clinical challenge is to find the ORF in each case,
where the process can unfold most productively and benignly. The encounter is well characterized
as a “dance with the brain, but the brain gets to lead.”
This closely mirrors what happens in Alpha-Theta. Here a context is created in which the person
is liberated to migrate in psychological state space toward the priorities of the core self. In ILF
training the brain is liberated to migrate in neurophysiological state space toward its own priorities,
namely restored functional competence. In this undertaking, the brain merely requires information;
it is not in need of instruction. Both kinds of feedback are permissive rather than prescriptive.
There is a remarkable parallelism here, and the two approaches clearly complement each other.
Infra-Low Frequency Neurofeedback: The Process
Inevitably, signal processing in the ILF regime both reveals and distorts the signal proffered to
the brain. With frequency-selective filters we have made the process exquisitely sensitive to the
choice of target frequency. On the one hand, that makes the training possible in the first place, and
on the other, it constrains the process to specific frequencies, the ORFs that populate the entire
frequency range for everyone. The highly dysregulated brain can be thought of in chaos theory
terms as having a state space populated with adverse attractors. These, however, are not to be
thought about as fixed entities, by analogy perhaps to Scylla and Charybdis, but rather as
dynamically generated states. The power-law distribution of their incidence testifies to that. The
ILF training process accelerates the journey through state space and thus magnifies the risk of
encountering (precipitating?) adverse attractors. This means a clinician always needs to be actively
involved to guide the process to its most propitious outcome through choice of placement and
target frequency.
The rapid journey through state space can be a challenge to the brain that is susceptible to
instabilities such as seizures, migraines, panic attacks, asthma attacks, and bipolar excursions.
Brain stability may need to be targeted as a first priority, and it has been found that brain stability
depends critically on the relationship between the two hemispheres (Othmer, Othmer, Kaiser, and
Putman, 2013). This aspect is trained using inter-hemispheric placements, in particular T3-T4. The
various kinds of brain instabilities all respond to the same protocol, which suggests that all of them
trace back to the same core mechanism, the delicate balance and coordination that must exist
between the two hemispheres.
In ILF Training, the guiding principle is the brain’s hierarchy of regulation. Stability of brain
function is the first priority, as in any self-regulating system, but particularly so by virtue of the
above considerations. The second priority is the quality of arousal regulation, to which the right
hemisphere gives us preferential access. The training of self-regulation is therefore begun with a
combination of enhancing arousal regulation with T4-P4 and of enhancing cerebral stability with
T3-T4, each optimized based on client response. The ORF is invariably the same for both
placements, but it has been found that the precision of the ORF is more critical with the instabilities
than with arousal regulation. With respect to the latter, it is mainly a matter of calming the system,
of restoring access to a well-regulated resting state. The regulation of physiological arousal is
intimately associated with the regulation of the autonomic nervous system, which is a matter of
restoring the proper balance between the sympathetic and parasympathetic arms. That, in turn,
takes us back to the issue of balance between the hemispheres. Both arousal regulation and
autonomic regulation are in turn intimately associated with the regulation of the affective domain,
the province of the right hemisphere (Othmer, S. F., 2019).
In this manner, we have encroached upon the home turf of the traditional biofeedback
modalitiesthe regulation of the autonomic nervous system. Here affect regulation is the
secondary consequence of autonomic regulation, and the same holds for arousal regulation. The
difference is that whereas peripheral biofeedback comes to the task of affect and arousal regulation
by going up the down staircase,’ so to speak, ILF neurofeedback goes more directly to the source
of the problem. Arousal regulation, autonomic regulation, and affect regulation are simultaneously
engaged at the level of the intrinsic connectivity networks. The two starting protocols in fact do
most of the heavy lifting in the clinical work. Whatever is not dealt with by means of the two
starting protocols is handled in the same manner by a small number of complementary protocols.
An Emerging Synthesis
Several elements of our narrative now fall into place. The ILF training covers the base that in the
CRI-Help study was being targeted with the SMR-beta training. It also addresses the issues that
Peniston covered with the temperature training component of his protocol. And finally, it handles
the problems that Bill Scott encountered during the CRI-Help Study. Scott found that a number of
clients did not respond well to the Alpha-Theta training at the outset, for reasons of their profound
dysregulation status. His remedy was to train down elevated alpha amplitudes in a self-regulation
model before initiating the usual Alpha-Theta protocol.
It turns out that attending to the client’s general dysregulation status at the outset potentiates the
Alpha-Theta experience when it is encountered later. It does so by removing impediments to the
success of the latter. Additionally, there are the many cases where substance dependency or
addiction is traceable to physiological mechanisms rather than to the trauma response or other
psychological factors. And finally, there are the many cases of addiction that are seen in
conjunction with antisocial personality disorder or other personality disorders. In these cases, the
underlying personality disorder needs to be addressed, for which once again ILF training is the
remedy of choice.
Consider the implications of the following case vignette: an older veteran is court-referred for
neurofeedback because of a violent episode. He has a 20-year history of both PTSD and
schizophrenia. At the end of the first session of training, he remarks to the practitioner that
curiouslyhe does not feel like smoking. By this time, he has not smoked in several hours and
would ordinarily need another cigarette. Coming in to session five some weeks later, he tells the
therapist that he has not smoked since session four. Consulting his notes, the therapist establishes
that it had been nineteen days.
It is well-known that nicotine is typically experienced as calming in schizophrenia, and would
therefore not be given up readily. The fact that it was given up so easily in this case, and without
any intention to do so, speaks volumes. There was no transformative moment here, no
psychological involvement. There was no therapeutic mandate here, no moral suasion, not even a
subtle suggestion. Smoking had even not been raised as an issue. What happened here must be
understood entirely at the physiological level. The training had impacted the mechanism of nicotine
dependency that had undoubtedly consolidated over many years. It had impacted the schizophrenia.
And it had done so in very short order.
This was clearly a highly unusual case, unprecedented in our experience. And yet it was not
unique. Sue Othmer once worked with a middle-aged woman who was well situated with an intact
family and ambitious plans for her future. The roadblock was a dependency on heroin and cocaine
that had a fifteen-year history. From the first moment the young woman experienced heroin, she
was willing to move heaven and earth to have that experience again. She had undergone 25 failed
addiction treatments of the conventional sort. After fourteen ILF training sessions, she declared:
“There has been no urge to use drugs. Pretty shocking, actually. No craving since starting the
neurofeedback. I feel like a normal person.” After 20 sessions: “Just getting off the drugs is such a
great relief. I am much happier.” “Life involved this compulsive, self-destructive drug behavior.
It’s gone. The desire for drugs is completely gone.” Observe that the subsidence of drug cravings
was not mentioned until session fifteen, even though it was noted already after the first session. The
reason is obvious: the client was reluctant to believe that the change would persist, so it went
All this transpired well before any thought was given to introducing Alpha-Theta. The later role
of Alpha-Theta would be the appropriate one of resolving the traumatic aspects of this woman’s
crushing failure to measure up in her own eyes and those of her family. Once the addiction itself
was sequestered as a primarily physiological dependence, it no longer carried the stigma of
personal failing. The two aspects of the protocol were both critical, and they reinforced each other.
The Further Evolution of Trauma Therapy
Throughout the history of Alpha-Theta, there has been an established pattern of promoting self-
regulation by one or another means prior to initiating Alpha-Theta training. With ILF training we
now have the additional rationale of redressing the physiological mechanisms of substance
dependency directly. This gives us a multi-pronged ability to target both the physiological and the
psychological drivers of the addiction process. This is best done sequentially, with
psychophysiological regulation preceding the initiation into Alpha-Theta.
With the maturation of the ILF training over the past decade, the major burden of the recovery
process has increasingly shifted to the ILF component of the neurotherapy. The Alpha-Theta
experience is introduced only when the person is ready for it. This makes for a more efficient
training process, and the term abreactions has slipped out of the conversation entirely. At an
appropriate point during the ILF training, an Alpha-Theta session is offered on a trial basis, and if
the client is drawn into the process, then it is continued and becomes part of the mix. If not, then
the ILF training is resumed exclusively for a time before the Alpha-Theta experience is offered
once again. Sooner or later, Alpha-Theta training will typically be welcomed. When that occurs, it
is likely to become the preferred training mode from that time forward. Shorn of impediments,
progress in Alpha-Theta may then occur swiftly.
With the ILF training assuming such a major role in the recovery process, it bears further
discussion. All the ILF placements are either interhemispheric at homotopic sites, or they are
lateralized to the four quadrants of cortex. The principal electrode sites consist entirely of those
where the default mode network (DMN) are accessible to us at the cortical surface (Buckner,
Andrews-Hanna, & Schacter, 2008). The primary task is the functional re-normalization of the
default mode network, our task-negative network. Under this rubric we target brain stability and
arousal regulation as joint objectives. This process can also be understood as instrumentally
assisted relaxation training. The brain utilizes the information provided to re-acquire its desired
resting-state configuration. Dysregulation status limits the brain’s access to its full range of states,
and makes for inefficient cortical processing. Fortuitously, providing information back to the brain
on its own function is usually sufficient to guide the process to its successful outcome.
The next step in the ILF training is to bring the salience network into the schema, and the
control networks related to executive function, depending on the clinical priorities. The salience
network mediates between the task-positive networks and the task-negative network, the default
mode. The salience network plays a monitoring role, one that is largely responsive, and hence
mostly passive. This involves the limbic system, and thus the most intimate association of the
salience network is with the affective domain. Training this linkage is critical to the taming of
emotional reactivity. The implications for the smooth unfolding of the subsequent Alpha-Theta
experience are obvious.
The above schema carried us forward for several years, until David Kaiser alerted us to another
critical aspect of default mode training. The primary axis along which the default mode network is
organized is front-back, with the primary hubs being a frontal and a parietal hub (along with two
posterior lateralized hubs; Lehmann et al., 2014). It was in fact the close coordination of the frontal
and parietal hubs of the DMN that led to the identification of the default mode in fMRI research
originally (Raichle et al., 2001; Raichle, 2010). Curiously, the front-back relationship is not
addressed at all in current ILF training! That does not mean, however, that it has been missing from
the repertoire of neurofeedback protocols in general. It is simply a contingent fact of history that in
all our development over the years the midline has gotten very little attention ever since we
migrated from Cz to C4 in 1992 for a stronger, more hemisphere-specific effect in the SMR-beta
training regime.
It may well be the case that the coordination of the default mode in general, and of the front-
back axis especially, is the specific virtue of the alpha synchrony training that has been practiced
since the early days of the field by Jim Hardt, Lester Fehmi, Chuck Strobel, and Adam Crane
(Fehmi, 1978; Fehmi & Robbins, 2007; Hardt, 2007). This cannot be done as readily in the ILF
regime. To promote coordination of the two primary hubs one would like to do synchrony training,
which calls for a neutral reference that does not exist in the low frequency regime. Hence, the only
truly valid signal there is a differential signal such as we have been using. Alternatively,
coordination between sites can be promoted through feedback on relative timing, and such work is
best done at the higher frequencies, namely in the EEG range, for improved timing discrimination.
As it happens, the alpha band is the only one for which global synchrony over cortex is well
tolerated. That presents the therapeutic opportunity, one that was seized quite early in the
development of the field.
In our evolving worldview, we now understand alpha synchrony training largely in the frame of
default mode training, and in pursuit of that objective it now goes hand-in-hand with the ILF
protocols. Indeed, the experience of alpha synchrony training is typically very different from that of
Alpha-Theta, at least partly because it is being done in a very different context, that of alert-state
training. It has found its place as another steppingstone on the path to Alpha-Theta, following the
ILF protocols. Rather than promoting whole-brain synchrony, however, our present protocols
merely promote synchrony on the midline between AFz and Pz, in our own implementation of a
David Kaiser protocol. In sum, we depend on the synchrony training to organize the front-back axis
and on the ILF protocols to manage the inter-hemispheric and lateralized functional relationships
within the default mode. That combination seems to be serving us well.
Since this monograph was first written in 2017, one further key innovation has been introduced.
The coordination of the frontal and parietal hubs of the DMN via synchrony training has been
achieved in the ILF region. We found that the lack of a quiet reference doesn’t confound ILF
training to the point of infeasibility. The same problem exists in the EEG range, after all, in that an
ear reference is not quiet either, and yet referential training can be done successfully. The same
holds for ILF synchrony; in consequence, it has assumed a preferential role with respect to Alpha
Synchrony training in that cause. For certain clients, that turns out to be a critical protocol.
A Comprehensive Trauma Recovery Program
Taking stock of where we are presently, a comprehensive strategy toward self-regulation has
emerged, one that respects the hierarchy of concerns. Core regulation is addressed at the outset,
followed by more specific targeting of dysfunctions. Only after physiological regulation has been
restored are the psychic wounds of trauma tended to. With respect to physiological regulation, the
hierarchy we discern is also the developmental hierarchy, and this turns out to line up well with the
hierarchy in the frequency domain. We have been well rewarded for our journey to the low
frequencies. In view of the above correlations, this protocol can also be described as a journey back
in time to the early phases of the child’s development. In this manner, patterns of dysregulation that
were consolidated via early trauma become accessible to remediation.
Subsequently, the EEG range of frequencies is addressed to achieve more refined regulation of
temporal relationships in cortex. Finally, we arrive at the point where our intrinsically human
faculties—as opposed to our brain’s operating system—can become our primary concern through
the Alpha-Theta experience. The individuality and particularity of the response to these protocols is
evident in every phase of the program. And at each stage, it is either the client’s brain or the core
self that determines the journey. Full latitude is being given to the person’s intrinsic healing
resources, and these merely need to be potentiated by providing real-time information on the
person’s state, on the one hand, and the removal of impediments, on the other. The role of the
therapist in this process is critical, but it is largely supportive rather than being directive or even
The natural history of PTSD, of substance dependency, and of traumatic brain injury (TBI) is
that self-recovery is the predominant expectation. Most people age out of an addiction at some
point in their lives, and most do so without the benefit of any therapy. Self-recovery has been the
standard assumption in the field of medicine for traumatic brain injurythe default position in the
absence of any available medical remedy. And most people recover from their traumas without
lingering PTSD. This expectation holds even for combat-related trauma, as we observed after the
Vietnam War.
The implication is that those who visit our offices with these conditions are most likely to be
those whose nervous systems were more severely impacted by the trauma, or they were already
dysregulated when they had their significant head injury, encountered their trauma, or were
beguiled by their drug of choice. Their recovery potential had been compromised earlier in their
history. We get to see the result of a cumulative history of prior traumas, minor head injuries, and
chemical insults to the brain. We refer to this as the dysregulation cascade. The key factor that
made PTSD and TBI such prominent issues in the recent conflicts was multiple deployments,
leading to the concatenation of both physical and psychological traumas. The compounding of
effects then makes self-recovery much less likely. Even minor traumas count.
The key factor that made TBI so prominent an issue in the recent wars was blast injury, where
no physical injury to the brain could be identified and yet service members were rendered
dysfunctional. For the first time, the field of medicine was confronted massively with the issue of
functional injury, in which manifest deficits could not be traced to obvious physical injury. All of
this strengthens the case for redressing physiological deficitsthe functional injuryprior to
dealing with the psychological aspects of trauma. Finally, the physical trauma of TBI is
simultaneously also a psychological trauma, as the victim surveys his uncertain prospects in the
face of the precipitous loss of functionality. The close kinship of TBI and PTSD is manifest, and it
is also traceable to commonality at the level of failure mechanisms. Both are grounded in altered
functional connectivity of the neural networks, and both are comparably recoverable.
Clinical experience with both EMDR and exposure therapy is supportive of the above
proposition. EMDR procedures frequently lead people into distress, just as exposure therapy does.
In all such cases, one surmises, the causal chain involves responses triggered by dysregulation.
Recovery from PTSD must therefore be understood firstly in a physiological rather than a
psychological frame. Once the physiological aspects of PTSD are resolved, PTSD can no longer be
diagnosed. At a superficial level, this is in consequence of the dominant role of physiological
symptoms in the diagnostic criteria for PTSD. Once these are cleared, PTSD is unlikely to be
diagnosed. At a deeper level, this is attributable to the intimate coupling of psychological aspects of
PTSD with their physiological underpinnings. However, even this belies the yet deeper reality of
the trauma response. PTSD is physiologically rooted in its essence. Now that we have the tools to
resolve the physiological dysregulation with ILF training, combined with ILF- and Alpha-band
synchrony training, the Alpha-Theta experience can finally assume its intended role, the healing of
the psyche and the unbinding of the soul. This is an intensely personal and, for many, an essentially
spiritual journey, one to which ideally everyone would be given entrée at some point in their lives.
The most critical test of the above propositions is provided by our military veterans. The
Vietnam era veterans have lived for 40 years with the condition (some amalgam of PTSD and TBI),
and have witnessed the progressive deterioration of their physiological integrity over that time.
Veterans of the recent and ongoing wars give us a chance to work with PTSD and TBI in its early
post-trauma status.
Clinical Validation
Franklin came to us in 2009 from Bell Shelter, a Salvation Army shelter for formerly homeless
veterans, offering them transitional housing until they can be rehabilitated. At age 59, he was one of
their most challenging residents. His family had cut off contact years ago. He had had a very
checkered history with drug use and with the criminal justice system. By now he was diabetic, obese,
and had sleep apnea. In consequence of poor sleep, it was difficult for him to stay awake during the
early sessions of ILF training. Our symptom tracking program was used to record symptom severity
every three sessions. Tracking the symptoms most closely associated with PTSD revealed the
following: suicidal thoughts, flashbacks of trauma, nightmares and vivid dreams, and binging and
purging were no longer listed as problem areas by the third session, and were never a problem again
thereafter. Other rapidly resolving symptoms included irritability, anxiety, anger, and emotional
reactivity, all of which essentially resolved in 18 sessions. By session 18, all the above categories
were listed as zero on a 10-point scale, whereas they had been key issues at the outset. In this
compilation, only sleep symptoms remain. The symptom regression profile is illustrated in Figure 3.
Figure 3. Progress in symptom severity for a Vietnam era veteran is shown here for the first
eighteen sessions. a) The symptoms most directly associated with PTSD are illustrated here; they
were also the symptoms most readily responsive. Overall recovery by more than 90% was observed
over 18 sessions, and gains were sustained subsequently.
On the presumption that his extended history with PTSD had determined Franklin’s total
dysregulation status, symptoms of dysregulation were tracked comprehensively. These included (in
addition to those already mentioned) peripheral neuropathy pain, chronic nerve pain, nausea, high
blood pressure, fatigue, difficulty walking or moving, chronic constipation, lack of appetite
awareness, tinnitus, sleep apnea, restless sleep, and difficulty maintaining sleep. Many of these are
not expected to yield quickly to neurofeedback, yet collectively these symptoms exhibited more
than 80% reduction in severity in 18 sessions. This symptom profile is illustrated in Figure 4.
Symptom severity largely plateaued at that point for the subsequent 40 sessions, except for a
transient increase in emotional reactivity as Franklin reconnected with his family at session 42.
At the point of graduating from the training at session 60, residual symptoms related to his
obesity (difficulty walking, although he was now mostly out of his wheelchair); lack of appetite
awareness; and the emotional reactivity already mentioned. Sleep apnea episodes had ceased to be
an issue, apparently. There were no more complaints of pain. The 23 medications he was supposed
to be taking were down to one: insulin. Franklin became the happy and joyful man that he had once
been, and he lives independently. There was never an opportunity for him to experience Alpha-
Figure 4. All the significant symptoms of dysregulation are tracked collectively (including those
shown in Figure 3). Overall improvement was at more than 80% in eighteen sessions, and gains were
sustained over the longer term. Prominent residual symptoms related to sleep apnea, obesity, and
peripheral neuropathy pain attributable to diabetes. These are conditions for which neurofeedback is
not expected to be a remedy.
This case report testifies to the proposition that PTSD is lodged largely in the physiological
domain. After that aspect is resolved with neurofeedback, there may indeed still be traumamoral
injury, relationship loss, survivor guilt, etc.but the classical disorder labeled PTSD will no longer
be diagnosable. What remains can be aided by Alpha-Theta training, with the support of
psychotherapy and the ministrations of the healers among us.
This conceptionof PTSD lodged in the neurophysiological domainis so contrary to prevailing
perspectives that a single case report cannot be dispositive on the issue. A case report has just been
published that implicitly makes the same case, and it does so by way of standard assessment
instruments. Swedish trauma therapist Anna Gerge presented the case of a woman diagnosed with
complex PTSD and unspecified Dissociative Disorder. Now in her forties, she had been sexually
abused in childhood in a shame-based culture, and she had also suffered civil war-related trauma that
involved missing and murdered relatives. She suffered through an abusive relationship in adulthood.
Her brother was murdered two years before therapy was initiated. Between two assessment events ten
weeks apart, the one parent with whom she had a partly secure attachment died. She was also in
refugee status in an alien culture that was not particularly welcoming.
Therapy consisted of ten sessions of Infra-Low Frequency (ILF) Neurofeedback, plus one session
of EMDR. Between the second assessment and follow-up at four months, PTSD Checklist (PCL-5)
score improved by 83%, from 71 to 12. Symptom Check List (SCL-90-R) score improved by 98%,
going from 223 to 4. DES, the Dissociative Event Scale, improved by 97%, going from 62 to 2, with
all of the improvement coming in the NF portion of the therapy. The Symptom Rating Scale, SR,
improved by 98%, going from 8.1 to 0.2. The Positive States of Mind Scale, PSOM, improved by a
factor of 3.6, going from 5 to 18, with most of the improvement occurring during the NF portion. The
results are shown graphically in Figure 5.
Prior to this report, such rapid abatement of susceptibility to dissociative events would have been
regarded as impossible. By the end of eleven sessions, neither DID nor PTSD remained diagnosable.
Here the ILF neurofeedback served to calm and stabilize the nervous system to the point where even
a single session of EMDR could be highly productive. In a comprehensive neurofeedback strategy,
this part of the therapy would have been pursued with Alpha-Theta training.
Figure 5. Symptom-tracking data for case of DID/PTSD. PCL PTSD Check List; SCL -- Symptom
Check List; DES -- Dissociative Events Scale; DES-taxon -- subset of DES; SR -- Symptom Rating
5 NF 10 NF 1 EMDR 4 Mo FU
PCL-5 SCL-90-R DES DES-taxon SR-scale
Regarding PTSD and TBI relative to recent and ongoing conflicts, we have had the
extraordinary opportunity to work with the Department of Deployment Health at Camp Pendleton
(and the relationship continues with the Department of Mental Health). The staff there had heard
Siegfried’s talk at the Navy and Marine Corps Combat Stress Management Conference in 2008,
which was followed by a presentation at Camp Pendleton. When the Department Commander
realized that we were talking about nothing more than biofeedback, and that the procedure had the
necessary approvals from the FDA, she saw no further barriers to a trial. It was not long before the
ILF and Alpha-Theta training came to dominate the work at the Department, which had to give
clearance to every service member planning to redeploy. The entire professional staff of the
Department got trained in ILF neurofeedback. Between 2009 and the present, between one and two
thousand Marines and Navy received the benefits of the ILF training to qualify them for
For the first 300 going through the training in the 2009-10 time frame, the findings were as
follows: some 25% of the service members reduced their symptoms below clinical significance
within 20 sessions, with a median of about 10 sessions. A further 50% reduced their symptoms to
clinical insignificance within 40 sessions, with a median of about 20 sessions. The remaining 25%
either needed more sessions or complementary therapies in addition to the neurofeedback, or they
were simply non-responsive. The staff was working under difficult circumstances of inconsistent
scheduling, and estimated that under more ideal conditions the intractable fraction of the training
cohort was likely around 5%.
In line with the above observations, most individual symptom categories distributed tightly
around 75% to 80% response. Over 60 different symptoms were being systematically tracked,
grouped into categories of sleep, pain, physical, psychological, psychophysiological, sensory, and
cognitive function. The most responsive symptom was migraine, with 90% responding strongly.
The least responsive symptom was tinnitus, with 50% showing substantial recovery. Addictive
behaviors responded at the 60% level. Suicidality, hypertension, asthma, constipation, effort
fatigue, and stomach pain responded in everyone where it had been an issue. The most dramatic
response was for depression and anxiety, where scores for nearly all the responders were cut in half
within six sessions.
Most of the trainees did not stay around for the Alpha-Theta experience. This was not much of a
surprise to the clinicians, as they had already experienced the reluctance of service members to
engage in psychotherapy before the neurofeedback was introduced. This can be attributed to the
spirit inculcated in the Marines of taking responsibility for one’s issues. One reason the
neurofeedback flourished as it did was likely because it fit the military training model. ILF
neurofeedback was seen as brain fitness training.
It is possible that in view of a rushed training schedule, Alpha-Theta was offered too early, at
which point they tended not to like it or get much out of it. The experience is very different when
Alpha-Theta is phased in appropriately, as now occurs with the veterans in private practice. They
gravitate to the A-T readily, and from then on tend to prefer it to the ILF training.
Finally, we have the report on a pilot project conducted by the Swedish Red Cross, in which ILF
training was offered to victims of torture among the refugees, all of whom had failed to respond to
conventional therapies for from 6 months to several years. The results of 20 sessions of training are
shown in Figure 6. A substantial reduction in symptom severity was achieved, even though the
practitioners were relatively new to the method. Also, torture victims present a challenge to our
method because they don’t respond well to being asked to tune into their bodies. T hey have learned
not to attend to how their body feels as a counter-measure against the torture. In consequence, it
was difficult to determine the ORF for these patients. That, in turn, meant a slow start for the
effective training process.
Figure 6. Average recovery curves for the five participants are indicated in the Figure for
eighteen of the twenty sessions, for the symptoms listed in the legend. The first symptom appraisal
took place only after the first session, and the last assessment took place at the twentieth session,
and therefore does not reflect the gains attributable to the first and last sessions. Substantial
remediation of their critical complaints is indicated.
Clinical Strategies and Clinical Realities
The tools are now in hand with which both the physiological aspects and the psychological
consequences of dysregulation in general, and of trauma specifically, can be systematically,
effectively, and efficiently remediated. The problem of addiction, in its various manifestations, fits
nicely within this schema. Just where remediation is to be found in a particular case is not
predictable in advance. It is therefore incumbent on the clinician to have at his or her command the
full panoply of remedial techniques, along with skill in their deployment.
In this section, we shed more light on the respective roles of the two tall poles in the tent, the
ILF and the Alpha-Theta aspects of the therapy. We do so with the aid of some instructive clinical
vignettes. As indicated previously, the problem of drug craving can frequently be resolved within
the ILF phase of the program, and sometimes quite readily. A clinician working with a binge
drinker with ILF protocols reported that he had been “thinking about” his use of alcohol as he was
undergoing the training for his general condition of overwhelm at work and at home. He had five
training sessions over the course of seven weeks. Coming in after New Year’s he reported that he
hadn’t had a drink since mid-December, despite severe year-end pressures on his job. When
tempted to drink after work, he was now able to tell himself, “why blow it,” and to maintain
abstinence even well before Alpha-Theta training was begun with him.
The resolution of drug craving fits into a larger picture of relief for the compulsive aspect of
various addictive tendencies such as gambling, thrill-seeking, and lying, etc. The Alpha-Theta
training is more specifically helpful in moderating and defanging particular triggers of addictive
behavior. It buffers the person against the external, environmental, and contextual drivers of the
propensity to use, whereas the ILF training resolves the internal, physiological drivers.
With the insertion of ILF training in advance of Alpha-Theta training, the subsequent experience
is typically more consistently positive, with the dropout of concern about the abreactions that
exercised Eugene Peniston. Our professional training course environment, however, continued to
present a special circumstance in which the training schedule was necessarily compressed, and
Alpha-Theta was experienced before some attendees were ready for it. The experience of a
seasoned trauma specialist who had been working with torture cases for many years is illuminating
on the relationship of both aspects of the training.
Voices intruded on his first Alpha-Theta experience, and they were insistent and persistent. His
outward demeanor was totally calm during this time, according to his partner in the training, and
yet he was experiencing a lot of turmoil. This lasted about 15 minutes, at which time he removed
the eye shades and headphones and ended the session. He continued with ILF for stabilization, and
interestingly the thoughts were the same, but now he could manage them better.
All this came as rather a surprise to him, because as a long-time psychotherapist he thought that
he had been successful in keeping himself in line with his skill set. And yet he was now confronted
with all these loose ends. It was unsettling. He was confronted with self in a new way. Here is how
he described the experience:
“I just had these voices in my head; they were terrible voices… I couldn’t stop it. It was quite
awful… I was really in the grip of it… A lot of what my life is about is working with these systems…
I started using everything I knew in terms of breathing and imagery, and it wouldn’t quitMy
question coming in [to this training program]: Is this real? Is this placebo? The reason I threw
myself at this in this way… I wanted to see whether something was going to happen to me without
my doing anything…”
That question was clearly resolved!
With the shift back to ILF after fifteen minutes in the boat, he said:
My relationship to these thoughts changed. There was a qualitative shift in my experience of
my own thoughts… The ILF allowed me to have the thoughts rather than the thoughts having me...
From a psychotherapist point of view, it was about the absolute intra-subjective shift in my
reaction to my own thoughts... [The experience] was great, but it was also oh, shitMore work
to do…’
In the grip of the moment, he consoled himself with the realization that “I have lots of ways to
get back to normal...
Most unusual here is that his Alpha-Theta experience was so intensely verbal. And yet it had
qualities of an Alpha-Theta experienceit came out of another part of himself that he had not yet
tamed with his left-brain consciousness. From beginning to end his reaction to the new
phenomenology was that of a psychotherapistrestoring control to the cognitive domain. Scariest
was the loss of top-down control of his own thoughts, and the realization that the part of himself he
had succeeded in mastering was only a part of the whole. The cauldron of his own collective
trauma experience was in fact still bubbling.
The more generalizable aspect of this report is that people in generalbut mental health
professionals in particulartend to react more strongly to both ILF and Alpha-Theta than they
expect. Both kinds of training take them out of the comfort zone of their cognitively ordered self-
perception. “I was not prepared for this. I did not think I had a problem,” is a typical response.
Plainly, the experience of the training acquainted therapists with their own dysregulation status,
one that their self-management skills had not in fact conquered. A further observation, however, is
that we know of no case in which the journey is regretted in retrospect. It is ultimately always ego-
Sometimes the alert-state training has a transformational quality itself. Before the era of ILF
training, Sebern Fisher worked with a CEO-type over an extended period with neurofeedback
aloneno psychotherapy, as he was not there for that. At one session he became overtly emotional,
and when Fisher inquired, said that “I have never known what love is. I don’t know why my wife
has stuck with me all these years” (Fisher, personal communication). Obviously, the connection
had just been made in his internal circuitry. With ILF training we now have the key to the
personality disorders. This work takes a long time, and progress is largely accomplished in the ILF
phase of the training, but at least this is now doable.
At issue here is the entire spectrum of attachment disorder, of which personality disorders are a
manifestation. Fisher related yet another case in which extensive alert-state training had been done
(at low EEG frequencies, but before the ILF era) with a young adult with an extreme case of
attachment disorder. When Alpha-Theta training was finally initiated, the girl regressed, stopped
coming to therapy, and even neglected the feeding of her dog. The conditions for successful Alpha-
Theta training had not yet been met. There was no core self to come home to; the girl instead
encountered a black hole, a total emptiness, without means of support. Matters might well have
gone differently with ILF to shore up the scaffolding for the project of constructing a self. This
cautionary tale remains a singular event in memory (and a good outcome was ultimately achieved).
With ILF having priority in the training, nothing remotely similar has been observed since.
Transformational experiences are much more commonplace in the Alpha-Theta portion of the
therapy. One middle-aged man reported that his journey took him back the New Jersey beaches
where his father used to walk with him. At one point the father dropped his hand, and the 8-year
old boy interpreted that as the loss of the love of his father, with long-term adverse consequences
for their relationship. Revisiting that event in his adult consciousness, the man now realized the
innocuous nature of that event, and in that moment repaired the relationship with his father. This
was not a matter of mere cognitive reframing. It was affective, and it was visceral. The bond of
filial affection had been restored.
A middle-aged woman reported on her remarkable Alpha-Theta journey as follows. She was an
eagle flying near her childhood home. She flew higher and higher, with her house becoming ever
smaller, until she was among the stars. Eventually she retraced her flight, ending back at her former
home. Nothing more happened than that she had re-constructed her relationship to her mother and
to her siblings in the course of that flight. This had occurred entirely non-verbally and essentially
beneath consciousness. The negatives in each of these relationships from childhood times had
simply shrunk to insignificance along with the house during that singular journey into space.
Another middle-aged woman, one with a history of early trauma, found herself walking the
beach until she came upon an infant girl sitting alone on the wet sand. “I picked her up and realized
that that was me.” She would now get the caring that she herself had not had.
These are healing journeys that appear to be so totally inner-directed that one might readily ask
just what the role of a therapist needs to be in this aspect of the work. One voiced his frustration as
follows: “Personally, I am getting a little glum seeing people have amazing experiences, resolving
intense trauma, and blossoming while I sit on the sidelines entering notes….” It is imperative, first
of all, that clinicians have their own house in order. One M.D. who had transitioned to
neurofeedback practice after burning out as an emergency room doc never had good results with
Alpha-Theta work among her patientsby self-report. Her own unresolved PTSD may well have
been the confounding issue.
One explanation for the lack of abreactions in our Alpha-Theta work could be that in connection
with the CRI-Help study back in the mid-nineties we increased the center frequency of the theta
band from what Eugene Peniston had relied on, from 48 Hz to 58 Hz. This may have kept clients
from going too deep into theta dominance. In our present realization in Cygnet, the standard center
frequency of the theta band is 7 Hz. There appears to be a relationship between the theta target
frequency and early trauma: lower theta frequencies may target traumas that occurred earlier in the
child’s history or had more pervasive impact. This relationship became quite evident in one case of
alert-state training in which Sue Othmer walked down the target frequency toward the delta band in
one session and the client (with Dissociative Identity Disorder) transiently regressed to ever
younger ages, eventually speaking in the high voice of a child. Walking the frequency back up
restored her to her adult self.
The conjectured frequency dependence motivates a clinical strategy in which clients who are
well along in their Alpha-Theta experience could be invited to venture into the lower frequency
range for a deeper experience by gradually lowering the theta-band center frequency from session
to session. This progression can be fine-tuned as necessary. One clinician recently reported on her
results with this approach:
I started off slowly on the theta band, going from 7 to 6.5 and eventually to 5. [Clients] would
come back with so much information and resolution of trauma that at times they themselves were
overwhelmed with how much they achieved from Alpha-Theta versus years of talk therapy. It
really digs deep and I think the client needs to be fully prepared in terms many sessions of awake
state and regular Alpha-Theta
The reader acquainted with EMDR will recognize the point of contact here between the two
methods. EMDR was an early method of accessing traumas with a frequency-based stimulation
technique in the delta range of frequencies. This allowed them to be dealt with cognitively. In our
current perspective, the difficulties encountered in such work can be readily appreciated. In first
instance, traumas can be stirred up that the client is not ready to handle either psychologically or
physiologically. And the role assigned to the cognitive domain is more than it can bear. A proper
sequencing of the process of trauma recovery (and of addiction recovery) is easier on the client and
the clinician, as well as being much more successful.
Early on, in the Eugene Peniston era, Tom Allen turned Alpha-Theta sessions into something
like EMDR. Armed with the physiological measures of finger temperature and galvanic skin
response, he would seize moments of excursion in the measures to rouse clients from their journey
and to engage them with whatever might have prompted that turmoil. He talked so proudly of his
tactics, utterly persuaded of their merit. We now know better. This moment of transformational
change is the absolute worst time for the clinician to come crashing into the scene.
What holds for EMDR holds even more for exposure therapy, which is surely the therapy from
hell. It is simply perverse to think that exposing people to traumatic material ought to help them,
particularly when the evidence is so strongly against it. The bifurcation point between de-
sensitization and re-traumatization is not readily subject to external control. Relying on cognitive
control is likewise a false hope. Trauma is not lodged in the cognitive realm, and the solution is not
to be found there. Once trauma is resolved by methods described here, previously traumatic
material can be readily revisited without dramatic consequence. The trauma no longer has the
person in its grip.
In one memorable instance from many years ago, Sue Othmer was working with a person
recovering from rape. She was also seeing a psychotherapist, who in her wisdom decided at one
point that flooding would be a good idea. The client completely cratered. She went home, took to
her bed in fetal position, remained in seclusion for many days, and stopped all therapies. This is
supposed to be helpful? Once again, the story ended well. Eventually, she came back for
neurofeedback, where she also resolved her PMS, a major issue in her life. Years later, upon a
reporter’s inquiry, we asked whether she would be willing to talk to him. “Well, yes” she said, “but
why are you asking me about PMS?” It had all been forgotten.
Contrast the above with the experience of a Canadian vet who had served with the UN in
Bosnia, where he was compelled to witness horrors while being subject to official strictures on
intervention. He came to our office in 2007 after some ten years of failed psychotherapy. With our
first generation of ILF training, he shed his claustrophobia by the second session, and body pains
were reduced. The garbage bags in the elevator that had triggered flashbacks after session two were
no longer body bags at sessions five. The first Alpha-Theta session at session seven left him
“strangely calm….” Images came up and did not elicit an emotional reaction. “Awesome. I can’t
wait to do it again.” At the second A-T session he had a visit from his dead grandfather. At the
third, he confronted his issues of guilt. Nightmares were subsiding. He had had his first panic
attack in a movie theater, and subsequently avoided them. After the fifth A-T session, he could go
to a movie theater without difficulty. At session #18 he came in ‘craving Alpha-Theta.’ He went
very deep in that session. He disclosed that traumatic events he had never been able to bring up in
years of therapy had ceased to be traumatic. The events never needed to be talked about at all. He
had 24 training sessions in total, 12 of which had been Alpha-Theta, before returning home to
Canadaa changed man.
Even worse than exposure therapy is the insult to the integrity of the human body that is
represented by detox. In all instances of drug dependency, from anxiolytics to anticonvulsants to
neuroleptics, whenever downward titration is called for, the watchword is to ‘go slow.’ The
singular exception appears to be alcohol and illicit drugs. Why the infernal haste? Is this just the
residue of the moral opprobrium that has historically attached to alcoholism and to illegal drug use?
The physiological ravages attributable to detox are so unnecessary. Even the risk of seizure is
tolerated. We can now train the brain away from its dependence on alcohol and it will be very clear
when one has succeeded. Moreover, it will be the client’s own victory over his condition. Success
does not lie in the client clutching onto abstinence by sheer force of will. It lies in a life
transformed... a brain restored to functional integrity and a psyche liberated from its traumas.
A common thread running through the above narratives is that historically clinicians have sought
to install themselves as the central persona in the healing journey out of trauma and addiction, to
place themselves in charge of the process and to micro-manage it. This was necessitated because
the pathway to healing was thought to be via the cognitive domain. This has been a monumental
blunder. With core dysregulation at issue, there is no alternative but to facilitate the path to self-
healing; it cannot be mandated, willed, or prescribed. The project cannot be outsourcedto a
therapist, to a medical remedy, or even to an instrumental process. In the actual remedy, cognition
plays only a minor role. Instead, the mission is to remove impediments to the intrinsic healing
process, and to empower both the brain and the core self with guidance on its own journeyas
opposed to prescription. The desired process of transformation must ultimately be self-directed.
One therapist said:
I have seen multiple sessions with nothing more than a good relaxed feeling and one 22 min
session where someone goes back to Iraq, has a coherent conversation with dead comrades in the
middle of battle, gets chewed out for having little to no insight, and returns with a more profound
understanding of life than I could offer up in a century of therapy.
I feel like a damn porter in a cosmic train station.
Perhaps it’s time to board the train.
Optimum Functioning
Alpha-Theta training has been utilized and researched in an optimum functioning context for
many years. The most prominent such study was undertaken at the Royal College of Music in
London, where music students were offered beta and SMR training along with Alpha-Theta
training, using our protocols and our first-generation NeuroCybernetics instrumentation. No
benefits of the SMR and beta training was identified among these highly selected and highly
functional students. The Alpha-Theta component, on the other hand, made a substantial difference
in their musical performance. Gains were the equivalent of 2 years’ progress in musical maturity, as
established in blinded testing by professional musicians (Egner & Gruzelier, 2003). And yet the
students had only experienced 10 sessions for 20 minutes each. In this study, one has the chance to
observe the positive contribution that the Alpha-Theta experience can make in a context where no
obvious impediments to functionality exist. In consequence of this finding, Egner and Gruzelier
then studied the temporal dynamics of alpha and theta in more detail (Egner & Gruzelier, 2004).
It is in the optimum functioning context that synchrony training finds its most appropriate niche.
It is also part of the healing journey, as previously mentioned. It was not dwelt upon in the above
clinical discussion mainly because it does not pose great challenges to the clinician; secondly,
because it lacks drama that compels our attentions; and thirdly, because of an absence of
association with any condition. It is typically inserted between the ILF training and the deep-state
work, and it is either obviously helpful or it is not perceived to make much difference. Sessions are
usually brief. Adverse reactions are typically quite mild and readily recovered from autonomously.
It would be preferable if no distinction were made at all between clinical applications and
training toward optimal functioning. That would be entirely appropriate to the methods under
discussion here. These are all function-focused rather than dysfunction-focused. Irrespective of the
specific objectives, the ILF training is always individualized with respect to target frequency, and
with respect to the selection and sequencing of placements drawn from a standard set. Orientation
is toward generality rather than specificity. Dysfunction subsides via the enhancement of function.
Alpha-Theta and synchrony training utilize standard bands and standard placements throughout.
These methods are appropriate for the entire range of functionality from dysfunction to optimum
functioning, and ultimately to the frontier of anomalous experience. This is also in line with the
self-perception of our clients, who generally choose to see themselves as functional rather than as
being defined by their condition. The optimum functioning perspective takes us beyond a narrow
focus on symptoms and on functional shortcomings. It is the common ground that should be the
point of departure for our therapeutic adventure.
Summary and Conclusion
Surveying the history of Alpha-Theta from the early discoveries at the Menninger Foundation to
the present day, it appears that we have come full circle. The primary interest of the Menninger
group early on was not in remediating addiction or any other condition. It was in exploring the
dimensions of our human condition more fully, aided now with instrumental conditioning.
Realization of the therapeutic potential of the method emerged over time. In the Peniston era, the
late eighties and early nineties, Alpha-Theta became identified with recovery from addiction and
PTSD. Even in our CRI-Help study, we saw Alpha-Theta as the essential core of the overall
program, with the SMR-beta component playing a supporting role.
ILF neurofeedback now alters the landscape substantially. The burden of recovery has shifted
toward alert-state training from the deep-state training of Alpha-Theta as the clinical priority. This
follows straight-forwardly from the regulatory hierarchy: physiological self-regulation must come
first. Further, the domains of physiological self-regulation and of psychological and spiritual
healing are now more distinct. This brings us much closer to the objectives that the Menninger
group had for Alpha-Theta training at the outset. Already during the ILF training at Camp
Pendleton the trainees often complained that the focus was entirely on their symptom status: “Why
don’t you ask about what is going well in my life?” They had moved on toward an optimum
functioning orientation, and were no longer concerned with their earlier symptoms.
Liberated from the conceptual burden of being tied up with “recovery,” Alpha-Theta needs to be
viewed in the positive frame of facilitating the journey toward wholeness, toward acceptance,
toward integration of the fragmented self, toward personal integrity, and toward enlarging one’s
affective depth and scope. It speaks to the yearning for transcendence. Alpha-Theta opens the door
to an encounter with self that is likely to be welcomed by most people. It should be offered to all
adolescents when issues of personal identity first arise for them. It should be available to all elderly
as they approach the end of life’s journey.
But there is more. Ultimately one cannot make transpersonal phenomenology go away. It exists,
and if that is the case, does it not make our universe richer and more interesting? Consciousness
transcends the self. Does this not testify to our being in relationship in the larger sense?
Consciousness is not bounded by space. Does this not contradict the materialist hypothesis, and
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Consciousness suffuses our universe. What a comforting thought. This is the reality in which Elmer
Green lived his entire life, and which inspired his work. We honor him by continuing his work in
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abusing population. American Journal of Drug and Alcohol Abuse, 31(3), 455469. The content is accessible here:
... It has also been learned that memory is not absolute, but contingent, and it can be retroactively modified. Ideally, the work of trauma recovery is one of transitioning the trauma experience from one that is viscerally felt in all bodily systems, to one that appropriately resides in historical memory, like all other recallable events in one's life (Othmer and Othmer, 2021). ...
... The bias in this choice was toward taming impulsivity and enhancing pre-frontal inhibitory control. The assumption was that a well-regulated brain would be able to exercise good judgment, "thus paving the way for mastery over addiction" (Othmer and Othmer, 2021). The protocol consisted of Beta1 training at C3-Fpz (i.e., 15-18 Hz), in combination with SMR training at C4-Pz (12-15 Hz). ...
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This paper reviews how and why ILF Neurofeedback has proven to be a parsimonious and efficient way to remediate the neuro-physiological effects of trauma. Reference is made to several large- and small-scale institutional proof of concept experimental studies each addressing a specific kind of trauma. It ends with a case report by the author (Kirk) working with an American combat veteran. It makes the argument that given its success that ILF Neurofeedback and Alpha-Theta training become accepted as part of an integrative and holistic approach for treating survivors of trauma.
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Introduction and foundation This chapter describes a novel approach to understanding and treating addictions. This approach involves the use of EEG biofeedback (neurofeedback) as a modality for treating addictions. In the case of EEG biofeedback, the data generated the model. It is preferable, however, for an explanation of the model to precede the data. Addictions can result from both psychological and physiological factors. Neurofeedback lies at the nexus between them. Though it is tempting (and perhaps traditional) to leave the realm of brain behavior entirely to neurophysiology, doing so could omit or minimize some critical elements. Medical science has supplied a great deal of knowledge about structural deficits in brain function; additionally, however, the functional domain of brain behavior is crucially relevant. Cognitive neuroscience – which concerns itself with brain function – has only begun to engage the challenge of psychopathology. Neuronal networks organize behavioral repertoires. These networks exhibit a high level of integration and hierarchical organization. On the operational level, as in all communication networks, timing is crucial. Whenever a system is compelled to operate under tight constraints, there is opportunity for departure from functional integrity. A key assumption is that psychopathology in general, and addiction in particular, arises from deficits in network relations. Recent thinking posits “connectivity deficits” as central to disorders such as schizophrenia, autism, and Alzheimer's disease. These clinical syndromes aside, this model may also help explain less acute or more “characterological” problems.
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Abstract This monograph recounts the development history of the Othmer Method of neurofeedback over more than 30 years. With beginnings in the standard EEG-band protocols developed by neurofeedback pioneers Sterman and Lubar, the method migrated in successive stages from fixed protocols, implemented in an operant conditioning design, to a systematic, sequential, but non-prescriptive approach that is organized according to the developmental hierarchy. This method places initial reliance on training on the tonic slow cortical potential, in the infra-low frequency regime, as the developmental hierarchy maps directly into a frequency hierarchy. The training has to be done in a frequency-specific manner, at frequencies referred to as optimal response frequencies that are unique to each individual. Thus, while the training approach is nomothetic in design, it is idiopathic in execution. The absence of any reinforcers in the training places the brain in charge of the particulars of its journey to functional recovery. The reliance on endogenous neuromodulation to target critical frequencies yields an efficient process with a comprehensive scope. The Infra-Low Frequency (ILF) neurofeedback is complemented by more conventional EEG-band protocols for specific objectives.
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A brain microstate is characterized by a unique, fixed spatial distribution of electrically active neurons with time varying amplitude. It is hypothesized that a microstate implements a functional/physiological state of the brain during which specific neural computations are performed. Based on this hypothesis, brain electrical activity is modeled as a time sequence of non-overlapping microstates with variable, finite durations (Lehmann and Skrandies 1980, 1984; Lehmann et al 1987). In this study, EEG recordings from 109 participants during eyes closed resting condition are modeled with four microstates. In a first part, a new confirmatory statistics method is introduced for the determination of the cortical distributions of electric neuronal activity that generate each microstate. All microstates have common posterior cingulate generators, while three microstates additionally include activity in the left occipital/parietal, right occipital/parietal, and anterior cingulate cortices. This appears to be a fragmented version of the metabolically (PET/fMRI) computed default mode network (DMN), supporting the notion that these four regions activate sequentially at high time resolution, and that slow metabolic imaging corresponds to a low-pass filtered version. In the second part of this study, the microstate amplitude time series are used as the basis for estimating the strength, directionality, and spectral characteristics (i.e., which oscillations are preferentially transmitted) of the connections that are mediated by the microstate transitions. The results show that the posterior cingulate is an important hub, sending alpha and beta oscillatory information to all other microstate generator regions. Interestingly, beyond alpha, beta oscillations are essential in the maintenance of the brain during resting state.
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Neuromodulation in the bioelectrical domain is an attractive option for the remediation of functionally based deficits. Most of the interest to date has focused on exogenous methods, such as repetitive transcranial magnetic stimulation, transient direct current stimulation, vagus nerve stimulation, and deep brain stimulation. Much less attention has been given to endogenous methods of exploiting latent brain plasticity. These have reached a level of sophistication and maturity that invites attention. Over the last 7 years, the domain of infralow frequencies has been exploited productively for the enhancement of neuroregulation. The principal mechanism is putatively the renormalization of functional connectivity of our resting-state networks. The endogeneous techniques are particularly attractive for the pediatric population, where they can be utilized before dysfunctional patterns of brain behavior become consolidated and further elaborated into clinical syndromes.
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Background. It has been shown recently that accurate feedback of alpha and theta electroencephalographic (EEG) activity, as employed in the commonly used “alpha/theta protocol,” induced linear increments in within-session theta-over-alpha ratios in comparison to non-contingent feedback in a healthy sample. These data verify that alpha/theta feedback can facilitate within-session operant control over the EEG signature targeted by the training protocol. However, it is neither known whether any between-session theta/alpha ratio changes do reliably occur, nor what kind of temporal dynamics between the alpha and theta band amplitudes characterise within-session and/or between-session theta/alpha ratio changes.Method. In order to address these issues, analyses of an extensive data set (n = 48) of alpha/theta training in healthy volunteers were carried out. Specifically, alpha, theta, and theta/alpha ratio EEG dynamics were contrasted between groups of subjects that engaged in 10 sessions of training at PZ (n = 28), five sessions of training at PZ (n = 10), and 10 sessions at FZ (n = 10).Results. For alpha/theta training at PZ, significant within-session increments in theta/alpha ratios were mediated by slightly less pronounced decrements in theta than in alpha activity during the sessions. The traditional alpha/theta protocol at PZ was nevertheless associated with significant theta activity increments across the training process. For training at FZ, no significant within- or between-session changes in theta, alpha, or theta/alpha ratio values were found, but a progressively higher rate of within-session theta/alpha ratio modulation was evident across sessions. Furthermore, in contrast to the PZ groups, any changes in theta/alpha ratio at FZ were mediated by increases in theta relative to alpha amplitudes.Conclusions. These data elucidate the dynamics underlying the within-session theta/alpha ratio increments associated with posterior alpha/theta training, and document an increase in theta activity across 10 sessions of training, offering further evidence for a neurophysiological impact of this training protocol. In addition, the contrasting EEG characteristics associated with frontal versus posterior alpha/theta training underline the heterogeneous nature of these frequency components across varying scalp sites.
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A baseline or control state is fundamental to the understanding of most complex systems. Defining a baseline state in the human brain, arguably our most complex system, poses a particular challenge. Many suspect that left unconstrained, its activity will vary unpredictably. Despite this prediction we identify a baseline state of the normal adult human brain in terms of the brain oxygen extraction fraction or OEF. The OEF is defined as the ratio of oxygen used by the brain to oxygen delivered by flowing blood and is remarkably uniform in the awake but resting state (e.g., lying quietly with eyes closed). Local deviations in the OEF represent the physiological basis of signals of changes in neuronal activity obtained with functional MRI during a wide variety of human behaviors. We used quantitative metabolic and circulatory measurements from positron-emission tomography to obtain the OEF regionally throughout the brain. Areas of activation were conspicuous by their absence. All significant deviations from the mean hemisphere OEF were increases, signifying deactivations, and resided almost exclusively in the visual system. Defining the baseline state of an area in this manner attaches meaning to a group of areas that consistently exhibit decreases from this baseline, during a wide variety of goal-directed behaviors monitored with positron-emission tomography and functional MRI. These decreases suggest the existence of an organized, baseline default mode of brain function that is suspended during specific goal-directed behaviors.
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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.
The methods of Neurofeedback (Kirk et al., 2016) and Eye Movement Desensitization and Reprocessing (Shapiro, 2018; Shapiro & Silk Forrest, 1997) will be reflected in relation to a short-time treatment of a patient with complex PTSD and an unspecified dissociative disorder. The aim is to inspire colleges to integrate therapy methods in their quest to help dysregulated patients to become stabile and regulated enough to endure trauma work. This is considered important, especially when working with patients with severe and complex posttraumatic conditions and dissociative disorders, where the evidence-based treatments often not fit for purpose (Corrigan & Hull, 2015). An alternative approach is presented with a single case-study of a patient treated with neurofeedback and EMDR in a psychodynamic short-time psychotherapy. The results of these interventions are presented together with the patient’s drawings and reflections and finally discussed.
Biofeedback-assisted modulation of electrocortical activity has been established to have intrinsic clinical benefits and has been shown to improve cognitive performance in healthy humans. In order to further investigate the pedagogic relevance of electroencephalograph (EEG) biofeedback (neurofeedback) for enhancing normal function, a series of investigations assessed the training's impact on an ecologically valid real-life behavioural performance measure: music performance under stressful conditions in conservatoire students. In a pilot study, single-blind expert ratings documented improvements in musical performance in a student group that received training on attention and relaxation related neurofeedback protocols, and improvements were highly correlated with learning to progressively raise theta (5-8 Hz) over alpha (8-11 Hz) band amplitudes. These findings were replicated in a second experiment where an alpha/theta training group displayed significant performance enhancement not found with other neurofeedback training protocols or in alternative interventions, including the widely applied Alexander technique.