Published Articles by Dr. White

• Consulting Editor, The Journal of Neurotherapy, Haworth Press
• "Theories of the Effectiveness of Alpha-Theta Training for Multiple Disorders". Introduction to Quantitative EEG and Neurofeedback. Evans and Abarbanel (Eds.) New York: Academic Press, 1999.
• "Alpha-Theta Training for Chronic Trauma Disorder, A New Perspective". 1995, The Journal of Mind Technology and Optimal Performance, Mega Brain Report. Vol. II, No. 4. Full article below:

Neurotherapy: A Multilevel

Matrix of Intervention

TABLE OF CONTENTS

I. INTRODUCTION
    A. THE PENISTON PROTOCOL

II. THEORIES OF THE PROTOCOL'S EFFECTIVENESS
    A. STATES OF CONSCIOUSNESS AND THE CONTINUUM OF AROUSAL
    B. STATE-CONTEXT DEPENDENT LEARNING AND RETRIEVAL
    C. TRAUMA AND MIND-BODY INTERACTION
        1. Childhood Trauma and Stress
        2. Mind-Body Relationships
    D. PATIENT-THERAPIST RELATIONSHIP

III. TOWARD A SYNTHESIS
    A. A MULTILEVEL MATRIX
    B. COEX SYSTEM
    C. THE TRANSPERSONAL DOMAIN

IV. A CASE STUDY
    A. BACKGROUND AND TREATMENT EXPERIENCE
    B. FOLLOW-UP

V. SUMMARY AND CONCLUSIONS
REFERENCES

I. INTRODUCTION
Twenty-five years ago EEG feedback was of major significance in the field of biofeedback. Elmer and Alyce Green at The Menninger Institute were experimenting with theta training and creativity, Thomas Budzynski with twilight learning, Lester Fehmi with open focus, Barry Sterman with epilepsy, Joel Lubar with attention deficit hyperactivity disorder (ADHD), and Joe Kamiya with alpha training. Others also were focusing on the training of the brain and central nervous system, but, because the technology was crude, promises of the value of brain wave training seemed to evaporate. EEG feedback became an almost forgotten stepchild.

With the publication of the research of Peniston and Kulkosky (1989), the "child" returned from exile and is growing and developing and expressing its original, almost forgotten, promise. Peniston's focus was a population of alcoholics, all of whom had been difficult alcoholics for more than 20 years and had been in rehabilitation unsuccessfully four to five times. Using his protocol of alpha-theta brain wave training combined with imagery of desired outcome, he was able to show reduction to elimination of craving for alcohol. To my knowledge this original research population is still showing better than 80% success rate some 9 years later.

Peniston and Kulkosky (1991) then expanded their research to a population of Vietnam veterans who were hospitalized for post-traumatic stress disorders and were having nightmares, flashbacks, and many other problems, dysfunctions, and diagnoses. By the end of the research protocol, the symptoms of this population also appeared to have resolved. They were no longer having nightmares and flashbacks. Whereas all subjects were on medications at the beginning of the study, only one was on medication by the end of the study and his dosage had been reduced by one-half. Perhaps the most remarkable outcomes of both of these studies were the major personality shifts that were recorded in their pre- and post-Minnesota Multiphasic Personality Inventory (MMPI-2) and Millon Clinical Multiaxial Inventory (Millon II) scores. Most of the pathology of these personalities had normalized (Peniston & Kulkosky, 1990).

A. THE PENISTON PROTOCOL <top>

To summarize briefly the protocol originally used by Dr. Peniston in his research, the training began with several sessions of thermal biofeedback and autogenic training as an entr6e into EEG feedback. In the original research the protocol involved fifteen 30-min sessions, typically performed twice a day, 5 days a week, on Veterans Administration Hospital in-patients. In the field today there are many versions of this original protocol, with the most common employing the original thermal and autogenic training followed by approximately 30 EEG feedback sessions, including an imagined scene of the rejection of the undesired behavior and imagery of desired outcome, which are introduced at the beginning of each EEG session and repeated in each session throughout the treatment.

The electrode placement typically is 01, monopolar, referenced to linked ears and a forehead ground with feedback tones of the computer rewarding attainment of clinician-set thresholds of increasing alpha and theta brain wave amplitudes. Other placements might be CZ, PZ, or 02. Each clinician seems to have his or her own variations on the theme. Despite the differences in placement, results seem to be consistently positive in treatment of addictions and other symptomology.

In the initial stage of this protocol, a layman's explanation of the brain, the limbic area, the neurochemistry, and its process to effect change is believed to offer the patient both a conscious and an unconscious program to follow and, along with the clarification of goals, to create a clear intention for the desired outcome. The subsequent development of imagery of the desired outcome apparently enhances the result.

Handwarming with autogenic training and temperature biofeedback follow as the next step of this protocol. Handwarming has been used in the field of biofeedback for many years as an effective tool to correct hypertension and other symptoms of sympathetic overarousal. It is helpful in teaching one to relax and be calm in any situation. Handwarming involves the circulatory aspect of the sympathetic branch of the autonomic nervous system involved in the "fight or flight" response. In the fight or flight response, the body is alerted and blood flow is increased to the major organs. This can become a chronic stress response. To counter this state, as the peripheral circulation is increased with training, the body relaxes. Handwarming also is a way of teaching the body to respond to cues from a tangible feedback to which the patient can easily relate and acts as a bridge to lower arousal states as a pretraining to eventual achievement of alpha and theta EEG frequencies. Autogenic training exercises (Green & Green, 1977) are used in combination with the temperature biofeedback training to achieve further relaxation of the body and a quiet, inward turned state of mind. In addition, rhythmic diaphragmatic breathing is taught to still body functions and focus attention.

During his or her initial sessions of thermal feedback and autogenic training exercises, the patient and his or her therapist develop a graphic, detailed visualization of the desired outcome, including a scene rejecting undesired behavior or a "clearing" of the condition to be altered. This final state visualization also involves the image of being already healed, which is believed to skirt the problems of potential harm that might result from imaging the healing process incorrectly, and is designed to reprogram the "unconscious" in a desired direction. "Programming the unconscious" with mental rehearsal of new images and intentions of desired change seems to effect healing and change both physiologically and psychologically (Green & Green, 1977; Achterberg, 1985; Simonton & Simonton, 1978). Imagery is one of the earliest forms of healing. There is archaeological evidence suggesting that the techniques of the shaman using imagination for healing are at least 20,000 years old, with vivid evidence of their antiquity in the cave paintings in the south of France. Asclepius, Aristotle, Galen, and Hippocrates, often regarded as the fathers of medicine, used imagery for diagnosis and therapy (Achterberg, 1985). At the present time Drs. Dean Ornish, Bernard Siegel, Norman Shealy, Carl Simonton, Larry Dossey, and others collectively (and courageously) are reinstating the role of the imagination in healing. Imagination is said to act on one's physical being. Images may communicate with tissues and organs, even cells, to effect change (Simonton & Simonton, 1978; Achterberg, 1985; Rossi, 1986; Siegel, 1986).

Many theories for the apparently remarkable success of alpha-theta brain wave training have been proposed by researchers and clinicians in the field of neurotherapy. Is it practical to take this protocol apart in its different aspects to find its power, or would this be reductionistic thinking akin to examining the vocal cords to see how one is a talented singer and another is not? The power of this protocol seems to lie in its generalized interaction with many aspects, and it may be of greater value to examine how its impact in specific areas contributes to a whole that creates a positive outcome for most patients treated. Empirical science, as we know it, seeks to understand reality from the point of view of the five senses. However, this protocol seems to represent a technology designed for the induction of higher states of consciousness and insight, and one's relationship to the world is altered by these insights. It is a therapy that contains elements of the five senses, but its very nature takes one beyond the five senses to abilities that may lie latent within us all. It is a transpersonal therapy. Toward the end of his life, Abraham Maslow, one of the major pioneers in humanistic psychology, called attention to possibilities beyond self-actualization in which the individual transcended the customary limits of identity and experience. In 1968 he concluded, "I consider Humanistic, Third Force Psychology, to be transitional, a preparation for a still 'higher' Fourth psychology, transpersonal, transhuman, centered in the cosmos, rather than in human needs and interest, going beyond humanness, identity, self-actualization, and the like" (Maslow, 1968; Walsh & Vaughan, 1980). This protocol seems to follow his prediction. In this chapter I propose to show that within the protocol itself rational explanations of its generalized effectiveness may be found.

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