Alpha-Theta Training for Chronic Trauma Disorder,
A New Perspective -- Section II.
Theories of the Protocol's Effectiveness

TABLE OF CONTENTS

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

THEORIES OF THE PROTOCOL'S EFFECTIVENESS
To begin, the seemingly remarkable workings of the alpha-theta protocol tend to fit well within the framework of generally accepted psychological contexts, among them the functions of various states of consciousness, statedependent learning and retrieval of memories, the relatedness of multiple diagnoses in patients with major dysfunction and addictions, the effects of childhood trauma, mind-body connections, and patient-therapist relations. Each of these is discussed in the following sections.

A. STATES OF CONSCIOUSNESS AND THE CONTINUUM OF AROUSAL <top>

Brain wave frequencies are correlated with various states of consciousness/arousal. With a predominance of beta waves (approximately 13 Hz and higher), arousal occurs and the thinking process with its accompanying ego reactions is engaged. There is a focus on the external world. With a predominance of delta waves (0-4 Hz), a sleep state, the brain is at the opposite end of the arousal spectrum, and one basically is disassociated from the external world. With a predominance of theta waves (48 Hz) focus is on the internal world, a world of hypnogogic imagery where an "inner healer" is often said to be encountered. Alpha brain waves (813 Hz) may be considered a bridge from the external world to the internal world and vice versa. With some addicts and patients previously exposed to major trauma, alpha amplitudes can be low, thereby creating an inflexibility that keeps one from shifting readily between inward and outward states (M. Sams, personal communication, May 1996). Generally with such patients there is an avoidance of internal states where one may find awareness of self.

In everyday existence, the ideal state of the ego may well be a state of poise between the inner world of self and the outer world of objects. As one increases alpha amplitudes via neurotherapy, he or she gains the ability to shift with ease and appropriateness. Any overintense concern with the outer world is tempered and the individual may gain detachment with a sense of humor and loss of ego-centeredness. As one turns inward and attains deeper states, sensorimotor awareness tends to decrease and consciousness centers on questions concerning the meaning of life. Patients exposed to these states usually describe the latter experience as serene and peaceful, providing them with new abilities and possibilities. They seem to develop a powerful coping skill and may have access to such inner calm no matter what is occurring in their environment (Wuttke, 1992).

Another related notion is suggested by the work of Thom Hartmann (1997), who states: "Everybody is familiar with the edge between normal waking consciousness and sleep: it's often a time of extraordinary feelings, sensations, and insights, particularly as we move from sleep into wakefulness.... When the brain is brought to the edge of the world of God, the place of 'true' consciousness, a fractal intersection occurs. An unstable and dynamic system is created, and, like the rainbow colors of water and oil, new energies and visions are created." The Peniston alpha-theta protocol seems to enhance this ability to shift states, to move to this edge. In such states many aspects of the self involving wisdom and insight may be encountered, and awareness of earlier traumas (or "woundings") occurs, thus making them more accessible for healing.

B. STATE-CONTEXT DEPENDENT LEARNING AND RETRIEVAL <top>

An aspect of the power of this protocol might be found in the realm of state-dependent learning and memory, or state-context dependent learning and retrieval as Jon Cowan (1993) has noted. The predominant waking brain wave frequency of children under the age of 6 is in the 4-8 Hz range associated with the "theta" frequency band in adults. As we mature, our average brain wave frequencies get faster, and in adulthood these lower frequency waves are usually associated with reverie and hypnogogic imagery, occurring largely in the transitions from wakefulness to sleep.

The surfacing of memories from early childhood during the alpha-theta brain wave training fits observations of "state-dependent memory." Because information learned while in one state of consciousness may be more difficult to access when in another state of consciousness, the natural shift in dominant brain wave frequencies during maturation could result in dysfunctional childhood learnings being preserved in the unconscious as an adult. To gain access to most of these "state-bound" memories, one may have to return to the state in which they were created, in other words, a predominantly "theta state." In utilizing the Peniston protocol of alphatheta therapy, there is often a profound alteration in the state of consciousness of the patient. As the "subconscious" appears to become more accessible to consciousness in this deeply altered state, traumatic memories of the past are often released and appear as flashbacks from the past. As these flashbacks are relived with current adult resources and perceptions available, the contents of the "subconscious" seem more readily available for healing and alteration.

Dr. Tom Budzynski (1971, 1997) reported that a predominance of theta in the EEG was the ideal state for "rescripting" or "reimprinting" the brain, eliminating destructive behaviors or attitudes that are a result of "scripts" laid down in childhood (during times when the child is naturally in a theta state) and replacing them with more suitable and more positive scripts for a mature adult. Rossi (1986) states that each time we access the state-dependent memory, learning, and behavior processes that encode a problem, we have an opportunity to "reassociate and reorganize" or reframe that problem in a manner that resolves it. This reliving, releasing, and rescripting may be one of the few ways in which an adult can modify old scripts and store new information in the subconscious.

Robert Boustany (personal communication, 1998), a biophysicist involved in neurofeedback research, also alludes to phenomena related to state-dependent learning. He suggests that NMDA receptors act as a double lock and key to encoded patterns of behavior in the individual, and that ability to "broadly" activate the NMDA receptors is essential to personal transformation. As proposed, this activation must occur in the hippocampus of the brain, but also may occur in the amygdala and a few other areas. The use of the term encoded patterns indicates that children will learn certain survival response patterns while they are very young and the brain is still forming. These patterns are reflected in the subtle structure of the brain and are correlated with behavior. They may be considered as electronic circuits, which respond in specific ways. The response patterns encoded in the brain of the young child create unconscious responses later in life, some of which may be maladaptive. As an older child or an adult, a cognitive awareness that a certain behavior causes problems will not change the behavior until the "emotional pliability" to handle that insight is developed. Neurofeedback may be one means of creating more adaptive behavior by facilitating change in these encoded patterns. While neurofeedback has been used successfully in the treatment of a variety of problems, the NMDA receptors hypothesis seems particularly well demonstrated in the treatment of alcoholism as explained later in this chapter.

Boustany proposes the following mechanisms and reasoning with respect to neurofeedback's effectiveness with alcoholism. The neurotransmitter glutamine has a protective effect against alcohol, and can be used to prevent an individual from becoming inebriated. Glutamine in the brain also relates to function of the NMDA receptors. Glutamine is required at the first stage of the two-stage process of reaching long-term potentiation (LTP) in NMDA receptors. (LTP refers to a process in which cell response to a given stimulus becomes increasingly frequent and of increasingly greater amplitude than usual.) Without LPT in certain brain regions individuals show rigid aversion to change. Although adequate levels of glutamine normally are required for LTP, certain types of repeated stimulation and theta wave production also are reported to facilitate LPT, which persists for hours or even days. Thus, in the absence of sufficient glutamine, training for high-amplitude theta waves (relative to other frequencies) with neurofeedback is believed to facilitate LTP in certain hippocampal cells, with resulting decreases in rigidity and an increasing ability to access and change encoded patterns of maladaptive behaviors. In the alcoholic, glutamine is present in reduced quantities, and hence LTP is reduced. Such persons tend to be tense and rigid and have great difficulty spontaneously producing high-amplitude theta waves. Nevertheless,, with sufficient numbers of sessions, they often learn to produce such waves. In treating alcoholism, the production of high-amplitude theta waves, as learned through neurofeedback, results in a more adaptive individual, as indicated by pre-post MMPI 2 testing. Individuals with proper neurofeedback training recognize both cognitively and emotionally the nature of their behavior and seem more readily able to walk away from addictive behaviors. It also is common for the individual who has undergone proper neurofeedback protocols to have remarkable insights into the reason for the addiction, which is a strong indication that learning, flexibility, and adaptability have increased. Typically, the individual can no longer tolerate even small amounts of alcohol, and seems readily able to end addictive behavior. In summary, Boustany's theory asserts that NMDA receptors act as a double lock and key on encoded patterns of behavior, and when LTP is reached in certain NMDA receptors, the individual can gain conscious access to these patterns, and thus become more adaptive, physically predisposed to stop alcohol use, mentally perceptive relative to the addiction, and emotionally able to relate to the need for change.

C. TRAUMA AND MIND-BODY INTERACTION <top>

In the following section I discuss the notion that childhood traumas or "woundings" are the basic source of many different psychiatric disorders, several of which may exist simultaneously. Next, I discuss evidence for mind-body interactions in the manifestations of effects of early trauma, and speculate on how various alpha-theta related changes in higher conscious processes may relate to the many positive results so commonly observed during and following neurotherapy.

In surveying the field of neurotherapy we are finding that many seemingly disparate diagnoses are being treated successfully. In addition to Peniston and Kulkosky's (1989, 1990, 1991) published research on populations presenting with alcohol addiction and post-traumatic stress disorder (Vietnam veterans), Dr. Carol Manchester (1995, 1997; Manchester et aL, 1998) reports achieving integration of dissociative identity disorder in 30-60 sessions, a disorder usually requiring years of therapy and even then with inconsistent results. Brownback and Mason (1998) have reported similar results. Psychological disorders, including affective disorders, personality disorders, "rage-aholism," eating disorders, addictions, and relational dysfunctions (including marital conflict and codependency) presumably are being successfully treated (White, 1994). Somatic complaints including hypertension, cardiovascular problems, chronic fatigue, and immune dysfunction (Schummer, 1995) were reported to be improved with this unusual approach. Several clinicians offer peak performance training. One has even worked with Olympic athletes (R. Patton, personal communication, April 1991).

Addictions, along with multiple personality disorders (MPDs), or dissociative identity disorder (DID) as it is now frequently called, usually present with a multiplicity of diagnoses. MPD patients frequently meet the diagnostic criteria for many psychiatric disorders, including depression, borderline personality disorder, somatization disorder, substance abuse, bulimia and anorexia nervosa, panic disorder, and others. There also has been much written recently about dual diagnosis (usually multiple diagnoses) in the addict and the negative effect on recidivism (Wolpe et aL, 1993; Continuum, 1993) and yet these patients are reported to be good candidates for this protocol of an altered state therapy.

In our work at the Neurotherapy Center in Houston, multiple diagnoses are being addressed and showing positive outcomes as measured by the MMPI and the Millon administered both pre- and post-treatment. For example, our center did an outcome analysis focusing on the five scales of depression found in these two personality tests. The population was 44 heterogeneous patients taken in order of presentation. In four of the five scales we found a statistically significant reduction (p > 0.001) in depression (White, 1995, 1996).

With the appearance of both research and clinical reports describing the multiplicity of disorders being addressed, most of them quite successfully, skeptics have been aroused. One of the major critics of EEG feedback (at least in the field of attention deficit disorder) speaks for many of them. Russell Barkley publicly stated during an interview by Russ Mitchell for the Eye to Eye with Connie Chung television show (Mitchell, 1994): "We have a rule of thumb in this business. The more things you claim you can cure, the less effective your treatment is likely to be. It's a good rule of thumb to keep in mind." In spite of the skeptics, we see remarkable positive shifts in people presenting with multiple diagnoses when using the Peniston protocol.

What accounts for the far-reaching effects of this protocol on so many disorders, including both physical, mental, and emotional diagnoses? Perhaps it is that, since we are working with the brain and central nervous system regulation with all its manifestations, we are going to the source of the problem. With the feedback tones of a computer set to reward the production of alpha and theta brain waves, the slowed cortical activity may set the stage for generalized healing and the emergence of higher states of consciousness (Wuttke, 1992).

1. Childhood Trauma and Stress <top>

One might consider the work of Dr. Bruce Perry (1992, 1997) who states that prolonged "alarm reactions" induced by traumatic events during infancy and childhood can result in altered development of the central nervous system (CNS). He hypothesizes that with this altered development one would predict a host of abnormalities related to catecholamine regulation of affect including anxiety, arousal/concentration, impulse control, sleep, startle, and autonomic nervous system regulation. He further states that it is likely that the functional capabilities of the CNS system mediating stress in the adult are determined by the nature of the stress experiences during the development of these systems in utero and during infancy and childhood. When the stressful event is of a sufficient duration, intensity, or frequency, stress-induced "sensitization" occurs-the neurochemical systems mediating the stress response change, becoming more sensitive to future stressful events. Many factors appear to be important in the lasting impact of the trauma, for example, the nature of the trauma, the degree to which body integrity is threatened, the family support system following the trauma, whether the trauma is acute or chronic or both, and whether the pattern of the trauma and/or abuse is continued into adulthood.

A child who is reared in an unpredictable, abusive, or neglectful environment may have evoked, in his or her developing CNS, a milieu that will result in a poorly organized, "dysregulated" CNS catecholamine system. Early life trauma may play an important role as a facilitator of genetically determined vulnerabilities to a variety of neuropsychiatric disorders and medical conditions. That is, it could be hypothesized that such an individual would be susceptible to the development of more severe signs and symptoms when exposed to psychosocial stressors through the course of his or her life. For instance, Schneider (1998) states that a child, particularly in the first year, who lives in a constant state of fear from abuse will often exhibit an overdevelopment of the sympathetic pathways that may lead to post-traumatic stress disorder (PTSD). With the brain bathed in dopamine and acetylcholine, the amygdala is overstimulated, with lasting and permanent effect in the orbital frontal area of the cortex. Ventral tegmental dopamine is accelerated and the sympathetic system is overstimulated. The child is potentiated to develop PTSD later in life. When trauma is experienced, the vulnerable system from childhood may elicit PTSD symptoms. PTSD involves a heightened excitation of both sympathetic and parasympathetic systems as defense against trauma. Even if the brain itself is not injured, the old PTSD-eliciting circuits apparently remain.

From the field of genetics, Blum (Miller & Blum, 1996) has offered further information on the handling of stress. His research proposes a reward deficiency syndrome (RDS), which involves imbalance of neurotransmitters in the brain related to the Al allele of the dopamine receptor gene (DRD2). Originally called "the alcohol gene" it is now recognized that it is not limited to an alcoholism marker, but may be a gene involving pleasure states. To feel pleasure or relief from pain, the brain's receptors must be stimulated with large amounts of dopamine, particularly in times of high stress. When there is an imbalance or shortage of doparnine and other pleasure-related chemicals, the addict will ingest mood-altering substances to control stress and restore a sense of well-being, a desire for euphoria. (These substances imitate and fit into the brain's receptors for natural brain chemicals and prevent the reuptake of these naturally occurring "feel good" chemicals, creating a flood of such chemicals and resulting in feelings of euphoria.) A traumatized person with this gene variant could illustrate this inability to manage stress. In fact, there is one report that 59% of Vietnam veterans diagnosed with PTSD showed this DR2 gene variant (Miller & Blum, 1996).

In a recent issue of Science News, two brain-imaging studies, conducted independently, were reported which indicated that severe, repeated sexual abuse in childhood may result in damage to the hippocampus, a structure in the brain that helps orchestrate memory. Significant reductions in the size of the hippocampus were found both in a study of Vietnam veterans and in a population of women who had suffered severe sexual abuse during childhood. The severe trauma reportedly had unleashed a cascade of stress hormones that harmed the hippocampus and related areas over time (Bower, 1996). Such cerebral injury may predispose people to experience an altered state of consciousness known as dissociation, which involves an alteration in consciousness induced by terror, including absorption in one's thoughts to the exclusion of the external world, feelings of detachment from one's body or self, and/or memory lapses. Such injury often leads to the development of other symptoms of PTSD, perhaps exacerbated if the genetic marker for RDS occurs as mentioned earlier.

As the studies mentioned suggest, there is much evidence that trauma, especially childhood trauma, can have negative effects on brain development and function and later resistance to stress.

2. Mind-Body Relationships <top>

The work of Candace Pert (1993,1997) illustrates that emotion and body chemistry are inseparable, "mind is body and body is mind." It is known that stress elicits neuropeptides and that the whole body undergoes physical changes when it is under stress. Years of research from scientists such as Walter Cannon and Hans Selye have shown the potential for stress to hamper the immune system. Furthermore, it has been shown that feelings of helplessness and powerlessness can suppress immune response (Schummer, 1995). However, it also has been reported that a variety of techniques, such as eliciting specific images or positive feelings, giving certain suggestions, and learning to respond to stressors in more relaxed ways, all have the potential for increasing the ability of the immune system to counter disease (Achterberg, 1985). Further studies have shown that the immune system itself is under direct control of the central nervous system, perhaps especially those areas of the brain implicated in the relating of imagery to body processes (Achterberg, 1985; Rossi, 1986). Thus, something as intangible as one's perception of an event alters the chemistry of the body (Pert, 1997). It follows from this that the imagined rejection of unwanted behavior and the image of desired outcome involved in the alpha-theta protocol have potent roles to play.

On this mind-body point, Steve Fahrion (1995), quoting Henry (1992), stated, "Activities that are usually unconscious in the early stages of life must be allowed to arise in the form of symbols (in other words, hypnogogic imagery) that have both emotional and informational value that themselves serve to integrate the activities of the limbic system and the neocortex." Perhaps this is the condition produced when one enters the "theta state" and is held there by the feedback loop. In this state one experiences awareness without active thought (process without content), a sort of void in which unconscious material is accessible apart from the surveillance of the waking ego and in which only "potential" exists. As the void is extended in this state (as with Dr. Deepak Chopra's "silent space between the thoughts"), elements of the "hidden blueprint of intelligence" (Chopra, 1989) may be unmasked and altered by the patient's current intent, earlier made real to him or her through active visualization.

It is known that emotions alter neurochemistry and vice versa, and that neurochemistry alters brain waves. Could it not happen the other way around? Could not the altering of brain waves alter neurochemistry? The brain's cortex interacts with the limbic system, often referred to as the emotional brain, by means of its cortical-subcortical connections. These cortical-subcortical connections process elements of emotional memory orchestrated by the limbic system, perhaps from "banks" of the unconscious and perhaps mediated by the hippocampus (Winson, 1990). By consciously and deliberately increasing amplitude of theta during neurofeedback, a specific state of consciousness may be created into which one can "drop" imagery of desired outcome, providing intent to this goal-directed system as an agent of change.

It has been stated that we have no voluntary control over production of theta brain waves (Sterman, 1995). If so, we must question whether or not, during neurotherapy, one is simply learning the ability to let go of the "thinking" mind and enter a state where theta waves are dominant. With the feedback tones of neurofeedback equipment, one learns to enter this state with some degree of reliable consistency. It would seem that this essentially constitutes the equivalent of deliberate control of the theta rhythm. In any event, from the research mentioned earlier, one can readily hypothesize that the changes which occur during neurotherapy are reflected not only in the brain wave patterns, but in the underlying neurochemistry as well.

To summarize this section on trauma and mind-body interaction, the view was presented that traumas, especially early childhood "woundings," adversely affect brain structure, neurochemistry, and the immune system, giving rise to multiple symptoms and diverse psychiatric diagnoses. It was suggested that the altered state associated with production of theta frequency EEG (perhaps in conjunction with specific visual imagery) alters neurochemistry in positive directions, thus accounting for its reported effectiveness with diverse disorders.

D. PATIENT-THERAPIST RELATIONSHIP <top>

In examining possible reasons for effectiveness of the alpha-theta protocol, it would be inappropriate to overlook the importance of the therapeutic alliance. Brugental (1987) states, "The art of psychotherapy . . . insists that what goes on inside the therapist, the artist, is crucial to the whole enterprise." Relatedly, others such as Dr. Edgar Wilson have reported brain wave synchrony between healer and patient at the time of peak effectiveness (Cowan, 1993). Fahrion et aL (1993) found that this interpersonal EEG synchrony was highest during times of apparent healing, especially in the alpha frequencies between left occipital areas of the practitioner and the patient. Several instances have been reported by clinicians in which even the thoughts of the therapist in another room simultaneously seemed to influence the subject matter of spontaneous imagery of the patient.

White and Martin (1998) state that the quality of the patient relationship with the therapist seems to be a significant component, especially during the abreaction/catharsis. The therapist's empathy and sensitivity to the patient's emotional healing experience during the highly charged, vulnerable experience of the theta state is important to create the atmosphere of trust needed for the patient's willingness to "let go." The seasoning of the therapist, not so much by the years lived, but by life traumas the therapist has experienced and from which he or she has healed, may create the power and compassion of the therapist's "inner healer" that connects with the inner healer of the patient and offers hope. While the exact nature of any such connection may be unmeasurable at present, neurotherapists generally agree that trust of the therapist and rapport between therapist and client are crucial to successful treatment. As in Bell's theorem (Herbert, 1988), the therapist and patient can no longer be considered as separate and independent units, because both are changed in the process of healing.

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