Neurofeedback in the Treatment of Alcoholism - The Legacy of the Peniston-Kulkosky Protocol

In the year 1989, Eugene Peniston and Paul Kulkosky released the results of their research in the paper, "Alpha-Theta Brainwave Training and Beta-Endorphin Levels in Alcoholics", ushering in a new era of addiction treatment that is still unrealized by the public at large in the current day and age.

Previous research at that time showed that to varying degrees, alcoholics show a decreased amount of alpha waves in their brain when measuring brainwave activity by an electroencephalagram (EEG), and that subsequently alcohol can have the effect of increasing alpha wave activity. Alpha waves are a brainwave commonly associated with a state of calm, relaxed, tranquil, and serene focus. Simply said, some individuals with alcoholism in sober periods have a difficult time naturally producing alpha waves and the state of inner peace it is associated with, and they use the alcohol to help themselves produce it. A reasonable hypothesis would then be, if you can help alcoholics produce alpha waves some other way, they will no longer need the alcohol to do it for them.

But it was not so simple as that. The patients Peniston was used to treating were at the Veterans Administration Medical Center in Fort Lyon, Colorado... alcoholics that were Vietnam veterans who had undergone the horrors of war and likely were experiencing Post-Traumatic Stress Disorder. Alpha-Theta training was a protocol developed at the Menninger Foundation by a research group led by Elmer and Alyce Green in the late 1960's and was gaining increased popularity in the brainwave training field to treat a variety of disorders. Peniston had used this protocol before with previous success, and so now Peniston and Kulkosky took this protocol and used it for their study, to see if it would be effective for treating alcoholism within individuals at varying socio-economic levels. They also layered into the methods of treatment other tools being developed at the time for controlling the body and behavior, such as temperature biofeedback, autogenic relaxation techniques, and visualization practices to support abstinence.

Theta waves are associated with states of deeper meditation, of visualization, of dream-like states of mind, and the accessing of emotional memory. Alpha-Theta training, at its essence, teaches people and their brains how to produce more alpha and theta brainwaves. The theory, increase a person's alpha waves to induce a state of inner peace, and increase a person's theta waves to tap into the deeper recesses of their subconsicous and unconscious mind to facilitate processing of repressed psychological contents and promote emotional growth.

The results were nothing short of astounding. The experimental group showed significant 12-fold increase in production of alpha waves, a reduction of depression measures by 50% (measured using Beck's Depression Inventory), and 8 out of 10 of the experimental subjects were maintaining abstinence with no relapse after a 13 month follow up. Others studies would go to show significant stabilization of personality measures following alpha-theta training.

When I first began my initial foray into my study of neurofeedback, I was amazed at what wide range of results people were finding was possible with what I came to see as a revolutionary techonology and imperitive tool for the problems of modern psychology. Among these though, this piece of research stood out center stage and in the spotlight as a shining example of what was possible with this technology. Absolutely amazing and yet, in a sense, also quite unbelievable. N=10 is a small sample size, and to be taken with a grain of salt, and yet even with this small amount... an 80% success rate is unheard of, especially in regards to a pervasive and difficult problem to treat like alcoholism. How could this be possible?

I have seen first hand the terrible consequences of those consumed by the bottle... the sorrow seen in a friend from the death of a mother and son due to drunk driving... a group of friends lost in depression and vodka struggling to keep their jobs... a girlfriend's brother with alcohol-fueled rages tearing their family apart... the state of a frantically worried mother who has no clue on how to help her son, a son lost in psychological pain and confusion... an acquaintance in a loveless marriage drinking to disconnect from her emotions, to forget her multiple affairs, and to escape the chronic shame... a dear friend who took his life at a young age after many years of battle with severe alcoholism. These are anecdotes from my own life, and does not even touch on expanding the perspective to the broader world.

I am not familiar with the scientific literature on the effects of alcohol abuse on the society at large, and do not currently have the time to dive into research on the topic...although I do know there is research evidence out there that indicates it has a role in increasing incidences of domestic violence. It doesn't seem like a stretch that alcohol abuse can be implicated in other things on a societal scale: how much of a factor does it play in childhood abuse? Emotional neglect of children or partner or family? In instances of sexual violence? How many fatal car accidents are due to excessive alcohol consumption? What are the increase in costs to health care due to alcoholism? How much does it decrease the earning potential of an individual? How much does it reduce a nations economic productivity? How is it in involved in joblessness? Homelessness? Relationshiplessness? Even the loss of one's life in an existential sense... individuals drinking day after day when work is done out of boredom, how much human potential is wasted in this?

Just to be clear, as a psychologist, I understand the use of alcohol and have spent plenty of time in my life enjoying it myself. It is a great social lubricant, it's an excuse to use to get together with friends, it can be useful at times in creative work, some like it to boost the experience of intimate times, with moderation it can be all well and good. What we are talking about here is when it becomes pathological, when it becomes an addiction. In this it becomes a way to protect oneself, it is used as a defense mechanism, a coping strategy. To disconnect, to numb, to forget, to lose oneself... a way to medicate oneself against what is overwhelming them from the inside. This is standard procedure in most people suffering from unresolved trauma without access to psychological care. Only some turn to alcohol, some turn to other excesses; food, television, video games, sex, and shopping... just to name a few. So once the defense mechanism of alcohol abuse is in place and becomes rigid, it stunts psychological development and often leads to further psychological injuries (of both oneself and others), then leading to more reliance on the alcohol and a negative feedback loop is established, and the person then loses control.

So now, amidst all this pain, suffering, confusion, anger, depression, and sordid degradation of the human life that the addiction to alcohol brings out... now there is a treatment that has a 80% success rate on its first trial run. THERE'S NO WAY! I would have heard about a treatment like that if it existed. This study was run in 1989, and I learned about this treatment in 2020 during the outset of the Covid-19 pandemic... that's 31 years. I feel like if this was real and actually worked this well then I would have heard about it somewhere. If it was real then people would be using this far and wide to be treating alcohol addiction at addiction centers and hospitals and psychotherapy clinics and everywhere. If it was real and worked so well, this would be common knowledge by this point, how could it not be?

But the other evidence I had begun to find was becoming increasingly more convincing.

Peniston and Kulkosky followed up with further research papers. In 1990, showing personality changes in alcoholics following alpha theta training. In 1991, providing evidence for treating PTSD in Vietnam Veterans with continued positive results. In 1995, in treating alcoholics with depressive symptoms, showing sustained improvements in multiple dimesions over 21 months.

Others too have sought to replicate the results and written about their successes using their protocols in books and papers and on the internet. There are a number of papers published on the use of alpha-theta neurofeedback and the Peniston-Kulkosky protocol being used not only for alcohol treatment, but other substance addictions as well, and trauma generally speaking. Look it up, do some of your own research if this sparks your curiousity, it is not too hard to find if you give it a good look.

And in the end, after years of my study and training and practice, I was able to see it for myself. A small glimmer compared to the bright light that Peniston-Kulkosky put forth, but a light none-the-less. A client who I was seeing for psychotherapy, who has given his permission to share this.... who had been a serious alcoholic for years, was able to go 3 months without any alcohol after only 4 sessions of Upper Alpha Training. Not Alpha-Theta, no fancy thermoregulation biofeedback equipment, no visualization scripts or involved breathing practices. Simply training the 10-12Hz freqency band on the parietal lobe for 4 sessions that didn't last more than 30 minutes.

Here is an excerpt from Sebern Fisher's "Neurofeedback in the Treatment of Developmental Trauma" reiterating the history, studies, and effects of alpha-theta training in a way that I cannot do.

"Alpha–theta, or deep state training, is probably the most celebrated protocol in the

fields of PTSD, addiction, and, interestingly, peak performance. This is a protocol

with many authors, the most influential among them being Elmer and Alyce Green

and Eugene Peniston. The Greens, then at the Menninger Clinic in Topeka, Kansas

(Green & Green, 1989), were exploring theta training as a portal to expanded

consciousness. One of the Greens’ workshop students, Eugene Peniston, took their

work with “normals” and designed what was to become the Peniston–Kulkosky or

alpha–theta protocol. His goal was to provide his patients with access to the often

unremembered trauma (coded in theta) while holding the nervous system in a state of

calm (alpha).

Peniston worked at the VA Medical Center in Fort Lyon, Colorado, with men

suffering from severe PTSD and crippling addiction to alcohol. Their first study

(Peniston & Kulkosky, 1989) was with alcoholics who had been hospitalized four or

more times due to relapse. All participants were given an EEG, the Beck Depression

Inventory (BDI), the Minnesota Multiphasic Personality Inventory (MMPI), and the

Millon Clinical Multiaxial Inventory (MCMI). They all had blood taken to measure

levels of stress hormones. Ten of the 30 study participants were not alcoholic and

were only given these measurements; 20 were relapsed alcoholics. Ten alcoholic

controls were provided with standard therapies (i.e., talk sessions and a 12-step

programs) and 10 of the 20 relapsed alcoholics were trained with alpha–theta every

day for a month in addition to standard therapy.

All of those given standard treatment were rehospitalized within 18 months. In the

alpha–theta group, eight stopped drinking completely, one drank once but got sick

(dubbed the Peniston flu ) and didn’t drink again, and one continued to drink but the

alcohol didn’t make him drunk. These patients showed increased power in both alpha

and theta frequencies, stabilization of beta-endorphin levels, clear and positive

changes on both personality inventories, and a marked reduction in depression as

measured by the BDI. These results were maintained, without further hospitalization,

on 3-year follow-up. Experts in addiction have told me that they expect a 75–80%

relapse rate.

Of course, most of these vets had a comorbidity: the Vietnam war. These were the

men (there were only men in these initial studies) whose condition had called for a

new diagnosis: PTSD. In 1991, Peniston and Kulkosky published the results of a

second study on the use of alpha–theta to resolve symptoms of PTSD. By the end of

the month-long study, again the alpha–theta group showed marked improvement in

clinical scales and in symptoms. They too normalized their MMPI and MCMI scores

(see Figure 7.4). Nightmares, flashbacks, and manifestations of hypervigilance were

significantly reduced, and they used less psychotropic medication after training. In a

follow-up 2½ years later, 12 of the 15 alpha–theta veterans were living normal lives,

whereas all 14 in the control group were still suffering from PTSD." (Fisher, 2014, pg 234)

The future is here, and we have new solutions. If you or a loved one struggles with your alcohol use, there is help in ways that the past did not have. Any way it goes, I hope this leads you closer to the solution that is meant for you or the ones that you love.

Take care as best you can and maybe I'll see you in the next article!

References

https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1530-0277.1989.tb00325.x

https://www.giuliotarantino.com/wp-content/uploads/2020/04/penistonptsd-peniston1989.pdf

https://onlinelibrary.wiley.com/doi/abs/10.1002/1097-4679(199509)51:5%3C685::AID-JCLP2270510514%3E3.0.CO;2-K

http://www.eeginfo.com/research/researchpapers/Evolution-of-a-Trauma-Protocol-Quarter-Century-11-22-20.pdf

Fisher, S. F. (2014). Neurofeedback in the treatment of developmental trauma: Calming the fear-driven brain.  W. W. Norton & Company.