NINE FUNCTIONS OF THE PREFRONTAL CORTEX: NEUROTHERAPY –DYSFUNCTIONAL TO FUNCTIONAL

A B S T R A C T

This case report illustrates how addiction as a brain-body disease is related to the nine mid-prefrontal functions of the brain. It builds on the understanding of the brain-body relationship and how this integration can either lead negatively to destructive behavior or positively to sustainable recovery. This progress report is a preliminary effort to illustrate how Low Energy Neurofeedback Systems (LENS) works to bring the nine mind-prefrontal functions of the brain to optimal functioning.

INTRODUCTION

The Evolution of Addiction Recovery - More than a half century ago, the book Alcoholics Anonymous brought into the mainstream of American consciousness the idea that alcoholism is a physiological disease, as opposed to a moral failing.

Until then, America thought on the matter was dominated by the Calvinist principles of our Puritan forbearers. This tradition, which saw private life as a matter of public welfare, found resounding failure in the 12-year experience of Prohibition. If the United States as a nation learned anything from the era of the 18th Amendment (the Volstead Act), it was that moral teachings, however worthy, cannot stop most alcoholics from drinking, and punitive models of treatment, however well-intended, do not work.

Traditional AA programs only have a 25% success rate…so obviously there was still a missing link in understanding addiction. With the advent of neuroscience – and technological advancements that include brain imaging – researchers began to see not only how addictive behaviors damage brain functioning – but that with abstinence the brain can actually begin to repair itself. 

The Science of Addiction - Science has had a profound impact on both our understanding of and our ability to treat addiction. Addiction recovery treatment has evolved from the traditional AA – 12-Step approach to optimizing brain functioning first, and then attending AA meetings. One must first be able to count to 12 before applying the 12 steps. In other words the addict’s brain must reach an optimal level of functioning in order to combat the progressive, terminal disease of addiction.

The Advent of Neurotherapy

Addicts Are Hardwired Differently Than Normal People – Dr. D. Corydon Hammond of the University of Utah School of Medicine suggest that alcoholics and their children find it difficult to relax and tend to self-medicate with alcohol and other drugs in an effort to treat their own brain pathology (Hammond, 2011). Research has found that addicts as a population have lower levels of alpha and theta brain waves and an excess of fast beta activity (Bauer, 1993, 2001; Prichep, et al, 1996; Prichep et al, 1996; & Winter, et al, 1998).

Brief Historical Perspective of Neurofeedback Treating Addiction - Neurofeedback in the treatment of addiction has at least a 30-year history. Based on the pioneer work of Kamiya and Green (Budzynaski, 1995), Eugene Peniston and Kullosky (1989, 1990, & 1991) developed the alpha-theta protocol for treating addictions. While the exact mechanism of alpha-theta neurofeedback remains elusive, it is expected that it increases beta-endorphin levels related to the stress of abstinence (Peniston & Kulkosky, 1989 & 1990, Peniston, et al, 1993 and Gruzelier & Egner, 2005).    

Promising Results - Today the Peniston Protocol of Alpha-theta Neurofeedback modified by Scott, et. al. (2005) and with a faith-based component introduced by Burkett, et. al. (2005) the success of treating the “untreatable disease” has climbed to 80%-90% success rate. In addition to the significant improvements in treatment retention rates is the establishment and maintenance of a regular residence, holding a steady job or attending school, as well as decreased depression and anxiety and reduced re-arrest rates.

Research suggests that neuro-therapy has real potential in not only treating but also remediating some of the serious damage to the brain that occurs through drug abuse (Alpert, et al., 1998; Prichep, et. al., 1996; & Strauman & Patrick, 1994).  Dr. Claire Albright (2011) reports that neurofeedback actually retrains the brainwaves to modulate at frequencies that are more consistent with a calm, non-stressed state of mind and body. She states that when used in conjunction with other types of therapy, neurofeedback has the potential to radically increase the overall effectiveness of any treatment, resulting in a very favorable outcome.  

The Role of Nutrition in Addiction Recovery – It has been determined that the neurotransmitters must transmit before the brain waves can wave. Nutrition may sound simple and unworthy as an adjunct therapy for addiction. The reader will reach a valid understanding of the attributes of neurotransmitter balancing and the nutritional component of care (Braverman, et al, 2003; Blum, 1991, 1996; Cass, Pert, 1999; Ross, 2002; Stitt, 2004). This report refers to neurotherapy as the combination of neurofeedback and neurotransmitter rebalancing.

The Basis for this Report - This report illustrates how addiction as a brain-body disease is elated to the nine middle prefrontal functions of the brain. This report builds on the understanding of the brain-body relationship and how this integration can either lead negatively to destructive behavior or positively to sustainable recovery. 

Neural-Body Integration

Neuroscience has allowed a micro-analytic approach to understanding neural integration and to allow the understanding of the brain and body as a whole system. While the macro-view has been apparent for many decades, the micro-view of the past two decades abounds with extensive support related to the function of the Middle Pre-Frontal Functions of the Brain as it relates to bodily functions and the actual decision making process. Thus we have been provided with the keys to understanding human behavior and more specifically an understanding of addiction as a brain disease.

Integrated Brain-Body Attunement - This report gives credit to previous science conducted and reported by the Center for Culture, Brain and Development at UCLA which was and is currently headed up by Dr. Daniel Siegel (Siegel, 20007). This report applies Dr. Siegel’s work to understanding how the addicted brain functions and what must occur to bring the addicted brain to optimal functioning and to help addiction find sustainable recovery.

Nine Middle Pre-Frontal Functions of the Brain

Dr. Daniel J. Siegel in his book The Mindful Brain (2007) identifies nine functions of the middle prefrontal cortex, each of which is discussed below:

1. Bodily Regulation – The first of the nine middle prefrontal functions is brain regulation which serves as the brakes and acceleration for coordination and balance. When the neurological system is balanced all other bodily systems are automatically balanced. Substance abuse and subsequent addiction causes all bodily systems to become dysregulated. (Critchley, et al, 2003; Lane, et al, 2001; Nauta, 1971; Onguii & Price, 2000; Porrin & Goldman-Rakic, 1982).
2. Attuned Communication – There seems to be a co communication breakdown within an addicted brain. When the neurological system is balanced communication becomes attuned resulting in effective coordination of input between two minds (Bar-On, et al, 2003; Beer, et al, 2003; Mah, et al, 2005; Nitchke, et al, 2005; Shore, 2003; Trevarthen, 2001).       
3. Emotional Balance – An optimally operating neurological system allows the executive functions of the brain to provide the capacity for humans, monkeys, and mice to maintain emotional balance. Research shows that the brain’s middle prefrontal regions actually monitor and inhibit limbic firing with the optimal level of bidirectional flow from the subcortical limbic to the middle prefrontal regions (Blumberg, et al, 2003); Busch & Posner, 2000; Davidson et al, 2000; Happaney et al, 2004; Phan et al, 2002; & Tucker et al, 2995).
4. Response Flexibility – Do mice have the capacity to respond at the emotional level? Personal observations indicate that mice have a reactive response. One day many years ago I found a nest of baby mice on my red fuzzy bedspread. My cowboy husband gathered them up and flushed them down the toilet. A bit later, my 10-year-old son came to me crying. He said: “That momma mouse is frantically looking for her babies.”

To respond in an active or proactive manner is a neurological choice that allows responsive flexibility. Research has shown that To make the right choice becomes a process of assessing ongoing stimuli, the delay of reaction, selection from a variety of possible options, and the selection of the responsive action. Thus the middle prefrontal brain is responsible to work in conjunction with the side areas to carry out the responsive function (Carter & Cohen, 1999; Chambers et al, 2006; Fellows, 2004; Gehring & Fencsik, 2004; Gottfried et al, 2003; Schoenbaum, 2001; & Tucker & Swick, 1999).

1. Empathy – The data shows that for a human to express empathy the brain’s middle prefrontal regions can actually assess attributes on another human to determine what might be going inside that person (Carr et al, 2003; Decety & Jackson, 2004; Heisel & Beatty, 2006); Shamay-Tsoory et all, 2005; & deWaal & Preston, 2002).
2. Insight (Self-Knowing Awareness) – To experience insightful awareness requires a linkage of the past, present, and future aspects of time. Research has discovered that the middle prefrontal cortex has input and output fibers to many areas of autobiographical memory stores and limbic firing that provides emotional access to events from the past, an awareness of the present and potential images of the future (Beer et al, 2006; Beittman & Nair, 2005; Frith & Frith, 1999; & Wood et al, 2005).
3. Fear Modulation – The release of GABA (gamma amino butyric acid), an inhibitory neurotransmitter has been found to modulate fear. The lower limbic (primitive) areas of the brain mediate fear or the flight or fight response. However, it is the middle prefrontal fibers that have the capacity to modulate fear and the response to fearful events (Harris, et al, 2005; Phelps et al, 2004; Morgan et al, 2003; and Sotres-Bayon et al, 2006).
4. Intuition – That “Gut Feeling” actually comes from our body’s viscera, i.e., the heart, lungs, and intestines. The human capacity for deep ways of knowing becomes a function of the body registering input to the middle prefrontal regions of the brain to influence reasoning and reactions to occurring events (Critchlet et al, 2001; Damasio, 1994 & 1999; and Lieberman, 2000).

Morality – It has been found that the middle prefrontal regions of the brain when damaged can lead to mental impairment and moral thinking can turn to various forms of amorality (Anderson et al, 1999; Bechara et al, 2000; Green et al; 2004; Green et al, 2004; King et al, 2006; & Moll et al; 2002). Preliminary Progress Report – LENS in Relation to the Nine Mid-Prefrontal Cortex function: It has been determined that the majority of the substance dependent clients experience low functioning mid-prefrontal cortex functions. It was also determined that when clients were given an initial LENS Mapping that the mid-prefrontal sites were invariably the lowest functioning on the Suppression Map.Mid-Prefrontal Functions as shown by LENS - The Tables below show initial and follow-up LENS Suppression Maps for an N of 185 Courage to Change clients. Initial and follow-up LENS suppression mappings we given to each. It is essential to point out that some of the mid-prefrontal sides follow up frequencies were greater than the initial mapping frequencies. Many of the clients actually required additional LENS training sessions and it is noted that many times the sequence of sites actually changes during training's. 

Neurotherapy for Sustainable Addiction Recovery: The Integrated Solution

Neurotransmitter Rebalancing - Upon admission each client submits to a urinary-saliva neurotransmitter laboratory analysis that provides neurotransmitter and adrenal hormone profiles for: Hormones: Cortisol x 4, and DHEA and Neurotransmitters: Epinephrine, Norephinephrine, Dopamine, Serotonin, Glycine, GABA, Glutamate, PEA and Histamine. The laboratory report serves as a guideline for the practitioner to suggest an amino acid neuroceutical regime designed to balance the neuro-adrenal systems. Each client has an individual neuroceutical regime and is re-tested after 30 days to determine whether the neuro-adrenal systems are more balanced (Miller, et al, 2010).

LENS Low Energy Neurofeedback System – Upon admission each client completes a psycho-social history, a Central Nervous System Questionnaire and a Sensitivity Test. These documents serve as the initial guidelines for the Mapping procedure. The MAP measures the Alpha, Theta, Delta and Beta waves and creates a composite report of the amplitudes and frequencies and rank orders the receptor sites for LENS treatments. Within the 30 day timeframe, each receptor site is treated twice and a follow-up MAP is completed to determine the training effectiveness. 

The Function of Neuro-feedback – “When the executive portion of the brain is functioning well, life is just not as frightening” (Demos, 2005). Neurotherapist, John N. Demos notes that biofeedback promotes greater control over the Autonomic Nervous System and the cerebral cortex. With this technology the mind-body connection can be quantified, measured, and observed on computer.

The Neuro-feedback Application: Low Energy Neurofeedback Systems (LENS) – LENS as developed by Dr. Len Ochs of Ochs Labs, Inc., is designed to restore the brain’s neurochemistry by gently releasing repressions and enhancing mental efficiency. This system utilizes low energy biofeedback signal to connect neurological pathways compromised by physical and emotional trauma. Treatments are non-invasive, painless, and can lead to dramatic improvement in chronic debilitating neurological conditions. It is an exceedingly mild form of non-cognitive biofeedback that takes information from the brain directly and the client does not have to do anything but sit quietly in the treatment chair. The neurological activity from a single site location is processed through a biofeedback loop in the computer and a return stimulation is sent back to the brain with slight modifications. The feedback signals can have a remarkable therapeutic effect as they allow the brain to re-connect its own blocked nerve pathways.

A New Standard of Justice - Furthermore, these studies provide valuable evidence for the criminal justice system. Since it is recognized that addiction is a brain disease, that is treatable and preventable, perhaps funding can eventually be reallocated to state-of-the-science treatment programs and less to correctional institutions. The research team has a blatant prejudice that believes that The Department of Correction is an oxymoron or incongruent to say the least. Johnny Cash sings a song: “San Quentin, What good do you think you do?”

An article by Nora D. Volkow, in The Washington Post, (08/18/06) titled “Treat the Addict, Cut the Crime Rate,” that in 2002 approximately 60% of male juvenile detained and 46% of female detainees tested positive for drug use. The estimated cost to society of drug abuse in 2002 was $181 billion -- $107 billion of it associated with drug-related crime. Dr. Volkow pointed out that when drug abusers enter the criminal justice system, it signals a pivotal crisis in their lives. It offers a unique opportunity to institute treatment for drug abuse and addiction. Her reasoning for this action is quoted below:

 “Addiction is a disease of the brain that affects the circuits involved in processing punishment and reward and in exerting inhibitory control. As a result, the addicted person will seek drugs compulsively even when they consciously don't want to and despite the threat of severe punishment, such as incarceration and loss of child custody, and at the expense of natural reinforces, such as family and friends.

“The circuits involved in punishment and reward are circuits that are in our brain in order to motivate behaviors that are indispensable for survival, such as finding food, finding a partner, taking care of children. And drugs activate exactly the same circuits, but in much more efficient ways. When a person becomes addicted, those circuits basically signal to the brain the equivalent of a signal you need to do drugs in order to survive.

“So the person that is addicted in the process seeks the drug not out of pleasure, but out of need.

“Knowing that punishment may be forthcoming, but the value of punishment, when the signal is one of survival, becomes pale in comparison. So the person seeks the drug regardless of the catastrophic consequences. And that, I think, is a message extremely important for the criminal justice system, because one of the things that is very frustrating in speaking with judges is how come we cannot affect the behavior by punishment? Well, the brain is not responding the same way that it would have had the person not been affected by the drugs. So, I mean, it goes beyond putting a dollar amount into these things.” (Volkow, 2002)

Control Group – Critique of This Report - This report does not meet the “Gold Standard” in that there was no control group. Our staff deemed it unethical to treat any of our fragile clients without neurotherapy. It is recognized that the first 7-days of treatment are critical to addiction recovery as that is the time when most addicts are most uncomfortable and most vulnerable. Addicts tend to want relief immediately if not sooner. However, there are actually thousands of control clients within the traditional recovery programs that do not provide neurotherapy. The success rates of these programs vary between 20% and 40%, whereas the neurotherapy programs reach 80%-90% success rate. In a sense our control data can come from those recovery programs that only provide the 12-step approach and do not consider the state-of-the-science recovery regime that this model provides.

Dr. Jay Gunkelman (2005) reported that many researchers in the neurotherapy field are against conducting double blind studies due to the lack of proper humane treatment of those in the control group who receive no treatment. In fact, Gunkelman notes, the World Health Organization even considers the practice of withholding treatment to be unethical if the treatment is known to be effective, Gunkelman also notes that a recent issue of the New England Journal of Medicine which reviews research design has cast doubt on the need for placebo-controlled research designs.

Call for Future Investigation – Frequency distribution data related to the mid-prefrontal cortex EEG sites present an interesting analysis of how LENS training can be related to the actual functioning of the nine mid-prefrontal cortex functions. What would be more intriguing would be an in-depth investigation of the actual amplitudes of the initial and follow-up LENS sessions for clients of low mid-prefrontal cortex functioning. It is exciting to expect that LENS can be a great contributing factor in helping low-functioning people obtain optimal functioning and thus change destructive behavior to productive high-functioning individual.  

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++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++Dr. Judith Miller, PhD is a CAC III and creator of the Soaring Hope Recovery program. Fundamental to the program is the utilization of therapies in addition to individual and group counseling supplemented by the traditional 12 steps. Dr. Miller serves on the Colorado Attorney General’s Task Force on Prescription Drug Abuse and is a registered psychotherapist. She is the Executive Director of Soaring Hope Sustainable Addiction Recovery – Colorado-based residential recovery center for chemical dependency and prescription drug addiction. For more information, please visit www.soaringhoperecovery.com. Dr. Miller can be reached by telephone: 719-541-4912 and her email is: [email protected]

If you are interested in receiving the entire paper with tables and data, please email Dr. Miller.