FROM MEGABRAIN REPORT VOL. 2 NO. 3
Edited by Michael Hutchison



              Alpha-Theta Brainwave Biofeedback:   
 
      The Many Possible Theoretical Reasons for Its Success
      

                               by


                        Jonathan D. Cowan


       

                            Abstract

A new neurotherapy, employing alpha-theta brainwave biofeedback 
preceded by imagery of desired personal changes, has been
reported to  produce profound personality and mood changes in
substance abusers and other patients.  This has raised questions
about the theoretical mechanism(s) underlying the clinical
improvements:  Why should the new therapy be beneficial?  What is
the relationship of these brain rhythms to substance abuse?  This
paper includes an annotated list of a number of possible
theoretical reasons for these clinical gains, as well as a
discussion of recent experimental evidence linking these brain
rhythms to alcohol and other drug abuse.  

        

        
KEYWORDS:  EEG, biofeedback, substance abuse treatment, mental
health treatment, alpha rhythm








The rediscovery of brainwave biofeedback, particularly in its 
new application as alpha-theta training, has left many
practitioners and  researchers puzzled about its reputed power. 
Just a few years ago, the  training of the EEG was restricted to
a few diehards who knew its  potential.  The recent explosion of
interest in this field, spearheaded by the work of Drs. Eugene
Peniston and Paul Kulkosky (1989, 1990, 1991), has produced a
rapidly expanding group of practitioners claiming remarkable
results in treating a number of disorders: chemical dependence,
post-traumatic stress disorder, depression, anxiety, multiple
personality, panic, and eating disorders, to name a few.  In a
recent article in the Association for Applied Psychophysiology
and Bio-feedback's newsmagazine, Biofeedback, Dr. J. Peter
Rosenfeld (1992) raised the question of "the conceptual
foundation of brainwave training effects", as well as other
issues. To restate his questions more clearly:   

		1. Why should alpha-theta brainwave biofeedback have a
          positive effect   on alcoholism and other forms of
          substance abuse?  
		2. What is the relationship of the alpha and theta
		rhythms to substance abuse?   

Although I can see the remarkable success of this therapy in my
own clinical work, from a scientific perspective, I can also
understand why Dr. Rosenfeld and others are justifiably puzzled.
I am also keenly aware that others postpone thinking about these
issues at all, waiting for a larger number of controlled outcome
studies. Although it is clear that additional clinical trials are
very necessary, further consideration of Dr. Rosenfeld's
questions will add to our understanding and thereby refine these
studies. I have been thinking about these questions since I first
read Peniston and Kulkosky's paper in May, 1989, and visited Dr.
Peniston that September. Since then, I have had a number of
illuminating discussions about this with many others in the
field, including Dr. Lester Fehmi, Dr. Joe Kamiya, Dr. Scott
Lukas, and Dr. Peniston.    

The ideas and references that they suggested have helped me to
understand that there are a large number of possible reasons for
the success of this therapy. While it is clearly too early to
decide about the relative importance of these reasons, I feel
that it is important to put forward an annotated list of possible
explanations, in the hope that it will stimulate dialogue,
research, and improved therapeutic approaches. I would certainly
welcome comments and discussion from others. 

This new neurotherapy--known as either alpha-theta training,
Imagery and Attention Control Training, or (perhaps too vaguely)
as neurofeedback, EEG or brainwave biofeedback--actually goes
back quite a long time. The use of imagery and biofeedback
involving both the alpha and theta states was first explored in
the late 1960s by Dr. Elmer Green and his colleagues at the
Menninger Foundation, who termed it "programming the unconscious"
(Green & Green, 1986). Conversations with Dr. Green revealed that
he had modified an approach to changing life patterns that he had
excerpted from the ancient Yoga sutras: Hold the image of change
firmly in mind as you quiet down both physiology and thought
processes, and then release it without attachment. Dr. Green has
discussed this approach at many Menninger Foundation courses on
brainwave biofeedback, including one that Dr. Peniston attended. 

The essentials of alpha-theta training have been covered in
detail by Dr. Len Ochs (Ochs, 1992). As originally performed by
Dr. Peniston, the nucleus of the training consisted of 6-8
sessions of thermal biofeedback and autogenic training, followed
by 30 sessions of evoked images (of personal change) and alpha-
theta EEG biofeedback. The sessions were typically performed
twice a day, five days a week, on Veterans Administration
Hospital inpatients. The training in hand warming, which was
taken to a criterion of 94 degrees, was used to create an
experience of mastery, as well as a state of relaxation that
evidence suggests will also produce an enhancement of the
patient's theta rhythm. Dr. Peniston used a standardized set of
imagery instructions, which he varied slightly for different
diagnoses (alcoholism, drug, abuse, post-traumatic stress
disorder, chronic pain, etc.). He then told the patient to "sink
down" into a state just above sleep, keeping his mind quiet and
his body still, while listening to the biofeedback tones. The two
tones were triggered if the occipital (O1) alpha or theta
amplitudes went above a preset threshold. Alpha and theta were
trained simultaneously, not sequentially, as Ochs (1992) stated.
The simultaneous training, in combination with the instructions,
results in the production of alpha rhythms that are primarily at
the lower end of the alpha frequency range. A trainee will
typically spend several minutes producing predominantly low alpha
rhythms, before this drops out and somewhat increased theta
amplitudes supervene. From there, the course of the 30 minute
biofeedback experience is highly variable, as are the subjective
reports. As Dr. Ochs indicated, each clinician who has employed
this protocol has added his or her own variations. Some of them
are described in the accompanying article. 

Despite this inconsistency, the results of the therapy have been
remarkably positive and robust among patients who have completed
the recommended number of sessions. Some of the evidence for its
effectiveness was put forward at a symposium at the recent AAPB
meeting in Colorado Springs. An informal meeting of practitioners
at the same conference produced reports of about 80% short-term
effectiveness with over 300 patients in the wide variety of
conditions listed above. Dr. Peniston's efforts accounted for
about 180 of these patients, whose success has been followed up
for 2-4 years. The network of therapists that I have talked with
about this particular technique reports a similar pattern in a
much larger number of patients. There is also a partial overlap
with other successful methods of EEG biofeedback therapy with a
much longer track record, including the numerous practitioners
trained over the years by Dr. Lester Fehmi, Dr. Thomas Budzynski,
the Menninger Foundation, and several others. On balance, I
should also point out that there are real practical difficulties
in providing enough encouragement for patients to complete this
therapy in an outpatient setting, as Dr. Ochs discussed in great
detail. However, there are modifications and additions to the
therapy that produce major gains in the first few sessions and
thereby improve compliance. 

To start the list of reasons where the therapy begins, with
thermal biofeedback, is to review territory familiar to most
biofeedback clinicians. Clearly, thermal biofeedback, coupled
with autogenic phrases, can be very relaxing, thereby relieving
stress that the trainee has accumulated. Teaching the student how
to achieve this relaxed state does create a perception of self-
mastery over stress, which can be healing in itself. It is
probable that if the 6-8 sessions of this training were extended
by 30 more, additional gains in relaxation and mastery would be
forthcoming. Would these gains be sufficient to account for the
effectiveness of Peniston's approach? This is a researchable
question. To confound the issue, these reasons for success should
also apply to learning control of the low alpha and theta brain
rhythms, but perhaps the latter task produces an even more
profound experience of relaxation and mastery. 

In an Association devoted to biofeedback and psychophysiology, it
is easy to overlook the importance of the imagery instructions
given prior to the EEG biofeedback in each session. In private
conversations, Dr. Peniston has consistently emphasized the
importance of evoking these images of personal change. The
imagery instructions used here provide mental rehearsal of new
intentions and images of positive alternatives to unwanted
responses, such as drinking alcohol. The instructions are
repeated without variation in each of the 30 sessions. This
degree of massed practice and rehearsal may be very valuable in
healing, in and of itself. From the viewpoint of learning and
memory, the repetition of intentional images or visualizations is
quite different from a series of guided imagery experiences. It
is much more likely to reinforce learning and produce the
overlearning of the particular response that is important in
creating personal change. In fact, finding ways to evoke the same
images several times in each session may be very useful in
decreasing the number of sessions necessary for successful alpha-
theta therapy. Adapting some of the characteristics of effective
visualization discussed by Dr. Patricia Norris (1989) to this
therapy should also increase its effectiveness. To achieve this,
I make sure that each of my students is deeply involved in
writing his or her own script to evoke imagery. 

These images of personal change are experienced in a relaxed
state, followed closely by the affect induced by alpha-theta
biofeedback, which is usually very pleasant. This forms an
association between the images and pleasant affect which is
repeated 30 times throughout the course of therapy; the well-
learned association between the two should make the new
intentions and behaviors seem more desirable. 

The power of alpha-theta training may be partly due to inputting
images and suggestions in such a way that they bypass the
conscious mind, thereby benefiting from the lack of interference
from adult disbelief and disempowerment. 

Before setting forth the rest of the reasons associated with the
feedback of the alpha and theta rhythms, it is important to
clearly establish the distinction between brain rhythms and brain
states. The underlying configuration of psychological,
neurological and biochemical activity, which may shift from
moment to moment, is the brain state, state of consciousness, or,
more precisely, state-context (Kiefer and Cowan, 1979). I prefer
our terminology because it emphasizes the fact that elements of
context, particularly cognitive patterns, also influence the
neural background on which experiences are encoded and stored in
the brain. The impairments of retrieval produced by changes in
state and cognitive context are both consequences of the shift in
neuronal background in effect at storage and retrieval, and are
therefore nearly impossible to separate. I believe the term
state-context dependent retrieval is a more accurate description
of the phenomenon than the original term, state-dependent
learning. 

The EEG is but one of a number of multiple converging indicators
of state-context, as Dr. Joe Kamiya is fond of pointing out. The
multiple rhythms of the EEG are often overlaid on one another at
the same time; the amplitudes, frequencies, and phase
relationships of these rhythms presumably have some connections
to the underlying brain state-context. However, comments such as
those indicating that a student is "in the theta state" when he
is practicing the augmentation of his theta rhythm grossly
oversimplify a highly complex reality. There are a number of
problems with this all too convenient approach:
 
		1. The theta rhythm itself is not a unitary phenomenon.
          Undoubtedly, there are important distinctions relating
          to the meaning of different frequencies, waveforms, and
          electrode sites, especially if pathological EEGs are
          also considered. 

		2. There probably are multiple underlying state
          contexts which characteristically produce large amounts
          of theta activity at a particular electrode site. These
          state-contexts have evolved differently in each person,
          shaped by many factors in the individual's
          developmental history. More on this later. 

		3. One should not confuse the rhythm that the therapist
          is attempting to train with the pattern of rhythms that
          the student is producing at the moment. This is
          particularly troublesome if he is being trained by
          turning on a sound when he is above an arbitrary
          threshold, which the therapist can change at whim.
          Without looking at the whole pattern, it is impossible
          to assign a meaning to producing a certain percentage
          of theta above threshold. It is often difficult even if
          you can see the whole pattern. 

It is probably more accurate to state that EEG rhythms roughly
reflect one or several dimensions of the focusing and deployment
of the student's attention, ranging from the relatively narrow
focus associated with some predominantly beta rhythms to the more
open or even diffuse attention, divided among multiple objects,
characteristic of low alpha dominance (Fritz & Fehmi, 1982). 

By training the student to produce more or less of these brain
rhythms, we are actually doing something far more complex:
Teaching him to perceive and control a number of different
transitions among his own unique state-contexts, which differ
among themselves in the amounts of each of these rhythms that
they produce. We are training the student to activate certain of
these state-contexts by instructing him to emphasize certain
rhythms. In some cases, we are also teaching him new state-
contexts, and their distinction from other previously learned
ones. 

One possible reason for the success of this therapy is that we
are training the student to better control many of his
transitions between his unique state-contexts, by teaching him
how to control the way he focuses and deploys his attention.
Certain types of state-contexts may only be activated if
attention is focused and deployed among possible objects in a
characteristic manner, one associated with the predominance of
certain brain rhythms. For example, it may be easier to activate
or stabilize a state-context in which one is narrowly focussing
on anxious thoughts and feelings, as well as the associated
events and memories, if the predominant brainwave rhythm is beta.

Parenthetically, there may be a more direct way of measuring the
student's ability to produce appropriate transitions between
brain rhythms. One problem with current approaches is that we
rarely train complete control, in that we omit teaching them how
to turn off these rhythms. Dr. Kamiya did this in his early work
with alpha training, in which he alternated between two minutes
of alpha enhancement and two minutes of suppression. With our
current technological richesse, it would be a simple matter to
devise a program that measured how quickly an individual could
make transitions back and forth between predominant rhythms. By
quantifying this latency, we may be able to develop a training
outcome measure with greater validity. By training the student to
produce quick transitions between brain rhythms, we may also be
able to train them to improve their ability to transit between
some of their underlying state-contexts--those that typically
produce the changes in brain rhythm and the consequent
biofeedback. 

Dr. Martin Wuttke's article (1992) sets forth a related reason
for the success of alpha-theta therapy--the development of the
"witness" consciousness through training these transitions. "With
training you eventually develop the ability to consciously
observe and witness internal and external stimuli, without
judging or thinking...This skill brings with it a new volition in
regard to cognitive processing." (1992, p. 21) This increased
ability to choose between experiencing a state-context containing
unpleasant thoughts, feelings, and associated memories, or a more
pleasant one, can clearly improve anyone's mental health. During
and after this therapy, patients regularly report increased
control of their state-contexts. 

Patients also report a greater ability to "let go" of unwanted
thoughts and feelings. In view of the alpha rhythm training, this
is not at all surprising. For many years, Dr. Lester Fehmi has
been teaching clients and therapists to use low alpha, in
combination with certain images, to open the focus of their
attention and include more of the sensory/perceptual field
surrounding each experienced event (Fritz & Fehmi, 1982). Dr.
Karl Pribram has uncovered a number of systems within the brain
which allow it to vary between a narrow focus on one aspect of
experience and dividing attention more equally among multiple,
narrow bandwidth input channels (Pribram, 1971). By broadening
the focus of attention to include many sensory input channels, it
becomes more difficult to narrowly focus on one repetitive "tape"
or "conversation" or a "vicious cycle" involving unpleasant
thoughts, feelings, and memories, each intensifying the other. If
the attentional focus is diffuse, as it is in many state-contexts
characterized by large low alpha output, these thoughts can be
"let go" more easily, since they represent only a small portion
of the totality of experience at the moment. If they recur, or
other unpleasant thoughts come up, it is easier to watch them
dissolve again without attachment. By developing the ability to
allow the "witness" to control this Open Focus of attention, the
student can learn to experience and accept all events equally
without attachment, transcending pleasure and displeasure (Fritz
& Fehmi, 1982) [For more on this technique see the interview with
Dr. Fehmi elsewhere in this issue--Ed.]

Is there something unique about state-contexts with predominant
theta rhythms that can account for some of the treatment's
effectiveness? There is a fact that may have immense implications
here: As we mature, our average brainwave frequencies get faster.
During the important formative period from one to six years old,
the predominant brain rhythms fall in the theta range, but the
waveforms of the posterior dominant rhythm look more like alpha
spindles (Duffy, Iyer, & Surwillo, 1989). Older children's
frequencies are in the alpha range until puberty, when the faster
adult pattern supervenes (Kooi, Tucker & Marshall, 1978). The
implications of this shift are fascinating, especially when
combined with the principle of state (or state-context) dependent
learning and retrieval. The highly emotional experiences of early
childhood, and the (often mistaken) decisions which stem from
them, are learned and stored as modifications of the slower
background frequencies that were activated at the time. These
initial associations between the cortex and the limbic system--
the emotional brain--are formed in individualized state-contexts
characterized by cortical theta rhythms, and strongly
consolidated in memory by the actions of neurohormones (such as
epinephrine and vasopressin) released during emotional
experiences. Over the years, as brainwave rhythms move to faster
and faster frequencies, access to these original memories is
gradually lost due to the state-context change and state-context
dependent retrieval. Newer experiences which are connected to the
original ones by cognitive or emotional similarities are stored
in association with them, but at faster frequencies, generally
easier to retrieve at a later time. The part of this matrix of
associated memories which is hidden from consciousness by state
dependence can be considered to be the subconscious. A subset of
these subconscious memories--particularly those related to
sexuality and aggression--are further modified and obscured by
psychodynamic memory processes to form the unconscious, in the
sense used by Freud and his followers. However, Green and Green's
(1986) use of the word "unconscious" appears to be closer to the
broader subconscious I am describing, with an emphasis on the
clear links to the control of psychophysiological functions. 

During the alpha-theta therapy, the subconscious becomes more
accessible to alteration or "programming" (as Dr. Green puts it)
by new images, as well as the release of old images. As I
suggested in a remark at the end of the alpha-theta EEG
biofeedback seminar at the 1990 AAPB meeting in Washington, the
images generated by the student are being stored in a variety of
state-contexts, each characterized by predominant slow EEG
frequencies. In each session, after the images are evoked, they
remain in short term memory as the student "sinks down" into a
series of these state-contexts. It is likely that in this unusual
attempt to relax deeply without falling asleep, the student
reactivates a number of state-contexts that have been largely
dormant since childhood, since his adult experience with state-
contexts of deep relaxation is typically very limited. He will
permanently store the new images in each state-context that he
reactivates. Although each new memory increment may be weak, over
the 30 sessions the student will generalize these repeated images
from his adult state-contexts to a number of those initially
learned in childhood at predominantly lower frequencies. Each
training session may reactivate a different selection of state-
contexts, and the consolidation of memory in them will be
probabilistic and cumulative. This is one of the few ways in
which adults can store new information in the subconscious--in
state-contexts dominated by theta and low alpha rhythms, with
their well learned but state dependent connections to the limbic
system and early emotional memories. Hypnosis and NLP may offer
other approaches. If this therapy does offer a powerful method to
reprogram the subconscious, by overlaying images of new
intentions and positive alternatives, this is clearly a reason
for its success. 

The release of old images--that is, the integration of
subconscious, possibly repressed material into conscious
awareness during this therapy--may form the basis of another
reason for the success of the alpha- theta training. As Wuttke
(1992, p. 21) states "A goal of psychotherapy is the integration
of repressed material into conscious awareness. This self-
integrative process occurs quite often during brainwave training
sessions as the individual maintains a semi-conscious awareness
(referred to as reverie). . . . The result is a natural
integration of repressed material, usually through symbolic mini-
dreams." This integration may have a basis in the brainwave
changes seen in alpha-theta training, according to an upcoming
paper by Dr. Peniston. He reports that repressed, abreactive
material is most likely to surface when the student learns to
slow down the predominant alpha frequency to the point where it
is below eight cycles per second, technically within the theta
range. At these frequencies, the posterior dominant rhythm
resembles that of childhood. The emergence of subconscious
memories, stored during childhood and reinforced by other highly
emotional experiences which reactivate the associations between
the limbic system and cortical theta rhythms, becomes more
understandable as an effect of state-context dependent retrieval.

Dr. Peniston also noted a large amount of synchrony between
electrode sites during these abreactive episodes. Brainwave
synchrony indicates that the portions of the cerebral cortex
sensed by the electrodes in question are firing in phase with one
another. The origin of this coordinated cerebral rhythmic
activity is now thought to be in the reticular nucleus of the
thalamus (Steriade et al., 1990), a network of neurons that
surrounds the centrally located thalamus like an eggshell.
Although many of the more widespread, synchronous rhythms do
appear at times when the cerebral cortex is arguably doing
nothing more than idling (e.g., the alpha rhythms of relaxed
wakefulness, the delta rhythms of deep sleep), other information
supports the idea that some synchronized rhythms (and even some
forms of idling) coincide with profoundly altered state-contexts
that may produce integration and healing. There are several
studies that indicate that long-term meditators show increased
amplitudes and synchrony (and decreased frequency) of their low
alpha rhythms, particularly in the frontal lobes. For over 18
years, Dr. Lester Fehmi has used a five channel EEG biofeedback
instrument that trains people to increase both the amplitude and
synchrony of the selected brain rhythms. His approach, which
combines this training with the images of Open Focus, has become
accepted as a treatment for a wide variety of conditions,
including chronic pain and anxiety. Dr. Fehmi, Dr. Jean Millay
and others have reported that brainwave synchrony between
individuals results in increased rapport and reports of
remarkably similar experiences. Others, such as Dr. Edgar Wilson,
have found synchrony between healer and patient at the time of
peak effectiveness. I have suggested a mechanism for this type of
synchrony-induced information transfer (See "Mind as the
Projection and Reception of Electroholomorphic Fields by the
Brain," in Megabrain Report, Vol. 2, No. 2 [1994], pp. 23-30, and
Cowan, 1991). I mention all of this in support of the suggestion
that the development of synchrony during alpha-theta brainwave
training may be an important reason for its success on
neurophysiological, psychological and transcendental levels. 

Once individuals have been thoroughly trained using this protocol
for alcohol or other drug abuse, if they transgress by using
these substances again, they have a good chance of developing the
"bone sick flu". This unexplained illness, which has frequently
been described as "the worst flu I have ever had in my life"
(Peniston, personal communication) may constitute a reason for
therapeutic success with some patients. Rather then getting high
from his drug of choice, the user experiences bone, joint, and
muscle aches, as well as fever and malaise, for about two days
before the symptoms resolve spontaneously. It should be noted
that Peniston was using this method with success long before he
uncovered this reaction and therapists became obligated to inform
their patients, thereby establishing an expectation which
reinforces abstinence. 

There have been some speculations involving the possible role of
the hippocampus. I strongly doubt that the hippocampal theta
rhythm has anything to do with alpha-theta training, since Winson
(1985, pg. 185), who has done a considerable amount of work in
the area, states "In all probability there is no such rhythm in
any primate". It is true, however, that the hippocampus is
desynchronized at many times when large portions of the cortex
are in synchrony. The significance of this finding for the alpha-
theta training has not yet been clarified. 

I am also cautious about suggesting that the reasons for
effectiveness are primarily based at the neurochemical or
endocrine level. Although it is fashionable to seek explanations
that attempt to root neuropsychological phenomena in supposedly
deeper bedrock, I find that I must agree with Dr. Siegfried
Othmer, a physicist who has turned his attention to EEG
biofeedback, in wryly terming this type of reductionist approach
"physics envy". While there is no doubt that any therapy which
produces changes in the central nervous system as profound as
this one does will produce many secondary changes in
neurochemistry, to jump to the conclusion that any one (or even a
few) of these changes cause the transformation of the individual
that we see clinically is to put the cart in front of the horse.
This situation is quite different from that involved in
administering a drug, where it is thought that the drug must bind
to a receptor, thereby leading to changes at the biochemical
level that cause its psychological effects. With our current
state of knowledge, there is simply no reason to assume that any
one change in biochemistry or endocrinology is the primary event,
eventually causing all the other changes. Although Peniston and
Kulkosky (1989) did find that this training prevented a rise in
beta-endorphin levels that was seen in the control group just
before release, they admitted that this change could very well be
due to the increased stress experienced by the control group in
anticipation of their release from the hospital. Presumably, the
brainwave training helped the experimental group to minimize this
stress. 

Recent studies by Dr. Scott Lukas and Dr. Jack Mendelson have
cast considerable light on the second question, concerning the
relationships of these alpha and theta rhythms to substance
abuse. They provide support for the assertion that the euphoria
produced by many drugs is associated with increases in the output
of low alpha waves. One study (Lukas & Mendelson, 1988)
demonstrated that the euphoria and the alpha wave output of
normal subjects drinking alcohol both peaked almost
simultaneously, about a half hour after starting a fifteen minute
drinking period. The blood levels of ACTH and corticosteroids
also peaked at about the same time. In contrast, the blood
alcohol concentrations continued to rise over the next half hour
or more. In this and other studies, they have found a consistent
relationship between momentary experiences of euphoria and very
short term increases in alpha wave output due to alcohol,
marijuana, or cocaine (Lukas, 1991). 

These findings reminded me that during my tenure at the National
Institute on Drug Abuse Addiction Research Center, I had learned
about the concept of "negative euphoria" put forth by Dr. Clifton
K. Himmelsbach, the first Director, over 50 years ago. He
hypothesized that many addicts used drugs not to feel good, but
to forget that they felt badly. I performed a study which showed
that alcohol could help normals to forget their feelings, whether
positive or negative (Cowan, 1983), and demonstrated that this
was a specific effect. This data supports the hypothesis that the
euphoria produced by alcohol and perhaps some other drugs of
abuse could be largely a negative one--that by helping
individuals to achieve a particular low alpha state, the drugs
may also help them to "let go" or forget a variety of unwanted,
intrusive thoughts and feelings. The alpha-theta training may
very well be teaching these drug-dependent individuals, who are
usually troubled by a variety of unfavorable feelings and
attitudes (particularly towards themselves), how to naturally
achieve this escape, when it is beneficial to do so, by producing
a state-context with an increased, and perhaps more synchronous,
low alpha rhythm. Learning to enhance the theta rhythm may lead
them to produce state-contexts of even deeper serenity and peace.

There is a lot to think about here. There are few answers, but
perhaps these hypothesized mechanisms will help in framing better
questions. The immense promise of the alpha-theta technique and
its many variants deserve a great deal of further attention both
from researchers, intent on demonstrating its effectiveness and
answering some of these questions, and from clinicians interested
in refining this highly beneficial approach to personal change. 

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Jonathan D. Cowan
Attention Control Training, Inc., 
4010 Dupont Circle, Suite 517
Louisville, Kentucky, 40207