The Treatment of Compulsive Sexual Behavior with EEG Biofeedback:
Special thanks to the volunteers who have participated in this study
and to Dan Gray for his help in recruiting participants.
Mark D. Chamberlain, Ph.D.
Family Center for Brief
415 So. Medical Dr. C-103
Bountiful, UT 84010
Alpha-Theta Training for Addiction
In 1989, Eugene Peniston published the first study indicating that EEG biofeedback, when added to a standard treatment program, was helpful in reducing relapse in alcoholics. 80% of those alcoholics who had thirty sessions of alpha-theta brain wave training remained sober eighteen months after treatment, compared to 20% of the control group who received conventional treatment alone (Peniston & Kulkosky, 1989). In succeeding years the same approach has been used to enhance the treatment of addictions to other substances (Bodenhamer-Davis & deBeus, 1995; Scott, 1998). Furthermore, a growing number of cases indicate that the same approach can be helpful with other compulsive behaviors such as bulimia (Othmer, 1998).
Application to Compulsive Sexual Behavior
Beginning in early July of 1998, I began a research project designed to address the question of whether similar results could be gained in the treatment of compulsive sexual behavior. I determined to provide thirty sessions of alpha-theta training to four individuals struggling with sexual compulsions, following the treatment protocol used to treat other addictions and described in the literature.
Since beginning, one individual has undergone the full compliment of thirty sessions and three are currently in progress, having undergone twelve sessions each. Results thus far have been promising and intriguing. Clinical observation and qualitative assessment of progress including the descriptions of clients themselves indicate a response pattern that resembles that of the other populations with which this method has been practiced and shown to be effective
Participants and Their Response to Treatment
The purpose of this initial report is to briefly summarize indications of effectiveness that are evident at this point in the study; demographic information and more detailed personal histories of the individual participants will be included in a later report. The four participants are struggling to resist compulsive sexual behaviors of various kinds.
One participant, case B, has noted no beneficial effects from the training. There has been some consistency in the response of the other three, cases A, C and D. They have independently reported that they have noticed feeling “not as tightly wound,” “more calm” “a subtle . . . sense of greater well-being” and “more relaxed” in their day-to-day functioning since beginning the training.
Interestingly enough, A and B both reported feeling increased tension during their first session or two, what A described as feeling of being enclosed, like I wanted to jump up and scream. I have heard similar reports from two other individuals receiving alpha-theta training for other issues. I have wondered if for some this might result from having learned to associate a state of vulnerability with danger due to traumatic experience. Or perhaps the discomfort results from the difficulty “coming down” from a more aroused “set-point” that has been learned in response to trauma, is biologically based, or some combination of both. Whatever the cause of this initial discomfort, it lasted for only parts of the first session or two and no later difficulties of this nature were reported.
They have also noticed a corresponding decrease in the intensity of their urges for compulsive behavior, which will be described in more detail on a case-by-case basis below
Case A: Other than an increased sense of calm, the first effect reported by A during training was the resolution of a long-standing difficulty that at first may seem unrelated to his sexual compulsions. A couple weeks into the training, he stated, “Something kind of strange happened this afternoon. For as long as I can remember I’ve been unable to go to the bathroom at the urinal in a public restroom. Well, today I discovered that I no longer have that problem.” I concluded that the brain-wave training may be increasing the flexibility of A’s autonomic nervous system response, allowing him to shift more easily from sympathetic control (the “fight or flight” response) to the parasympathetic mode with a corresponding increased capacitation of vegetative functions.
The next effect he reported was an expanding ability to say “no” to temptation. He went to a place he had frequented before, and the urge to initiate contact was “not as compelling as usual,” he said. “In fact someone approached me and I simply said ‘no.’ I felt more powerful than usual.” A couple of days later he noted that “There is no temptation for pornography, like there usually is.” The urge to initiate contact with other men remained, but took on a more casual quality. “It felt like I was seeking acceptance and maybe even the power of knowing I was attractive to them, but the drive for sex isn’t so strong.” He also reported a decreased sense of singularity of purpose: instead of a tunnel vision focus on sex, at the park he noticed the trees and the birds and spent some time “just people-watching”.
He completed the bulk of training on August 1 (returning to town for a brief stay several weeks later to finish the last of the 30 sessions). He was interviewed by phone on September 29 for the purpose of this report. He said that since beginning the training he has noticed no difference in the nature of his basic sexual desires for other men. (No indication of such an effect was promised or implied, but he had nonetheless been hopeful that the training might help in this regard.) However, he said, the desires have become substantially less compelling in nature. He has not acted on these feelings by initiating a sexual encounter since beginning the training. (It has not been unusual for him to go years between such encounters in the past, so this is not necessarily an indication of improvement.) A more regular sexual compulsion for A has been the viewing of pornography, and this struggle has been impacted more noticeably. “As far as the pornography goes, once in a while there are thoughts about that, but it seems much more controllable. Not that I’m invulnerable now, not that I can now do whatever I want. I still have to be very careful to manage my life. But I do think that controlling the pornography compulsion is the key for me, because then temptations for the other (anonymous sex) become more manageable.” Regarding the role of the brain wave training in his continuing progress, A emphasized, “This has just been one piece of the puzzle. It had to come in conjunction with some good therapy or I’m not sure how much it would have helped.”
An increased capacity to relax and feel at peace about life seems to have had a salutary effect on A’s personality. He reported that “My mom has noticed I’m not as stressed. I haven’t worried as much about my career, about marriage, or about life in general.” Providing psychotherapy for A, I have seen recent improvement in his capacity to acknowledge and integrate feelings of homosexual attraction into a coherent self-concept. It seems to me that perfectionistic expectations and intense self-recrimination have actually fueled the compulsive cycle in the past rather than acting as a prophylactic, and that “lightening up” and acknowledging these feelings as his own in this way has actually had the effect of reducing their power over him. He said, “It has been helpful to accept the full range of my emotions. Now I realize they are more dynamic, whereas when I tried to keep them blocked off to the side they never changed. Now it’s not this entire part of me that makes me see myself as bad. I accept it and somehow, ironically, that allows me to move on. I was making progress even before becoming more accepting, but it seems I’m working now at a different level.”
As a psychotherapist, I have often attempted to help those with sexual compulsions relax, become more aware of the grace of God in their lives, and realize that sometimes change is facilitated more by acceptance than force (Byrd Chamberlain, 1995). However, even when individuals understand these concepts intellectually, it is often quite difficult for them to “ease up on the controls” of their lives and open themselves up more to the power, love, and aid of God. Having worked with A in psychotherapy off and on for two years prior to the brain wave training, I observed some progress in this regard before the training. However, I have noted increased growth in this regard over the several months since he began the training, and thus concluded that perhaps his increased capacity to “lighten up” and accept himself has been facilitated by the training. Adding additional weight to this possibility is the fact that similar personality shifts, that seem to play a role in reducing the compulsive drive, have been documented quantitatively in the alcoholics Peniston treated (Peniston Kulkosky, 1990).
Case B: The only female in the study, B has completed 12 sessions but has not yet accessed a state of calm relaxation even during the training sessions themselves. This has been apparent from her self-report as well as the lack of alpha wave production observed on the electroencephalogram. Furthermore, she has had limited success in the hand-warming exercises that are often used as an initiation into the process of biofeedback. Along with psychotherapy, the brain-wave training was initiated in the hopes that it would help her decrease her dependency on an abusive former partner with whom she has been involved to varying degrees over the past decade. Psychotherapy within our clinic focused on self-esteem, depression, and personal power has been of more benefit. We also referred her for massage therapy, which has helped her to relax somewhat. A laboratory analysis of her neurotransmitter levels revealed serotonin, dopamine, and norepinephrine values all outside the normal range, and she is presently undergoing medical evaluation and treatment in an effort to address the coinciding anxiety and depression. Brain wave training has not provided immediate relief, and thus has been implemented on an irregular schedule, often taking a back seat to other methods designed to address more pressing concerns.
Case C: When interviewed on September 27, 1998 for the purpose of this report and asked how things had been going since beginning treatment, C answered, “In some ways better, and in some ways worse. I’m not as tightly wound, and I’m more deliberate in what I’m doing. In fact, until yesterday I had gone for 20 days without acting out, which is a long time for me! But yesterday I blew it, and discovered that even the acting out is different now. Before I was much more impulsive, but yesterday I felt more calm. And that is what scares me a little bit and why I say things are worse in some ways than before. It wasn’t that frantic pursuit with that sense of tunnel vision. I made a conscious decision about what I was going to do, planned it out, called my SA (Sexaholics Anonymous) sponsor and said ‘this is what I’m going to do,’ and then went and did it. So even though I relapsed, it didn’t have that intensity, that driven quality to it where I felt like it was out of my control.”
Experience is quite similar to that reported by a bulimic who underwent alpha-theta training (Othmer, 1998). In the process of developing more control over her eating habits and eventually eliminating her binges, she reported instances where she consciously decided she was going to binge and then deliberately went through the steps of gathering and gorging on food. It is too early to determine whether C will eventually develop the control over his sexual life that this woman was able to over her eating. At this point we can at least say that the intensity of C’s sexual compulsions are beginning to decrease; that is, his acting out is beginning to take on a more deliberate, less compulsive quality.
Case D: On September 18, 1998, after several weeks of training, D spontaneously reported some improvement. “I can handle setbacks better. Setbacks, in regard to this addiction, are not as much of a crisis to me anymore. I was doing well for a couple of weeks, and then I relapsed. But I didn’t wallow in it as much as I used to.”
On September 28, 1998 I interviewed D. in order to summarize his progress for this report. He reported that he is acting out (pursuing anonymous sex) less frequently now. Before beginning the training, he typically did so at least once a week. In the last seven weeks of training, the periods between his four most recent relapses have been two weeks, one week, two weeks, and two weeks.
“It is subtle, but I feel a sense of greater well-being. In fact it’s subtle enough that I almost hesitate to say that. Things aren’t perfect. I still have my ups and downs. But it seems to me that I don’t get as down. I do get down, and those periods can last two or three days just like they always have, but it’s not as deep. “This ties in to my cycle because I use acting out to get me out of it. I’m more likely to feel down if I haven’t acted out recently. I get lethargic, I don’t know what to do with myself, it seems like there’s nothing to look forward to, and I feel incapable of being effective in my life. Basically I feel ineffective, unmotivated, “lame,” and like I’m not good at anything. Well, sometimes to break that I act out. After I have procrastinated and things have built up on me, I get overwhelmed and don’t see a way out. Then I act out and it gives me a surge, a rush. I feel a sense of vitality, especially when I’m “cruising” (looking around in an effort to initiate a sexual encounter), maybe in part because there’s some risk involved. In contrast to the previous state of lacking direction and initiative, when I’m pursuing sex there is a clear-cut goal and in a perverted sort of way I feel like I’m accomplishing something. Of course, after acting out I feel filthy and like a slime, but then at least I have the energy and initiative to get on with things. The down feeling, the guilt and anxiety that follow acting out, is easier to deal with. The other depression, that comes before acting out, has a stagnant quality to it, it keeps me from getting on with life.
Since I’ve been doing the feedback, both kinds of depression are not as bad, not as deep, and I don’t get lost in them like I used to. It’s not completely different, but there is less of a sense of being so caught up in it. For example, I used to “cruise” for two to three hours at a time. Now I might do it for 45 minutes to an hour, and more frequently now I can let go of it and say, ‘Come on D, just drop it.’ I tend to break away from it. Before I would have become so caught up in the fantasy about who I might meet and what it was going to be like that I couldn’t let go like that.
Conclusion: The progress thus far in the cases reported herein identifies alpha-theta brain wave training through EEG biofeedback as a promising modality for enhancing the treatment of compulsive sexual behavior. More conclusive statements about effectiveness await long-term observation of these and other clients. Nonetheless, the common patterns of response noted thus far between these cases and clients in treatment for other addictions and compulsive behavior, among whom this method been shown to be quite effective, provide grounds for optimism.
Byrd. A. D. Chamberlain, M. D. (1995)
Willpower is not enough: Why we don’t succeed at change. Salt Lake City, Utah: Deseret Book Co.
Othmer, S. (1998). EEG Spectrum Practitioner Training Course, June 4-8, Encino, CA.
Peniston, E. G. Kulkosky, P. J. (1989).
Alpha-theta brainwave training and beta endorphin levels in alcoholics. Biofeedback Self-Regulation 14 (2): 83-88.
Peniston, E. G. Kulkosky, P. J. (1990).
Alcoholic personality and alpha-theta brainwave training. Medical Psychotherapy, 3:37-55.
Scott, W. (1998).
EEG Spectrum Practitioner Training Course, June 4-8, Encino, CA