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Matthew
Kelley, Ph.D Besides addressing the client's specific environmental and psychological concerns in a culturally appropriate way, it is very likely that many traditional Navajo medicine and Native American Church procedures (such as sweat lodge, "blessing-way,” herb-usage, and a wide range of intense ceremonies) will produce significant and measurable psychophysiological, stress-relieving benefits. Currently, for example, active participation in the Native American Church is considered by both researchers and traditional therapists to be more effective than the standard 12-step treatment or medical treatment protocol (Albaugh & Anderson, 1994; Hill, 1990; Pascarosa & Futterman, 1976). Christian support, for Christian-oriented Dine’, has also proven to be a significant intervention for some people. As indicate above, the target population of this evaluation (40 chronic alcohol dependent Dine’) has a multiplicity of serious conditions. Although chronic binge drinking certainly exacerbates these situations, in many cases, excessive drinking has eventually become a coping (or response) mechanism apparently useful for sanity and survival. If the deep issues of personal, social, and economic crisis are not addressed, long term sobriety is unrealistic. Because time and resources are limited within most treatment programs, emphasis primarily must be placed both on both emotional and cognitive restructuring and psychophysiological practices which help a client “in making his or her own medicine” (e.g. developing a new and more satisfying experiential and belief systems). Depending upon the western trauma-release-talk-therapy and educational medical model is becoming more and more unrealistic. A successful training protocol must necessarily convert the powerful negative attributes common to the “negative” tough mindedness of these clients into what might be called “positive” warrior tough-mindedness; a mental strategy based on supportive spiritual Navajo “beauty-way” (Farella, 1984). A statement typical of such a spiritual and philosophical outlook might be, “against all odds, I walk in beauty.” Such an internal cognitive framework (roughly comparable to the lifestyle championed by Zen philosophy) may serve as a psychophysiologically based, highly adaptive world-view. Fortunately, because Dine’ philosophy is still relatively intact with the culture, even the chronic problem drinkers should be quick to understand this “beauty-way” approach. For a Dine’-based treatment facility to not match “treatment to client” or to not utilize these rich and available cultural tools is professionally negligent.
Quite importantly, recent findings in applied
psychophysiology may also support (and help explain) the use of traditional
Native American therapeutic practices within modern treatment settings. For
example, numerous researchers believe that intensive training in biofeedback
(applied psychophysiology or self-regulation training) may offer the substance
abuser a healthier self-regulating, physiological method of “normalization”.
Such physiologically measurable benefits triggered by these internal biofeedback
techniques may also provide the daily stress resiliency and stress
inoculation-like patterns these clients require for comfortable sobriety (Bodenhamer-Davis
& deBeus, 1995. April; Fahrion, 1995); Kelley, 1998;(Peniston
& Kulkosky, 1989; Walters, 1992). Select Native American therapeutic
practices, for example, may produce quantifiable psychophysiological changes
similar to the positive results found in these studies. As an example, the
Native American Church may be one of the most complex and rigorous therapeutic
protocols utilized anywhere in the world. Its protocols involve an intense 14
hour family and community ceremony, extreme fatigue, trance singing and
drumming, extreme sensory beauty, precise formal ritual, ceremonial use of
tobacco and herbs, intense affirmation-prayer-cathartic release,
emotional/cognitive restructuring, and the careful use of peyote (a complex,
mild, time-focusing psychedelic alkaloid) (Albaugh
& Anderson, 1994; Bergman, 1971). Other techniques such as the
ceremonial use of the sweatlodge also contain psychophysiological triggers: a
dark and mystical environment where the participants sit almost naked for hours;
intense heat; carbon dioxide buildup in the lungs causing better oxygen tissue
saturation; intense singing/chanting; intense cathartic release; fatigue; varied
psychologically purifying procedures such as tobacco and cedar protocols; social
bonding; cognitive ego re-structuring. Such
practices may rightly stretch the boundaries of what we call applied
psychophysiological techniques. Applied psychophysiology (a more accurate word
for the mind/body complexities of quality biofeedback training) is the practice
of intentionally (and even unintentionally) training a person to self-generate
beneficial physiological self-healing (Shellenberger
& Green, 1989).
An assumption made here is that many of these chanting, dancing, meditating, blessing, and smoking techniques produce a high amplitude alpha/theta brainwave state (an enhanced altered state of consciousness). A deeper review of the relevant biofeedback literature may offer us encouragement to step away from the exclusive use of the medical treatment model and to step toward the adjunctive use of select traditional Native American therapeutic practices as measurable, relatively low cost, high volume, self-regulation techniques. For example, in Peniston's (Peniston, 1994) controlled neurofeedback study, ten clients who were suffering from chronic alcohol dependence and chronic treatment relapses were trained in alpha/theta neurofeedback. These participants were taught to intentionally increase the amplitude and coherence of their transient alpha/theta brainwaves in their occipital lobes with the use of a specially designed EEG feedback devise. Quite unusually, eight of these participants remained generally abstinent at least three years after treatment. Peniston also reported that these participants showed significant improvement from pre-training to post-training MMPI personality scales (including hypochondriasis, depression, hysterical, psychopathic deviate, and paranoia). They also experienced a decrease in stress-related, blood-based Beta endorphins. A three year follow-up indicated that these results remained stable. Other studies have found similar results (Bodenhamer-Davis & deBeus, 1995. April). (Fahrion, 1995). A three year follow-up study of 19 chronic alcohol dependent Dine’ clients who completed a culturally sensitive, alpha/theta neurofeedback training program was also very positive (Kelley, 1998). The active ingredients in such successful self-regulation training are controversial. Several researchers (Ochs, 1992; Peniston, 1994; Walters, 1992) suggested that the most active (and apparently transformational) properties of neurofeedback training may involve teaching the participants to intentionally increase the amplitude and coherent interaction of both their alpha and theta brain wave frequencies in either the occipital or the central brain locations. Fahrion (1995) also stated that this apparent neurological "normalization" is responsible for shifting the trained client into a physical state of comfortable sobriety. Fahrion suggested that when chemically dependent persons are sober they often have a neurologically-based inability to experience pleasant feelings from simple stimulation. Blum (1995) concurred with these ideas and suggested that neurofeedback training may trigger a neurological-normalizing shift, as explained by his RDS model of the endless quest for neurotransmitter balance. With a different but not necessarily contradictory emphasis, Cowan (1993) suggested that the apparent effectiveness of such training may be due more to the enhanced imprinting of positive sobriety suggestions and the feeling of inner empowerment which the alpha/theta state seems to encourage. McPeake, Kennedy, and Gordon (1991) suggested that self-induced altered-states such as those found in various forms of meditation can sometimes replace the self-destructive pursuit of alcohol induced "highs." In another opinion, Rosenfield (1992) questioned whether there would be any difference between Peniston's neurofeedback protocol, general relaxation, and hypnotic suggestion. Others suggest that the same results can be accomplished with meditation procedures alone (Taub, Steiner, Smith, Weingarten, & Walton, 1994). In an article reviewing Penniston's (1991) original neurofeedback study, Erickson (1989) suggested that effective treatment for substance abuse would always require a combined physiological and psychological approach. He criticized clinicians for frequently ignoring the more complex, underlying, physiological and environmental mechanisms. For example, few treatment programs address the neurophysiological issues of addiction (such as depression and neurometabolism) except on a superficial level. He suggested that, without improving an addict's neurophysiology, treatment is often fruitless or incomplete. This criticism is easily illustrated by the highly motivated addict who is left with a "white knuckle" version of sobriety often involving depression and tension. Many clients, for example, leave treatment facilities with higher measurable stress levels than their pre-treatment condition yet few treatment programs effectively address this stressor-neurological complex (Medicine, 1990; Peniston & Kulkosky, 1989). Those which do, seldom have time for more than a few, relatively insignificant mental or physical exercises. The active ingredients of the above bio/neurofeedback studies certainly involve a complex range of influences including: (a) induction of the relaxation response; (b) induction of a beneficial neurologically-based altered state of consciousness which produces both chemical balance and emotional satisfaction; (c) the benefits of both Hawthorne and placebo responses combined with the other essential psychological values of faith, expectation, belief, and hope; (d) the new experience of physiological/ psychological self-control in a situation where the client had previously felt helpless; (e) the apparent experience of what the participants commonly describe as a significant spiritual insight. These components may someday become the essential modality within the ideal treatment package no matter what techniques are applied to achieve them (including intense Native American psychophysiological therapies). The effective mechanism of bio/neurofeedback appears to also address the Reward Deficiency Syndrome and Feel Good Response model (Blum, 1991), the Altered-State Fulfillment model (McPeak et al., 1991), the Natural Mind model (Weil, 1972), and the Tension Reduction and Stress-related hypothesis. To increase cost-effectiveness, a more streamlined group approach than the above complex self-regulation protocols is absolutely essential. Although there are numerous benefits to using neurofeedback/biofeedback training and verification equipment, it is also possible that non-instrument based neuro-enhancement techniques (such as meditative, hypnotic-like procedures, or select Native American therapeutic practices) may produce similar neurological/behavior results. Such alternatives, especially if combined adjunctively with the best techniques of western-oriented therapies, may have many significant advantages (such as increased self-sufficiency, better long-term compliance, and cultural compatibility). Select Native American healing practices may be eventually seen as complex and sophisticate psychophysiological (inoculation-like) therapeutic tools for intelligent, modern, and dynamic Native American people. Native
American Therapy and the Community Reinforcement Approach Many of the therapeutic principles used in the HBS protocol are also unintentionally compatible with the acclaimed Community Reinforcement Approach. After an extensive meta-analysis of the efficacy of various treatment approaches the University of New Mexico’s CASAA (Center on Alcoholism, Substance Abuse, and Addictions) for research program complied a multi-modal holistic substance abuse strategy treatment into what they refer to as the Community Reinforcement Approach (CRA) (Miller & Hester, 1995). This approach attempts to help the client re-arrange his or her once difficult vocational, familial, and social environment into a positive and encompassing system of reinforcers such that it is emotionally awkward for the problem-drinker to take time out for drinking. Emphasis is taken off of the single individual as the center of the drinking problem. Focus is placed on the dynamics between both the individual and the environment. Clients are taught ways ‘to feel good sober’, ‘to make their own medicine’, and to become as self-sufficient as possible. A new life is created, one which is ‘better than drinking’. The classic CRA model includes most of the following components:
The protocols utilized in HBS naturally included some aspect of these CRA components (with the exception of vocational training and the use of medications).
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