THE CORRECTIONAL PSYCHOLOGIST 9 MEMBER ARTICLE Reducing Sheriff’s Officers’ Symptoms of Depression Using Cranial Electrotherapy Stimulation (CES): A control experimental study

Ronald R. Mellen, Ph.D. and Wade Mackey, Ph.D.—Contact: [email protected]

This article examines the Blarcum, 2008; Scott, 2004; Griffin However, two of the studies employed possibility of reducing depression & Bernard, 2003; Zhao, 2002; Finn, biological measurements: EEG and anxiety in sheriffs’ officers 2000). Anti-anxiety medications, P-300 brainwaves; the MAO-B (an using the Alpha-Stim SCS, a cranial biofeedback, and progressive enzyme that slows break down of electrotherapy stimulation (CES) relaxation therapy are among the dopamine) and the neurotransmitter unit. The dependent measures were traditional techniques used to reduce (Gama-aminobutric acid or the Beck Depression Inventory stress. A relatively new approach GABA). One additional study used (BDI; Beck, 1996), the Beck Anxiety for the treatment of stress is CES. biofeedback instrumentations. Inventory (BAI; Beck, 1990), and The utility of Alpha-Stim SCS As noted by Matteson and the Brief Symptom Inventory (BSI; for the treatment of many clinical Ivancevich (1986), corporate Derogatis, 1993), which has both disorders has a 25-year history of middle management supervisors depression and anxiety scales. supportive research. For example, frequently report significant levels The treatment group used active there have been over 126 human of stress. These mid-management Alpha-Stim SCS units to provide subject studies, as well as, two meta- supervisors, who were also electrotherapy stimulation at the analyses establishing the efficacy of pursuing MBA degrees at the minimal therapeutic level (100 uA), CES for treating mental disorders University of Houston, formed the while a sham control group of officers (Kirsch, 2002). In addition, the treatment group of a CES study. used inactive units (electric current Alpha-Stim SCS has been cleared The CES was found to produce was at a non-therapeutic level). by the FDA for treating depression, reductions in state anxiety, trait When depression scores anxiety, and insomnia. Below is a anxiety, depression, anger, fatigue, from the treatment group were small sampling of studies where confused thinking, hostility, and a compared to the sham control physical and mental disorders were sense of dejection. In juxtaposition, group, significant improvements on successfully treated using CES. the subjects reported increased the BSI Depression scale (p<.01) energy, fewer health complaints, and the BDI (p<.05) scores were Business executives Matteson less sleep problems, less stress, found. Results on the two anxiety and Ivancevich, (1986), drug abusers and greater reductions in tension. scales were non-significant. (Braverman, Smith, Smayda, & Outpatients (N=197) reporting Because trends were noted in the Blum, 1990), alcoholics (Krupitsky, high levels of anxiety were subjects remaining BSI scales, a Sign test Burakov, Karandashova, Katsnelson, in Overcash’s (1999) research. (trend analysis) was completed. Ten Lebedev, Grinenko, & Borodkin, While most did not have histories of the remaining 11 BSI sub-scales 1991), subjects with migraine of treatment for their anxiety (58%), indicated downward directions of headaches (Broatman, 1989), about 26% had been refractive difference (p=<.01) in the treatment outpatients with clinical levels to anti-anxiety medications. All group when compared to the control of anxiety (Overcash,1999), the subjects completed pre-post self- group. The finding suggested a violent mentally retarded (Childs, assessments. Subjects were broad trend toward reductions in the 2005) and hospitalized patients divided into three treatment groups full range of clinical symptoms. (Passini, Frank, Watson, & Herder, using different pre- post-treatment 1976) with a variety of mental health biological measures: Literature Review diagnoses, have all been treated Research has shown stress successfully with CES. Group 1: electromyogram levels are high in many criminal (EMG) justice disciplines including In most studies reviewed in this Group 2: electrodermal re- jails, correctional facilities and article, mental health assessments sponse (EDR) law enforcement agencies (Van were used for dependent variables. (Continued on page 10) 10 THE CORRECTIONAL PSYCHOLOGIST MEMBER ARTICLE

CES... (Continued from page 9) Group 3: peripheral digit and thus may have greater officers from the sheriff’s staff. These (middle finger) temperature applicability than just depression, included jail security, patrol officers, (hand-thermal biofeed- anxiety, and insomnia. There investigators and administrators. back) were no corresponding amplitude Eleven officers were males, and increases in the control group. 10 were females. Subjects were Pre- post-treatment assessments At the biochemical level, low randomly assigned to either the found significant reductions in concentrations of MAO-B (enzyme) treatment or control groups and subject stress levels in biological, and GABA (neurotransmitter) were blind to group assignments. as well as, psychological measures. have been reported in alcoholic At follow-up, 73% of the subjects populations. The GABA is the main Apparatus were “well satisfied” with their neurotransmitter that supports a The CES unit utilized in the treatment outcomes. In another person’s ability to inhibit hostile present study was the Alpha-Stim study (Brotman,1989), significant emotions and actions. MAO-B works SCS produced by Electromedical reductions in migraine headache with neurotransmitters to strengthen Products International, Mineral symptoms were observed when a a person’s inhibitory response. Low Wells, Texas. The unit is hand held combination of CES and Quieting levels of GABA and MAO-B weaken (10 cm height; width is 7.5 cm; 2.3 Reflex Training was utilized. the inhibitory response and can lead cm depth) and uses a standard 9 volt CES was also effective with to increased anxiety and depression, battery to generate the appropriate inpatient volunteers. In this early which can increase the likelihood of current level. It is about the size of study by Passini et al. (1976), relapse. Krupitsky et al. (1991) found an early I-Pod and comes with two subjects (N=60) with a wide CES increased GABA and MAO-B ear clips, one for each ear lobe that range of mental health disorders levels in substance abusers. This deliver the electrical current. In responded well to CES treatment. increase in patient’s blood levels non-research settings, the range of Their disorders included alcohol provides patients with greater ability electrical current is determined by and drug dependence, manic- to control their anger and aggressive the subject using a side-dial. The depressive episodes, organic brain behaviors. The GABA and MAO-B therapeutic range is from 100 to disorders, and anxiety neurosis. levels in the control group did not 500 uA (micro-amps). One hundred The volunteer subjects were increase. uA is the lowest therapeutic level treated for anxiety and depression While many studies looked at CES and is approximately 80% as with the goal of increasing coping as a treatment for various mental effective as the maximum 500 uA. skills and energy. The subjects, disorders, only three (Childs, 2005; Two timing settings are built into while still on psychotropic and Childs, 1995; Mellen & Mitchell, the Alpha-Stim, 20 minutes and 1 other medications, experienced 2008) have demonstrated its utility hour; however, it can be used for significant reductions in depression in reducing violent behavior, an issue any time period. and anxiety. No side-effects were of particular concern in the criminal While using the Alpha-Stim, the reported by the researchers. justice field. In other areas, such as officers went about their daily office One biological marker for high- using CES to reduce correctional tasks. However, driving a car or heavy risk drug abuse is the presence officer stress, no studies have been equipment is not recommended of low P-300 waves on the EEG. published. while using the Alpha-Stim. Braverman et al. (1990) used While it is not intended to replace CES to treat substance abusers METHOD pharmacological interventions, it and found significant increases in Research Question can be highly effective, substantially P-300 amplitudes secondary to Would the application of CES less expensive and will generally treatment. Specifically, there were reduce depression and anxiety in a produce fewer and less severe side- positive changes in the Alpha, county sheriff’s jail security and patrol effects than many medications. Beta, Delta, and Theta bandwidths. officers? These results suggested CES As Giordano (2006) reported, the produced positive global changes Subjects “microcurrent waveform activates in the patients’ cortical functioning The subjects were 21 volunteer (Continued on page 11) THE CORRECTIONAL PSYCHOLOGIST 11 MEMBER ARTICLE

CES... (Continued from page 10) particular groups of nerve cells feelings of inadequacy and self- were completed while the officers that are located at the brainstem deprecation. were on-duty. All treatment and These groups of nerve cells Depression: measures symptoms of control group members received a produce the chemicals serotonin clinical depression such as dysphoria, $20 Wal-Mart gift certificate upon and acetylcholine which can affect and a lack of motivation. completion of 20 sessions and the chemical activity of nerve Anxiety: measures symptoms such as post-treatment assessments. cells at nearby and more distant nervousness, tension, apprehension, Only one subject was removed sites in the nervous system” (see and panic. from the study. After the third Figure 1). These actions modulate Hostility: measures anger and other session, the subject reported the brain and encourage the related negative feelings. increased levels of agitation production of Alpha waves which Phobic Anxiety: measures irrational secondary to treatment. The help an individual focus and remain fears and avoidant behaviors. literature was reviewed, covering relaxed, an excellent mental state Paranoid Ideation: measures sus- approximately 5,000 subjects, for handling stress. As the picture piciousness, delusions, hostility, and and one similar incident has been below demonstrates, the Alpha- thought projection. reported. Stim modulates brain activity by Psychoticism: measures withdrawal, Pre-assessments were increasing serotonergic activity interpersonal alienation, psychosis, administered 2 days before (5-HT). This increase enhances and thought dysfunctions. treatments began. Because officers the Alpha (8-13 Hz) bandwidth The three BSI global scales are: completed their treatments on necessary for a relaxed and focused Global Severity Index (GSI): it is the different days, post-assessments mental state. In juxtaposition, most sensitive indicatory of stress were taken the week following each it also inhibits cholinergic and and like the other global scales, subject’s final treatment session. noradrenergic systems which draws data from a number of the are involved in the production of clinical scales. Hypotheses agitation and aggression (see Positive Symptom Total (PST): Two tiers of hypotheses Figure 1). It appears, at this time, this scale gives the total number were tested. The first tier of that the Alpha-Stim SCS may be of symptoms endorsed by the test four hypotheses compared the producing a more global modulation taker. treatment group with the sham effect on the brain than the more Positive Symptom Distress Index control group: targeted effects of pharmacological (PSDI): this scale provides information treatments. on a patient’s tendency to minimize 1. The treatment group, com- or exaggerate stress by the subject. pared to the sham control Dependent Variables group, will have lower BSI The BDI, BAI, and BSI were used Administration of Treatment anxiety scores. as dependent variables. The BAI Subjects in both the treatment 2. The treatment group, com- and BDI are both single dimensional and control groups completed 20 pared to the sham control assessment instruments. sessions using the Alpha-Stim SCS, group, will have lower BSI The BSI is composed of a and each session lasted 20 minutes. depression scores. depression and an anxiety scale The Alpha-Stim units were loaned to 3. The treatment group, com- as well as measures of seven the experimenters by Electromedical pared to the sham control additional clinical scales. It also has Products International, Inc. The group, will have lower BAI three global scales. The BSI clinical experimental and control group anxiety scores. scales are: units were factory pre-set at the 4. The treatment group, com- Somatization: measures stress lowest therapeutic level (10 uA) pared to the sham control from physical ills. preventing manipulation by subjects. group, will have lower de- Obsessive/Compulsive: measures The control group received a non- pression scores. thoughts and/or actions that are therapeutic level of current. The unremitting and unwanted. time of day for treatment was set by Interpersonal Sensitivity: measures individual subjects and all sessions (Continued on page 12) 12 THE CORRECTIONAL PSYCHOLOGIST MEMBER ARTICLE

CES... (Continued from page 11)

DECREASED AROUSAL AGITATION

Figure 1: Pathways Activated and Inhibited by CES* The above arrows indicate down, but the “Xs” above present and noradrenergic systems). electro-current pathways in cortical and sub-cortical areas in *Electromedical Products cortical and sub-cortical areas. which CES inhibits the thalamo- International granted permission CES not only activates areas of cortical activity which contributes to for the use of this picture. the cortex that calm a person arousal and agitation (cholinergic

Table 1: Comparisons of Mean Differences and Standard Deviations For Focal Group Versus Sham/Sham/ControlControl Group Group Across Across BSI Sub-Scales BSI Sub-Scales M M BSI Sub-Scales Focal SD Sham/Control SD t-value (df=19 SOM .258 ** (.219) .197 ‡ (.293) 0.51 n.s. OC .640 * (.973) .223 * (.301) 1.54 n.s. IS .432 n.s. (.929) .075 n.s. (.290) 1.15 na DEP .516 * (.638) -.138 n.s. (.369) 2.77** ANX .439 n.s. (.834) .103 n.s. (.601) 1.01 n.s. HOS .654 ‡ (1.050) .268 n.s. (.620) 0.99 n.s. PHO .164 n.s. (.644) .240 n.s. (.440) 0.30 n.s. PAR .442 n.s. (.906) .320 ** (.215) 0.41 n.s. PSY .363 ‡ (.564) .060 n.s. (.280) 1.50 n.s. GSI .423 * (.576) .197‡ (.281) 1.10 n.s. PST 9.366 * (11.587) 2.800 n.s. (6.620) 1.53 n.s. PSDI .372 * (.496) .026 n.s. (.383) 1.71 n.s. BECK A/I 4.636 ‡ (8.200) 4.800* (6.560) 0.06 n.s. BECK D/I 5.360 ** (5.32) -.100 n.s. (4.200) 2.49* ‡ p < 05 (1-tailed); *p<.05 (2-tailed); **p<.01

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CES... (Continued from page 12) Results BDI, confirmed Hypotheses 2 and (Sign test) are provided. The p 4. Hypotheses 1 and 3, regarding <.01, demonstrated a strong trend As seen in Table 1, results of the anxiety, were not supported. In Table toward reductions in all symptoms two depression scales, BSI and 2, the results of the trend analysis but two, BSI Phobia and BAI.

Table 2: Sign Test—Comparisons of Mean Scores for Focal Group Versus Sham/Control Group Across BSI Sub-Scales

M M M Direction of BSI Sub-Scales Focal Sham/Control Differences Differences SOM .258 .197 .060 Down OC .640 .223 .417 Down IS .432 .075 .357 Down DEP .425 -.138 .563 Down ANX. .561 .103 .458 Down HOS .655 .268 .387 Down PHOB .164 .240 .076 Up PAR .442 .320 .122 Down PSY .273 .060 .213 Down GSI .317 .197 .120 Down PSI 9.360 2.800 6.560 Down PSDI .372 .026 .346 Down Beck (BAI) 4.360 4.800 .440 Up Beck (BDI) 5.360 -.100 5.460 Down

Number of differences down = 12; Number of differences up = 2; Number of ties = 0; Sign test: p < .01

Discussion could improve their effectiveness at of being blocked by obsessive Statistically significant results work and at home. thinking patters. Such changes were found on both measures Reductions in other scales could could lead to improved decision of depression (BDI, p<.05 and have ramifications for officers’ quality making. BSI, p<.01), and a Sign test of life both on the job and at home. With lower scores on Hostility, demonstrated a very strong trend The lower Somatization scores one could anticipate improved (p.<01) toward a reduction in other may reflect CES’s ability to provide ability to handle the inherent BSI symptoms. In the broadest officers’ an improvement in their challenges in their jobs and reduce sense, these results may support general sense of physical well being. the risk of officers over reacting. the theory that the Alpha-Stim SCS Reductions in Psychoticism would Reductions in Interpersonal has a global modulating effect on increase cortical control. Cortical Sensitivity scores means officers brain dysfunctions. Officers struggle control means officers would be experienced reduced feelings of with many emotional issues and better able to use logic-based thinking alienation translating into a better these results suggest CES may processes to control their emotions workplace environment for the produce benefits, as noted below. when dealing with highly intense jail officer and his/her colleagues. With reduced depression, situations. While officers must be vigilant, officers could have more energy Changes in the Obsessive/ higher scores on Paranoia suggests for productive activities, as opposed Compulsive scores may reflect a level of personal concern that to spending energy worrying and/ reductions in excessive checking and goes beyond vigilance. Reducing or feeling lethargic. Such a change double checking, as well as a feeling (Continued on page 14) 14 THE CORRECTIONAL PSYCHOLOGIST MEMBER ARTICLE

CES... (Continued from page 13) these scores would help officers transcranial electro-stimulation holic patients. Drug and maintain the healthier levels of improves the efficacy of thermal Alcohol Dependence, 27, 1-6. watchfulness. All three global stress biofeedback and quieting reflex Matteson, M., & Ivancevich, J., indexes indicated reductions in training in the treatment of (1986). An exploratory inves- stress for the officers. classical migraine headache. tigation of CES as an em- American Journal of Electro- ployee stress management Overall, the results were positive medicine, 6, 120-123. technique. Journal of Health regarding depression scores and Childs, A. (1995). Droperidol and and Human Resource Ad- Sign test results. Results may CES in Organic Agitation, Clin- ministration, 9, 93-109. have been stronger had the level of ical Newsletter, Austin Rehab- Mellen, R., & Mitchell, S. (2008). treatment not been permanently set ilitation Hospital. Cranial Electrotherapy Stim- at 10 uA. Also, the small N made Childs, A. (2005). Cranial Elec- ulation: A case study. The Cor- achieving a statistically significant trotherapy Stimulation reduces rectional Psychologist, 40, difference difficult. Finally, while the aggression in a violent re- 4-8. officers in this study had problems tarded population: a prelim- Overcash, S. (1999). A retro- secondary to stress, their issues inary report. The Journal of spective study to determine did not achieve clinical levels. Neuropsychiatry and Clinical the efficacy of Cranial Elec- The ability of CES to bring about neurosciences, 17, 548-551. trotherapy Stimulation (CES) change seems to increase as the Derogatis, L. (1993), Brief Symp- on patients suffering from severity of a patient’s psychological tom Inventory, Minneapolis, MN: anxiety disorders. American dysfunction increases. National Computer Systems. Journal of Electromedicine. Results suggest a follow-up Finn, P. (2000), Issues and prac- 16, 49-51 study using a larger sample could tices: Addressing correctional Passini, F., Frank, G., Watson, produce even stronger evidence for officer stress: Programs and C., & Herder, J. (1976). The the utility of CES as an inexpensive strategies, Washington, DC: effects of cerebral electric and effective treatment for reducing U.S. Department of Justice, therapy (electrosleep) on stress in law enforcement officers. National Institute of Justice. anxiety, depression, and The Sign test revealed a reduction hostility in psychiatric patients. in BSI measured anxiety, but not Giordano, J. (2006), How Alpha- with the BAI. Stim Cranial Electrotherapy Journal of Nervous and Mental Stimulation (CES) works. Disease. 163, 263-266. References From brochure published by Scott, Y. (2004). Stress among Beck, A. (1990). Beck Anxiety Electromedical Products inter- rural and small-town patrol Inventory. San Antonio, TX: national, Inc., Mineral Wells, officers: A survey of Penn- The Psychological Corpora- Texas. sylvania municipal agencies. tion. Griffin, S., & Bernard, T. (2003). Police Quarterly, 7, 237-261. Beck, A. (1996). Beck Depres- Angry aggression among police Van Barcum P. (2008). Critical sion Inventory. San Antonio, officers. Police Quarterly, Incident Stress Management TX: The Psychological 6, 3-21. Team, Ulster County Sheriff’s Corporation. Kirsch, D. (2002). The science Office, Ulster County, New Braverman, E. Smith, R., Sma- behind cranial electrotherapy York. yda, R., & Blum, K. (1990). stimulation. Edmonton, Alberta: Zhao, J. (2002). Predicting five Modification of P-300 ampli- Canada, Medical Scope Pub- dimensions of police officer tude and other electrophys- lishing Co. stress: Looking more deeply iological parameters of Krupitsky, E., Burakov, A., Karan- into organizational settings for drug abuse by cranial elec- dashova, G., Katsnelson, J., sources of police stress. trical stimulation. Current Lebedev, V., Grinenko, A., & Police Quarterly, 5, 43-62. Therapeutic Research. 48, Borodkin, J. (1991). The ad- 586-596. ministration of transcranial Brotman, P. (1989). Low-intensity electric treatment for affective disturbances therapy in alco- (Continued on page 15) THE CORRECTIONAL PSYCHOLOGIST 15 MEMBER ARTICLE

CES... (Continued from page 14)

Ronald R. Mellen Ph.D. is a of CES to manage impulsively violent Criminal Justice, Jacksonville Correctional Psychologist and inmates and reduce officer stress. He State University, Jacksonville, an Associate Professor in the also utilizes qEEG to assess inmates Alabama. He is responsible Department of Criminal Justice, for severe cortical dysfunctions and for all statistics and research Jacksonville State University, treatment. design courses in the Department Jacksonville, Alabama. His Wade Mackey Ph.D. is a visiting Criminal Justice. research focuses on the utilization professor in the Department of

ASSOCIATION UPDATES CONGRATULATIONS DR. EDWIN I. MEGARGEE In your former role as President the International Association for Cor- The first lecture, The Use of of our Association, and for over 40 rectional and Forensic Psychology Risk and Needs Assessment in years as a teacher and researcher, (IACFP), we are extremely proud to Evidence-Based Sentencing, was your seminal contributions to psy- confirm the beginning of what we ex- the featured event at the ICCA chology and criminal justice have pect will be a long series of lectures luncheon banquet, October 20, benefited forensic psychologists, in your name. 2008, at the Millennium Hotel in St. other mental health and correction- The series is titled: The Dr. Edwin Louis, MO. The speaker was the al workers, students and research I. Megargee Honorary Lecture Series, Honorable Michael Wolff, a sitting colleagues around the world. and is scheduled to take place each Justice and former Chief Justice of In honor of your lifetime of contri- year at the International Community the Missouri Supreme Court. butions to our field, and on behalf Corrections Association’s (ICCA’s) of the members and Directors of Annual Research Conference.

DOCTOR ROBERT R. SMITH PRESENTS

Doctor Robert R. Smith, The November 12-14, 2008, in Huntsville, Cognitive Therapy, a therapy that Correctional Psychologist (TCP) Alabama. Smith’s keynote was he and his colleague, Dr. Victor S. Executive Editor, presented the titled: Integrity and the Importance Lombardo, TCP Associate Editor, keynote address for the Alabama of Valuing Every Human Being. He co-founded, and another workshop Department of Corrections also conducted two workshops at on behavior modification Executive Leadership Conference, the conference, one on Rational

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