A sensational title
Cranial
Electrotherapy
Stimulation
as a treatment for
Three Violent Inmates
Ronald R. Mellen and Aubrey Leah Simmons
There are multiple types of aggressive inmates, including the predatorial and impulsively violent. This article reviews three single case studies of violent jail inmates who volunteered for treatment utilizing a cranial electrotherapy stimulation (CES) device. The studies were completed between 2008 and 2021. In each of the three inmates studied, positive changes in clinical measures and reductions in aggressive behaviors were found.
Three Inmate Studies The three inmates discussed in this article were recommended by their county sheriffs and have a history of violence and drug abuse. One of the most common descriptors of all three inmates was: “He is always involved in every fight.”
Treatment The CES treatment device is a handheld instrument that uses a 9-volt battery to produce a proprietary electric current, and its use was the same for each inmate. The electrical current encourages relevant neurons to produce higher levels of the neurotransmitter serotonin. The increased serotonin creates a calming effect on brain functioning.
The treatment also reduces cholinergic activity in the thalamo-cortical circuit (anxiety and stress). Increasing serotonin levels—and at the same time reducing cholinergic activity—reduces aggressive behaviors and increases positive decision-making skills. There are more than 100 published studies where the device was used as a treatment for psychological dysfunctions and pain management (Kirsch, 2002).
Methodology The three inmate studies all followed the same basic design using the device as the treatment variable. The dependent variables measured changes in personality traits, clinical symptoms, and executive functioning. Self-assessments and assessments by others were sometimes completed. In one study, Quantitative Electroencephalogram Test (qEEG) readings were taken pre- and post-treatment.
First Case Study: Inmate RR The subject was a 19-year-old Caucasian of average height and weight with no physical or apparent cognitive disabilities. He was never married. The subject’s family was composed of biological parents, two stepparents, two sisters, and two stepsisters. During his childhood, he lived with his mother and stepfather (Mellen & Mitchell, 2008).
He described his mother as an intermittent recovering alcoholic and his stepfather as a chronic marijuana abuser. His biological father had a history of methamphetamine abuse and had at least one criminal conviction. The inmate reported an extensive history of fistfights with his biological father. RR’s experiences are similar to the life experiences of the other offenders in this overview.
The CES treatment device is a handheld instrument that uses a 9-volt battery to produce a proprietary electric current.
RR described his childhood as unhappy, painful, and hard to remember, and himself as active, aggressive, irresponsible, rebellious, and stubborn. He reported problems with getting along with others, experienced frequent nightmares, and suffered from a chronic intense fear of failure. When he was 13 years old, he was brutally initiated into a gang.
Arrested at age 14, he was sentenced to boot camp for violent behavior and substance abuse issues, but eventually went AWOL. He fought on the streets, especially when drugs were involved. His nose has been broken twice, and he stated that he has had “more black eyes than he can count.”
RR reported two serious incidences of head trauma. The first was at the age of four years when a horse kicked him in the head. The injury required 48 stitches to the left eyebrow area. The injured area was near the orbitofrontal cortex, which is involved with controlling emotions. The second injury occurred when he was 17 years old and was a passenger in a car wreck.
His drug history included marijuana, cocaine, pills, opiates, and barbiturates. He began using crack cocaine and methamphetamines at the age of 17. Most recently, he was using meth intravenously.
RR had been court ordered to complete the detention center’s substance abuse treatment program. If he failed, he was to be transferred immediately to the state prison system. If he successfully completed the program, he would be sent home. The director of the detention center related RR’s experiences in the treatment program prior to starting the CES treatment. He noted that in this program inmates resided in pods with a population of 8 to 10 inmates.
During the first week, RR was involved in a physical altercation. As a result, he was assigned to Administrative Segregation (Ad Seg) for 40 days in order “to think things over.” Upon release he was involved in a second fight and received 40 additional days in Ad Seg. He was again released from Ad Seg at which time he attacked a jail security officer and threatened the officer’s wife.
The director liked the young inmate, but the sequence of events had exhausted his patience. He told RR that this would be his last Ad Seg. If he engaged in any aggressive behavior, he would be sent immediately to state prison. The inmate stated he did not care if he went to prison. However, on his release from Ad Seg, RR volunteered for the CES treatment.
Treatment Program. The inmate completed 15 treatments with each lasting 40 minutes. All treatments were completed within a 45-day period. The dependent variables included the 16 Personality Factors Inventory, inmate personal self-assessments, and behavioral assessments by the substance abuse program leader.
Results. Post-treatment results from the 16 Personality Factors Inventory indicated support for the following changes: increases in warmth, emotional stability, spontaneity, social boldness, openness to change, affiliativeness, and self-discipline. Also, decreases were observed in threat sensitivity, tension, and apprehensiveness.
A weekly assessment of the inmate was completed by the substance abuse program leader who noted that prior to the third treatment session the inmate stated he felt “more natural” and less agitated. The inmate found himself sharing his thoughts with other members in his pod. On the fourth day of treatment, he reported an increased ability to concentrate. By the fifth day, he reported he felt less negative toward other people. On the eighth day of treatment, the subject volunteered to be a part of a new inmate suicide watch.
RR’s self-assessments included the issues of anger, anger control, calmness, anxiety, coping skills, and patience. The range was from a score of 1, which indicated serious trouble with the issue being addressed, to a score of 10 that indicated no negative symptoms. His beginning daily mean was 3.6 and his average at the completion of treatment was 7.1. The program staff saw a significant increase in positive behaviors and thinking, which led the inmate to his promotion to pod leader.
Second Case: Inmate DH The second subject was a 31-year-old male Caucasian with a long history of drug use and violent behavior (Ruckers, Mellen, & Manners, 2010). His current charge was attempted capital murder of a deputy sheriff officer. His father died of a heroin overdose at the age of 36 years and his mother died in a motorcycle accident. The inmate also stated his jail incarcerations were too numerous to count. The research staff had significant doubts regarding the possibility of a positive outcome due to his age and history of violent behavior.
The program staff saw a significant increase in positive behaviors and thinking, which led the inmate to his promotion to pod leader.
Methodology. The treatment variable was CES. The dependent variables were the BRIEF-A (executive functioning), the Brief Symptom Inventory (clinical symptoms), the 16 PF (personality factors), and the Mini-qEEG (a measure of cortical activity). Inmate DH received 12 CES sessions over the course of 20 days. Each session lasted 45 minutes.
Findings. The calming effects of the CES treatment were apparent in the qEEG readings. Positive global modulation effects were found, as demonstrated by the following bandwidth readings: Delta dropped 40%, Theta was reduced by 25%, Alpha was reduced by 17%, and Beta dropped 12%.
Changes in Delta, Theta, and Alpha suggested an improvement in alertness when interacting with the environment. The BRIEF-A results showed reductions from the clinical range to normal functioning in four domains related to executive functioning: ability to self-inhibit, increased cognitive flexibility, ability to control emotions, and ability to self-monitor. DH’s scores on the 16 PF showed positive reductions in tension, vigilance, and the need for privacy. His results also indicated willingness to trust others, liveliness, emotional stability, and social boldness.
The inmate’s BSI’s nine clinical measures were, initially, all in the extreme negative range (64–80). Under normal circumstances two scores in the clinical range would call for a full psychological assessment. The post-treatment results showed eight of his clinical scores were within the normal range: insomnia, obsessive-compulsive, depression, anxiety, hostility, phobia, paranoia, and psychasthenia. DH’s post-treatment debriefing remarks included:
• “My legs don’t bounce up and down all the time like they used to.”
• “I’m less agitated.”
• “Even though my brain used to be more active, I now get more things accomplished.”
Five years after completing the CES treatment the principal investigator received the following unsolicited missive from DH:
“Don’t know if you’ll remember me, but I participated in a research study between 2006 and 2011. When I look back it seems surreal. And now things are drastically different. I can be found five years almost to the day later in a positive light from the same newspaper [article]. Since my release, I have custody of my nine-year-old daughter and another daughter turning one in May. I am married to a wonderful woman who has started an organization to help people suffering, I am the compliance officer at a court-ordered nonprofit and work full time as an optician at a practice where all my talents and abilities are utilized. (I am able to manage the optical department, develop the web presence, administer the network, service the high-tech optical equipment, plus much more. As well, I am the resident maintenance technician at a very nice apartment complex.) All I know is that sometimes I look back and it is amazing.”
A remarkable change in behavior for a 31-year-old individual whose prior years were composed of violence and drug use.
Third Case Study: Inmate DT The subject was a 22-year-old Caucasian male. He had a history of serious drug abuse and frequently engaged in violent behavior, which contributed to his numerous encounters with law enforcement. He also stated that he has lost count of how many times he had been in jail. However, he was proud of the fact that he only been sent to prison once (Mellen, Kimberly, & Hill, unpublished study).
Methodology. The independent variable was also a CES device. The dependent variables were Brief Symptom Inventory, BRIEF-A, Trauma Symptom Checklist, Emotion Identification Scale, and a daily inmate self-assessment.
Treatment Application. The inmate received 10 Alpha-Stim treatments each lasting 40 minutes.
Results. The dependent variables showed positive changes in the BSI’s Clinical Scales of Somatization, obsessive-compulsive thinking, depression, and hostility. His results showed improved interpersonal-sensitivity.
BRIEF-A results showed significant improvement in his ability to inhibit his behaviors, his ability to shift his thinking (flexibility in thinking), and working memory. His Emotion Identification Scale was close to normal, 7 out of 10. DT’s scores on the Trauma Symptom Checklist fell within the non-offender range and he showed no evidence of suicidal thoughts.
Post-treatment assessments by jail security officers noted he had demonstrated positive behavioral changes and no longer created trouble in the jail. Such improvements in psychological functioning and general cooperation suggests that this device can ensure the jail security officers jobs and inmates are safer.
Summary While the above summaries are from single-case studies, treatments using a CES device produced significant and positive changes in the emotions and behaviors in the three inmates. As noted above, these changes not only proved helpful to the inmates but reduced the risk of harm to the jail security staff.
References
Kirsch, D. (2002). The science behind cranial electrotherapy stimulation, 2nd edition. Edmonton, Alberta, Canada: Medical Scope Publishing Corporation.
Mellen, R., & Mitchell, S. (2008, October). Cranial electrotherapy stimulation as treatment for non-predatorial violence and aggression in a county detention center inmate: A case study. The Correctional Psychologist, 40(4), 4–8.
Ruckers, J., Mellen, R., & Manners, K. (2010). Improved pre-frontal functioning, reduced clinical symptoms, and reductions in excessive alpha and theta bandwidth activity secondary to an alpha-stim SCS treatment regimen with a violent/aggressive jail inmate: A single case study. The Correctional Psychologist, 42(2), 8–15.
_____________________________ Ronald R. Mellen, Ph.D., is a retired correctional psychologist professor from the Department of Criminal Justice Jacksonville State University in Alabama. He can be contacted at hobbits6@bellsouth.net.
Aubrey Leah Simmons MA, ICPS, is an office assistant, researcher, and adjunct faculty in the Department of Criminal Justice & Forensic Investigation at Jacksonville State University in Alabama. She can be contacted at Asimmons17@jsu.edu.