TREATING INTERMITTENT EXPLOSIVE DISORDER WITH NEUROFEEDBACK
Another Psychologist referred a young man for the treatment of Intermittent Explosive Disorder. He had originally been seen in a community mental health crisis center following suicidal threat, during a crisis with a girlfriend. He was moderately guarded, but acknowledged and verbalized a desire to eliminate his explosive behavior, which had on more than one occasion been directed at his girlfriend. While gathering historical information he reported that during childhood he had been abandoned by his mother, who left the family and all but disappeared from his life. He stated he grew up with his father, who was alcoholic and demonstrated an increasing alcohol problem following his early retirement from a utility company. He reported that his father was gruff and at times abusive during childhood and adolescence. The patient reported that his tendency to become angry and ruminate until exploding was, if anything, increasing in frequency and occurred both on the job and in his relationship with his girlfriend. He stated that he felt little control when he became tense, and that he would suddenly lash out verbally, and at times become physically aggressive. He described the aggressive episodes as being preceded by a sense of tension or arousal and followed immediately by a sense of relief.
He stated that later he would feel upset, remorseful, and embarrassed by his aggressive behavior. He reported being employed as a delivery man for a local retail store. Following the short history and concurrence of the diagnosis of Intermittent Explosive Disorder, the concept of electrical activity occurring in the brain and brain waves was introduced to the patient. The ranges and names of EEG activity were explained. He was informed that using EEG Biofeedback for his Intermittent Explosive disorder would facilitate his learning to increase the amplitude of slow brain wave (Alpha and Theta) activity, and facilitate a more relaxed cognitive experience. He was also told that the Neurofeedback involves the surface placement of several sensors (electrodes): two ground/reference sensors placed on the back of the neck (at C-7) and on an ear lobe, and an active sensor placement on the surface of the scalp, from which his EEG activity would be monitored. Once the sensors were placed, he was instructed to relax with his eyes closed, and listen to the computer tones which represent his having surpassed the Alpha and Theta EEG amplitude thresholds set during the training session. He was told that the computer tones he would hear were instantaneous verifications of his having produced the kind of brain wave activity that induces a calm and non explosive state of consciousness, and that his memorizing the sensation of this increase in amplitude would help him gain control of his emotional outbursts.
He was also instructed to engage in at least one 20 to 30 minute daily home session each day. He was told that during these sessions his objective was to produce the same sensation or state of consciousness he experienced during the office sessions. It was emphasized that like most skills, the rapid learning of consciously induced EEG change requires frequent task replication. The patient was told that identifying the tension phase of his episodes was important, and he was instructed to begin learning to identify the sensations and situations that produced his emotional conflict and physical tension increase.
He progressed well through the course of treatment, demonstrating gains in Alpha and Theta amplitudes within the first two training sessions. During session three he described feeling generally calmer during the previous week. In the fourth session he reported that the experience of calmness continued, and during the fifth session he described calmly walking away from situations that would have previously triggered emotional conflict and physical tension. By the end of the sixth session he was ready to begin tapering off session frequency beginning with alternate week training sessions.
While this case is an anecdotal report, it demonstrates the efficiency of EEG Biofeedback as a treatment modality for individuals with Intermittent Explosive Disorder. As I have treated at least a half dozen others with similar results, including a couple using Touch Association Retraining (previously reported), it appears that this viable brief treatment modality with significant ramifications for social and family relationships. Furthermore, the results of these cases suggest that EEG Biofeedback may hold significant promise in reducing spousal/partner and child abuse.