Neurofeedback, affect regulation and attachment: A case study and analysis of anti-social personality.

Abstract

Abstract This case study examines the effects of neurofeedback (EEG biofeedback) training on affect regulation in a fifty-five year-old man with a history marked by fear, rage, alcoholism, chronic unemployment and multiple failed treatments. He had been diagnosed with ADHD and attachment disorder and met criteria for anti-social personality disorder. The case will demonstrate the effectiveness of neurofeedback in quieting this man's pervasive fear, his baseline affect, while increasing his ability to regulate affect and enhancing his capacity for adult attachment. His progress will be measured with the Symptom Checklist 90 (SCL-90 R). Keywords: Neurofeedback, EEG biofeedback, fear, rage, affect regulation, attachment disorder, anti-social personality disorder, empathy. Introduction I am running on pure This was one of the first statements Lyle made when he came for his initial assessment. He had sought out neurofeedback training after reading about it on the Internet. He stated that he was the end of his rope. He reported that he had tried psychotherapy, and that talking about his past only made him feel worse. He had tried many medications and they hadn't helped him either. He said, somewhat matter-of-factly, that if neurofeedback didn't help him he would end his life. Neurofeedback is biofeedback to the brain based on the operant conditioning of frequencies which the brain fires. The training process begins with an in-depth clinical assessment that includes a standard clinical and family history, as well as a medical history and a physical status report that covers physiological markers such as sleep, blood pressure, and bowel function. This intake is formulated to give the clinician an overview of the patient's arousal as it manifests emotionally, psychologically and physically. It provides a profile that indicates whether the patient is over or under aroused, has an instability of arousal or mixture of arousal symptoms. When the assessment is completed, sensors are attached to the patient's head to record the real time EEG (electroencephalogram) on a computer. The trainee looks on a second screen a video game that corresponds directly to this EEG and plays the game by shifting the amplitude of targeted frequencies in his brain. Brain frequencies relate to states of arousal. As an example, if someone is making a robust amount of 8-11 Hz (alpha waves) in the right hemisphere, they are likely to feel calm. If they are producing appropriate amplitudes of 15-18 Hz (beta) in the left hemisphere, they are likely to feel alert. The patient is rewarded for increasing appropriate frequencies in the appropriate hemisphere, as established with the assessment, while decreasing frequencies that might interfere with optimal functioning. It was clear from his assessment that Lyle was over aroused and having great difficulty regulating his emotions, particularly and rage. Affect regulation is the province of the right hemisphere (RH). More specifically, rage and are generated (primarily) by the amygdala in the right hemisphere. The right hemisphere is the non-verbal side of the brain,--in the vast majority of people the language centers are in the left hemisphere--and the amygdala is deep in the sub-cortical temporal lobe. This brain topography may provide a clue to why Lyle felt at the end of his rope, particularly with talk therapies. His history and his own report strongly suggested that his fight-flight-freeze RH amygdala was hyper reactive, and that it could not be reached with left hemisphere language. The outcome of this case suggests that neurofeedback training is an effective approach to disorders that are driven by fear. The author agrees with LeDoux (1996), that fear is a core emotion in psychopathology. The results of this case suggest the potential of neurofeedback in all based disorders, across DSM IV categories. Neurofeedback has been clinically demonstrated to be effective with many severe disorders and the mechanism in common may in fact be that neurofeedback enhances affect regulation, particularly the regulation of fear. …