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Patients With Anti-Social Personality Disorder Benefit From Extended Neurofeedback

human_brainResearchers report in a clinical case series that patients with anti-social personality disorder benefited from extended quantitative electroencephalography (QEEG)-guided neurofeedback sessions. QEEG-guided neurofeedback provides individually tailored neurotherapy sessions based on a patient’s unique EEG and comparisons to age appropriate, normative databases. This is the first neurofeedback study that I am aware of with this population.

Nine male and 4 female participants (n=13) diagnosed with antisocial personality disorder, aged 19-48, completed 80-120 QEEG-guided neurofeedback sessions. All subjects were medication free, received no other treatments, including psychotherapy, during neurofeedback, and had attended at least 1 other failed treatment (non-neurofeedback) before enrollment in this study. Pre/Post assessments included a clinical interview, QEEG assessment with normative database comparisons (NxLink), Minnesota Multiphasic Personality Inventory (MMPI), Test of Variables of Attention (TOVA), and the Symptom Assessment-45 Questionnaire.

The researchers reported that 12 of 13 subjects who completed treatment experienced remarkable improvements on measures of behavioral impulsivity (reductions in visual and auditory TOVA commission errors) and on all but one of the MMPI clinical scales, such as improvements on psychopathic deviancy, depression, psychasthenia (anxiety), and paranoia. For those more technically inclined, statistically meaningful improvements were noted on the following MMPI scales: L, F, K, Hs, D, Hy, Pd, Pa, Pt, Sc, Ma, and Si. Please see the article for examples of subject improvements reported by several participants. Neurofeedback was also believed to help patients have greater treatment adherence.

A 2-year follow up revealed that the 12 who benefited from treatment continued to do so, while the lone treatment non-responder had ongoing behavioral problems. The researchers did not elaborate further on the details of the 2-year follow up.

Of course, this is a small clinical case series that did not include a control group. Thus, one cannot say, “this caused that.” The methods used in this study suggest that the treatment gains could only be attributed to neurofeedback or a placebo effect (interactions with the researchers). If attributable to a placebo effect, this would one enormous, long lasting effect in this notoriously difficult to treat population! A controlled study will help elucidate more clearly the actual treatment effects.

The study also provided initial potential EEG phenotypes for persons with anti-social disorder. The researchers reported that all participants had excessive frontal alpha, theta, and beta amplitudes, and coherences when compared to a normative database.

Several side notes: You may have noticed the large number of neurofeedback sessions used in this study. This is consistent with my clinical experiences that as the severity of the disorder increases, so does the number of neurofeedback sessions required for successful treatment. For example, Reactive Attachment Disorder (RAD) can require 100 or more sessions, and Autism can require 80 or more sessions (based on my clinical experience). The current study suggests that this may be true with personality disorders. Also, neurofeedback has many names, including “neurotherapy” and “EEG biofeedback.” The researchers in the current study introduced a new name (at least for me) for neurofeedback: neurobiofeedback.

Surmeli, T., & Ertem, A. (2009). QEEG guided neurofeedback therapy in personality disorders: 13 case studies. Clinical EEG and Neuroscience, 40(1), 6-10.

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