Rage: Rage treatment

When Lyle first sought neurofeedback and counseling, he presented with a myriad of problems that included severe anger with frequent uncontrollable rage, unrelenting fear, voices and songs in his head, restless sleep, psoriasis and a strong, unpleasant body odor that he could not get rid of, regardless of the number of showers. His marriage was more unimportant than unhappy, and he had no friends other than the regulars he saw at his AA meetings. He presented himself as unattached, instrumental, wary and desperate.

“I am running on pure fear.” 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 at 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.

During the initial interviews there was little sense that he could feel empathy or put himself in another’s shoes. He was entirely pre-occupied with his own survival which seemed mysteriously but constantly under threat. His lack of affect regulation suggested that neurofeedback training would focus on the right hemisphere and eventually on the right pre-frontal cortex. What follows are session summaries of neurofeedback training, much of it in Lyle’s own words. Most training was done either at the right temporal lobe and/or the right pre-frontal cortex. Protocol decisions in terms of what frequencies to reward depended on his response to the prior session. In his case, all changes that were made through the course of training involved dropping frequencies that we rewarded which, in turn, helped him to quiet his baseline state of arousal.

Session 1: After his first thirty minute session and while still in the chair Lyle said, “I am calmer. The chatter is gone. This is powerful stuff”.

Sessions 2-7: He reports that he feels no resentments and although he had been sorely provoked several times, he had had no rage reactions. This surprised him. He said that he was handling daily stress better; that his eyes weren’t darting as much and that he startled less. His voice was still loud, his body odor was bad, his sleep was still restless, and he continued to talk at me. I reduced the frequency which was rewarded.

Sessions 8-11: I introduced pre-frontal training at session 8. He reports what he calls “a ‘be here now’ sensation”. “I am neutral, a huge void and waiting; waiting to be part of society. I feel deeper; more within myself.” Remarkably, after the introduction of the right pre-frontal training, his body odor disappeared. Lyle described it as “the smell of fear.” He was, however, still impatient and driving twenty miles over the speed limit. He defended his driving by saying he liked it that way, aggressively cutting off inquiry as he had been known to cut off drivers.

Sessions 12-32: “I dream Space Race.” Space Race is the name of the video game that Lyle had chosen for feedback. I had been slowly dropping reward frequencies and changing placements, all on the right frontal and temporal areas. He reported that the songs were still playing, but less often and less insistently. At session 24, he reported nearly immobilizing fear and said he felt rage when he couldn’t capture the gem in the video game. This gratuitous arousal suggested that he could benefit from training at even lower frequencies and I made the change.

Sessions 33-43: At session 35, Lyle reported that he has been anxious to come to see me and to train. “My life has been quieter because I have gotten so much quieter.” He also spoke about loneliness, a new emotion for him, even as he was noticing that people seem more attracted to him. He didn’t have anyone who he felt would understand what he was experiencing within himself and with the brain wave training and now he found he really wanted that person in his life. He struggled with the notion that he had to learn to love himself and that that should suffice. Through this period of approximately three weeks, he also reported feeling closer to me, and feeling a level of emotional intimacy that was “a completely new experience”. Sleep and songs both got quieter. He began marathon training which included running up a steep hill six times in a row, and he reported that this was easy to do.

Sessions 44-75: Lyle reported, “I feel great. He said, “I am new at this relating business.” At session 55, he commented directly on what seemed like a fundamental shift in orientation from the instrumental to the interpersonal: “I feel much better when I come here because of my closeness with you and because of the training. I used to think it was all the training; that you didn’t matter.” This session was 7 months after Lyle began neurofeedback. He talked now of his younger brother with great tenderness. “It must be empathy. It’s new to me.”

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