Effects of an Anger Management Virtual Reality Cognitive Behavioral Therapy Program on EEG Patterns Among Destructive and Impulse-Control Disorder Patients

Integrative cognitive behavior therapy is a well-known and useful tool for the treatment of hostility, anger and aggression. Recent clinical evidence suggests that an immersive anger management virtual reality cognitive behavior therapy program (AMVR-CBTP) is a more effective approach to treating anger management and destructive and impulse-control disorder (DICD). The purpose of this clinical trial was to verify the effectiveness of AMVR-CBTP on cortical activation patterns and associated anger control using advanced QEEG brain mapping and the State Trait Anger Expression Inventory-2 (STAXI-2) measurements, respectively, among individuals with DICD. The intervention included 90 minute sessions three times a week, for a total of six sessions. EEG data were acquired from the scalp using the Geodesic EEG system (GES) Net Amps 400 amplifier and a 32 EEG channels HydroCel Geodesic Sensor Net. EEGs were recorded from 19 electrode sites based on a standard international 10/20 system at a sampling rate of 1000 Hz. Outcome measures indicated that the main differences between the pre- and post-QEEG maps are characterized by notable decrements in slow waves (theta and delta bands). Compared to the pre-QEEG maps, the post-QEEG maps showed normalized delta bands in absolute power and markedly decreased theta bands in both absolute and relative power, which were centered in the vicinity of the prefrontal cortex (PFC) area. This finding was also associated with anger reduction. These results suggest that the intervention may have inhibited impulsive anger control disorder by means of normalizing abnormal brain signals in the PFC area. In conclusion, the AMVR-CBT intervention was effective for restoring abnormal brain activation waves and increasing associated anger control among individuals with DICD. The present QEEG mapping data provide clinical insights indicating that the QEEG mapping analysis was accurate and sensitive to minute changes in the intervention-related progress in both normal and pathological brain electrical signals and activation patterns.