A Pilot Study of Neurofeedback for Chronic PTSD

Abstract

EEG Biofeedback (also known as neurofeedback) has been in use as a clinical intervention for well over 30 years; however, it has made very little impact on clinical care. One reason for this has been the difficulty in designing research to measure clinical change in the real world. While substantial evidence exists for its efficacy in treating attention deficit/hyperactivity disorder, relatively little evidence exists for its utility in other disorders including posttraumatic stress disorder (PTSD). The current study represents a “proof-of-concept” pilot for the use of neurofeedback with multiply-traumatized individuals with treatment-resistant PTSD. Participants completed 40 sessions of neurofeedback training two times per week with sensors randomly assigned (by the study coordinator, who was not blind to condition) to sensor placements of either T4-P4 or T3-T4. We found that neurofeedback significantly reduced PTSD symptoms (Davidson Trauma Scale scores averaged 69.14 at baseline to 49.26 at termination), and preceded gains in affect regulation (Inventory of Altered Self-Capacities-Affect Dysregulation scores averaged 23.63 at baseline to 17.20 at termination). We discuss a roadmap for future research.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

Notes

  1. 1.

    Because the natural-log of zero is undefined, the transformed variable was calculated by takin the natural log of our time variable plus one. The natural-log of 1 is zero; therefore, the intercept for the natural-log model represented outcome levels at the first assessment.

References

  1. Aderka, I. M., Foa, E. B., Applebaum, E., Shafran, N., & Gilboa-Schechtman, E. (2011). Direction of influence between posttraumatic and depressive symptoms during prolonged exposure therapy among children and adolescents. Journal of Consulting and Clinical Psychology, 79(3), 421–425.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Arns, M., de Ridder, S., Strehl, U., Bretelier, M., & Coenen, A. (2009). Efficacy of neurofeedback treatment in ADHD: The effects on inattention, impulsivity and hyperactivity: A meta-analysis. EEG and Clinical Neuroscience, 40(3), 180–189.

    Article  Google Scholar 

  3. Baker, D. G., Diamond, B. I., Gillette, G., Hamner, M., Katzelnick, D., Keller, T., et al. (1995). A double blind, placebo controlled study of brofaromine in the treatment of post traumatic stress disorder. Psychopharmacology (Berlin), 122(4), 386–389.

    Article  Google Scholar 

  4. Bauer, D. J., Preacher, K. J., & Gil, K. M. (2006). Conceptualizing and testing random indirect effects and moderated mediation in multilevel models: New procedures and recommendations. Psychological Methods, 11(2), 142–163.

    Article  PubMed  Google Scholar 

  5. Bisson, J., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner, S. (2007). Psychological treatments for chronic posttraumatic stress disorder: Systematic review and meta-analysis. British Journal of Psychiatry, 190, 97–104.

    Article  PubMed  Google Scholar 

  6. Bradley, R., et al. (2005). A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162(2), 214–227.

    Article  PubMed  Google Scholar 

  7. Briere, J. R. (2002). The Inventory of altered self-capacities: A standardized measure of identity, affect regulation, and relationship disturbance. Assessment, 9(3), 230239.

    Article  Google Scholar 

  8. Davidson, J. R., Book, S. W., Colket, J. T., Tupler, L. A., Roth, S., David, D., et al. (1997). Assessment of a new self-rating scale for post-traumatic stress disorder. Psychological Medicine, 27, 153–160.

    Article  PubMed  Google Scholar 

  9. Davidson, J. R. T., Rothbaum, B. O., van der Kolk, B. A., Farfel, C. R., & Sikes, G. M. (2001). Multicenter, double-blind comparison of sertraline and placebo in the treatment of posttraumatic stress disorder. Archives of General Psychiatry, 58(5), 485–492.

    Article  PubMed  Google Scholar 

  10. Ehring, T., Welboren, R., Morina, N., Wicherts, J. M., Freitag, J., & Emmelkamp, P. M. G. (2014). Meta-analysis of psychological treatments for posttraumatic stress disorder in adult survivors of childhood abuse. Clinical Psychology Review, 34(8), 645–657.  

    Article  PubMed  Google Scholar 

  11. Feingold, A. (2009). Effect sizes for growth-modeling analysis for controlled clinical trials in the same metric as for classical analysis. Psychological Methods14(1), 43–53.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Georgopoulos, A. P., Tan, H. R. M., Lewis, S. M., Leuthold, A. C., Winskowski, A. M., Lynch, J. K., et al. (2010). The synchronous neural interactions test as a functional neuromarker for post-traumatic stress disorder (PTSD): A robust classification method based on the bootstrap. Journal of Neural Engineering, 7(1), 016011.

    Article  Google Scholar 

  13. Goodman, L. A., Cocoran, C. B., Turner, K., Yuan, N. P., & Green, B. L. (1998). Assessing traumatic event exposure: General issues and preliminary findings for the Stressful Life Events Screening Questionnaire. Journal of Traumatic Stress, 11, 521–542.

    Article  PubMed  Google Scholar 

  14. Goodman, L. A., Rosenberg, S. D., Mueser, K. T., & Drake, R. F. (1997). Physical and sexual assault history in women with serious mental illness: Prevalence, correlates, treatment, and future research directions. Schizophrenia Bulletin, 23(4), 685–689.

    Article  PubMed  Google Scholar 

  15. Graap, K., & Freides, D. (1998). Regarding the database for the Peniston alpha-theta EEG biofeedback protocol. Applied Psychophysiology and Biofeedback, 23(4), 265–272.

    Article  PubMed  Google Scholar 

  16. Gruzelier, J. H., Foks, M., Steffert, T., Chen, M. L., & Ros, T. (2014). Beneficial outcome from EEG-neurofeedback on creative music performance, attention and well-being in school children. Biological Psychology, 95, 86–95.

    Article  PubMed  Google Scholar 

  17. Harned, M. S., Jackson, S. C., Comtois, K. A., & Linehan, M. M. (2010). Dialectical behavior therapy as a precursor to PTSD treatment for suicidal and/or self-injuring women with borderline personality disorder. Journal of Traumatic Stress, 23(4), 421–429.

    Article  PubMed  Google Scholar 

  18. Institute of Medicine. (2001). Small clinical trials: Issues and challenges. Washington, DC: National Academy Press.

    Google Scholar 

  19. Jarusiewicz, B. (2002). Efficacy of neurofeedback for children in the Autistic Spectrum: A pilot study. Journal of Neurotherapy, 6(4), 39–49.

    Article  Google Scholar 

  20. Jokic-Begic, N., & Begic, D. (2003). Quantitative electroencephalogram (qEEG) in combat veterans with post-traumatic stress disorder (PTSD). Nordic Journal of Psychiatry, 57(5), 351–355.

    Article  PubMed  Google Scholar 

  21. Jonas, D. E., Cusack, K., Forneris, C. A., Wilkins, T. M., Sonis, J., Cook Middleton, J. et al. (2013). Psychological and pharmacological treatments for adults with posttraumatic stress disorder (PTSD). Comparative Effectiveness Reviews, 92. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK137702/ website.

  22. Kenny, D. A., Korchmaros, J. D., & Bolger, N. (2003). Lower level mediation in multilevel models. Psychological Methods, 8(2), 115–128.

    Article  PubMed  Google Scholar 

  23. Kouijzer, M., de Moor, J. M. H., Gerrits, B. J. L., Congedo, M., & van Schie, H. T. (2009). Neurofeedback improves executive functioning in children with autism spectrum disorders. Research in Autism Spectrum Disorders, 3(1), 145–162.

    Article  Google Scholar 

  24. Lanius, R. A., Williamson, P. C., Boksman, K., Densmore, M., Gupta, M., Neufeld, R. W. J., et al. (2002). Brain activation during script-driven imagery induced dissociative responses in PTSD: A functional magnetic resonance imaging investigation. Biological Psychiatry, 52(4), 305–311.

    Article  PubMed  Google Scholar 

  25. Liverant, G. I., Suvak, M. K., Pineles, S. L., & Resick, P. A. (2012). Changes in posttraumatic stress disorder and depressive symptoms during cognitive processing therapy: Evidence for concurrent change. Journal of Consulting and Clinical Psychology, 80(6), 957.

    Article  PubMed  Google Scholar 

  26. Loo, S. K., Lenartowicz, A., & Makeig, S. (2016). Research review: Use of EEG biomarkers in child psychiatry research–current state and future directions. Journal of Child Psychology and Psychiatry57(1), 4–17.

    Article  Google Scholar 

  27. Mackinnon, D. P., Fritz, M. S., Williams, J., & Lockwood, C. M. (2007). Distribution of the product confidence limits for the indirect effect: Program PRODLIN. Behavior Research Methods, 39(3), 384–389.

    Article  PubMed  PubMed Central  Google Scholar 

  28. MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7(1), 83–104.

    Article  PubMed  PubMed Central  Google Scholar 

  29. McNally, R. J. (2006). Cognitive abnormalities in post-traumatic stress disorder. TRENDS in Cognitive Science, 10(6), 271–277.

    Article  Google Scholar 

  30. Monastra, V. J. (2005). Electroencephalographic biofeedback (neurotherapy) as a treatment for attention deficit hyperactivity disorder: Rationale and empirical foundations. Child and Adolescent Psychiatric Clinics of North America, 14, 55–82.

    Article  PubMed  Google Scholar 

  31. Monastra, V. J., Lynn, S., Linden, M., Lubar, J. F., Gruzelier, J., & La Vaque, T. J. (2006). Electroencephalographic biofeedback in the treatment of attention-deficit/hyperactivity disorder. Journal of Neurotherapy, 9(4), 5–34.

    Article  Google Scholar 

  32. Moriyama, T. S., Polanczyk, G., Caye, A., Banaschewski, T., Brandeis, D., & Rohde, L. A. (2012). Evidence-based information on the clinical use of neurofeedback for ADHD. Neurotherapeutics, 9(3), 588–598.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Peniston, E. G., & Kulkosky, P. J. (1991). Alpha-theta brainwave neurofeedback for Vietnam veterans with combat-related post-traumatic stress disorder. Medical Psychotherapy, 4(1), 47–60.

    Google Scholar 

  34. Rauch, S. L., Shin, L. M., & Phelps, E. A. (2006). Neurocircuitry models of posttraumatic stress disorder and extinction: Human neuroimaging research–past, present and future. Biological Psychiatry, 60, 376–382.

    Article  PubMed  Google Scholar 

  35. Rauch, S. L., van der Kolk, B. A., Fisler, R. E., Alpert, N. M., Orr, S. P., Savage, C. R., et al. (1996). A symptom provocation study of posttraumatic stress disorder using positron emission tomography and script-driven imagery. Archives of General Psychiatry, 53, 380–387.

    Article  PubMed  Google Scholar 

  36. Raudenbush, S. W., Bryk, A. S., & Congdon, R. (2005). HLM 6.0: Hierarchical linear modeling. Lincolnwood, IL: Scientific Software International.

    Google Scholar 

  37. Ros, T. J., Baars, B., Lanius, R. A., & Vuilleumier, P. (2014). Tuning pathological brain oscillations with neurofeedback: A systems neuroscience framework. Frontiers in Human Neuroscience, 8, 1008.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Ros, T., Moniek, A. M., Munneke, D. R., Gruzelier, J. H., & Rothwell, J. C. (2010a). Endogneous control of waking brain rhythms induces neuroplasticity in humans. The European Journal of Neuroscience, 31(4), 770–778.

    Article  PubMed  Google Scholar 

  39. Ros, T., Munneke, M. A. M., Ruge, D., Gruzelier, J. H., & Rothwell, J. C. (2010b). Endogenous control of waking brain rhythms induces neuroplasticity in humans. European Journal of Neuroscience, 31(4), 770–778.

    Article  PubMed  Google Scholar 

  40. Ros, T., Théberge, J., Frewen, P. A., Kluetsch, R., Densmore, M., Calhoun, V. D., & Lanius, R. A. (2013). Mind over chatter: Plastic up-regulation of the fMRI salience network directly after EEG neurofeedback. Neuroimage, 65, 324–335.

    Article  PubMed  Google Scholar 

  41. Schottenbauer, M. A., Glass, C. R., Arnkoff, D. B., Tendick, V., & Gray, S. H. (2008). Nonresponse and dropout rates in outcome studies on PTSD: Review and methodological considerations. Psychiatry, 71(2), 134–168.

    Article  PubMed  Google Scholar 

  42. Shin, L. M., Orr, S., Carson, M. A., Rauch, R. L., Macklin, M. L., Lasko, N. B., et al. (2004). Regional cerebral blood flow in the amygdala and medial prefrontal cortex during traumatic imagery in male and female Vietnam veterans with PTSD. Archives of General Psychiatry, 61, 168–176.

    Article  PubMed  Google Scholar 

  43. Singer, J. D., & Willett, J. B. (2003). Applied longitudinal data analysis: Modeling change and event occurrence. Cambridge: Oxford university Press.

    Google Scholar 

  44. Sonuga-Barke, E. J., Brandeis, D., Cortese, S., Daley, D., Ferrin, M., Holtmann, M., et al. (2013). Nonpharmacological interventions for ADHD: Systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. American Journal of Psychiatry, 170, 275–289.

    Article  PubMed  Google Scholar 

  45. Stein, D. J., van der Kolk, B. A., Fayyad, C., Clary, R., & Austin, C. M. (2006). Efficacy of sertraline in posttraumatic stress disorders secondary to interpersonal trauma or childhood abuse. Annals of Clinical Psychiatry, 18(4), 243–249.

    Article  PubMed  Google Scholar 

  46. Suvak, M. K., Walling, S. M., Iverson, K. M., Taft, C. T., & Resick, P. A. (2009). Multilevel regression analyses to investigate the relationship between two variables over time: Examining the longitudinal association between intrusion and avoidance. Journal of Traumatic Stress, 22(6), 622–631.

    PubMed  Google Scholar 

  47. van der Kolk, B. A., Dreyfuss, D., Berkowitz, R., Saxe, G., Shera, D., & Michaels, M. (1994). Fluoxetine in post-traumatic stress. Journal of Clinical Psychiatry, 55(12), 517–522.

    PubMed  Google Scholar 

  48. Zelazo, P. D., & Cunningham, W. A. (2007). Executive function: Mechanisms underlying emotion regulation. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 135–158). New York: Guilford Press.

    Google Scholar 

Download references

Acknowledgments

Richard Jacobson, Ilya Yacevich, Regina Musicaro, Marla Zucker Ph.D., Hilary Hogdon Ph.D., Janice Stubblefield. This study was supported by a Grant from the ANS Foundation.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Mark Gapen.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gapen, M., van der Kolk, B.A., Hamlin, E. et al. A Pilot Study of Neurofeedback for Chronic PTSD. Appl Psychophysiol Biofeedback 41, 251–261 (2016). https://doi.org/10.1007/s10484-015-9326-5

Download citation

Keywords

  • EEG biofeedback
  • Neurofeedback
  • Treatment outcome
  • Posttraumatic stress disorder
  • Complex trauma