PTSD
Post-traumatic stress disorder treatment: neurofeedback for trauma recovery, emotional regulation, and clinical protocols.
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Showing 6 of 42Amygdala downregulation training using fMRI neurofeedback in post-traumatic stress disorder: a randomized, double-blind trial
Zhao, Zhiying, Duek, Or, Seidemann, Rebecca, Gordon, Charles, Walsh, Christopher, Romaker, Emma, Koller, William N., Horvath, Mark, Awasthi, Jitendra, Wang, Yao, O'Brien, Erin, Fichtenholtz, Harlan, Hampson, Michelle, Harpaz-Rotem, Ilan (2023) · Translational Psychiatry
Hyperactivation of amygdala is a neural marker for post-traumatic stress disorder (PTSD) and improvement in control over amygdala activity has been associated with treatment success in PTSD. In this randomized, double-blind clinical trial we evaluated the efficacy of a real-time fMRI neurofeedback intervention designed to train control over amygdala activity following trauma recall. Twenty-five patients with PTSD completed three sessions of neurofeedback training in which they attempted to downregulate the feedback signal after exposure to personalized trauma scripts. For subjects in the active experimental group (N = 14), the feedback signal was from a functionally localized region of their amygdala associated with trauma recall. For subjects in the control group (N = 11), yoked-sham feedback was provided. Changes in control over the amygdala and PTSD symptoms served as the primary and secondary outcome measurements, respectively. We found significantly greater improvements in control over amygdala activity in the active group than in the control group 30-days following the intervention. Both groups showed improvements in symptom scores, however the symptom reduction in the active group was not significantly greater than in the control group. Our finding of greater improvement in amygdala control suggests potential clinical application of neurofeedback in PTSD treatment. Thus, further development of amygdala neurofeedback training in PTSD treatment, including evaluation in larger samples, is warranted.
View Full Paper →Neurofeedback for post-traumatic stress disorder: systematic review and meta-analysis of clinical and neurophysiological outcomes
Askovic, Mirjana, Soh, Nerissa, Elhindi, James, Harris, Anthony W. F. (2023) · European Journal of Psychotraumatology
Background: Posttraumatic stress disorder (PTSD) is a debilitating condition affecting millions of people worldwide. Existing treatments often fail to address the complexity of its symptoms and functional impairments resulting from severe and prolonged trauma. Electroencephalographic Neurofeedback (NFB) has emerged as a promising treatment that aims to reduce the symptoms of PTSD by modulating brain activity.Objective: We conducted a systematic review and meta-analysis of ten clinical trials to answer the question: how effective is NFB in addressing PTSD and other associated symptoms across different trauma populations, and are these improvements related to neurophysiological changes?Method: The review followed the Preferred Reporting Items for Systematic Reviews and Meta analyses guidelines. We considered all published and unpublished randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) involving adults with PTSD as a primary diagnosis without exclusion by type of trauma, co-morbid diagnosis, locality, or sex. Ten controlled studies were included; seven RCTs and three NRSIs with a total number of participants n = 293 (128 male). Only RCTs were included in the meta-analysis (215 participants; 88 male).Results: All included studies showed an advantage of NFB over control conditions in reducing symptoms of PTSD, with indications of improvement in symptoms of anxiety and depression and related neurophysiological changes. Meta-analysis of the pooled data shows a significant reduction in PTSD symptoms post-treatment SMD of -1.76 (95% CI -2.69, -0.83), and the mean remission rate was higher in the NFB group (79.3%) compared to the control group (24.4%). However, the studies reviewed were mostly small, with heterogeneous populations and varied quality.Conclusions: The effect of NFB on the symptoms of PTSD was moderate and mechanistic evidence suggested that NFB leads to therapeutic changes in brain functioning. Future research should focus on more rigorous methodological designs, expanded sample size and longer follow-up.
View Full Paper →16 Aberrant emotional memory encoding in a transdiagnostic sample of patients with intrusive memories
Smith, Alicia J., Bisby, James A., Dercon, Quentin, Bevan, Anna, Dalgleish, Tim, Hitchcock, Caitlin, Nord, Camilla (2022) · Journal of Neurology, Neurosurgery & Psychiatry
Emotion can affect the way in which experiences are stored in our memory. The dual representation account proposes that traumatic events may be encoded as fragmented sensory-perceptual details without a broader conceptual organisation. This can result in involuntary retrieval of perceptual information triggered by environmental cues without the associated context – a phenomenon referred to as intrusive memories.Currently, it is unknown whether individuals who experience intrusive memories have an underlying vulnerability to aberrant memory encoding, which may lead to the onset or maintenance of symptoms.In Experiment 1, we examined memory recall for neutral and negative images in a transdiagnostic sample of patients with intrusive memories (N = 36), compared to healthy controls (N = 44). Clinical diagnoses in the patient sample included Post-Traumatic Stress Disorder, Major Depressive Disorder, Social Anxiety Disorder, Generalised Anxiety Disorder, Panic Disorder and Other Specified Feeding or Eating Disorders. We excluded participants currently taking psychotropic medication. At encoding, participants viewed neutral, negative and mixed valence image pairs. In the test phase, participants were presented with cues and, if recognised, were asked to recall the associated image. We found a significant group effect, with patients demonstrating impaired item memory for negative images [F(1,280) = 4.435, p = 0.036], relative to healthy controls. This group difference might suggest that individuals with intrusive memories experienced greater sensitivity to negative stimuli, leading to disruptions in memory encoding. Recent work highlights attention maintenance on threat and high levels of threat-related emotional arousal in anxiety- and fear-related disorders which may be one factor driving the disruption to item memory observed in our clinical population.For Experiment 2, in a separate sample of healthy participants (N = 18) we measured eye-tracking behaviour during the encoding phase of the same task. Healthy participants showed greater item memory [F(3, 136 = 2.893, p = 0.0377] and avoidance of fixation [F(1, 110) = 4.898, p = 0.029] on highly arousing, negative stimuli relative to neutral. This might suggest that a shift in attention away from negative stimuli prevents item memory impairments for emotional information.Our future work will identify biological factors driving attentional biases and higher emotional arousal in clinical populations.
View Full Paper →Case Report: Infra-Low-Frequency Neurofeedback for PTSD: A Therapist's Perspective
Spreyermann, Regula (2022) · Frontiers in Human Neuroscience
The practical use of a combination of trauma psychotherapy and neurofeedback [infra-low-frequency (ILF) neurofeedback and alpha-theta training] is described for the treatment of patients diagnosed with complex post-traumatic stress disorder (C-PTSD). The indication for this combined treatment is the persistence of symptoms of a hyper-aroused state, anxiety, and sleep disorders even with adequate trauma-focused psychotherapy and supportive medication, according to the Guidelines of the German Society of Psycho-Traumatology (DeGPT). Another indication for a supplementary treatment with neurofeedback is the persistence of dissociative symptoms. Last but not least, the neurofeedback treatment after a trauma-focused psychotherapy session helps to calm the trauma-related reactions and to process the memories. The process of the combined therapy is described and illustrated using two representative case reports. Overall, a rather satisfying result of this outpatient treatment program can be seen in the qualitative appraisal of 7 years of practical application.
View Full Paper →Differential mechanisms of posterior cingulate cortex downregulation and symptom decreases in posttraumatic stress disorder and healthy individuals using real-time fMRI neurofeedback
Nicholson, Andrew A., Rabellino, Daniela, Densmore, Maria, Frewen, Paul A., Steryl, David, Scharnowski, Frank, Théberge, Jean, Neufeld, Richard W. J., Schmahl, Christian, Jetly, Rakesh, Lanius, Ruth A. (2022) · Brain and Behavior
BACKGROUND: Intrinsic connectivity networks, including the default mode network (DMN), are frequently disrupted in individuals with posttraumatic stress disorder (PTSD). The posterior cingulate cortex (PCC) is the main hub of the posterior DMN, where the therapeutic regulation of this region with real-time fMRI neurofeedback (NFB) has yet to be explored. METHODS: We investigated PCC downregulation while processing trauma/stressful words over 3 NFB training runs and a transfer run without NFB (total n = 29, PTSD n = 14, healthy controls n = 15). We also examined the predictive accuracy of machine learning models in classifying PTSD versus healthy controls during NFB training. RESULTS: Both the PTSD and healthy control groups demonstrated reduced reliving symptoms in response to trauma/stressful stimuli, where the PTSD group additionally showed reduced symptoms of distress. We found that both groups were able to downregulate the PCC with similar success over NFB training and in the transfer run, although downregulation was associated with unique within-group decreases in activation within the bilateral dmPFC, bilateral postcentral gyrus, right amygdala/hippocampus, cingulate cortex, and bilateral temporal pole/gyri. By contrast, downregulation was associated with increased activation in the right dlPFC among healthy controls as compared to PTSD. During PCC downregulation, right dlPFC activation was negatively correlated to PTSD symptom severity scores and difficulties in emotion regulation. Finally, machine learning algorithms were able to classify PTSD versus healthy participants based on brain activation during NFB training with 80% accuracy. CONCLUSIONS: This is the first study to investigate PCC downregulation with real-time fMRI NFB in both PTSD and healthy controls. Our results reveal acute decreases in symptoms over training and provide converging evidence for EEG-NFB targeting brain networks linked to the PCC.
View Full Paper →Amygdala electrical-finger-print (AmygEFP) NeuroFeedback guided by individually-tailored Trauma script for post-traumatic stress disorder: Proof-of-concept
Fruchtman-Steinbok, Tom, Keynan, Jackob N., Cohen, Avihay, Jaljuli, Iman, Mermelstein, Shiri, Drori, Gadi, Routledge, Efrat, Krasnoshtein, Michael, Playle, Rebecca, Linden, David E. J., Hendler, Talma (2021) · NeuroImage. Clinical
BACKGROUND: Amygdala activity dysregulation plays a central role in post-traumatic stress disorder (PTSD). Hence learning to self-regulate one's amygdala activity may facilitate recovery. PTSD is further characterized by abnormal contextual processing related to the traumatic memory. Therefore, provoking the personal traumatic narrative while training amygdala down-regulation could enhance clinical efficacy. We report the results of a randomized controlled trial (NCT02544971) of a novel self-neuromodulation procedure (i.e. NeuroFeedback) for PTSD, aimed at down-regulating limbic activity while receiving feedback from an auditory script of a personal traumatic narrative. To scale-up applicability, neural activity was probed by an fMRI-informed EEG model of amygdala activity, termed Amygdala Electrical Finger-Print (AmygEFP). METHODS: Fifty-nine adults meeting DSM-5 criteria for PTSD were randomized between three groups: Trauma-script feedback interface (Trauma-NF) or Neutral feedback interface (Neutral-NF), and a control group of No-NF (to control for spontaneous recovery). Before and immediately after 15 NF training sessions patients were blindly assessed for PTSD symptoms and underwent one session of amygdala fMRI-NF for transferability testing. Follow-up clinical assessment was performed at 3- and 6-months following NF treatment. RESULTS: Patients in both NF groups learned to volitionally down-regulate AmygEFP signal and demonstrated a greater reduction in PTSD symptoms and improved down-regulation of the amygdala during fMRI-NF, compared to the No-NF group. The Trauma-NF group presented the largest immediate clinical improvement. CONCLUSIONS: This proof-of-concept study indicates the feasibility of the AmygEFP-NF process-driven as a scalable intervention for PTSD and illustrates its clinical potential. Further investigation is warranted to elucidate the contribution of AmygEFP-NF beyond exposure and placebo effects.
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