Can Neurofeedback help with Post Traumatic Stress Disorder ?
Neurofeedback was first used to help symptoms of PTSD in the 1980’s. This study published in 1991 compared two groups of Vietnam veteran PTSD sufferers – one received Neurofeedback brain training and the other didn’t. The Neurofeedback group showed significantly greater reduction in symptoms. 2.5 years after the training, PTSD symptoms had returned in only 20% of the Neurofeedback group, compared with 100% of the control group:
This 2009 paper describes two more case studies – a Canadian veteran of the Bosnia conflict and a Marine veteran of Iraq, and includes SPECT scans of the brains of one of the clients showing changes in the brain before and after brain training:-
Othmer, S., & Othmer, S. F. (2009). Post traumatic stress disorder-The neurofeedback Remedy. Biofeedback, 37(1), 24-31. In the USA, a network of hundreds of Neurofeedback therapists are now offering treatment to US Veterans under the banner Homecoming for Veterans. This video explains more about Neurofeedback and PTSD:
What is Post-Traumatic Stress Disorder (PTSD)
PTSD is an anxiety disorder caused by being exposed to a traumatic event, which is then often relived after the event, with feelings like guilt, isolation and irritability, difficultly sleeping and concentrating. Various events can lead to different traumas. From being bitten by a dog, an accident, to war, working as first responder collecting human remains or police officers repeatedly exposed to details of child abuse. What these events have in common, is that each person is ‘exposed to actual or threatened death, serious injury or sexual violence’; one of the criteria of a Post-Traumatic Stress Disorder (PTSD) diagnosis. The DSM-5 provides additional information regarding this criteria:
Exposure to actual or threatened death, serious injury or sexual violence
|Directly experiencing the traumatic event(s)|
|Witnessing , in person, the event(s) as it occurred to others|
|Learning that the traumatic event(s) occurred to a close family member or close friend|
|Experiencing repeated or extreme exposure to aversive details of the traumatic event(s)|
Complex PTSD isn’t a formal diagnosis yet, it is under review for ICD-11 (the 11th Revision of the WHO International Classification of Diseases).
For trauma that occurred in childhood or adolescence tt is also known as Developmental Trauma Disorder, a term coined by Bessel van der Kolk who has long campaigned for such a diagnosis to be recognised and who is an ardent promoter of Neurofeedback for trauma, or Complex Trauma.
It is different from so-called ‘simple’ PTSD in that the patient has suffered long-term traumatic stress, which could include sexual abuse (especially child sexual abuse), physical abuse, emotional abuse, domestic violence, torture or psychological torture.
Neurofeedback is particularly suitable for C-PTSD with protocols to both process the trauma (whether consciously remembered or not), and improve brain regulation to address the long-term symptoms of trauma.
Symptoms of PTSD
Everyone suffering from PTSD experiences different symptoms at various levels, regardless of the nature of the traumatic event(s) or the age of being exposed. The symptoms can appear immediately after the event, or many years after. DSM-5 identifies four different types of symptoms for two age groups; children 6 years and youngsters and adults, adolescents, and children older than 6 years. The symptoms are all associated with the traumatic event(s) and begin or worsen after the traumatic event(s) occurred. The symptoms for adults, adolescents, and children older than 6 years:
|Recurrent, involuntary, and intrusive distressing memories of the traumatic event|
|Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s)|
|Dissociative reactions (flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring|
|Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)|
Persistent avoidance of stimuli
|Avoidance of or efforts to avoid distressing memories, thoughts or feelings about or closely associated with the traumatic event|
|Avoidance of or efforts to avoid external reminders (e.g. people, places) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)|
Negative alterations in cognitions and mood
|Inability to remember an important aspect of the traumatic event(s)|
|Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world|
|Persistent distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others|
|Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame)|
|Markedly diminished interest or participation in significant activities|
|Feelings of detachment or estrangement from others|
|Persistent inability to experience positive emotions|
Marked alterations in arousal and reactivity
|Irritable behaviour and angry outbursts expressed as verbal or physical aggression toward people or objects|
|Reckless or self-destructive behaviour|
|Exaggerated startle response|
|Problems with concentration|
It’s quite normal to experience some of these symptoms when you are exposed to a traumatic event, but usually they subside. When they continue for more than a month a PTSD diagnosis may be made.
Causes of PTSD
It is believed that PTSD symptoms persist when the sufferer has not yet come to terms with the emotions the initial trauma caused. Because the memories and emotions can be strong and painful, it is natural to want to avoid them, especially for people who are not used to or comfortable with acknowledging their emotions. But the further they are pushed away, the worse the PTSD will get. By coming to terms with the trauma you can also regain your sense of control so that the memories of the trauma are no longer controlling your life.
Treatment for PTSD
The best treatment for PTSD helps you to come to terms with the trauma, usually through psychotherapy. Another technique that is relatively new in the UK is Eye movement desensitisation and reprocessing (EMDR), which involves moving the eyes from side to side whilst reliving the trauma. It is believed that the distressing memories are ‘frozen’ on a neurological level, and the therapy ‘unfreezes’ the memories by unblocking the information processing system. The technique sounds simple but EMDR therapists need a high level of skill to help you through the process. Sometimes antidepressant medication will be prescribed to help with the symptoms, but it is acknowledged that this will not address the root causes of the recurring PTSD symptoms.
Neurofeedback for PTSD
The objective with Neurofeedback training for PTSD is the same as that for psychotherapy or EMDR – to process the trauma so it no longer affcets them in the same way. The difference is that Neurofeedback offers a way to do this without having to talk about uncomfortable feelings or reliving them. Neurofeedback training for PTSD would start with a training protocol to calm the client physically and mentally. We would then move onto what we call Alpha-Theta training (as described in the study above) which encourages the client to enter a very relaxed state. In this state, any images of the trauma do not normally have the emotions usually attached to them, and the memory is ‘reprogrammed’ as a historic one. The number of sessions required would depend on the severity of the symptoms and how well the client responds to Neurofeedback, but we would recommend 20 sessions.
Read Adam’s story of how Neurofeedback with BrainTrainUK helped him.
More case studies can be read here.