Dr. Sharrie, Neurotherapist
4701 Wrightsville Ave., Bldg. 1
Wilmington, NC 28403
910 524 5277
PTSD & Neurofeedback
Camp Pendleton’s Deployment Health Clinic: “Clinical practice and observations of
infra-low neurofeedback as an adjunctive treatment.” April 26, 2011, presented to
Combat & Operational Stress Control conference, on 350 active duty service members.
Results: over 350 cases of PTSD with or without TBI were tracked through
neurofeedback training over 10-20 sessions. Over 60 symptom categories were
tracked. Forty-five symptom categories were analyzed quantitatively. Average
effect size of 0.80 was found for the 45 symptom categories. (Typically an effect
size in research of 0.2 is considered small, 0.5 medium, and 0.8 is large).
Briefly, some of the results included 75% of active duty Pendleton Marines showing
significant recovery from PTSD symptoms, and 80% have experienced significant relief
specifically from depression. Statistically, these results exceed what can be achieved
with anti-depressant medication. Moreover, 60-80% of the personnel showed a
significant decrease in a variety of other symptoms (see the table below). The military
has expanded the research to five other bases in the U.S.
Symptom
% of military personnel who had a decrease in symptoms
(comparison of before & after 5 months of neurofeedback)
Suicidal thoughts
75%
Flashbacks
70%
Panic attacks
80%
Agitation
70%
Anxiety & depression 70%
Fears/phobias
60%
Night sweats
80%
Headaches
75%
More specifically,
about one fourth of trainees respond quite rapidly to training, within 10-20
sessions, and the improvement tends to cut across all symptom categories.
about another half of trainees respond at a more typical rate, requiring 20-40
sessions for substantial symptom abatement.
this leaves another quarter of trainees who either respond more slowly or not at
all.
the most common complaints related to sleep quality, involving 200 of the 350
subject. An effect size of 0.8 was obtained
irritability was an issue with 164 subjects, and yielded an effect size of 0.96.
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being unmotivated was a complaint of 114 subjects, and that yielded an effect size
of 1.0
depression symptoms were a complaint of 104, and that yielded an effect size of
0.84.
migraines were a complaint of 84, and that yielded an effect size of 0.5
This plot shows substantial relief from depressive symptoms was obtained by four out of
five participants. The initial quick response time across the board is quite striking. This
uniformity of behavior argues for a common underlying mechanism, one that is clearly
accessible to us in EEG feedback. Antidepressant medication certainly does not work this
fast.
Results of this kind have been obtained for all the classic symptoms of PTSD. However,
the target of neurofeedback is not PTSD per se, but rather physiological disregulation in
general.
“A Pilot Study of Neurofeedback for Chronic PTSD” Mark Gapen, et al, Applied
Psychophysiolology Biofeedback, 40(4), 2016.
Participants were between the ages of 32-64, recruited from the Boston metro area. The
sample was primarily white (N=19) and female (N=15). They were included as having
PTSD if they met criteria on the Davidson Trauma Scale, were medically stable and able
to maintain meds through the course of the study.
Measures used were the
Stressful Life Events Screening Questionnaire (SLESQ), a 13 item self-report
measure self-report designed to elicit information about traumas.
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Davidson Trauma Scale (DTS), a 17 item self-report measure assessing the
presence and severity of PTSD.
Inventory of Altered Self-Capacities (IASC) consists of 63 items on a 5 point
Likert scale assessing disturbed functioning of self to others, including one
subscale ‘Affect Dysregulation’ (AD) as it assesses problems in affect regulation
and control.
‘Changes Observed After Neurofeedback’ was developed for this study and asks
participants to rate over- and under-arousal symptoms on a 5 point Likert scale. It
contains 36 items, the sole purpose being to guide decisions on whether to make
changes to the reward band.
The study employed two groups designed to assess effectiveness of two alternative scalp
placements for sensors (T4-P4 or T3-T4). Post-testing was done after session 40.
Results of the study support the notion that neurofeedback may be a promising addition
to existing treatments for PTSD. Overall, we found that individuals’ PTSD symptoms
were significantly reduced (from a score of 69.14 to 49.26), and that such reductions in
PTSD were related to decreases in affect dysregulation (which went from 23.63 to 17.20).
We were unable to detect statistically significant differences in sensor placements and
both appeared to provide benefit, although there was a trend toward the T4-P4 showing a
larger decrease in symptoms. While 40 sessions of treatment provided significant
decreases in PTSD symptoms, it by no means provided complete recovery. Our sample
consisted of a chronic treatment resistant population, who had received a mean of more
than ten years of therapy. All had significant trauma exposure that resulted in developing
PTSD prior to age 18. The mean time since their primary trauma was more than 27 years.
While we expected the most significant results with hyper arousal symptoms, all three
clusters of PTSD symptoms (intrusion, avoidance, and hyper arousal) were reduced
significantly. In addition, the reductions in PTSD symptoms preceded reductions in
affect dysregulation symptoms. We conjecture that affect regulation appears to be related
to executive functions of the frontal lobes, while our sensor placement was over the
temporal-parietal regions and therefore not likely directly affecting the neural
underpinnings of the executive functioning system. This was the first study to examine
neurofeedback in a non-veteran PTSD population.
“Neurotherapy of traumatic brain injury/PTSD stress symptoms of OEF/OIF
veterans”
J. Neuropsychiatry Clinical Neuroscience, Spring 24(2), 237-240.
Abstract: The Flexyx Neurotherapy System, a novel variant of EEG biofeedback, was
adapted for intervention with seven treatment refractory Afghanistan/Iraq veterans, and
brought about significant decreases in bothersome neurobehavioral and PTSD. It may
help ameliorate mixed trauma spectrum syndromes.
“Alpha-Theta Brainwave Neurofeedback for Vietnam Veterans with Combatrelated PTSD”. Eugene Peniston, Paul Kulkosky. Medical Psychotherapy, 1991, vol. 4,
pp 47-60
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The MMPI was used to assess personality changes in Vietnam combat veterans with
PTSD, after either traditional medical treatment (TC), or alpha-theta brainwave
neurofeedback (BWT). Brainwave training was for 30 half hour sessions resulted in
decreases in MMPI T-scores on all the main clinical scales. The traditional medical
group showed decreased T-score only on scale Sc. All 14 BWT patients initially
receiving psychotropic meds reduced their dosages after treatment, but only 1 of 13 TC
patients reduced dosage. A 30 month follow up study showed all 14 TC patients had
relapsed, in contrast to only 3 of 15 BWT patients. These findings indicated that
application of alpha-theta brainwave training is a more efficacious treatment modality for
PTSD and prevention of relapse.
Understanding the graphs: T-score of 50 is average. Standard deviation of 10. Scores at
70 or above are clinical. The little bar above each graph is the standard deviation.
TC group was given only pre- and post-MMPI, and base rate EEG brain wave measures.
They were also instructed not to use any biofeedback relaxation training during the study.
PTSD and neurofeedback
Dr. Sharrie
Scale
Number
L
F
K
Hs
D
Hy
Pd
Mf
Pa
Pt
Sc
Ma
Si
5
What it measures
‘Lie’ scale. Attempting to portray oneself overly favorably.
(‘Fake bad’) Detects atypical ways of responding
‘Fake good.’ Attempting to deny or exaggerate problems.
Tendency to deny good health and admit to a variety of physical
symptoms (hypochondriacal)
Depression
Somatic complaints, tendency to deny psych or social problems.
Alienation, rebellion
Gender stereotypes patterns (masculine/feminine)
Feeling misunderstood, persecuted, treated unfairly
Anxious, worry, obsess, ruminate
Disturbed thinking, mood, behavior
Activity/energy level, excitability
Introversion, tendency to withdraw from social contact and
responsibilities
Results:
F: only BWT showed a significant decrease and it was lower than TC on post-test. L, and
K were not significant changes.
Hs: Significant decrease in BWT, and significantly lower than TC on post-test.
D: significant decrease in BWT, and a significant between groups post-test.
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Hy had a significant decrease for BWT and was significantly lower than TC on the posttest (p<.05).
Pd, a significant decrease for BWT and a significant difference between groups on posttest.
Mf, a decrease in BWT and lower than TC on post-test.
Pa, BWT scores decreased over time, and were lower than TC on post-test (p<.05).
Pt, BWT decreased significantly and were lower than TC on post-test.
Sc, both groups decreased significantly over time, and BWT had lower scores than TC
post-test (p<.05).
Ma, BWT showed a significant decline across time, and was lower than TC on post-test.
Si, only BWT had a significant decrease.
The PTSD scale showed a significant decline for BWT and it was significantly lower
than TC on post-test.
Medication (antidepressant and anti-anxiety) changes in the group, over time
Group
Increase Decrease No change
BWT (N=15) 0
14
0
TC (N=14)
10
1
2
(The control group had 13 people on meds at the outset of the study.)
30 month follow-up study
Group Relapse No relapse
BWT 3
12
TC
14
0
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Follow up study was by phone contact, monthly for 30 months after completion of BWT.
Subjects were asked to report instances of PTSD symptoms such as flashbacks,
nightmares, anxiety attacks, depression, etc.
“Neurofeedback Treatment & PTSD: effectiveness of neurofeedback on PTSD and
the optimal choice of protocol.” Karen Andersen, Søren Bo, Jessica Carlsson. J. of
Nervous and Mental Disease, Feb. 2016, 24(2), 69-77.
Abstract included: neurofeedback had a statistically significant effect in three of five
studies reviewed. Neurobiological changes were reported in three studies. The optimistic
results presented here qualify neurofeedback as probably efficacious for PTSD treatment.
“The Effectiveness of Neurofeedback Training on Reducing Symptoms of War
Veterans with PTSD.” Zahra Yeganeh, Behrouz Dolatashalee, Ebrahi Dogaheh.
Practice in Clinical Psychology, 4(1), 17-24.
Abstract includes: Patients with PTSD were randomly selected by purposive sampling
method and assigned in experimental (15 persons) and control groups (15 persons). Data
were collected by the Post-Traumatic Checklist (PCL). After the pre-test, the
experimental group received neurofeedback for 20 sessions, 3 days per week. Results
showed differences between adjusted mean of PTSD symptoms in groups posttest by
removing the impact of pretest scores. Conclusions were that our findings show that
neurofeedback training has significantly decreased the score of total symptoms (p<.001).
“EEG alpha-theta synchronization in Vietnam theater veterans with combat-related
PTSD and alcohol abuse.” EG Peniston, et al. Advances in Medical Psychotherapy,
1993, 6, 37-50.
Abstract: 20 Vietnam vets with chronic PSD, all with comorbid alcohol abuse, were
randomly selected. All showed frequent (2-3 times/week) episodes of PTSD symptoms
and had been hospitalized for PTSD an average of five times. They were treated with 30
thirty minute sessions of alpha-theta neurofeedback training. Follow-up interviews with
the patients and their wives or family members were done monthly for 26 months. During
that time only 4 of 20 patients reported a few (1-3) instances of reoccurrence of
nightmares or flashbacks, and the other 16 patients had no reoccurrence of PTSD sx.