Neurofeedback for Post Traumatic Stress Disorder (PTSD)

This study is a report of an on-going project that provides treatment for US combat veterans. Both PTSD and mild-traumatic brain injury involves a wide range of possible neural dysregulations, and thus, the authors posit that maximal treatment outcome will result from optimal specificity of assessment and treatment. In this study, 11 cases are analyzed and it is found that Loreta Z-Score neurofeedback results in specific neurophysiological normalization in the regions of training and quantified progressive reduction in symptoms. Paired t-tests demonstrate learning occurred in every case. Cohen’s d analyses of current source density improvements quantified large effect sizes in 9 of 10 cases and a moderate effect size in one case.

This study was a randomized, waitlist controlled trial of brain/computer interaction, electroencephalogram neurofeedback training in patients with chronic PTSD to explore the capacity of neurofeedback to reduce PTSD symptoms and increase affect regulation capacities. 52 individuals with chronic PTSD were randomly assigned to neurofeedback or waitlist (control) groups. After 24 sessions of neurofeedback were conducted, it was found that participants in the neurofeedback group treatment showed significant improvements in PTSD symptomatology that had not responded to at least 6 months of trauma-focused psychotherapy, compared to the waitlist group that continued to receive treatment as usual.

The authors examine the reason behind why neurofeedback has made such little impact on approaches to clinical care, noting that designing research to measure clinical change in the real world presents itself as a barrier. As such, this paper offers a “proof-of-concept” pilot for the use of neurofeedback with multiply-traumatized individuals with treatment-resistant PTSD. After completing 40 sessions of neurofeedback training over the course of 2 weeks, the authors found that their protocol significantly reduced PTSD symptoms and preceded gains in affect regulation.

In this review, the authors reviewed the evidence on effectiveness and preferred protocol for neurofeedback treatments geared towards PTSD. After a systematic review of five major databases was undertaken, namely PubMed, PsychInfo, Embase, and Cochrane databases; 5 studies were singled out to form the basis of this review. From this, the authors conclude that neurofeedback is probably an efficacious for ptsd treatment.

In this study, Health university students were randomly assigned to the experimental group, sham group or control group. Participants in the experimental group trained to enhance beta waves at F4 and P4. Attentional performance and MRI data were recorded one week before training and one week after training. Higher scores on auditory and visual sustained attention were present in experiment group. Gray matter volume increases were detected in cerebral structures involved in this type of attention. This study constitutes the first empirical demonstration that neurofeedback training leads to microstructural changes in white and gray matter.

 In this study, veterans whose primary treatment for PTSD was artifact corrected neurofeedback were investigated. Participants underwent 40 half-hour sessions of treatment and were assessed by their auditory and visual performance as well as their general well-being. Assessments after 20 and 40 half-hour sessions showed significant improvements in both visual and auditory attention as well as well-being. Veterans were found to have greater enhancements in auditory vigilance, visual and auditory processing speed, along with visual and auditory focus after both 20 and 40 sessions. Improvements in well-being were significantly correlated with the increase in their overall auditory attention and processing speed. This study showcases the positive therapeutic effects of neurofeedback for veterans with PTSD.

 Post-traumatic stress disorder (PTSD) has been linked to abnormalities within the default mode network, salience network and central executive network within the brain. This study aimed to determine the effectiveness of LORETA z-score neurofeedback (LZNF) on altering these networks and reducing symptoms of PTSD. Twenty-three participants with chronic PTSD were randomly assigned to either 15 sessions of LZNF or heart rate variability biofeedback (HRVB). The LZNF group was found to have statistically significant decreases in PTSD symptoms and abnormal z-scores within the targeted networks compared to the HRVB group. This provides evidence to support LZNF training for adults with chronic PTSD.

 Developmental trauma or chronic early childhood exposure to abuse and neglect can have a long-lasting impact on a child’s mental and neural development. Children with developmental trauma rarely have positive results to current evidence-based psychotherapeutic and pharmacological treatments. This study examined 37 children aged 6-13 years with developmental trauma by dividing them into either active neurofeedback training (NFT) group or a treatment-as-usual control group and underwent 24 sessions twice a week. The NFT group showed significantly decreased PTSD symptoms, internalizing, externalizing, other behavioural and emotional symptoms, as well as increased executive functioning. 

The purpose of this study was to examine the effectiveness of Neurofeedback therapy (NFT) to ameliorate chronic pain in military veterans with traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Forty-one veterans participated in the study and were instructed to perform “mobile neurofeedback” (NTF delivered through a portable EEG headset linked to an application on a mobile device) independently at home for three months. During these three months, subjects completed around 33 NFT sessions, 10 minutes per session and thirty-six veterans returned for follow-up. The results of the study showed that the veterans reported lower levels of pain, pain interference, depression, PTSD symptoms, anger, sleep disturbance, and suicidal ideation compared with baseline participants who did not receive NFT therapy. Veterans also reported reduced pain intensity 67% of the time immediately after the mobile NFT session. This study shows evidence to support the use NFT through mobile devices for individuals with TBI and PTSD. 

There are only a few empirical studies that have examined the effectiveness of neurofeedback therapy in individuals with PTSD but none in individuals with refugee trauma. The current study looked at the pre and post changes in symptoms and cognitive functioning of refugees that underwent neurofeedback therapy (NFT) sessions targeting PTSD. 13 adult refugees with chronic PTSD participated in NFT combined with trauma counseling (TC) and were compared to 13 adult refugees that only received trauma counseling. The results of the study showed that the NFT-TC group exhibited significantly lower symptoms of trauma, anxiety and depression and an improvement in behavioral performance compared to those who only received TC. These results show support for the use of neurofeedback to remediate symptoms of PTSD in refugees.

The purpose of this study was to examine the effectiveness of Neurofeedback training (NFT) on decreasing symptoms of posttraumatic stress disorder (PTSD) in veterans. The researchers randomly selected and assigned thirty patients with PTSD to either the experimental or the control group. The experimental group received twenty sessions of NFT, three days a week and the control group did not receive any NFT training. Before and after the intervention, both groups were evaluated for intensity of symptoms through the post traumatic stress disorder checklist (PCL). The results showed that the experimental group that received NFT had a significantly lower score of total PTSD symptoms suggesting that this form of therapy can be beneficial in reducing PTSD symptoms in veterans. 

The purpose of this study was to examine the effectiveness of neurofeedback training (NFB) for individuals with symptoms of posttraumatic stress disorder (PTSD). Twenty-one adult participants (13 female, 8 males) completed the Davidson Trauma Scale and Inventory of Altered Self-capacities pre and post-NFB training. The participants went through NFB training sessions twice a week for one academic semester. The Neurofeedback training involved decreasing 2-6 Hz and 22-36 Hz while increasing 10-13 Hz with a placement of T4 as the active site and P4 as the reference site. The results of the study demonstrated significant improvement in affect regulation and trauma symptom severity and frequency. 

Veterans experience a considerable course of posttraumatic stress disorder (PTSD), and because of several psychosocial issues, traditional interventions and traditional intervention settings are ineffective for this population. A new cutting-edge approach, known as neurofeedback, trains clients to control and manipulate their central nervous system and ameliorate physiological symptoms of stress disorders. The authors delineate how neurofeedback can be an effective and innovative intervention for PTSD experienced by the military population.

This article discusses positive therapeutic gains made with veterans whose primary treatment for post-traumatic stress disorder (PTSD) was cognitive rehabilitation using artifact corrected neurofeedback. Assessments at baseline and following 20 and 40 half-hour sessions of neurofeedback treatment identified significant improvements for auditory and visual attention using the Integrated Visual and Auditory Continuous Processing Test (IVA-2) and significant improvements in well-being based on the General Well-Being Scale (GWBS). Neurofeedback positively affected veteran's overall auditory attention with auditory test scores reflecting significant improvement following neurofeedback training sessions. Ratings of well-being significantly improved after treatment with 84% of the veterans improving five points or more on the GWBS. Improvements in well-being were found to be significantly correlated with increases in veterans' overall auditory attention and auditory processing speed. By identifying and improving auditory and visual processing difficulties in veterans with PTSD using neurofeedback, improvements in cognitive functioning may hold promise for enhanced employment outcomes.

Novel, effective, and accessible therapeutic interventions for treating posttraumatic stress disorder (PTSD) symptoms are in demand given the significant physical and psychosocial impairment associated with the disorder.  Although PTSD is largely treated with cognitive behavioral therapy (CBT), treatment resistance, or nonresponse rates, continues to remain high.  Research has shown talk therapies can trigger the limbic system, keeping it in a continual state of fight or flight.  Consequently, many trauma survivors seek alternative treatments, such as EEG neurofeedback training.  This study explored the relationship between trauma-related symptoms (i.e., inattention and impulsivity) and visual and auditory functioning in a population of veterans and nonmilitary adults who reported previously being diagnosed with PTSD by a mental health clinician.  Results suggest that EEG neurofeedback therapy is clinically effective for improving visual and auditory attentional functioning in both veterans and nonmilitary adults.  Improved attentional functioning is believed to boost organizational skills, decision-making, frustration tolerance, and comprehension.  This is important given that two-thirds of veterans who complete CBT programs remain in the clinical range for PTSD with notable attention deficits.  Treatment outcome research, such as this study, is vital to improve the effectiveness of therapeutic interventions for persons diagnosed with PTSD, particularly within specific populations that have high nonresponse rates, such as veterans.

Deficits in self and emotion regulation are prominent features of post-traumatic stress disorder (PTSD). Cognitive reappraisal is an effective strategy for emotion regulation and frequently used in cognitive-behavioral treatment. However, PTSD patients often have difficulties reappraising negative stimuli. The lateral prefrontal cortex (LPFC) supports emotion regulation by modulating amygdala activity. In PTSD patients, LPFC responses to emotional stimuli are reduced, along with elevated amygdala responses. Neurofeedback based on real-time functional magnetic resonance imaging (rt-fMRI) enhances cognitive reappraisal and the regulation of amygdala involvement. In the present study, neurofeedback on left LPFC enhanced emotion regulation in PTSD patients. Two cohorts of ten patients with PTSD and 10 healthy controls each trained cognitive control of interference processing or reappraisal of images with negative valence, respectively. For cognitive interference the ACC was trained. For cognitive reappraisal, participants received feedback on their LPFC activity. A cross-over design allowed for comparison between cognitive reappraisal with and without enhancement by neurofeedback. Subjects learned control. In particular, the patients involved fronto-polar structures during ACC regulation more than controls. All subjects activated LPFC during cognitive reappraisal. In particular in the patients, the LPFC activation was stronger under neurofeedback. Results from follow-up catamnesis confirmed good acceptance of the training method. The current study provides first evidence that neurofeedback enhances common psychotherapeutic strategies to improve cognitive and affective regulation in patients with PTSD.

Electroencephalographic (EEG) neurofeedback training has been shown to produce plastic modulations in salience network and default mode network functional connectivity in healthy individuals. In this study, the authors investigated whether a single session of neurofeedback training aimed at the voluntary reduction of alpha rhythm (8–12 Hz) amplitude would be related to differences in EEG network oscillations, functional MRI (fMRI) connectivity, and subjective measures of state anxiety and arousal in a group of individuals with post-traumatic stress disorder (PTSD). Twenty-one individuals with PTSD related to childhood abuse underwent 30 min of EEG neurofeedback training preceded and followed by a resting-state fMRI scan. Alpha desynchronizing neurofeedback was associated with decreased alpha amplitude during training, followed by a significant increase (‘rebound’) in resting-state alpha synchronization. This rebound was linked to increased calmness, greater salience network connectivity with the right insula, and enhanced default mode network connectivity with bilateral posterior cingulate, right middle frontal gyrus, and left medial prefrontal cortex. This study represents a first step in elucidating the potential neurobehavioural mechanisms mediating the effects of neurofeedback treatment on regulatory systems in PTSD. Moreover, it documents for the first time a spontaneous EEG ‘rebound’ after neurofeedback, pointing to homeostatic/compensatory mechanisms operating in the brain.

The study examines the effectiveness of both neurofeedback and motor-imagery brain-computer interface (BCI) training, which promotes self-regulation of brain activity, using low-cost electroencephalography (EEG)-based wearable neurotechnology outside a clinical setting, as a potential treatment for post-traumatic stress disorder (PTSD) in Rwanda. Participants received training/treatment sessions along with a pre- and post- intervention clinical assessment, (N = 29; control n = 9, neurofeedback (NF, 7 sessions) n = 10, and motor-imagery (MI, 6 sessions) n = 10). Feedback was presented visually via a videogame. Participants were asked to regulate (NF) or intentionally modulate (MI) brain activity to affect/control the game. The NF group demonstrated an increase in resting-state alpha 8–12 Hz bandpower following individual training sessions, termed alpha ‘rebound’ (Pz channel, p = 0.025, all channels, p = 0.024), consistent with previous research findings. This alpha ‘rebound’, unobserved in the MI group, produced a clinically relevant reduction in symptom severity in NF group, as revealed in three of seven clinical outcome measures: PCL-5 (p = 0.005), PTSD screen (p = 0.005), and HTQ (p = 0.005). The study produced the first evidence to support a low-cost, neurotechnological solution for neurofeedback as an effective treatment of PTSD for victims of acute trauma in conflict zones in a developing country.

This study aimed to evaluate the effect of neurofeedback training on improving sustained attention of veterans with posttraumatic stress disorder (PTSD). The research design was quasi-experimental with pretest-posttest and control group. The study population consisted of veterans with PTSD who were hospitalized in psychiatric wards. Purposeful sampling method was done to select 30 patients in psychiatric hospitals located in Sadr, Delaram, and Parsa during spring, summer, and autumn of 2014 by considering their arrivals and departures. Then, they were randomly assigned into 2 experimental (n=15) and control groups (n=15). The neurofeedback training by alpha-theta protocol was administered to the experimental group, but the control group did not receive any neurofeedback training. The sustained attention was measured by continuous performance test (CPT). After that, the data was analyzed by multivariate analysis of variance. The results showed that neurofeedback training significantly increased the omission errors (P<0.001, F=17.074), commission errors (P<0.001, F=18.515), and reaction times (P=0.044, F=4.511) in sustained attention and reduced correct detection. According to the findings, the relation between alpha and theta waves, and based on underlying principles, neurofeedback treatment has achieved acceptable results.

The purpose of this study was to use EEG neurofeedback therapy to determine whether healthy soldiers can improve their ability to regulate emotions thus reducing their susceptibility to develop symptoms of Post Traumatic Stress Disorder (PTSD) during their time of service. Previous studies have collected both EEG and fMRI data at the same time and were able to identify a signature of amygdala activity in the EEG data called amygdala electrical fingerprint (EFP). In this study the researchers validated this signature by having healthy soldiers perform this amygdala EFP-EEG neurofeedback while undergoing stressful military training. The study had three cohorts, an experimental amygdala EFP group and two control groups; one of which did not receive any neurofeedback training and the other that underwent an EEG intervention for mood and anxiety disorders. The results of the study showed that after the NFB group underwent 6 sessions of therapy, significant improvements in the measures of emotion regulation were found, including faster reaction times during the emotion-regulation testing version of the Stroop task. Additionally, difficulties in cognitively processing emotion (alexithymia) had decreased compared to the participants’ score before training whereas alexithymia scores increased in the control group that did not undergo neurofeedback training. This study suggests that EFP-EEG neurofeedback is a more cost-efficient way to train healthy soldiers to regulate their emotions in turn decreasing their risk of developing PTSD.

Posttraumatic stress disorder (PTSD) is difficult to treat and current PTSD treatments are not effective for all people. Despite limited evidence for its efficacy, some clinicians have implemented biofeedback for PTSD treatment. As a first step in constructing an effective biofeedback treatment program, respiration, electroencephalography (EEG) and heart rate variability (HRV) as potential biofeedback parameters for a future clinical trial were assessed. This cross-sectional study included 86 veterans; 59 with and 27 without PTSD. Data was collected on EEG measures, HRV, and respiration rate during an attentive resting state. Measures were analyzed to assess sensitivity to PTSD status and the relationship to PTSD symptoms. Peak alpha frequency was higher in the PTSD group (F(1,84) = 6.14, p = 0.01). Peak high-frequency HRV was lower in the PTSD group (F(2,78) = 26.5, p < 0.00005) when adjusting for respiration rate. All other EEG and HRV measures and respiration were not different between groups. Peak high-frequency HRV and peak alpha frequency are sensitive to PTSD status and may be potential biofeedback parameters for future PTSD clinical trials.

Post-traumatic stress disorder (PTSD) is characterized by neurophysiological and psycho-emotional problems after exposure to trauma. Several pharmacological and psychotherapy limitations, such as adverse events and low adherence, increase the need for alternative therapeutic options. Neurofeedback is widely used for PTSD management. However, evidence of its clinical efficacy is lacking. The authors of this study conducted a randomized, waitlist-controlled, assessor-blinded clinical trial to assess the effectiveness, cost-utility, and safety of 16 sessions of neurofeedback on people with PTSD for eight weeks. Eleven participants were allocated to each group. One and two subjects dropped out from the neurofeedback and control groups, respectively. The primary outcome was PTSD symptom change evaluated using the PTSD Checklist-5 (PCL-5-K). The PCL-5-K levels improved more in the neurofeedback group (44.3 ± 10.8 to 19.4 ± 7.75) than in the control group (35.1 ± 18.5 to 31.0 ± 14.92). The change value was significantly improved in the neurofeedback group (24.90 ± 13.13 vs. 4.11 ± 9.03). Secondary outcomes such as anxiety, depression, insomnia, and quality of life were also improved. In an economic analysis using EuroQol-5D, the incremental cost-per-quality-adjusted life-year was approximately $15,600, indicating acceptable cost-utility. There were no adverse events in either group. In conclusion, neurofeedback might be a useful, cost-effective, and safe intervention for PTSD management. 

Dysregulation in amygdala activity plays an important role in individuals with Post Traumatic Stress Disorder (PTSD). This study used Neurofeedback training (NFT) in the form of feedback from an auditory script of a personal traumatic narrative to assist in downregulating limbic activity in PTSD individuals. 59 individuals with PTSD were randomly assigned to three groups; Trauma-script feedback interface (Trauma-NF), Neutral feedback interface (neutral-NF) and a control group (No-NF). All participants were blindly assessed for PTSD symptoms and transferability testing before and after 15 NF training sessions. A clinical assessment was also performed 3- and 6- months post intervention. The results of the study  indicated that participants in both NF groups learned to down-regulate limbic activity and exhibited reduced PTSD symptoms and improved down-regulation of amygdala activity during FMRI-NF compared to the control group. Furthermore, the trauma-NF group displayed the greatest improvement overall. This study suggests that neurofeedback could be used as an intervention for PTSD and demonstrates its clinical potential. 

In this study, 57 trauma center nurses/physicians participated in a 4-day intervention to learn relaxed alertness using mindfulness-based instructions and EEG neurofeedback. Neurofeedback was provided by a Bispectral IndexTM (BIS) system that continuously displays a BIS value (0–100) on the monitor screen. Reductions in the BIS value indicate that power in a high-frequency band (30–47 Hz) is decreased and power in an intermediate band (11–20 Hz) is increased. Mean BIS values were markedly decreased during neurofeedback when compared to baseline values. Post-session relaxation scores were higher than pre-session relaxation scores. Post-session relaxation scores had an inverse relationship with mean BIS values. For all participants, the wellbeing score was higher on day 4 than on day 1. Participants had a higher wellbeing score on day 4 than a larger group of nurses/physicians who did not participate in the BIS neurofeedback trial. 80% of participants demonstrated an improvement in the positive affect or non-stress score on day 4, when compared to day 1; the wellbeing, non-stress, and positive affect scores were substantially higher on day 4 than on day 1. These findings indicate that trauma center nurses/physicians participating in an EEG neurofeedback trial with mindfulness instructions had improvements in wellbeing.

Exposure to traumatic stimuli is so aversive that a significant number of patients drop-out of therapy during the course of treatment. Among various attempts to develop novel therapies that bypass such aversiveness, neurofeedback appears promising. A novel neurofeedback approach called Decoded Neurofeedback (DecNef) allows patients to implicitly regulate multivariate voxel patterns of the BOLD signals related to feared stimuli. DecNef effects are postulated to derive either from exposure or counter-conditioning, or some combination of both. Although the exact mechanism is not yet fully understood. DecNef has been successfully applied to reduce fear responses induced either by fear-conditioned or phobic stimuli among non-clinical participants. A systematic review was conducted to compare DecNef effect with those of conventional EEG/fMRI-based neurofeedback on PTSD amelioration. The authors also conducted DecNef on four PTSD patients. Following DecNef, a significant reduction of PTSD severity was observed. This effect was comparable to those reported for conventional neurofeedback approaches. Although a much larger number of participants will be needed in future, DecNef could be a promising therapy that bypasses the unpleasantness of conscious exposure associated with conventional therapies for fear related disorders, including PTSD.

This study is a systematic review of the literature on the effectiveness of neurofeedback in treating PTSD. Unlike prior reviews, this study focused solely on behavioural outcomes. Neurofeedback has shown promise in alleviating overall PTSD symptoms, including underlying neurobiological consequences. Successful results have been found among clients with PTSD who have not been responsive to prior treatment modalities. While a strong base of clinical anecdotes and case studies supports its success in treating PTSD, intervention studies on neurofeedback have been critiqued for lack of rigor and poor methodological design. Ten studies met the criteria for inclusion in this review. Neurofeedback demonstrated positive results in at least one outcome measure for the majority of participants across all studies. Interpretations, however, are limited by wide discrepancies in sample sizes, study designs, outcome measures, and the extent of reported results. Future research in this area would benefit from prioritizing randomized controlled trials with larger sample sizes and longitudinal follow-up results.

The default-mode network (DMN) and salience network (SN) have been shown to display altered connectivity in posttraumatic stress disorder (PTSD). Restoring aberrant connectivity within these networks with electroencephalogram neurofeedback (EEG-NFB) has been shown previously to be associated with acute decreases in symptoms. A double-blind, sham-controlled randomized trial of alpha-rhythm EEG-NFB was conducted in 36 participants with PTSD over 20-weeks. The aim was to provide mechanistic evidence underlying clinical improvements by examining changes in network connectivity via fMRI. Participants were randomly assigned with a primary diagnosis of PTSD to either the experimental group (n = 18) or sham-control group (n = 18). Resting-state fMRI scans were collected pre- and post-NFB intervention, for both the experimental and sham-control PTSD groups. Significantly decreased PTSD severity scores were found in the experimental NFB group only, when comparing post-NFB and 3-month follow-up scores to baseline measures. Interestingly, there was evidence to suggest a shift towards normalization of DMN and SN connectivity post-NFB in the experimental group only. Both decreases in PTSD severity and NFB performance were correlated to DMN and SN connectivity post-NFB in the experimental group. Critically, remission rates of PTSD were significantly higher in the experimental group (61.1%) as compared to the sham-control group (33.3%). The current study shows mechanistic evidence for therapeutic changes in DMN and SN connectivity that are known to be associated with PTSD psychopathology with no patient dropouts. This preliminary investigation merits further research to demonstrate fully the clinical efficacy of EEG-NFB as an adjunctive therapy for PTSD.

Brain oscillations exhibit long-range temporal correlations (LRTCs), which reflect the regularity of their fluctuations: low values representing more random (decorrelated) while high values more persistent (correlated) dynamics. LRTCs constitute supporting evidence that the brain operates near criticality, a state where neuronal activities are balanced between order and randomness. In this article, healthy adults used closed-loop brain training (neurofeedback, NFB) to reduce the amplitude of alpha oscillations, producing a significant increase in spontaneous LRTCs post-training. This effect was reproduced in patients with post-traumatic stress disorder, where abnormally random dynamics were reversed by NFB, correlating with significant improvements in hyperarousal. Notably, regions manifesting abnormally low LRTCs (i.e., excessive randomness) normalized toward healthy population levels, consistent with theoretical predictions about self-organized criticality. Hence, when exposed to appropriate training, spontaneous cortical activity reveals a residual capacity for “self-tuning” its own temporal complexity, despite manifesting the abnormal dynamics seen in individuals with psychiatric disorder. Lastly, we observed an inverse-U relationship between strength of LRTC and oscillation amplitude, suggesting a breakdown of long-range dependence at high/low synchronization extremes, in line with recent computational models. Together, the findings offer a broader mechanistic framework for motivating research and clinical applications of NFB, encompassing disorders with perturbed LRTCs.

PTSD is a set of continuous and frequent symptoms that occur after experiencing or observing a traumatic event, such as being involved in a war. The aim of this study was to evaluate the effectiveness of Powell's cognitive rehabilitation with neurofeedback in improving executive functions, memory, and attention to veterans with post-traumatic stress disorder. This semi-experimental study, with pre-test post-test design, was carried out on 24 veterans with post-traumatic stress disorder in two experimental and control groups. Powell's cognitive rehabilitation treatment with neurofeedback was performed for 12 sessions and three months for the experimental group. In order to conduct the study, PSSI test, Wisconsin Card Test, Stroop test, and working memory tests were used. Data was analyzed using the univariate covariance analysis and SPSS 24. By controlling the pre-test effects, there was a significant difference between the experimental and control groups in terms of overall score of executive functions, memory and attention (p=0.001). The findings of this study show, Powell's cognitive rehabilitation treatment with neurofeedback is effective in improving executive functions, memory and attention of veterans with post-traumatic stress disorder.

Previous research showed that the self-regulation of amygdala activity via real-time fMRI neurofeedback (rtfMRI-nf) with positive emotion induction was associated, in healthy participants, with an enhancement in the functional connectivity between the left amygdala (LA) and six regions of the prefrontal cortex. These regions included the left rostral anterior cingulate cortex (rACC), bilateral dorsomedial prefrontal cortex (DMPFC), bilateral superior frontal gyrus (SFG), and right medial frontopolar cortex (MFPC). This study performed a structural vector autoregression (SVAR) analysis of the effective connectivity for this network. According to the analysis, rtfMRI-nf training leads to a significant enhancement in the time-lagged effect of the left rACC on the LA. This research suggests that the rACC may constitute a promising target for rtfMRI-nf training along with the amygdala in patients with affective disorders, particularly posttraumatic stress disorder (PTSD).

Reducing alpha-rhythm amplitude using electroencephalogram (EEG) neurofeedback has been shown to alter PTSD associated neural networks, thereby leading to symptom alleviation. It is thought that the amygdala is a crucial brain region mediating PTSD symptoms. Therefore, the objective of the current study was to compare changes in amygdala connectivity using fMRI before and after neurofeedback training, to determine if alpha oscillatory and behavioural changes in patients are associated with subcortical mechanisms. The basolateral (BLA), centromedial (CMA) and superficial (SFA) amygdala complex resting state functional connectivity were examined in 21 individuals with PTSD before and after a 30 minute neurofeedback session targeting alpha desynchronization. It was found that amygdala complex connectivity shifted from areas involved in defensive, emotional and fear processing/memory retrieval, to areas involved in emotion regulation/modulation. This shift was associated with reduced arousal, greater resting alpha synchronization, and a decrease in PTSD symptom severity. Overall, these findings demonstrate that neurofeedback can promote neuronal reconfiguration in brain regions implicated in PTSD, in addition to acute symptom reduction. 

Posttraumatic stress disorder (PTSD) is characterized by insufficient prefrontal top-down modulation of the amygdala. Real-time fMRI neurofeedback (rtfMRI-nf) is an intervention with the potential to modify prefrontal-amygdala interactions. This study reported controlled emotion self-regulation in veterans with combat PTSD using rtfMRI-nf of the amygdala. The experimental group consisted of 20 participants, who had learned to upregulate blood-oxygenation-level dependent (BOLD) activity in the left amygdala (LA) using rtfMRI-nf during a happy emotion induction task. Whereas the 11 participants in the control group were given sham rtfMRI-nf. Participants underwent 3 neurofeedback training sessions with simultaneous EEG and fMRI recordings, and PTSD severity was assessed before and after training using the Clinician Administered PTSD Scale (CAPS). Participants in the experimental group had a significant reduction in CAPS scores following training, particularly in avoidance and hyperarousal symptoms. Further, they exhibited a significant reduction in depression severity. Though 80% of participants in the experimental group had a clinically meaningful reduction in CAPS scores compared to 38% in the control group, there was no significant difference in score changes between the groups. Additionally, the initial rtfMRI-nf session revealed enhanced functional connectivity of the LA with the orbitofrontal cortex and the dorsolateral prefrontal cortex (DLPFC), which was correlated with increased initial CAPS scores. Left-lateralized enhancement in upper alpha EEG coherence was also significantly and positively correlated with initial CAPS ratings. Reduction in PTSD severity was however correlated with enhanced functional connectivity between the LA and the left DLPFC. Overall, this study demonstrates that rtfMRI-nf has the potential to adjust amygdala-prefrontal functional connectivity, and thereby alleviate PTSD symptoms. 

The authors of this study investigated whether a single session of real-time fMRI (rtfMRI) neurofeedback would enhance self-control during exposure to negative stimuli and facilitate the transfer of learned emotional regulation skills to daily life in PTSD patients. Individuals with a PTSD diagnosis after a single traumatic event (n = 20) and individuals without a formal psychiatric diagnosis (n = 21) underwent cognitive reappraisal training. All participants completed two rtfMRI neurofeedback (NF)  runs targeting the left lateral prefrontal cortex (lPFC) and two control runs without NF (NoNF) while using cognitive reappraisal to reduce their emotional response to negative scenes. In comparison to the reappraisal without feedback, a neurofeedback-specific decrease in the left lateral PFC (d = 0.54) alongside an attenuation of amygdala responses (d = 0.33) emerged. Reduced amygdala responses during NF were associated with symptom improvement (r = -0.42) and less negative affect (r = -0.63) at follow-up. The difference in symptom scores exceeds requirements for a minimal clinically important difference and corresponds to a medium effect size (d = 0.64). Importantly, 75% of individuals with PTSD used the strategies in daily life during a one-month follow-up period and perceived the training as efficient. Our findings suggest beneficial effects of the NF training indicated by reduced amygdala responses that were associated with improved symptom severity and affective state four weeks after the NF training as well as patient-centered perceived control during the training, helpfulness and application of strategies in daily life. However, reduced prefrontal involvement was unexpected. The study suggests good tolerability of the training protocol and potential for clinical use in the treatment of PTSD.

The objective of this study was to explore brain activity mediators of the amygdala real-time functional magnetic resonance imaging neurofeedback (rtfMRI-nf) training effect on PTSD symptom reduction in combat veterans. The training program for the experimental group (EG) increased the neurofeedback signal from the left amygdala during positive autobiographical memory recall, whereas in the control group (CG), it was from a control region not implicated in emotion regulation. It was found that symptom reduction was mediated by  low activation in the dorsomedial prefrontal cortex (DMPFC) and the middle cingulate cortex. Further, there was less activation in these regions in the EG compared to the CG. Additionally, low activation in the precuneus, the right superior parietal, the right insula, and the right cerebellum also mediated symptom reduction. It was found that a higher signal was linked to a reduced effect on symptom reduction, and that this effect was not specific to the EG. Lastly, having a comorbid MDD diagnosis was associated with higher DMPFC activation, which resulted in less effective regulation of the feedback signal. Overall, these results indicate that neurofeedback mediated PTSD symptom reduction is not mediated specifically by targeted brain regions, but more broad regions. 

It is known that small hippocampal volume is an abnormality associated with posttraumatic stress disorder (PTSD). However, whether this occurs as a result of disease symptoms, or is a pre-existing risk factor for developing the disease, and whether it is a reversible or permanent trait is unknown. Therefore this study examined longitudinal changes in hippocampal volume following positive emotional training with left amygdala (LA) real-time fMRI neurofeedback (rtfMRI-nf) in combat veterans with PTSD. The experimental group was trained to increase the neurofeedback signal from the LA by recalling a positive autobiographical memory, whereas the control group trained a region not involved in emotion processing. It was found that the left CA1 head region had the most significant reduction in volume at baseline in PTSD. The experimental group had a significant volume increase in this region, whereas the control group had a significant decrease in volume. Further, the volume change in the control group was negatively associated with interval days between the scans. However, no cognitive improvement was associated with the hippocampal volume increase. Overall, rtfMRI-nf positive emotional training increased hippocampal volume in patients with PTSD, suggesting that hippocampal atrophy in PTSD is a modifiable trait.

The objective of this study was to describe a novel real-time functional magnetic resonance imaging neurofeedback intervention for treating and studying PTSD. This intervention involved training participants to control amygdalar activity after exposure to personalized trauma scripts. The study had a limited sample size of 3 combat veterans with chronic PTSD. 2 participants showed clinically meaningful improvements, despite the chronicity of their symptoms, and 1 showed smaller symptom reduction. Further, changes in resting-state functional connectivity patterns revealed a normalization of brain connectivity that was consistent wit clinical improvement. 

The objective of this study was to determine the effectiveness of alpha/theta neurofeedback training (increased theta waves ratio in mid and frontal areas of the brain relative to alpha waves) on PTSD symptoms and executive functioning. This study used a convenience sample of males diagnosed with PTSD in Kermanshah City. Participants were randomly assigned to experimental and control conditions. Participants in the experimental group attended 25 sessions of neurofeedback, each lasting between 30-40 minutes. Participants completed the Impact of Event Scale-Revised, Beck Depression Inventory-II, Wisconsin Card Sorting Test, and Tower of London. It was found that depression and PTSD symptoms significantly improved, though the improvements in depression were lower than PTSD symptoms. 

A central component of PTSD pathophysiology is amygdala dysregulation. Therefore, this study sought to investigate the regulation of emotional states during symptom provocation by targeting amygdala downregulation using real-time fMRI neurofeedback (rt-fMRI-nf) in patients with PTSD. Patients completed three sessions of rt-fMRI-nf with instructions to downregulate amygdala activation while viewing personalized trauma words. Amygdala downregulation was assessed by contrasting (1) regulate trials, with (2) viewing trauma words and not attempting to regulate. It was found that patients were able to downregulate both right and left amygdala activation, and had sustained effects within the transfer run, which followed training and did not involve neurofeedback. Increased activation in dorsolateral and ventrolateral prefrontal cortex (PF) related to emotion regulation was observed during the ‘regulate’ as compared to the ‘view’ conditions. Further, activation in the PFC, rostral anterior cingulate cortex, and the insula, were negatively correlated to PTSD dissociative symptoms in the transfer run. Increased functional connectivity between the amygdala- and both the dorsolateral and dorsomedial PFC was found during the ‘regulate’, as compared with the ‘view’ conditions during neurofeedback training. Lastly, it was found that amygdala downregulation involves both top-down and bottom-up information flow with regard to observed PFC-amygdala connectivity. Overall, this study was the first to demonstrate that the amygdala can be successfully downregulated using rt-fMRI-nf in patients with PTSD and can be sustained into a transfer run without training. This was associated with overall increased connectivity with prefrontal regions involved in emotion regulation. 

PTSD has been associated with disturbances in the central executive network (CEN), default mode network (DMN), and salience network (SN). This study investigated changes in the recruitment of these networks as a function of real-time fMRI neurofeedback (rt-fMRI-nf) during symptom provocation, during which the downregulation of the amygdala was targeted. Fourteen patients with PTSD completed three sessions of rt-fMRI-nf with the following conditions: (1) regulate: decrease activation in the amygdala while processing personalized trauma words; (b) view: process trauma words while not attempting to regulate the amygdala; and (c) neutral: process neutral words. Recruitment of the left CEN increased over neurofeedback runs during the ‘regulate’ condition, which was supported by increased dorsolateral PFC activation during the ‘regulate’ compared to the ‘view’ condition. Contrastingly, DMN task-negative recruitment was stable during neurofeedback runs, the highest during view conditions and increased (normalized) during rest periods. SN recruitment was high for both the ‘regulate’ and ‘view’ conditions. Overall, this study demonstrates that downregulating the amygdala using rt-fMRI-nf in patients with PTSD is associated with dynamic changes in the intrinsic connectivity networks. 

The default mode network (DMN) is frequently disrupted in patients with PTSD. It has been known that the posterior cingulate cortex (PCC) is the main hub of the posterior DMN. However, the therapeutic effect of real-time fMRI neurofeedback in this region was unknown, therefore this study investigated PCC downregulation while processing trauma/stress words. The study consisted of 14 patients with PTSD, and 15 healthy controls, who underwent 3 neurofeedback training runs and one transfer run without training. It was found that both PTSD patients and healthy controls demonstrated decreased reliving symptoms in response to trauma/stress stimuli, though the PTSD group additionally showed reduced symptoms of distress. Further, both groups were able to downregulate the PCC with similar success over the training sessions and transfer run, albeit with increased activation in the right dlPFC among healthy controls as compared to PTSD patients. During PCC downregulation, right dlPFC activation was negatively correlated to PTSD symptoms severity scores and difficulties in emotion regulation.

This study investigated the effect of amygdala-focused real-time fMRI neurofeedback (rt-fMRI-nf) training on resting-state functional connectivity in combat veterans with and without PTSD, who were trained to increase a feedback signal reflecting left amygdala activity while recalling positive autobiographical memories. It was found that  abnormal resting-state connectivity for combat veterans with PTSD was partly normalized after the training. This included hypoconnectivities between the left amygdala and the left ventrolateral prefrontal cortex (vlPFC) and between the supplementary motor area (SMA) and the dorsal anterior cingulate cortex (dACC). The increase of SMA-dACC connectivity was associated with PTSD symptom reduction. Additionally, an increase in connectivity between the precuneus and the left superior frontal cortex was found, which was associated with a decrease in hyperarousal symptoms. Further, abnormal connectivity for combat veterans without PTSD could also be normalized following training. Overall, this study demonstrates that rt-fMRI-nf provides symptom relief for PTSD patients through widespread brain modulation in regions even outside the target feedback area.

The objective of this study was to demonstrate the use of neurofeedback for refugee-related chronic posttraumatic stress disorder (PTSD) in two case studies. It was found that both clients had a significant reduction in PTSD symptoms and demonstrated improvement in daily functioning post-neurofeedback training. Further, quantitative electroencephalographic (EEG) measures indicate a normalization of EEG markers relating to trauma, including overarousal at resting and working memory function. 

The objective of this study was to assess personality changes in Vietnam combat veterans with PTSD after alpha-theta brainwave neurofeedback therapy. The participants were assigned to either the neurofeedback or traditional medical treatment group. It was found that brainwave training for thirty 30-minute sessions resulted in decreases in Minnesota Multiphasic Personality Inventory (MMPI) T-scores on clinical scales of hypochondriasis, depression, hysteria, psychopathic deviate, paranoia, schizophrenia, hypomania and social introversion-extroversion. The traditional medical control group only had decreased T-scores in the schizophrenia scale. Further, all neurofeedback patients initially receiving psychotropic medication reduced their dosages after treatment, whereas only 1 control patient reduced their dosage. At a thirty-month follow up, it was found that all fourteen control patients had relapsed, in comparison to only three of the fifteen neurofeedback patients. Overall, this study found that alpha-theta brainwave training was an effective treatment method for PTSD and prevention of relapse. 

Previous research has identified an electroencephalogram signature in patients with post-traumatic stress disorder where subjects have an abnormally reduced alpha rhythm. Authors of this study conducted a 20-session, double-blind, randomized controlled trial of alpha desynchronization neurofeedback in 39 individuals with diagnosed post-traumatic stress disorder over 20 weeks. Participants were divided into either an experimental group of a sham-controlled group. Resting-state activity was recorded both prior to and after neurofeedback treatment for both groups. The authors found significant alpha resynchronization within areas that displayed abnormally low alpha power at baseline in the experimental group only. Furthermore, they saw significantly decreased post-traumatic stress disorder severity scores both post-treatment and at the three-month follow-up in individuals in the experimental group. These results suggest that that neurofeedback training can improve reduced alpha rhythmicity in post-traumatic stress disorder. 

One of the neural markers of post-traumatic stress disorder (PTSD) is the hyperactivation of the amygdala. Improvement in the control of amygdala activity has been correlated with treatment success in PTSD. As such, this randomized, double-blind, clinical trial aimed to evaluate the efficacy of real-time fMRI neurofeedback as an intervention for PTSD. Twenty-five patients with PTSD were recruited and divided into an active experimental group and a control group. The active group completed three sessions of neurofeedback training designed to train control over amygdala activity while the control group received three sessions of a sham training protocol. They found significantly greater improvements in control over amygdala activity in the active group compared to the control group 30-days after treatment. Moreover, both groups showed significant reductions in PTSD symptoms. These findings suggest the potential of using neurofeedback as a treatment for alleviating PTSD symptoms. 

In the study, the researchers aimed to investigate the effects of a therapy called neurofeedback (NFB) on individuals with posttraumatic stress disorder (PTSD). NFB has been shown to normalize abnormal brain activity related to PTSD during rest. However, there is limited evidence on the effects of NFB when individuals are exposed to emotionally relevant cognitive tasks. Therefore, this study conducted a double-blind trial where participants underwent alpha-down NFB, and their brain activity was measured before and after the therapy. During the therapy, participants performed a working memory task that included emotionally neutral and trauma-related cues while undergoing functional magnetic resonance imaging (fMRI). The analysis included 35 participants with a primary diagnosis of PTSD, with 18 in the experimental group receiving alpha-down NFB and 17 in the sham-control group. The results showed significant reductions in PTSD symptom severity scores for the experimental group after the therapy, which persisted at the three-month follow-up. The neuroimaging analysis revealed that alpha-down NFB improved the engagement of cognitive and emotional control centers in the brain, such as the dorsolateral prefrontal cortex, and enhanced integration of different brain networks. Furthermore, better performance in alpha-down NFB correlated with increased activity in brain regions involved in top-down control and bodily consciousness. The study suggests that alpha-down NFB has the potential to be an effective adjunctive therapy for PTSD, emphasizing the need for further research to explore its therapeutic effects on cognitive and emotional regulation in individuals with PTSD.