Study Review: A Randomized Controlled Study of Neurofeedback for Chronic PTSD

A recent study led by Bessel van der Kolk, M.D. is the first randomized clinical trial on neurofeedback with a specific focus on chronic, treatment-resistant PTSD. Bessel van der Kolk is a world-renowned trauma researcher who has devoted his career to a search for effective treatment for this population. He has researched Prozac, EMDR, and yoga and discusses all of these, as well as neurofeedback, in his New York Times Science Best Seller, The Body Keeps the Score.

In the randomized clinical trial of neurofeedback that he led in 2016, he demonstrates a 40% increase in executive function after 24 sessions of neurofeedback, which translates to increased capacity to modulate emotions, better cognitive function, and better judgment. All of these results have profound implications for the treatment-resistant trauma population and, given its size and the interwoven role that trauma plays in public policy, for society at large.
 

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The team at van der Kolk’s Trauma Center in Brookline, MA focused on those who were suffering chronic PTSD, excluding those with histories of brain injury and substance abuse, to explore both the impact of the treatment and the cost of implementing it.

The study states that: “The equipment does cost less than $10,000 USD. If further research confirms the results from our study, neurofeedback has the potential of becoming widely available in community settings since it can be economically administered by well-trained technicians in small offices and clinics.”

In her book, Neurofeedback in the Treatment of Developmental Trauma, Sebern Fisher supports this claim, concluding that neurofeedback is an ideal therapeutic modality for therapists to use in their private practices as well as in schools, prisons, halfway houses, and shelters. Mental health practitioners can learn how to implement neurofeedback, typically in a four day intensive, which they follow-up with mentoring. The regulatory benefits to the brain allow the patient to begin the heavy lifting of other therapeutic modalities, or as is the case for many children, not to require them at all.

van der Kolk’s study fills a vital research niche. These are “the untreatable patients”, meaning those who receive only limited benefit from the treatments more widely available today.

They fill our shelters, our hospitals and our prisons. Neurofeedback practitioners and patients who have experienced its benefits have been clamoring for a randomized clinical trial (the holy grail for proof of effectiveness for a treatment modality) that would stand up to the detractors of neurofeedback and to the dominant paradigm of psychopharmacology.
In its section titled “Future Directions”, the van der Kolk study points out that:
“Clarifying to what degree NF induced psychological changes are correlated with specific changes in neural activity will be a complex scientific challenge akin to correlating the clinical effects of various psychiatric medications with specific neurochemical changes in the brain.”
The study again places its seminal findings within the larger narrative of mental health research:
“In an emerging new framework mental disorders are considered to be driven, at least in part, by abnormalities in underlying neural circuits [55]. A concerted effort is currently underway to map these networks, the so-called ‘human connectome project’ [56,57].”

There was a second groundbreaking neurofeedback study published in 2016. This one was led by Ruth Lanius, M.D., PhD, and in it she shows that the brains of people who have endured these histories profile differently than the brains of people who have not. Their amygdalas (the fear center of the brain) are hyper-connected to threat detection centers in the lower regions of the brain. These patients who present with dissociation are wired for threat and therefore they see threat where a healthy person would not. In the Lanius study, one session of neurofeedback showed changes in connectivity in 80% of subjects. Their amygdalas now showed beginning connectivity to the pre-frontal cortex. The prefrontal cortex is "command central" in healthy people.

 Both the van der Kolk and Lanius studies are landmarks in the field of trauma.

Put simply: the van der Kolk study shows that neurofeedback works for trauma patients where other treatments have failed and the Lanius study shows how neurofeedback makes changes in the traumatized brain. These studies may well change the way we understand the impacts of early childhood trauma and how to treat them.
For a deeper understanding of how neurofeedback and psychotherapy are integrated to treat abuse and neglect, take a look at Sebern Fisher’s book, Neurofeedback in the Treatment of Developmental Trauma and visit: www.sebernfisher.com to see vetted books written by other leading experts in this specific subset of the trauma research field.

(STUDY DETAILS: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0166752#pone.0166752.ref056
 

Neurofeedback works: Van der Kolk

POSTED on  www.attachmentdisorderhealing.com

Psychiatrist and trauma expert Bessel van der Kolk, MD, posted a webinar on neurofeedback August 9 which knocked me out. It changes the whole map on trauma healing. It may come down soon; please check it asap: http://neurofeedback2015.kajabi.com/fe/79711-rewiring-the-brain-free-ce-seminar.

[Or try this link to a 5 min intro. His  72-min seminar is below at “Click Here to Begin Your Free One Hour CE Seminar”http://neurofeedback2015.kajabi.com/fe/80095-support-neurofeedback-research-2015]
Please forward this your lists of therapists, colleagues, anyone interested in healing. Dr. Van der Kolk has promoted EMDR, yoga, and body work for decades. Now folks with early trauma can check out neurofeedback.

I’ve so far done 10 months of neurofeedback and the healing is enormous. But it’s not known enough or funded. Getting word out could stop suffering.
At minute 20, Van der Kolk shows graphics on how Sebern Fisher introduced him to neurofeedback. “She showed me drawings that traumatized kids did of their families (stick figures), then how they developed after 20 weeks of neurofeedback (real people), after 40 weeks (an attached group), and I was blown away by their development,” he says.
“There’s nothing I know that can do that,” he says. “When you see something like that, you pay attention. Can my psychoanalysis do that?  Can my acceptance and commitment therapy do that?  Can my friends who do EMDR or Somatic Experiencing do that? No. Nothing I know of can do THAT. Time to learn new things.”

My earlier blog on neurofeedback with links to Sebern Fisher interviews and locator pages to find a practitioner are here: http://attachmentdisorderhealing.com/neurofeedback/
I got a shock as Van der Kolk described “ways of being” which I have in spades, but never knew are symptoms of brain disorganization. Here’s what Van der Kolk said that knocked me for a loop:
“Our brain is shaped by human interactions, by the way that people respond to us, to rhythms, voices, touch, sounds, how we make music together.  We are rhythmic machines; I talk to you and move my hands, my face, and I image you responding in kind."

“But if you talk to your partner and they freeze their face, your mind goes blank — because we need feedback… If the world does not respond to you, if people do not smile at you, if as a little kid  when you come home people say, “Oh, you again”?  You miss the experience of being in tune with people. It goes to the very core of our central nervous system.”

At this point (6 minutes in) I had to lay down on the floor and sob for 10 minutes. It totaled me.  I had no attunement experiences until I was 4  1/2 and my sister was born. No responses, no rhythm.
“If you have many attunement experiences,” he says, ” when you get scared, someone’s there so the feeling gets repaired; someone gets mad but soon they repair it, then you get a sense of flow with other people. You know we can do things together, we can work things out. You know I can have a voice because my voice has an impact on you. You can have a voice because your voice has an impact on me.”

Again I was sobbing. What is he talking about?  Have a voice, what’s that?  I never had an impact. Work things out?  Unheard of.  I’m terrified at mis-attunement. I have no experience that what I feel matters.

In abuse or neglect, he says, “these neural rhythms get broken. The most important parts of the brain to grow in first years of life get you in tune with people, tell you what to be scared of, when to feel safe, how to connect, how to be in synch.”  I was never in synch.
At minute 15:30  he shows astonishing brain scans. He says they show that when normal people hear a strange sound (“eeek”), they need to figure out what it means, “so all the different parts of the brain synchronize to focus on that. They’ve developed an N-200 filtering wave that says ‘ignore your phone, your hunger… just pay attention to this sound.’

“But traumatized people have enormous problems filtering out irrelevant information. They are hyper-stimulated by sounds, sights, images, body sensation, have a terrible time filtering them out. As you see here, traumatized people have very different wave forms. Different parts of the brain are not in synch… which explains why they have such a hard time learning from new experiences… taking new information into the brain, paying attention, taking in life as it comes, learning from it.”
That’s me. I’m hyper-stimulated by sounds, sights, images, body sensation. Half the time I can’t filter them out.  This last point really concerns me.  I had no idea that most people can filter out these things.

I just called my neurofeedback therapist and told him that I need a lot more help. “I’m afraid both of us under-estimate how disorganized my brain is,” I said. “You may want to try other areas of my brain for your sensors and/or other procedures” during neurofeedback.

Thank Heaven for neurofeedback and fighters like Dr. van der Kolk.