Evaluation of Neurofeedback for Posttraumatic Stress Disorder Related to Refugee Experiences Using Self-Report and Cognitive ERP Measures

Abstract

Background. Neurofeedback holds promise as an intervention for the psychophysiological dysfunction found in posttraumatic stress disorder (PTSD). Few empirical studies have assessed the efficacy of neurofeedback for PTSD, and none in individuals with refugee trauma. A proposed mechanism for neurofeedback efficacy in PTSD is through remediating deficits in cognitive control. We assessed pre- and postchanges in symptoms and neurocognitive functioning of refugee clients participating in a neurofeedback intervention for PTSD. Methods. Clinical data for 13 adult refugees with chronic PTSD who participated in neurofeedback combined with trauma counseling (NFT) was compared with 13 adult refugees placed on a waitlist to receive neurofeedback. Waitlist clients continued to receive trauma counseling alone (TC). NFT was additionally assessed pre- and posttherapy for changes in event-related potentials (ERPs) and behavioral indices of cognitive control using a visual continuous performance task (VCPT). Comparison VCPT data from healthy controls (HC) was available from the Human Brain Index database. Results. Posttherapy, NFT had significantly lower symptoms of trauma, anxiety, and depression compared with TC. NFT demonstrated an increased P3 amplitude and improved behavioral performance suggesting a normalization of cognitive control. Conclusions. These preliminary observations are consistent with a possible benefit of neurofeedback for remediating PTSD. This may be achieved at least partially by an improvement in cognitive control. Further confirmation of the effectiveness of the treatment now requires a randomized controlled trial that considers issues such as placebo response, nonspecific therapist effects, and duration of treatment.

Sharpening Working Memory With Real-Time Electrophysiological Brain Signals: Which Neurofeedback Paradigms Work?

“…These studies mainly investigate the decoding method of single-trial responses ( Brandmeyer et al, 2013 ) as well as the neural mechanism underling reward stimuli ( Moser et al, 2014 ; Zioga et al, 2019 ; Wang et al, 2021 ). Research in the literature demonstrates broad applications of ERP-based NF training in cognitive deficits, including Attention-deficit/hyperactivity disorder (ADHD), Post-traumatic stress disorder (PTSD), and Subjective cognitive decline (SCD) ( Askovic et al, 2020 ; Pei et al, 2020 ; Deiber et al, 2021 ). The main challenge of developing NF training using ERP is designing reward functions associated with components of ERP as the adjustment target in single-trial responses.…”

Is There Evidence for EEG-Neurofeedback Specificity in the Treatment of Internalizing Disorders? A Protocol for a Systematic Review and Meta-Analysis

“…EEG-NFB is widely believed to work predominantly through operant conditioning, a type of associative learning whereby the probability of some given electrical behavior is modified via a temporally associated reinforcing stimulus (Alkoby, Abu-Rmileh, Shriki, & Todder, 2018;Enriquez-Geppert, Huster, & Herrmann, 2017;Orndorff-Plunkett et al, 2017). Although the use of EEG-NFB for IDs in routine clinical psychiatric practice has yet to receive widespread support (Arns et al, 2017;Begemann, Florisse, van Lutterveld, Kooyman, & Sommer, 2016;Omejc, Rojc, Battaglini, & Marusic, 2019), there is substantial evidence that EEG-NFB is efficacious (e.g., Askovic et al, 2019;Bell, Moss, & Kallmeyer, 2019;Cheon et al, 2017;Chiba et al, 2019;Hou et al, 2021;Noohi, Miraghaie, Arabi, & Nooripour, 2017;Orndorff-Plunkett et al, 2017;Panisch & Hai, 2018;Reiter, Andersen, & Carlsson, 2016;Ros et al, 2017;Schoenberg & David, 2014;Tolin, Davies, Moskow, & Hofmann, 2020;van der Kolk et al, 2016;Wang et al, 2019).…”

Is There Evidence for the Specificity of Closed-Loop Brain Training in the Treatment of Internalizing Disorders? A Systematic Review

“…EEG-NFB is widely believed to work predominantly through a form of associative learning known as operant conditioning whereby the probability of some given (neural) behavior is modified via a temporally associated reinforcing stimulus ( Enriquez-Geppert et al, 2017 ; Orndorff-Plunkett et al, 2017 ; Alkoby et al, 2018 ). Although the use of EEG-NFB for IDs in routine clinical psychiatric practice has yet to receive widespread support ( Begemann et al, 2016 ; Arns et al, 2017 ; Omejc et al, 2019 ), there is substantial evidence that EEG-NFB might be efficacious ( Schoenberg and David, 2014 ; Reiter et al, 2016 ; Van Der Kolk et al, 2016 ; Cheon et al, 2017 ; Noohi et al, 2017 ; Orndorff-Plunkett et al, 2017 ; Ros et al, 2017 ; Panisch and Hai, 2018 ; Askovic et al, 2019 ; Bell et al, 2019 ; Chiba et al, 2019 ; Wang et al, 2019 ; Tolin et al, 2020 ; Hou et al, 2021 ).…”