The impact of neurofeedback training on children with developmental trauma: A randomized controlled study.

Abstract

Objective: Developmental trauma or chronic early childhood exposure to abuse and neglect by caregivers has been shown to have a long-lasting pervasive impact on mental and neural development, including problems with attention, impulse control, self-regulation, and executive functioning. Its long-term effects are arguably the costliest public health challenge in the United States. Children with developmental trauma rarely have a satisfactory response to currently available evidence-based psychotherapeutic and pharmacological treatments. Neurofeedback training (NFT) is a clinical application of brain computer interface technology, aiming to alter electrical brain activity associated with various mental dysfunctions. NFT has shown promise to improve posttraumatic stress disorder (PTSD) symptoms. Method: This randomized controlled study examined the effects of NFT on 37 children, aged 6 -13 years with developmental trauma. Participants were randomly divided into active NFT (n ϭ 20) or treatment-asusual control (n ϭ 17). Both groups underwent 4 assessments during equivalent timelines. The active group received 24 NFT sessions twice a week. Results: This pilot study demonstrated that 24 sessions of NFT significantly decreased PTSD symptoms, internalizing, externalizing, other behavioral and emotional symptoms, and significantly improved the executive functioning of children aged 6 -13 years with severe histories of abuse and neglect who had not significantly benefited from any previous therapy. Conclusions: NFT offers the possibility to improve learning, enhance self-efficacy, and develop better social relationships in this hitherto largely treatment-resistant population. Clinical Impact StatementAbuse and neglect of children by caregivers often have long-lasting and pervasive effects on mental and neural development, including problems with attention, impulse control, self-regulation, and executive functioning. Impairment of affect regulation is thought to be the largest obstacle to effective intervention. In this pilot study of neurofeedback for polysymptomatic children with such histories, we found a significant improvement on affect regulation and executive functioning after 24 sessions of neurofeedback treatment. This offers the possibility of being able to improve learning, enhance self-efficacy, and develop better social relationships in this hitherto largely treatment resistant population.

A randomized, controlled trial of alpha-rhythm EEG neurofeedback in posttraumatic stress disorder: A preliminary investigation showing evidence of decreased PTSD symptoms and restored default mode and salience network connectivity using fMRI

“…In this preliminary investigation, we report that alpha-rhythm EEG-NFB led to reductions on PTSD severity scores as well as increased rates of PTSD remission for the experimental NFB group. Our data qualitatively replicate previous clinical trials of EEG-NFB in patients with PTSD ( van der Kolk et al, 2016 , Rogel et al, 2020 ) and extend the mechanistic insights from our previous neuroimaging studies investigating a single session of alpha desynchronizing EEG-NFB ( Ros et al, 2013 , Kluetsch et al, 2014 ). Critically, aberrant DMN and SN connectivity patterns detected among PTSD patients at baseline (compared to healthy controls) in the current trial were found to shift towards normalization after active NFB treatment.…”

“…Indeed, dropout rates from psychological therapies in PTSD remain a critical barrier to recovery ( Bisson et al, 2013 , Goetter et al, 2015 , Lewis et al, 2020 ). Finally, our EEG-NFB trial remission rates (61.1%) are comparable to those of current, gold standard treatments for PTSD ( Bradley et al, 2005 , Ehring et al, 2014 , van der Kolk et al, 2016 , Rogel et al, 2020 ). Taken together, NFB may represent a valuable adjunctive treatment for PTSD, where it has been suggested previously that NFB may be especially beneficial for PTSD patients experiencing high levels of anxiety, dissociation, and emotion dysregulation related to less optimal response to other forms of trauma-focused therapy ( van der Kolk et al, 2016 , Rogel et al, 2020 ).…”

“…Indeed, this notion is supported directly by research in the field of neurofeedback (NFB) aimed at modulating such ICN dynamics in PTSD, where results of these studies suggest that NFB may indeed be a fruitful treatment approach ( Peniston and Kulkosky, 1991 , Ros et al, 2013 , Zotev et al, 2018 , Kluetsch et al, 2014 , van der Kolk et al, 2016 , Nicholson et al, 2018 , Misaki et al, 2019 , Rogel et al, 2020 ). Electroencephalogram (EEG)-NFB is a brain-computer interface that allows individuals to directly self-regulate neural states.…”

“…Speaking to the use of NFB as a valuable adjunctive treatment for PTSD, participants in this study consisted of numerously traumatized individuals who had not responded to at least six months of trauma-focused psychotherapy ( van der Kolk et al, 2016 ). Similarly, a recent pilot EEG-NFB RCT in children with developmental trauma also demonstrates reductions on PTSD symptoms and improved executive functioning among patients with severe histories of abuse and neglect ( Rogel et al, 2020 ). In the current trial, we sought to extend the knowledge-base surrounding alpha-based EEG-NFB by providing crucial mechanistic evidence underlying its long-term therapeutic effect in PTSD.…”

“…Notably, whereas most evidence-based therapies for PTSD focus on the processing of trauma memories, the specific target of NFB is self-regulation of brain regions or networks ( Ros et al, 2014 , Sitaram et al, 2017 ). Recent systematic reviews of neurofeedback suggest that this intervention is associated with symptom improvements in patients with PTSD ( Schoenberg and David, 2014 , Panisch and Hai, 2018 ) and may be particularly beneficial among individuals who have been resistant to standard treatments ( van der Kolk et al, 2016 , Nicholson et al, 2020c , Rogel et al, 2020 ). Given the diversity of brain circuits associated with PTSD, modern NFB technology may facilitate a more personalized approach to medicine by targeting specific neural dynamics that are associated with unique symptoms among patients.…”