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Figure. Pre-post single photo emission computed tomography scan data are shown for veteran no. 2, comparing pretraining conditions with those prevailing after 24 sessions. Classic signs associated with post traumatic stress disorder include elevations in activity at the anterior cingulate, the basal ganglia, and the thalamus. In posttraining data, the activity level at the anterior cingulate and basal ganglia are reduced. Additionally, the high activation of the cerebellum has been reduced. A color version of this figure can be found at http://www.aapb.org/magazine.html.
Source publication
The application of neurofeedback to post traumatic stress disorder (PTSD) in returning veterans is described herein and is illustrated with two case histories. Initially, frequency-based electroencephalogram training was employed to promote functional recovery, in the manner of the traditional sensorimotor rhythm/beta approach. An optimization proc...
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Citations
... Similar to the recommendation of Fragedakis and Toriello (2014) related to utilizing neurofeedback for combat-related to PTSD, it is our recommendation that clinicians and researchers consider alpha and alpha asymmetry training when developing neurofeedback treatment plans for law enforcement officers. Integrating informed, empirically based neurofeedback protocols for officers can decrease maladaptive symptoms and the potential onset of comorbid concerns such as substance use (Hammond, 2007;Othmer & Othmer, 2009). ...
Occupational and organizational stressors impact workplace performance and contribute to mental health concerns among law enforcement officers. Although literature focuses on identifying the degree of relationship that these two factors have within this specific profession, studies offer limited solutions for decreasing associated symptoms relating to stressors. Implementing an intervention that acknowledges law enforcement factors such as psychological and physiological concerns, workplace culture, and mental health stereotypes could significantly impact both those that serve within this career as well as the community. In this article, we explore the use of trauma-informed neurofeedback a therapeutic intervention for the treatment of occupational and organizational stressors commonly experienced by law enforcement officers. We also present recommendations for clinical practice and research.
... With respect to the issue of emotional trauma specifically, early results for combat-related PTSD were reported by Othmer [97]. More recent publications of note include dramatic recoveries from combat-related PTSD and TBI observed in a small pilot study by Carlson and Ross [98] and rapid recovery from a case of complex PTSD by Gerge [99]. ...
Clinical work conducted over the last seventeen years at the EEG Institute in Los Angeles and by other neurofeedback providers around the world has demonstrated the utility of extending frequency-based neurofeedback deep into the infra-low frequency (ILF) region, using the method of endogenous neuromodulation described herein. The method is characterized by the absence of any overt reinforcements, which makes it possible to extend the clinical reach to extremely low frequencies. As the training frequency is lowered, the signal becomes more difficult to discriminate, and ultimately it can only be discerned by the brain itself, in the process of endogenous neuromodulation. The method emulates how the brain does skill learning in general: It must observe itself performing the skill, with feedback on its performance. While the immediate target of ILF neurofeedback is enhanced self-regulatory competence--with symptomatic relief and functional recovery the secondary consequences, progressive lowering of the target frequencies has led to improved outcomes in application to challenging dysfunctions such as episodic suicidality, migraine, seizures, and bipolar mood swings. The work has also yielded insights into how the frequency domain is organized. The training proceeds best at frequencies that are specific to each individual, and these are referred to as optimal response frequencies (ORFs). These frequencies differ for various placements but stand in two fixed relationships to one another, one that holds over the EEG spectral range, and another that holds over the entire ILF range. Training in the ILF region engages the dynamics of the glial-neuronal networks, which govern tonic, resting state regulation. The collective clinical experience with ILF neuromodulation within a large practitioner network supports the case for making protocol-based, individualized ‘homeodynamic’ regulation a therapeutic priority, particularly for our most impacted clinical populations: addiction, trauma formations, traumatic brain injury, and the dementias. The case is made for further outcome studies and foundational research.
... This places a great burden on the person, with high costs to the person's well being and everyday functioning. This state of chronic threat awareness and readiness to respond (fight/flight/freeze) typically defies standard therapeutic attempts to achieve its extinction (Othmer and Othmer, 2009;Lake, 2015). These are whole-body memories centered in the limbic structures and the autonomic nervous system, making them inaccessible for processing and resolution via the analytical mind for rational examination. ...
This paper reviews how and why ILF Neurofeedback has proven to be a parsimonious and efficient way to remediate the neuro-physiological effects of trauma. Reference is made to several large- and small-scale institutional proof of concept experimental studies each addressing a specific kind of trauma. It ends with a case report by the author (Kirk) working with an American combat veteran. It makes the argument that given its success that ILF Neurofeedback and Alpha-Theta training become accepted as part of an integrative and holistic approach for treating survivors of trauma.
... The technique has been described in a paper titled Clinical Neurofeedback: Training Brain Behavior [33]. The first reported clinical application was to Post-Traumatic Stress Disorder among military veterans [34]. The second dealt with cases of epilepsy [13]. ...
Infra-low frequency neurofeedback (ILF NF) has been proposed as an alternative or complementary treatment method. Previous studies have reported a good effect of ILF training on the subjective perception of positive psychological changes after training. Here we study whether the objective physiological parameters reflecting the brain function also change under the influence of ILF NF.
Eight participants 21–50 years of age with no history of neurological or psychiatric diseases, but reporting about some physiological or psychological complaints, performed 20 sessions of infra-low frequency neurofeedback training. EEG in visual Go/NoGo test was recorded before the course of Neurofeedback and after its completion. The spectral power of slow EEG oscillations in the post-training recording was compared with the pretraining baseline.
After 20 sessions of ILF training, the pattern of ILF activity at rest changed dramatically. The main difference was an increase in the amplitude of the ILF activity up to 0.3–1.0 mV in all recording sites. These results indicate that ILF training modified the baseline brain state in each case. Furthermore, after completion of 20 NFB sessions, all participants indicated improvement of their state. Most of them noticed a decrease of inner tension and reactivity to stressful factors. Further, they reported on stability of mood, improved body and space awareness, increase of energy level and of cognitive performance. Along with this remission of the clinical complaints, significant increase of spectral power in 0–0.5 Hz frequency band was observed in all eight participants in the post-training EEG patterns compared to the pretraining EEG.
Our study has shown the changes in the amplitude distribution within the ILF spectral range in all participants that seems to be induced by the ILF training. In other words, the ILF training leads to the changes of the functional state of the brain. We suggest that the modification of the baseline ILF EEG pattern may reflect the normalization in the metabolic balance in the brain tissue and increasing efficiency of compensatory mechanisms in the stress regulation systems.
... At present NF is recognised as an evidence-based treatment for PTSD in developed countries, supported by the findings of a substantial body of published research studies (Bell, 2018;Bell et al., 2019;Kluetsch et al., 2014;Lanius et al., 2015;Nicholson et al., 2016;Othmer and Othmer, 2009;Van Der Kolk et al., 2016). PTSD symptoms have been associated with the disruption of higher intrinsic brain function due to aberrant alpha oscillatory activity. ...
Background
: 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.
Methods
: 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 game. Participants were asked to regulate (NF) or intentionally modulate (MI) brain activity to affect/control the game.
Results
: The NF group demonstrated an increase in resting-state alpha (8-12Hz) 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 BCI group, produced a clinically relevant reduction in symptom severity in NF group, as revealed in four of seven clinical outcome measures: PCL-5 (p = 0.005), PTSD screen (p = 0.005), HTQ (p = 0.005), and CD-RISC (p = 0.041).
Limitations
: Data collection took place in environments that posed difficulties in controlling environmental factors. Nevertheless, this limitation improves ecological validity, as neurotechnology treatments must be deployable outside controlled environments, to be a feasible technological treatment.
Conclusions
: The study produced the first evidence to support low-cost, neurotechnological solution for neurofeedback as an effective treatment of PTSD for victims of acute trauma in conflict zones in a developing country.
... Since self-regulation is an essential and fundamental function of the brain, the clinical treatment spectrum of neurofeedback is broad. Thus, in addition to epilepsy and the already mentioned hyperkinetic disorder, neurofeedback has also been shown to be an appropriate treatment for many other neurological disorders involving brain dysregulation, such as autism spectrum disorder (ASD) [28][29][30][31][32][33], migraine [34,35], post-traumatic stress disorder (PTSD) [36][37][38][39][40], schizophrenia [20] and several others. The various neurofeedback methods used typically differ in the extraction of the frequency components of the measured EEG that are used to calculate and control the feedback signals. ...
In this observational study the outcomes of an EEG-based infra-low-frequency (ILF) neurofeedback intervention on patients with attention deficit (hyperactivity) disorder (ADHD) are presented. The question is addressed whether this computer-aided treatment, which uses a brain-computer-interface to alleviate the clinical symptoms of mental disorders, is an effective non-pharmaceutical therapy for ADHD in childhood and adolescence. In a period of about 15 weeks 196 ADHD patients were treated with about 30 sessions of ILF neurofeedback in an ambulant setting. Besides regular evaluation of the severity of clinical symptoms, a continuous performance test (CPT) for parameters of attention and impulse control was conducted before and after the neurofeedback treatment. During and after the therapy, the patients did not only experience a substantial reduction in the severity of their ADHD-typical clinical symptoms, but also their performance in a continuous test procedure was significantly improved for all examined parameters of attention and impulse control, like response time, variability of reaction time, omission errors and commission errors. In a post neurofeedback intervention assessment 97% of patients reported improvement in symptoms of inattention, hyperactivity or impulsivity. Only 3% of the patients claimed no noticeable alleviation of ADHD-related symptoms. These results suggest that ILF neurofeedback is a clinically effective method that can be considered as a treatment option for ADHD and might help reducing or even avoiding psychotropic medication.
... Exposure to a traumatic event may lead to maladaptive stress responses. These responses serve as signifiers of how the body remembers and re-experiences stressors when triggered (Othmer & Othmer, 2009). These stress responses include but are not limited to over arousal, hypervigilance, flash backs, nightmares, and fear. ...
... The common theme amongst PTSD treatment is an attention to the thoughts and memories associated with the event. Although there are various approaches that target these thoughts and memories once told aloud to the clinician, the goal of neurofeedback is to create better function in the affected areas of the brain through brainwave training (Othmer & Othmer, 2009). ...
This study examines the effectiveness of neurofeedback training for individuals presenting with a primary concern of posttraumatic stress disorder symptoms. The present study includes 21 adult clients with 62% (n = 13) self-reporting as female. Participants completed pre-and postassessments including the Davidson Trauma Scale and Inventory of Altered Self-Capacities and participated in neurofeedback training sessions twice a week for one academic semester. 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. Study findings demonstrated statistically significant improvement in affect regulation and trauma symptom severity and frequency. We present limitations and implications for future research.
... Othmer in 2006, as described in a paper titled Clinical Neurofeedback: Training Brain Behavior [35]. The method has demonstrated positive outcomes for a variety of mental conditions, including Post-Traumatic Stress Disorder among military veterans [36], different forms of anxiety, depression [37], sleep disturbances, ADHD, the Autism spectrum, developmental trauma, migraines, and other headaches, epilepsy [33] and traumatic brain injury [38,39]. ...
... At the same time, the feedback procedures that utilize infra-slow electrical potentials and HRV as feedback parameters are very well established. The positive effect on symptoms of anxiety, depression, and sleep disturbances has been demonstrated for both techniques [36,47]. ...
A formal comparison of Infra-Low Frequency Neurofeedback with an active control condition, Heart Rate Variability training, is undertaken in the present research. 17 participants 21-50 years of age with no history of neurological or psychiatric diseases conditions, but reporting about some physiological or psychological complaints were involved in the study. Participant progress was monitored by means of Visual Go/NoGo test performance and spectral power of slow EEG oscillations during the test before and after twenty sessions of training. Outcomes favored Infra-Low Frequency Neurofeedback training over Heart Rate Variability training with respect to health status and Visual Go/NoGo test results. Significant elevation in amplitudes in the Infra-Low Frequency range was observed only for the Neurofeedback cohort.
... 10 Neurofeedback is an available treatment for mental and psychological problems, including insomnia, anxiety, depression, and PTSD, 11,12 which is one of the major disorders that is widely treated with neurofeedback. 13,14 As demonstrated by several previous studies, neurofeedback can improve the function and electrical characteristics of damaged brain regions and reduce drug dependency. [15][16][17][18][19] There are several tools used to assess the efficacy of neurofeedback in patients with PTSD. ...
Background
Post-traumatic stress disorder (PTSD) has become an important public health problem. However, the conventional therapeutic strategy, including pharmacotherapy and cognitive behavioral therapy, has limitations. Neurofeedback is a technique that utilizes electroencephalography (EEG) signaling to monitor human physiological functions and is widely used to treat patients with PTSD. The purpose of our study is to assess the efficacy and safety level of neurofeedback treatment in patients with PTSD using quantitative EEG.
Methods
This is a randomized, waitlist-controlled, assessor-blinded, clinical trial. Forty-six patients with PTSD will be randomly assigned at a 1:1 ratio into two groups. The participants in the treatment group will receive neurofeedback treatment for 50 minutes, twice a week, for 8 weeks (16 sessions). Quantitative EEG will be utilized to monitor the physiological functions and brain waves of the participants. A four-week follow-up period is planned. The participants in the control group will wait for 12 weeks. The primary outcome is the Korean version of PTSD Checklist-5 (PCL-5-K) score. The PCL-5-K scores on week 8 will be compared between the two groups. Anxiety, depression, insomnia, emotions, EEG, quality-of-life, and safety level will be assessed as secondary outcomes.
Discussion
This trial will describe a clinical research methodology for neurofeedback in patients with PTSD. The numerous subjective and objective secondary outcomes add to the value of this trial’s results. It will also suggest a therapeutic strategy for utilizing quantitative EEG in patients with PTSD. Our trial will provide basic evidence for the management of PTSD via an integrative treatment.
Trial registration
Clinical Research Information Service (CRIS): KCT0003271
... As Sanya, due to her diagnoses, was considered to be emotionally fragile, easily triggered, and plagued with trauma-related phobias of mental contents, stabilization was needed. Neurofeedback, infra-low frequency training (Othmer & Othmer, 2009) was used during ten sessions for stabilization, and the short-time therapy ended with one EMDR session (Shapiro, 2018). These treatment methods were administrated in the frame of a resource-oriented psychodynamic psychotherapy, aiming at installation of hope and a reestablishment of human relations as safe enough, and reassuring. ...
The methods of Neurofeedback (Kirk et al., 2016) and Eye Movement Desensitization and Reprocessing (Shapiro, 2018; Shapiro & Silk Forrest, 1997) will be reflected in relation to a short-time treatment of a patient with complex PTSD and an unspecified dissociative disorder. The aim is to inspire colleges to integrate therapy methods in their quest to help dysregulated patients to become stabile and regulated enough to endure trauma work. This is considered important, especially when working with patients with severe and complex posttraumatic conditions and dissociative disorders, where the evidence-based treatments often not fit for purpose (Corrigan & Hull, 2015). An alternative approach is presented with a single case-study of a patient treated with neurofeedback and EMDR in a psychodynamic short-time psychotherapy. The results of these interventions are presented together with the patient’s drawings and reflections and finally discussed.