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Alpha-theta brain wave neurofeedback for Vietnam veterans with combat related post traumatic stress disorder

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... AUD) is brain regulation training via EEG-based neurofeedback (NF). Here, especially the training of alpha and theta EEG frequency bands named as the "Peniston Protocol" (Peniston and Kulkosky 1989, 1991 or the further developed "Scott-Kaiser Protocol" (Scott et al. 2005), demonstrated improvements in relaxation, craving, depression, post-traumatic stress disorder symptoms, and personality traits. Furthermore, decreased relapse rates were found after these EEG NF trainings (Saxby and Peniston 1995, White 1999, Callaway and Bodenhamer-Davis 2008, Lackner et al. 2016, Dalkner et al. 2017. ...
... Furthermore, decreased relapse rates were found after these EEG NF trainings (Saxby and Peniston 1995, White 1999, Callaway and Bodenhamer-Davis 2008, Lackner et al. 2016, Dalkner et al. 2017. The great success of this special alpha/theta (AT) NF protocol is seen in the generation of a state of deep relaxation, a state of reverie (Peniston and Kulkosky 1991). This normally not conscious mental state, before falling asleep, is associated with a decrease in alpha band and an increase in theta band, with the intersection (when the theta band becomes more dominant than the alpha band) named as "alpha/theta crossover." ...
... Based on previous successful protocols (Peniston and Kulkosky 1989, 1991Scott and Kaiser 1998;Scott et al. 2005), in the present study, clinical effects of an optimized combination of SMR and AT NF training were investigated in a population of adult patients with AUD. ...
Article
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Alcohol use disorder (AUD) is defined as the impaired ability to stop or control alcohol use despite adverse social, occupational or health consequences and still represents one of the biggest challenges for society regarding health conditions, social consequences, and financial costs, including the high relapse rates after traditional alcohol rehabilitation treatment. Especially the deficient emotional competence in AUD is said to play a key role in the development of AUD and hinders to interrupt the substance compulsion, often leading in a viscous circle of relapse. Although the empirical evidence of a neurophysiological basis of alcohol use disorder is solid and increases even further, clinical interventions based on neurophysiology are still rare for individuals with AUD. This randomized, controlled trial investigates changes in emotional competences and alcohol-related cognitions and drinking behavior before and after an established alcohol rehabilitation treatment (control group, nCG = 29) compared to before and after an optimized, add-on neurofeedback training (experimental group: nEG = 27). Improvements on the clinical-psychological level, i.e., increases in emotional competences as well as life satisfaction were found after the experimental EEG-neurofeedback training. Neurophysiological measurements via resting state EEG indicate decreases in low beta frequency band, while alpha and theta band remained unaffected.
... Neurofeedback is a type of operant conditioning used to learn reinforcement and compensation via audiofeedback in an eye-closed state [18]. To reduce anxiety and stress in patients with PTSD, we utilized alpha-theta brainwave neurofeedback using the protocol suggested by Peniston and Kulkosky [19], or Smith [20]. The purpose of NSRT is to maintain a relaxed state by strengthening the alpha and theta waves and suppressing any beta waves. ...
... Neurofeedback is a type of operant conditioning used to learn reinforcement and compensation via audio-feedback in an eye-closed state [18]. To reduce anxiety and stress in patients with PTSD, we utilized alpha-theta brainwave neurofeedback using the protocol suggested by Peniston and Kulkosky [19], or Smith [20]. The purpose of NSRT is to maintain a relaxed state by strengthening the alpha and theta waves and suppressing any beta waves. ...
... Our study results somewhat differed from those of previous RCTs [19,[46][47][48]. Three studies included only men [19,46,48], and two of these studies included only veterans [19,46]. ...
Article
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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. We 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.
... Neurofeedback training helps clients learn to better control brainwave patterns and further gain control over specific emotional networks (Johnston et al., 2010), improving behaviors and learning skills to self-regulate (Duffy, 2000;Hammond, 2007;Lubar, 2003). Clients often report positive changes in mood, an increase of energy, and a decrease of symptoms after engaging in a neurofeedback protocol (Hammond, 2007;Othmer & Othmer, 2009;Peniston & Kulkosky, 1991;Peniston, Marrinan, Deming & Kulkosky, 1993;Raymond et al., 2005;Thatcher & Lubar, 2009;Walker, 2009). Research found training certain brainwave patterns may reduce symptoms associated with specific psychological illnesses including anxiety disorders (Garrett & Silver, 1976;Rice, Blanchard, and Purcell, 1993), PTSD and panic attacks (Peniston & Kulkosky, 1991). ...
... Clients often report positive changes in mood, an increase of energy, and a decrease of symptoms after engaging in a neurofeedback protocol (Hammond, 2007;Othmer & Othmer, 2009;Peniston & Kulkosky, 1991;Peniston, Marrinan, Deming & Kulkosky, 1993;Raymond et al., 2005;Thatcher & Lubar, 2009;Walker, 2009). Research found training certain brainwave patterns may reduce symptoms associated with specific psychological illnesses including anxiety disorders (Garrett & Silver, 1976;Rice, Blanchard, and Purcell, 1993), PTSD and panic attacks (Peniston & Kulkosky, 1991). In addition, through use of neurofeedback, individuals may learn skills to better cope with and combat substance abuse disorders (Saxby & Peniston, 2006) and decrease impairments associated with learning disorders (Thatcher & Lubar, 2009;Thompson & Thompson 1998). ...
... The process is bi-directional as neurological changes results in physiological changes and vice versa (Thayer & Brosschot, 2005). Few studies have demonstrated an integrative approach, implementing both biofeedback measurements and neurofeedback protocols, though research suggests that this would make sense (Budzynski, 1972;Danskin & Walters, 1973;Othmer & Othmer, 2009;Peniston & Kulkosky, 1991;Thompson & Thompson, 1998) as the ANS and the CNS work together to form the CAN (Thayer & Brosschot, 2005). ...
Article
The purpose of this study was to evaluate clients' experience of engaging in a training protocol integrating biofeedback and neurofeedback in conjunction with counseling. The model constructed proposes that biofeedback applications may be used as a means to enrich the counseling experience as defined through the working alliance and treatment satisfaction.
... 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. ...
... However, these studies had several limitations in their clinical study designs and quantitative mechanism assessments. [15][16][17][18][19] To compensate for previous limitations, we will conduct a clinical study featuring a control group, sample size calculations, randomization, and a longterm follow-up. We will conduct a neurofeedback intervention for PTSD patients to determine their physiological responses to the intervention and to evaluate its effectiveness and safety level. ...
... 18 Several studies did not report the neurofeedback protocol, which limits their reproducibility and the clinical utility of their results. 17,26 To the best of our knowledge, our study will be the first randomized study with a control group to examine the effect of neurofeedback in patients with PTSD, using simultaneous QEEG feedback, in Korea. Our study has several strengths. ...
Article
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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
... Neurofeedback of slow wave (alpha and theta) frequency bands has been successfully employed in the treatment of PTSD (Peniston and Kulkosky 1991). After receiving NF only 3 of the 15 NF patients had a recurrence of PTSD symptoms over a 30 month long monthly follow-up assessment period compared to 100 % of the control group. ...
... After receiving NF only 3 of the 15 NF patients had a recurrence of PTSD symptoms over a 30 month long monthly follow-up assessment period compared to 100 % of the control group. In addition, the NF group showed significantly more improvement on 13 MMPI scales than the controls (Peniston and Kulkosky 1991). Given the promise of these results, it is surprising that there has been little to no research following up on these results. ...
... Our choice of treatment protocols for the current study was guided by both research evidence and clinical experience. Since Peniston and Kulkosky (1991) seminal work, brain imaging has provided significant evidence pointing to the right parietal areas of the brain as implicated in the maintenance of PTSD (Rauch et al. 1996;Lanius et al. 2002;Georgopoulos et al. 2010). For this reason NF training was done using a bipolar placement with T4 as the active site, P4 as the reference site, and the left ear (A1) as the ground. ...
... Since the late 1960s NFT has been used to treat adult individuals with AD; yet, most In most NFT studies an alpha and theta up-training protocol was used (Peniston and Saxby, 1995;Dadashi et al., 2015;Glueck & Strobel, 1975;Sadjadi & Hashemian, 2014;Cheon Koo, & Choi, 2015;Green, 1974;Peniston & Kulkosky, 1991) alpha, theta and beta up-training or a theta/alpha ratio uptraining (Eismont et al., 2011;Egner et al., 2002;Raymond et al., 2005;Gruzelier et al., 2009Gruzelier et al., , 2013. Almost equally frequently an alpha uptraining protocol was used (Bhat, 2012;Agnihotri, Sandhu, & Paul, 2007;Rice et al., 1993;Sarkar & Rathee, 1999;Vanathy et al., 1998;Plotkin & Rice, 1981;Hardt & Kamiya, 1978;Walker, 2009;Garrett & Silver, 1976;Dekker, Van den Berg, Denissen, Sitskoorn, & Van Boxtel, 2014). ...
... In the past 50 years only six studies were conducted with a clinical population and control group (i.e., not with healthy volunteers): Dadashi et al. (2015), Sadjadi and Hashemian (2014), Vanathy et al. (1998), Rice et al. (1993), Peniston and Kulkosky (1991), Glueck and Strobel (1975); out of those six studies only Vanathy et al. (1998) used a pre-and post EEG to measure if significant changes in brain oscillations could be found. While all authors except Dadashi et al. (2015) used an active control group, only Vanathy et al. (1998) and Rice et al. (1993) used a NFT-based active placebo group. ...
... Many studies did not have any kind of control group (Baehr & Rosenfeld, 2001;Gurnee, 2003;Kluetsch et al., 2013;Mills & Solyom, 1974;Saxby & Peniston, 1995), and quite a few that did not have a NFT control group did have a wait-list or a relaxation group, or a group with another treatment modality such as medication (e.g., Bhat, 2012;Dadashi, Birashk, Taremian, et al., 2015;Peniston & Kulkosky, 1989;Sarkar, Rathee, & Neera, 1999). Other studies had not been controlled for combination of NFT with other treatments, such as psychotherapy, medications, meditation, and breathing and hand warming exercises (e.g., Bhat, 2010;Glueck & Stroebel, 1975;Green, 1974;Peniston and Kulkosky, 1991;Saxby and Peniston, 1995); and some studies with a control group did not have a randomization procedure (Cheon, Koo, Seo, et al., 2015;Green, 1976;Gurnee, 2003;Sargunaraj, Kumaraiah, Mishra, et al., 1987;Saxby & Peniston, 1995). Only two studies had a single-or double-blind research design (Dekker et al., 2014;Egner & Gruzelier, 2003, respectively). ...
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Introduction: Alpha/Theta neurofeedback treatment (A/T NFT) has been administered to adults with anxiety disorders since the late 1960s, yet the efficacy of this treatment remains unclear. The present, single-blind study, for the first time, uses an active placebo NFT control group to test the A/T NFT protocol for trait anxiety on prodromal and clinical adult female participants. The effects this treatment has on activation and arousal states, self-perceived anxiety levels, neural oscillations, and other parameters were assessed. Methods: Twenty-seven women ranging in age from 19 through 69 who had scored higher than the 66th percentile in the STAI trait anxiety sub-scale (75% of whom had previously been diagnosed with an anxiety disorder) were randomly assigned to either the experimental (EG) or the control group (CG). The EG (n = 14) received ten sessions of A/T NFT in which alpha and theta EEG amplitudes were uptrained at Pz. The CG (n = 13) received ten sessions of active placebo NFT at Pz. During successive sessions beta- (15–19 Hz) and high beta amplitudes (20- 24 Hz) were uptrained or downtrained. Growth curve modeling (GCM) and traditional 2x5 repeated measures ANOVA were performed on the NFT sessions data to model individual and average group learning curves. Cognitive variables, such as treatment outcome expectancy, personal attribution styles, use, types, and efficacy of cognitive strategies in NFT, and correlations between NFT learning performance, time of day the NFT sessions were held, and a participant’s best or worst time to learn, were also investigated. Results: The analysis of individual learning curves, GCM, and ANOVA all confirmed that the majority of participants of the EG up-regulated absolute and relative A+T amplitudes within a NFT session, but so did the participants of the CG. However, a non-significant trend for the EG to have steeper learning curves was observed. Participants of both the EG and the CG felt significantly more deactivated by the end of a NFT session and reduced their self-perceived anxiety on all anxiety measures (STAI, BAI, GAD-7) by the end of the NFT trial. Although a trend could be observed that the EG reduced anxiety scores more than the CG, these differences did not rise to statistical significance. Lastly, no significant changes in the pre-post trial QEEG were found, although a trend of higher combined relative A+T power at the end of the trial was observed in the EG. In the EG the use of mental strategies was correlated with lower T/A ratio difference scores between the beginning and the end of the NFT trial but not with increased relative and absolute T+A amplitudes. The Time-of-day participants prefer or avoid learning did not correlate significantly with alpha or theta NFT amplitudes, i.e., NFT sessions being held during sub-optimal times of day were not associated with poorer learning performance. Conclusions: For both EG and CG absolute and relative T+A amplitudes increased within sessions and absolute and relative alpha increased across sessions although the CG protocol had not included an uptraining of alpha or theta amplitudes, nor low beta amplitudes (below 15 Hz) which may have represented upper alpha peak frequency in some of the younger participants. Thus, upregulation of beta and upper beta in NFT may be associated with alpha frequency uptraining due to functional coupling of alpha and beta EEG frequencies or it may be due to placebo and other non-specific effects such as EEG frequency drifts, alpha’s idling mode and inhibitory role during task performance, or perhaps simply that some frequency bands (alpha) are more susceptible to change and easier to train. Especially the inhibition of flanking bands in the NFT protocol, i.e., beta bands in A+T training, to prevent frequency drifts, will be necessary along with detailed GCM modeling of all frequency bands to see if and how the bands change over time and how those processes relate to NFT learning curves. Keywords: neurofeedback, EEG biofeedback, quantitative EEG, trait / state anxiety, anxiety disorders, active placebo control, alpha/theta protocol, growth curve modeling.
... Previous treatment outcome studies mainly focused on targeting power in alpha and/or theta frequencies as well as sensorimotor rhythm (SMR) to induce a relaxed mental state and improve attention while reducing motor activity [19][20][21]. As a new method, live Z-score NF (ZNF) has been gaining ground over the past decade. ...
... These electrode sites were chosen to maximize the global modulation of brain activities and minimize the influence of muscle and eye movement artifacts [17,23]. The training protocol involved the modulation of absolute power, relative power, phase, and coherence for delta (1-4 Hz), theta (4-8 Hz), alpha (8-12 Hz), low beta (12)(13)(14)(15), and high beta (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) [30]. The raw EEG data were bandpass filtered between 0.5 and 50 Hz, and impedances were maintained below 10 kOhms. ...
Article
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Individuals with traumatic experiences may develop symptoms of post-traumatic stress disorder (PTSD) and co-morbid disorders, such as anxiety disorders, major depression, and substance use disorder. Although exposure therapy is considered the "gold standard" for the treatment of PTSD, dropout rates and patient distress are relatively high. One promising approach is live Z-score neurofeedback (ZNF) training, but clinical evidence is sparse. Thus, the current study aimed to evaluate the feasibility and acceptability of ZNF training among individuals with PTSD. After undergoing a diagnostic interview utilizing the MINI Neuropsychiatric Interview, nine patients with PTSD (7 females; mean age = 20.75 [SD = 2.38]) completed ten ZNF sessions, lasting 20 min each, and the PCL-5 at pre-and post-treatment. Over the course of the study, only a few minor study disruptions, adverse events, and patient complaints were reported, and participants rated high on feasibility and acceptability. Results from repeated measures ANOVAs suggest significant improvements in overall PTSD symptoms. Although these findings need to be replicated in larger samples with active control groups, the current study provides support that ZNF is a safe, acceptable, and potentially effective treatment for PTSD.
... Presenting signs of psychotic and bipolar disorders; having a serious limiting physical illness, such as presenting signs of psychotic and bipolar disorders; and having serious limiting physical illness, such as cancer or kidney problems. Peniston, 1991 EG: Vietnam combat veterans with PTSD CG: Vietnam combat veterans with PTSD Only PTSD diagnostic criteria are presented. EG: Multi trauma, resistance to treatment (no effect on treatment for more than 6 months) CG: Multi trauma, resistance to treatment (no effect on treatment for more than 6 months) on the WL Received weekly traumafocused psychotherapy for a minimum of six months. ...
... Finally, a sensitivity analysis was implemented using the Baujat plot (Fig. 7). Noohi et al. (2017) and Peniston's (1991) study findings were considerably responsible for the heterogeneity. These studies applied Alpha-Theta neurofeedback as a treatment modality. ...
Article
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Posttraumatic stress disorder (PTSD) encompasses various psychological symptoms and a high early dropout rate due to treatment unresponsiveness. In recent years, neurofeedback has been implemented to control PTSD’s psychological symptoms through physiological brain regulation. However, a comprehensive analysis concerning its efficacy is lacking. Therefore, we conducted a systematic review and meta-analysis to determine neurofeedback’s effect on reducing PTSD symptoms. We analyzed randomized and non-randomized controlled trials (RCTs) from 1990 to July 2020, evaluating neurofeedback treatments for those diagnosed with PTSD and their symptoms. In addition, we calculated the standardized mean difference (SMD)using random-effects models to estimate effect sizes. We assessed ten articles comprising 276 participants, with a − 0.74 SMD (95% confidence interval = − 0.9230, − 0.5567), 42% I2, moderate effect size, and − 1.40 to -0.08 prediction intervals (PI). Neurofeedback was more effective for complex trauma PTSD patients than single trauma. Increasing and lengthening sessions are more effective than fewer, condensed ones. Neurofeedback positively affected arousal, anxiety, depression, and intrusive, numbing, and suicidal thoughts. Therefore, neurofeedback is a promising and effective treatment for complex PTSD.
... In a general way, the neural activity in the brain is supported by a variety of neuronal oscillations, characterized by their frequency ranges and anatomical locations, and widely correlated with cognitive and behavioral states (Buzsáki and Watson 2012). Several studies use the information from theses oscillations to investigate brain dynamics, synchronicity, or to establish neurofeedback protocols, wherein the patients are trained to modulate their brain activity according to an objective and clinical conditions (Orndorff-Plunkett et al. 2017), such as rehabilitation of people with motor deficits or cognitive arising from stroke (Cho et al. 2015), SCI (Shokur et al. 2016), or even for cognitive training in healthy people (Gomez-Pilar et al. 2014), and other conditions such as ADHD (Hodgson et al. 2014) and post-traumatic stress disorder (PTSD) (Peniston and Kulkosky 1991). ...
... The neurofeedback protocol used to treat PTSD is known as alpha-theta brainwave neurofeedback therapy (BWT), which basically focuses on reinforcement of those waves. Peniston and Kulkosky (1991) conducted a study on Vietnam-war veterans diagnosed with PTSD and found that training with BWT decreases the suffering/illness scores on clinical scales (e.g., depression, hysteria, and paranoia) compared to traditional drug treatment. ...
Chapter
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For a better rescuing of people with disabilities, it is crucial the development of new assistive technologies and therapeutic methods to rehabilitate people with some disabilities to integrate them to a complete social life. A very promising tool is the physiological self-regulation protocols based on biofeedback training. Biofeedback protocols are based on the premise that it is possible to learn how to self-modulate specific aspects of the body’s physiological activity. A biofeedback system is composed of input physiological information and output sensorial stimuli information in a real-time closed-loop process that allows patients to modulate a target physiological (dys)function. The application of biofeedback protocols has been widely studied and used in different clinical practices such as orthopedic, neurological, physiological, and cognitive conditions. This review focuses on the main aspects concerning the system arrangement and protocols of stimulation in biofeedback approaches, from its basic principles of operation to its clinical application in different contexts, with emphasis on sensorimotor and cognitive deficits.KeywordsSelf-regulationBiofeedbackNeurofeedbackBrain machine interfaceBrain computer interfaceRehabilitation
... Unfortunately, the evidence base for the efficacy of neurofeedback in treating the long-term effects of early life stress is extremely limited. In the early 1990s, Peniston and colleagues [23,24] began to establish a framework for examining the usefulness of neurofeedback (i.e., alpha-theta training) in treating veterans with PTSD. Building upon prior alpha-theta research which documented improvements in prognosis and psychological functioning, Peniston and Kulkosky [24] explored its application on a group of Vietnam veterans with a 12-to-15-year history of chronic combat-related PTSD. ...
... In the early 1990s, Peniston and colleagues [23,24] began to establish a framework for examining the usefulness of neurofeedback (i.e., alpha-theta training) in treating veterans with PTSD. Building upon prior alpha-theta research which documented improvements in prognosis and psychological functioning, Peniston and Kulkosky [24] explored its application on a group of Vietnam veterans with a 12-to-15-year history of chronic combat-related PTSD. A total of 29 participants were randomly selected and assigned to either an alpha-theta neuorfeedback training group or treatment control group (e.g., combined psychotropic medications and therapy). ...
Article
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Purpose of review Early life stress has been shown to have profound effects on the developmental trajectories of individuals. Findings have implicated most major areas of the brain as being affected, and existing treatments have been limited in ameliorating symptoms. The purpose of this review is to focus on the development of the autonomic nervous system in concert with the brain. Recent findings We suggest that the majority of psychopathology related to early life stress represents an allostatic equilibrium achieved by the autonomic nervous system organizing around threat states. Recent findings in the field of neurofeedback implicate alpha waves as a potential key to helping treat individuals who have been affected by early life stress. Summary We conclude that alpha neurofeedback may represent a novel treatment approach to engender changes within the autonomic nervous system in helping to achieve a homeostatic equilibrium. Alpha downtrain neurofeedback may represent a “nudge” for a stuck nervous system that acts as a precursor to increase the efficacy of other training protocols and more traditional talk therapy techniques.
... In a second study, Nicholson et al. (2023) confirmed these preliminary findings and further showed that at the three-month follow-up assessment, 60.0% of participants in the NFB experimental group no longer met the diagnostic criteria for PTSD. In the military population, as early as Peniston and Kulkosky (1991) evidenced that alpha-theta NF (8 sessions of 30 min) therapy significantly reduced anxiety-induced traumatic recurring nightmares/flashbacks in Vietnam theater veterans with combat-related PTSD and reduced the psychotropic medications. Zotev et al. (2018) showed that real-time fMRI training of amygdala reduces the PTSD severity scale, and symptoms of avoidance and hyperarousal in veterans with combat-related PTSD. ...
Article
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Operational environments are characterized by a range of psycho-physiological constraints that can degrade combatants’ performance and impact on their long-term health. Neurofeedback training (NFT), a non-invasive, safe and effective means of regulating brain activity, has been shown to be effective for mental disorders, as well as for cognitive and motor capacities and aiding sports performance in healthy individuals. Its value in helping soldiers in operational condition or suffering from post-traumatic stress (PTSD) is undeniable, but relatively unexplored. The aim of this narrative review is to show the applicability of NFT to enhance cognitive performance and to treat (or manage) PTSD symptoms in the military context. It provides an overview of NFT use cases before, during or after military operations, and in the treatment of soldiers suffering from PTSD. The position of NFT within the broad spectrum of performance enhancement techniques, as well as several key factors influencing the effectiveness of NFT are discussed. Finally, suggestions for the use of NFT in the military context (pre-training environments, and during and post-deployments to combat zones or field operations), future research directions, recommendations and caveats (e.g., on transfer to operational situations, inter-individual variability in responsiveness) are offered. This review is thus expected to draw clear perspectives for both researchers and armed forces regarding NFT for cognitive performance enhancement and PTSD treatment related to the military context.
... 12 Furthermore, training of the alpha frequency was associated with a significant improvement in the ability to relax. 13 In addition, an increase in alpha band frequency was associated with an increased ability to relax. 14 Moreover, cognitive abilities such as reaction time, cognitive control and selective attention could also be improved in healthy patients by training the alpha band. ...
Article
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Introduction Electroencephalographic neurofeedback (NFB), as a non-invasive form of brainwave training, has been shown to be effective in the treatment of various mental health disorders. However, only few results regarding manualised and standardised NFB trainings exist. This makes comparison as well as replication of studies difficult. Therefore, we developed a standard manual for NFB training in patients with mental health disorders attending a psychosomatic outpatient clinic. The current study aims at investigating the conduction of a standardised manual for NFB training in patients with mental health disorders. If successful, the study provides new opportunities to investigate NFB in a more controlled and comparable manner in clinical practice. Methods and analysis 30 patients diagnosed with a mental health disorder will be included. After the educational interview, patients will undergo baseline diagnostics (T0). The subsequent intervention consists of 10 sessions of NFB training aiming at increasing sensorimotor rhythm and alpha-frequency amplitudes and decreasing theta-frequency and high beta-frequency amplitudes to induce relaxation and decrease subjective stress. All patients will undergo a post-treatment diagnostic assessment (T1) and a follow-up assessment 8 weeks following the closing session (T2). Changes in amplitude bands (primary outcome) will be recorded with electroencephalography during pre-assessments, post-assessments and follow-up assessments and during NFB sessions. Physiological (respiratory rate, blood volume pulse, muscle tension) and psychometric parameters (distress, perceived stress, relaxation ability, depressive and anxiety symptoms, insomnia, self-efficacy and quality of life) will be assessed at T0, T1 and T2. Moreover, satisfaction, acceptance and usability will be assessed at T1 after NFB training. Further, qualitative interviews about the experiences with the intervention will be conducted with NFB practitioners 6 months after the study starts. Quantitative data will be analysed using repeated measures analysis of variance as well as mediation analyses on mixed linear models. Qualitative data will be analysed using Mayring’s content analysis. Ethics and dissemination The study was approved by the ethics committee of the Medical Faculty of the University of Duisburg-Essen (23–11140-BO) and patient enrolment began in April 2023. Before participation, written informed consent by each participant will be required. Results will be published in peer-reviewed journals and conference presentations. Trial registration number Prospectively registered on 28 March 2023 in the German clinical trials register, DRKS00031497.
... These serendipitous findings motivated the use of biofeedback in research on humans with epilepsy (Sterman, 2006). Because the EEG is altered in several other disorders, biofeedback research has expanded to a range of clinical disorders including addiction (Passini et al., 1977;Peniston & Kulkosky, 1989;Saxby & Peniston, 1995), anxiety (Angelakis et al., 2007), attention-deficit/hyperactivity disorder, autism (Coben & Padolsky, 2007;Pineda et al., 2008), depression (Baehr et al., 1997;Hammond, 2005), post-traumatic stress disorder (Peniston & Kulkosky, 1991), and sleep disorders (Cortoos et al., 2009). More recently, research has explored the potential of biofeedback to enhance normal cognition, e.g. to improve attention (Egner et al., 2002;Gruzelier et al., 2006), working memory (Hoedlmoser et al., 2008;Vernon et al., 2003), or athletic performance (Egner & Gruzelier, 2003;Vernon, 2005). ...
... The potential of NF to alter neural signals (McAdam et al., 1966;Kamiya, 1968) and mental states as well as associated behavior makes it a strong candidate as a new therapeutic tool for the treatment of a wide range of symptoms and disorders, including psychiatric and neurologic conditions. Clinical research mainly focused on the use of NF in conditions such as epilepsy (Egner and Sterman, 2006), ADHD (Monastra et al., 2002;Arns et al., 2009;Hodgson et al., 2012;Sonuga-Barke et al., 2013;Micoulaud-Franchi et al., 2015;Cortese et al., 2016), and PTSD (Peniston and Kulkosky, 1991;Kluetsch et al., 2014;Nicholson et al., 2016Nicholson et al., , 2017van der Kolk et al., 2016) and addictions (Scott et al., 2005). Symptoms that are part of the frontal dysfunction syndrome have been shown to benefit from NF, e.g., an impaired impulse control and attention deficits in patients with attention deficit hyperactivity disorder (ADHD) (Arns et al., 2014). ...
Article
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Background Frontal brain dysfunction is a major challenge in neurorehabilitation. Neurofeedback (NF), as an EEG-based brain training method, is currently applied in a wide spectrum of mental health conditions, including traumatic brain injury. Objective This study aimed to explore the capacity of Infra-Low Frequency Neurofeedback (ILF-NF) to promote the recovery of brain function in patients with frontal brain injury. Materials and methods Twenty patients hospitalized at a neurorehabilitation clinic in Switzerland with recently acquired, frontal and optionally other brain lesions were randomized to either receive NF or sham-NF. Cognitive improvement was assessed using the Frontal Assessment Battery (FAB) and the Test of Attentional Performance (TAP) tasks regarding intrinsic alertness, phasic alertness and impulse control. Results With respect to cognitive improvements, there was no significant difference between the two groups after 20 sessions of either NF or sham-NF. However, in a subgroup of patients with predominantly frontal brain lesions, the improvements measured by the FAB and intrinsic alertness were significantly higher in the NF-group. Conclusion This is the first double-blind controlled study using NF in recovery from brain injury, and thus also the first such study of ILF NF. Although the result of the subgroup has limited significance because of the small number of participants, it accentuates the trend seen in the whole group regarding the FAB and intrinsic alertness ( p = 0.068, p = 0.079, respectively). We therefore conclude that NF could be a promising candidate promoting the recoveryfrom frontal brain lesions. Further studies with larger numbers of patients and less lesion heterogeneity are needed to verify the usefulness of NF in the neurorehabilitation of patients with frontal brain injury (NCT02957695 ClinicalTrials.gov ).
... The neurofeedback protocol used to treat PTSD is known as alpha-theta brainwave neurofeedback therapy (BWT), which basically focuses on reinforcement of those waves. Peniston and Kulkosky (1991) conducted a study on Vietnam-war veterans diagnosed with PTSD and found that training with BWT decreases the suffering/illness scores on clinical scales (e.g., depression, hysteria, and paranoia) compared to traditional drug treatment. ...
Book
Collection of selected papers submitted and presented at the III Latin American Workshop on Computational Neuroscience (LAWCN'21), held in the city of São Luís do Maranhão, Brazil, from 8 to 10th December 2021. Papers have been peer-reviewed and selected for their superior quality and impact. Topics covered are within the areas of Computational Neuroscience, Artificial Intelligence, and Neuroengineering.
... The neurofeedback protocol used to treat PTSD is known as alpha-theta brainwave neurofeedback therapy (BWT), which basically focuses on reinforcement of those waves. Peniston and Kulkosky (1991) conducted a study on Vietnam-war veterans diagnosed with PTSD and found that training with BWT decreases the suffering/illness scores on clinical scales (e.g., depression, hysteria, and paranoia) compared to traditional drug treatment. ...
Chapter
The neuron motor system has the ability to update the control strategy according to the environment. Intercepting a moving object is a task that can provide and study this ability. The aim of this study is to determine the performance and the control strategy on visual occlusion perturbation to intercepting moving targets. Sixteen subjects (24.4 ± 5.32 years old; 12 males and 4 females) were recruited. The experiment was carried out with a familiarization and an experimental phase where the participants managed a Physical Effector Machine (PEM) synchronized with a Virtual Interception Task (VIT). During the familiarization phase, participants learned the movement time (200 to 250 ms). In the experimental phase participants performed under two different conditions: Perturbation condition (PC), which corresponds to the target occlusion for 75 ms and 300 ms before expected movement onset and Control condition (CC) where there was no occlusion. In both conditions, the target moved at a constant velocity (145 cm.s−1). The results were analysed from the kinematics Movement time (MT), Relative time to peak velocity (%tPV), Correction Numbers (CN) and Spatial absolute-error (AE). The statistics were run by non-parametric Mann Whitney test to verify differences between CC and PC. The results showed a higher AE for PC than CC condition [U(159) = 16.738; p = .01; r = .43]. For the TM, %tPV and NC there were no differences between conditions. Our findings allowed us to conclude that the occlusion affected the performance accuracy but the control strategy to intercepting seemed to be similar in both conditions.KeywordMotor controlFeedback mechanismInterceptive task
... Raymond et al. established progressions via comparing the treatment and control groups. Scott et al. concluded that neurofeedback treatment enhanced psychological health in mixed substance addicts (Bodenhamer-Davis & Callaway, 2004;Burkett, Cummins, Dickson, & Skolnick, 2004;Hashemian, 2015;Passini et al., 1977;Peniston, 1994;Peniston & Kulkosky, 1991;Raymond, Varney, Parkinson, & Gruzelier, 2005;Ross, 2013;Saxby & Peniston, 1995). Taremian and Heydari showed the efficacy of conventional NFB (alpha-theta protocol) in decreasing craving in opioid addict patients. ...
Article
Full-text available
Background: Previous studies have shown that conventional neurofeedback and cognitive modification treatments have led to numerous psychological improvements in patients suffering from substance use disorders. However, effectiveness of LORETA (Low-Resolution Brain Electromagnetic Tomography) Z score neurofeedback (LZNFB) and Cognitive rehabilitation therapy on reducing of opioid craving has yet to be investigated. Thus, aim of the present study was to compare effectiveness of LZNFB and Cognitive rehabilitation therapy with methadone maintenance treatment (MMT) in reduction of craving in patients with opioid use disorder.
... ay, Burkett et al. Raymond et al. established progressions via comparing the treatment and control groups. Scott et al. concluded that neurofeedback treatment enhanced psychological health in mixed substance addicts (Bodenhamer-Davis & Callaway, 2004;Burkett, Cummins, Dickson, & Skolnick, 2004;Hashemian, 2015;Passini et al., 1977;E. Peniston, 1994;E. G. Peniston & Kulkosky, 1991;Raymond, Varney, Parkinson, & Gruzelier, 2005;Ross, 2013;Saxby & Peniston, 1995). Taremian and Heydari showed the efficacy of conventional NFB (alpha-theta protocol) in decreasing of craving on opioid addict patients. They trained experimental group for 20 sessions and compared with control group by evaluation of their craving with DDQ t ...
Article
Full-text available
Introduction: Previous studies have shown that conventional neurofeedback and cognitive modification treatments have numerous psychological benefits for patients with substance use disorders. However, the effectiveness of LORETA (Low-Resolution Brain Electromagnetic Tomography) Z Score Neurofeedback (LZNFB) and cognitive rehabilitation therapy in reducing opioid craving has not been investigated. Thus, the present study aimed to compare the effectiveness of LZNFB and cognitive rehabilitation therapy with Methadone Maintenance Treatment (MMT) in reducing craving in patients with opioid use disorder. Methods: Thirty patients with opioid use disorder undergoing MMT were randomly assigned into three groups: LZNFB with MMT, cognitive rehabilitation with MMT (as experimental groups), and MMT alone control group. The LZNFB and cognitive rehabilitation groups received 20 and 15 sessions of treatment, respectively. The three groups were assessed using several questionnaires and dot-probe task at pretest, posttest, and one-month follow-up. Results: The results showed that both experimental groups accomplished a significantly greater reduction in opioid craving than MMT alone group at posttest and follow-up (P<0.05). The LZNFB plus MMT group showed a greater decrease in opioid craving than the cognitive rehabilitation plus MMT group. In addition, the cognitive rehabilitation plus MMT group experienced greater improvement in attentional bias towards craving cues than the LZNFB with MMT group at posttest and follow-up. Finally, the LZNFB plus MMT group and cognitive rehabilitation plus MMT group got higher scores on the recovery assessment scale than MMT alone group at posttest and follow-up. According to study results, LZNFB training is more effective than cognitive rehabilitation in decreasing cravings and improving the quality of life in addiction to opioids. Conclusion: The current study's findings provided preliminary support for the effectiveness of LZNFB and cognitive rehabilitation in reducing opioid craving, improving attentional bias towards craving cues, and the quality of life among Iranian opioid use patients. Highlights: LZNFB training showed higher decrease in opioid craving than the Cognitive rehabilitation in opioid addicts.Cognitive rehabilitation group experienced greater improvement on attentional bias towards craving cues than LZNFB.LZNFB and Cognitive rehabilitation with MMT group got higher scores on the recovery assessment scale than MMT alone group.LZNFB training is more effective than Cognitive Rehabilitation in decreasing of craving in addiction. opioids. Plain language summary: Addiction is a chronic relapsing disease that makes many problems for human society. Routine medical treatments are not completely effective and they have relapse. New forms of non-medical treatments such as neurofeedback and cognitive rehabilitation are effective and safe without impressive side effects . This article shows the efficacy of above mentioned interventions for decrease craving and control of this problem.
... Alpha downregulation has been performed with stroke patients suffering from visuospatial neglect and adults suffering from ADHD (Deiber et al., 2020) and anxiety (Kerson et al., 2009), among other disorders. Alpha upregulation may be performed to improve memory (Kober et al., 2015;Nan et al., 2012) and get clients into deeper states (as in the alpha/theta protocol) in the treatment of alcoholism, depression (Saxby & Peniston, 1995) and posttraumatic stress disorder (PTSD; Peniston, & Kulkosky, 1991). Posterior alpha enhancement protocols have also been associated with an induced sense of calm and pleasant relaxation (Angelakis et al., 2007;Norris, Lee, Cea & Burshteyn, 1998), reduced stress and anxiety among highly anxious individuals (Hardt & Kamiya, 1978) and reductions in stress response indices such as blood pressure (Norris, Lee, Burshteyn, & Cea-Aravena, 2000). ...
Article
Full-text available
Alpha band oscillations are characterized phenomenologically by a state of relaxed, unfocused attention and are implicated in enhanced learning and memory performance. Alpha power may reflect cortical inhibition in task-irrelevant brain regions, thus leaving more neural resources available to task-relevant regions and processes. In this paper we propose that a short priming session with a posterior alpha upregulation protocol may accelerate subsequent neurofeedback learning with the client’s main training protocols. Neurofeedback relies to a large extent on implicit learning processes mediated by the basal ganglia and frontal cortical regions. Alpha uptraining posteriorly may inhibit task-irrelevant cortical regions dedicated mostly to explicit processing and externally oriented attention, thereby clearing the way for cortical and subcortical regions directly involved in neurofeedback learning to process the feedback more efficiently. It may thus serve to accelerate the learning process and efficacy of neurofeedback training. Various considerations and possible side effects are discussed.
... 15 To date, different procedures using biofeedback 15 and NFB to modulate stress responses have been reported. In terms of reducing stress symptoms, NFB training procedures have focused primarily on PTSD 16,17 using the alpha-theta ratio in Vietnam veterans; 18 in comorbidity with drug addiction 19 and modulation of the amygdala complex connectivity through real-time functional magnetic resonance imaging (rt-fMRI) using alpha oscillation. 20,21 NFB also has shown effectiveness in managing the stress response in Olympic athletes, 22 in high-school students; 23 in kids 24 and in nursing students; 25 it also reduces social anxiety symptoms 26 and plays an important role in stress resilience in a military training programme, targeting the amygdala activity with rt-fMRI. ...
Conference Paper
Full-text available
Although musical neurofeedback is used in multiple works, few systems have been developed for stress regulation, and no systems have been developed for memory stimulation. For this reason, a music-based neurofeedback system for stress regulation and memory stimulation is proposed. This system was designed as a response to a previous research called "Neurophysiology of Emotions and Intimate Partner Violence (IPV) against Women". The designed system uses 8 EEG channels to analyze alpha and theta brainwaves from 4 areas of the brain: prefrontal, frontal, temporal and central. By recording a 30 seconds baseline, the system is capable to detect changes in the EEG signal that can be used for the interaction. For feedback, three musical features are modified depending on the EEG analysis: tempo, loudness and loudness of the voice of the singer. For testing the system, two protocols were designed, these protocols focused on memory stimulation and stress regulation. They were designed specifically for each one of the three types of feedback. These protocols were applied on two women (43 and 52 years old), both had been part of the previous project. Results are promising, showing changes in the EEG signals of the participants when comparing the first session and the last one. Changes in performance of some specific tasks in the protocols, show an adequate usability of the system. Further studies will be carry on in order to evaluate long-term effects of the system with more activities.
... Research in into oscillatory brain activity in PTSD has been limited to ongoing or resting oscillatory activity. For example, alpha-theta-ratio neurofeedback therapy has shown some degree of effectiveness for Vietnam veterans with combat-related PTSD 46 and for patients with anxiety disorders, where alpha power changed in proportion to anxiety levels (for review see Moore 47 ). Magnetic resonance therapy inducing alpha power increase resulted in decreases in PTSD symptom severity 48 . ...
Preprint
Part of the symptomatology of post-traumatic stress disorder (PTSD) are alterations in arousal and reactivity which could be related to a maladaptive increase in the automated sensory change detection system of the brain. In the current EEG study we investigated whether the brain’s response to a simple auditory sensory change was altered in patients with PTSD relative to trauma-exposed matched controls who did not develop the disorder. Thirteen male PTSD patients and trauma-exposed controls matched for age and educational level were presented regular auditory pure tones (1000 Hz, 200 ms duration), with 11% of the tones deviating in both duration (50 ms) and frequency (1200 Hz) while watching a silent movie. Relative to the controls, patients who had developed PTSD showed enhanced mismatch negativity (MMN), increased theta power (5-7 Hz), and stronger suppression of upper alpha activity (13-15 Hz) after deviant vs. standard tones. Behaviourally, the alpha suppression in PTSD correlated with decreased spatial working memory performance suggesting it might reflect enhanced stimulus-feature representations in auditory memory. These results taken together suggest that PTSD patients and trauma-exposed controls can be distinguished by enhanced involuntary attention to changes in sensory patterns.
... For example, connections involving the right lenticular nucleus (putamen) were selected by both studies, among others, indicating reliability in the pre-learn FS process. Taken together, consistent with previous reports on the involvement of alpha oscillations in PTSD [10,[55][56][57][58], our pre-learn FS process was able to identify alpha activity as effectively predicting PTSD severity at a later timepoint using earlier MEG functional connectivity data. ...
Article
Full-text available
Objective. The present study explores the effectiveness of incorporating temporal information in predicting post-traumatic stress disorder (PTSD) severity using magnetoencephalography (MEG) imaging data. The main objective was to assess the relationship between longitudinal MEG functional connectome data, measured across a variety of neural oscillatory frequencies and collected at two timepoints (Phase I and II), against PTSD severity captured at the later time point. Approach. We used an in-house developed informatics solution, featuring a two-step process featuring pre-learn feature selection (CV-SVR-rRF-FS, cross-validation with support vector regression (SVR) and recursive random forest feature selection) and deep learning (long-short term memory recurrent neural network, LSTM-RNN) techniques. Main results. The pre-learn step selected a small number of functional connections (or edges) from Phase I MEG data associated with Phase II PTSD severity, indexed using the PTSD CheckList (PCL) score. This strategy identified the functional edges affected by traumatic exposure and indexed disease severity, either permanently or evolving dynamically over time, for optimal predictive performance. Using the selected functional edges, LSTM modelling was used to incorporate the Phase II MEG data into longitudinal regression models. Single timepoint (Phase I and Phase II MEG data) SVR models were generated for comparison. Assessed with holdout test data, alpha and high gamma bands showed enhanced predictive performance with the longitudinal models comparing to the Phase I single timepoint models. The best predictive performance was observed for lower frequency ranges compared to the higher frequencies (low gamma), for both model types. Significance. This study identified the neural oscillatory signatures that benefited from additional temporal information when estimating the outcome of PTSD severity using MEG functional connectome data. Crucially, this approach can similarly be applied to any other mental health challenge, using this effective informatics foundation for longitudinal tracking of pathological brain states and predicting outcome with a MEG-based neurophysiology imaging system.
... Neurofeedback has been used to treat PTSD since the 1980s (Peniston & Kulkosky, 1991) and the advent of MRI-assisted neurofeedback, as opposed to EEG-assisted neurofeedback, appears to have stimulated new interest in its use. Transcranial magnetic stimulation is now an approved treatment in many countries for treatment-resistant depression (NICE, 2015). ...
Article
Full-text available
Background Non-pharmacological and non-psychological approaches to the treatment of post-traumatic stress disorder (PTSD) have often been excluded from systematic reviews and meta-analyses. Consequently, we know little regarding their efficacy. Objective To determine the effect sizes of non-pharmacological and non-psychological treatment approaches for PTSD. Method We undertook a systematic review and meta-analyses following Cochrane Collaboration guidelines. A pre-determined definition of clinical importance was applied to the results and the quality of evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Results 30 randomised controlled trials (RCTs) of a range of heterogeneous non-psychological and non-pharmacological interventions (28 in adults, two in children and adolescents) were included. There was emerging evidence for six different approaches (acupuncture, neurofeedback, saikokeishikankyoto (a herbal preparation), somatic experiencing, transcranial magnetic stimulation, and yoga). Conclusions Given the level of evidence available, it would be premature to offer non-pharmacological and non-psychological interventions routinely, but those with evidence of efficacy provide alternatives for people who do not respond to, do not tolerate or do not want more conventional evidence-based interventions. This review should stimulate further research in this area.
... Neurofeedback is a biofeedback-type procedure and has been reported to be effective with PTSD sufferers (e.g. Peniston & Kulkosky, 1991). EMDR has also been reported to be effective with PTSD sufferers (e.g. ...
Thesis
Current research has highlighted impaired learning and memory processes in adults diagnosed with Posttraumatic Stress Disorder (PTSD). Although some clients respond favourably to psychological therapy, outcome studies indicate that treatment rarely leads to a full remission of the disorder. Neuroimaging studies of adults with chronic PTSD have suggested altered brain morphology in regions associated with memory functioning, specifically the hippocampus. It is possible that impaired learning and memory processes adversely affect the capability of clients with PTSD to respond to treatment. This study investigated the memory, attention and learning profiles of 27 adults diagnosed with PTSD who presented at a specialist treatment centre prior to commencing cognitive-behavioural therapy. Measures of PTSD, anxiety, depression, and past and current history of alcohol/substance use were obtained on assessment. A neuropsychological test battery was then administered to assess baseline cognitive functioning, memory, learning, attention, and executive function. Twenty-three adults were followed up at session eight of treatment, and their PTSD diagnosis was re-evaluated. Clients who did not improve with treatment had significantly poorer performance on intake measures of verbal memory. In particular, a measure of encoding meaningful verbal material was found to independently predict outcome. Differences were not accounted for by performance on tasks of attention and executive function. Further, severity of PTSD symptomatology, severity of anxiety and depression, length of time since trauma, and alcohol and substance use were not related to memory functioning. The theoretical, clinical, and research implications of this were discussed.
... There have been only a few studies of neurofeedback in veterans or trauma populations [34][35][36] examining effects on psychiatric symptoms, not chronic pain. None have involved mobile EEG headset devices. ...
Preprint
Full-text available
Objective. Chronic pain is common in military veterans with traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Neurofeedback, or electroencephalograph (EEG) biofeedback, has been associated with lower pain but requires frequent travel to a clinic. The current study examined feasibility and explored effectiveness of neuro-feedback delivered with a portable EEG headset linked to an application on a mobile device. Design. Open-label, single arm clinical trial. Setting. Home, outside of clinic. Subjects. N ¼ 41 veterans with chronic pain, TBI, and PTSD. Method. Veterans were instructed to perform "mobile neurofeedback" on their own for three months. Clinical research staff conducted two home visits and two phone calls to provide technical assistance and troubleshoot difficulties. Results. N ¼ 36 veterans returned for follow-up at three months (88% retention). During this time, subjects completed a mean of 33.09 neurofeedback sessions (10 minutes each). Analyses revealed that veterans reported lower pain intensity, pain interference, depression, PTSD symptoms, anger, sleep disturbance, and suicidal ideation after the three-month intervention compared with baseline. Comparing pain ratings before and after individual neu-rofeedback sessions, veterans reported reduced pain intensity 67% of the time immediately following mobile neuro-feedback. There were no serious adverse events reported. Conclusions. This preliminary study found that veterans with chronic pain, TBI, and PTSD were able to use neurofeedback with mobile devices independently after modest training and support. While a double-blind randomized controlled trial is needed for confirmation, the results show promise of a portable, technology-based neuromodulatory approach for pain management with minimal side effects.
... There have been only a few studies of neurofeedback in veterans or trauma populations [34][35][36] examining effects on psychiatric symptoms, not chronic pain. None have involved mobile EEG headset devices. ...
Article
Full-text available
Objective: Chronic pain is common in military veterans with traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Neurofeedback, or electroencephalograph (EEG) biofeedback, has been associated with lower pain but requires frequent travel to a clinic. The current study examined feasibility and explored effectiveness of neurofeedback delivered with a portable EEG headset linked to an application on a mobile device. Design: Open-label, single-arm clinical trial. Setting: Home, outside of clinic. Subjects: N = 41 veterans with chronic pain, TBI, and PTSD. Method: Veterans were instructed to perform "mobile neurofeedback" on their own for three months. Clinical research staff conducted two home visits and two phone calls to provide technical assistance and troubleshoot difficulties. Results: N = 36 veterans returned for follow-up at three months (88% retention). During this time, subjects completed a mean of 33.09 neurofeedback sessions (10 minutes each). Analyses revealed that veterans reported lower pain intensity, pain interference, depression, PTSD symptoms, anger, sleep disturbance, and suicidal ideation after the three-month intervention compared with baseline. Comparing pain ratings before and after individual neurofeedback sessions, veterans reported reduced pain intensity 67% of the time immediately following mobile neurofeedback. There were no serious adverse events reported. Conclusions: This preliminary study found that veterans with chronic pain, TBI, and PTSD were able to use neurofeedback with mobile devices independently after modest training and support. While a double-blind randomized controlled trial is needed for confirmation, the results show promise of a portable, technology-based neuromodulatory approach for pain management with minimal side effects.
... Electroencephalogram (EEG) based NF is not only used in the optimal performance field [15][16][17][18][19][20][21] it is also used for the treatment of various neurological and psychological disorders [17,22] such as attention deficit hyperactivity disorder (ADHD), autism, stroke rehabilitation, depression, anxiety, stress, obsessive compulsive disorders, epilepsy, schizophrenia, and pain [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. A variety of NF training protocols has been applied for optimal peak performance and for treatment of neurological disorders. ...
Article
Full-text available
Neurofeedback (NF) training has been used for the treatment of neuropathic pain. This paper presents the results of assessment of the learning ability of five patients having neuropathic pain. The following two types of baselines were adopted: Baseline 1 refers to power on Day 1 in PreNF state; and Baseline 2 refers to power recorded on each training day in PreNF state. The result of the study demonstrated that not only the baseline its selection is also important to demonstrate the validity of training protocol. It was also found that Baseline 2 can be used to define cut-off time for training (when training should be stopped). All five patients can be classified as learner and alpha band was found to be most relevant for NF training.
... Compared with treatment-as-usual controls, veterans in the experimental condition had abstinence rates as high as 70%, and these results were maintained at a follow-up. Peniston and Kulkosky (1991) turned their attention to Vietnam veterans with combat PTSD. They recruited 29 Vietnam veterans suffering from chronic war-related PTSD, including frequent anxietyevoking nightmares and flashbacks. ...
Article
Full-text available
The posttraumatic stress disorder (PTSD) condition is a systemic neuroinflammatory state that emanates from a failure to recover from traumatic occurrence(s). Major complications associated with PTSD include problems with impulse control and issues related to verbal and physical outbursts of anger and rage. The Veteran's Administration (VA) projects a post-9/11 veteran population of around 3.5 million by 2019. Emotional problems are prevalent among combat service members and veterans with about half of the group suffering from various symptoms of PTSD. Three in four among them report they are reliving traumas in the form of flashbacks and nightmares. Current mental health treatments have not fully remediated the negative impact that results from PTSD. We present a case study of a novel and transformative treatment approach called Reconsolidation Enhancement by Stimulation of Emotional Triggers (RESET) Therapy. The intervention uses binaural sound to unlock the memory reconsolidation process, thereby releasing the emotional component of experienced trauma. RESET Therapy offers a compelling therapeutic adjunct to the practicing biofeedback/neurofeedback clinician, who is under constant pressure to deliver interventions that are rapid, tolerable, and cost-effective. Additionally, the treatment spares the therapist from repeated exposures to the raw limbic activity of traumatized patients, thereby minimizing the potential for vicarious traumatization.
... There is also a long-standing evidence that several neuromodulation sessions mobilize brain plasticity and generates anatomical and functional changes in the brain [21]. Those changes have long been associated with clinical improvement in various dysfunction of the central nervous system (CNS) such as attention deficit disorder (ADD) [11] and post-traumatic stress disorder (PTSD) [38]. However, the clinical evidence for most of these fields still lingers due to technical and methodological shortcomings [11]. ...
Article
Full-text available
Purpose: Chronic low back pain (cLBP) affects a quarter of a population during its lifetime. The most severe cases include patients not responding to interventions such as 5-week-long in-hospital multi-disciplinary protocols. This document reports on a pilot study offering an alpha-phase synchronization (APS) brain rehabilitation intervention to a population of n = 16 multi-resistant cLBP patients. Methods: The intervention consists of 20 sessions of highly controlled electroencephalography (EEG) APS operant conditioning (neurofeedback) paradigm delivered in the form of visual feedback. Visual analogue scale for pain, Dallas, Hamilton, and HAD were measured before, after, at 6-month and 12-month follow-up. Full-scalp EEG data were analyzed to study significant changes in the brain's electrical activity. Results: The intervention showed a great and lasting response of most measured clinical scales. The clinical improvement was lasting beyond the 6-month follow-up endpoints. The EEG data confirm that patients did control (intra-session trends) and learned to better control (intersession trends) their APS neuromarker resulting in (nonsignificant) baseline changes in their resting state activity. Last and most significantly, the alpha-phase concentration (APC) neuromarker, specific to phase rather than amplitude, was found to correlate significantly with the reduction in clinical symptoms in a typical dose-response effect. Conclusion: This first experiment highlights the role of the APC neuromarker in relation to the nucleus accumbens activity and its role on nociception and the chronicity of pain. This study suggests APC rehabilitation could be used clinically for the most severe cases of cLBP. Its excellent safety profile and availability as a home-use intervention makes it a potentially disruptive tool in the context of nonsteroidal anti-inflammatory drugs and opioid abuses. These slides can be retrieved under Electronic Supplementary Material.
... Compared with treatment-as-usual controls, veterans in the experimental condition had abstinence rates as high as 70%, and these results were maintained at a follow-up. Peniston and Kulkosky (1991) turned their attention to Vietnam veterans with combat PTSD. They recruited 29 Vietnam veterans suffering from chronic war-related PTSD, including frequent anxietyevoking nightmares and flashbacks. ...
Article
Full-text available
The posttraumatic stress disorder (PTSD) condition is a systemic neuroinflammatory state that emanates from a failure to recover from traumatic occurrence(s). Major complications associated with PTSD include problems with impulse control and issues related to verbal and physical outbursts of anger and rage. The Veteran's Administration (VA) projects a post-9/11 veteran population of around 3.5 million by 2019. Emotional problems are prevalent among combat service members and veterans with about half of the group suffering from various symptoms of PTSD. Three in four among them report they are reliving traumas in the form of flashbacks and nightmares. Current mental health treatments have not fully remediated the negative impact that results from PTSD. We present a case study of a novel and transformative treatment approach called Reconsolidation Enhancement by Stimulation of Emotional Triggers (RESET) Therapy. The intervention uses binaural sound to unlock the memory reconsolidation process, thereby releasing the emotional component of experienced trauma. RESET Therapy offers a compelling therapeutic adjunct to the practicing biofeedback/neurofeedback clinician, who is under constant pressure to deliver interventions that are rapid, tolerable, and cost-effective. Additionally, the treatment spares the therapist from repeated exposures to the raw limbic activity of traumatized patients, thereby minimizing the potential for vicarious traumatization.
... This training is also referred to as deep status work. Eugene Penniston and Paul Kulikowski later applied this alpha-theta training in rehabilitation intervention for alcoholics and in post-traumatic stress disorder (Penniston & Kulkosky, 1991). The goal of the training is to enter a "crossover" state wherein the theta band is greater in amplitude than the alpha band (Penniston & Kulkosky, 1989). ...
Chapter
Full-text available
Neurofeedback (NF) is a type of brain wave training based on operant learning. NF has been employed in research and clinical settings for the investigation and treatment of a growing number of psychological illnesses. This technique involves detection of electroencephalographic (EEG) information from the surface of the scalp of a subject by separating its frequency decomposition into its component waveform (alpha, beta, theta, gamma, and delta) and making these components visible usually as polygraphic traces on a computer screen. Neurofeedback is being considered as a promising new method for restoring brain function in a large number of mental disorder cases. NF takes into account behavioral, cognitive, and subjective aspects as well as the brain activity of the concerned individual. About 25 years ago, NF was employed for clinical and research purposes in psychological illness. These psychological illnesses include attention deficit disorder, addiction to drug, depression, stress, and eating disorders.
... Neurofeedback has been shown to exert therapeutic effects on attention-deficit/hyperactivity disorder (ADHD) (Carmody et al. 2000;Linden et al. 1996;Monastra et al. 2002;Rossiter and La Vaque 1995), alcoholism (Sokhadze et al. 2008), and depression (Baehr et al. 2001;Hammond 2000;Rosenfeld et al. 1995). Furthermore, the alpha/theta neurofeedback training has been reported to exert therapeutic effects on alcoholism (Peniston and Kulkosky 1990) and post-traumatic stress disorder (Peniston and Kulkosky 1991). Previous reports have also indicated that alpha/ theta training enhances the performance of healthy persons, including musicians and dancers (Egner and Gruzelier 2003;Gruzelier 2014). ...
Article
Full-text available
The underlying mechanisms of alpha/theta neurofeedback training have not been fully determined. Therefore, this study aimed to test the changes in the brain state feedback during the alpha/theta training. Twenty-seven healthy participants were trained during a single session of the alpha/theta protocol, and the resting quantitative electroencephalography (QEEG) was assessed before and after training. QEEG was recorded at eight scalp locations (F3, F4, C3, C4, T3, T4, O1, and O2), and the absolute power, relative power, ratio of sensory-motor rhythm beta (SMR) to theta (RST), ratio of SMR-mid beta to theta (RSMT), ratio of mid beta to theta (RMT), ratio of alpha to high beta (RAHB), and scaling exponent of detrended fluctuation analysis by each band were measured. The results indicated a significant increase of absolute alpha power, especially the slow alpha band, at all electrodes except T3 and T4. Moreover, the relative alpha power, especially the slow alpha band, showed a significant increase at all electrodes. The relative theta power showed a significant decrease at all electrodes, except T3. A significant decrease in relative beta power, relative lower beta power and relative mid beta power was observed at O1. RST (at C4, O1, and O2), RSMT and RMT (at F4, C4, O1 and O2), and RAHB (at all electrodes) showed significant increase. Scaling exponents at all electrodes except T3 showed a significant decrease. These findings indicate that a one-time session of alpha/theta training might have the possibility to enhance both vigilance and concentration, thus stabilizing the overall brain function.
... A second form of assessing brain-phenotypes, psycho-physiological assessment, demonstrates equal efficacy in reducing PTSD symptoms (Keith, Theodore, Rapgay, Schwartz, & Ross, 2015) and other brain-phenotype imbalances (Scott, 2018). Psycho-physiological assessments more coherently identify both PTSD and other cooccurring mental health symptoms then the DSM-V and ICD-10 include, thereby providing a broader understanding of the underlying brain-arousal levels and their implications for both assessment and treatment. ...
Article
Full-text available
Neurofeedback brain-training has a significant presence in the literature for its efficacy in alleviating the symptoms and behavioral manifestations of PTSD, with no enduring negative side-effects. It is considered a behavioral intervention in that it teaches the brain to better manage its own brainwave activity, leading to reduction of 80-85% of symptoms in the first 30-40 training sessions. Brain-training has shown efficacy in improving recovery from anxiety, depression, insomnia, addictions, emotional and cognitive dysregulation, attention, impulse control and many more co-occurring symptoms of PTSD. Barriers to broad-based implementation in both clinical and subclinical settings include cost of equipment, lengthy, in-depth training requirements, and a lack of clear guidance in developing and implementing brain-training protocols specific to each individual's brain-phenotype. Automated Psychophysiological assessment and EEG Biofeedback training systems demonstrate equal efficacy as clinician-guided EEG Systems. We propose that Automated EEG Biofeedback systems have evolved to differentiate and train a multiplicity of brain-phenotypes related to PTSD. Further, these systems decrease the cost of brain-training significantly, reduce the training requirements for brain-trainers, and significantly increase the effectiveness of all other behavioral and pharmacological interventions. We propose that automated brain-training can be more broadly implemented in clinical and sub-clinical settings as a primary behavioral intervention for PTSD.
... These disorders are also sometimes accompanied by aggressive outbursts and delinquent behavior ('t Hart-Kerkhoffs, 2010;Vermeiren, 2002;Wilson & Cumming, 2009). The efficacy of neurofeedback in treating these specific conditions is less empirically supported than that in treating ADHD and SUDs, although some evidence does exist ( Kouijzer et al., 2008;Martin & Johnson, 2005;Peniston et al., 1991Peniston et al., , 1993Peterson, 2000;Smith & Sams, 2005;Van Outsem, 2011). ...
Conference Paper
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For a better rescuing of people with disabilities, it is crucial the development of new assistive technologies and therapeutic methods to rehabilitate people with some disabilities to integrate them to a complete social life. A very promising tool is the physiological self-regulation protocols based on biofeedback training. Biofeedback protocols are based on the premise that it is possible to learn how to self-modulate specific aspects of the body's physiological activity. A biofeedback system is composed of input physiological information and output sensorial stimuli information in a real-time closed-loop process that allows patients to modulate a target physiological (dys)function. The application of biofeedback protocols has been widely studied and used in different clinical practices such as orthopedic, neurological, physiological, and cognitive conditions. This review focuses on the main aspects concerning the system arrangement and protocols of stimulation in biofeedback approaches, from its basic principles of operation to its clinical application in different contexts , with emphasis on sensorimotor and cognitive deficits.
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Thesis
Cette thèse porte sur la conception, l’implémentation et l’évaluation d’un système de neurofeedback EEG portable, d’aide à la gestion du stress, à destination du grand public. Un tel système permet aux utilisateurs d’apprendre à moduler leurs états mentaux par des phénomènes de plasticité cérébrale. Cependant, plusieurs facteurs peuvent compliquer cet apprentissage, comme un plus faible rapport signal sur bruit de l'EEG acquis par des électrodes sèches, la contamination par des artefacts ou encore la définition de paramètres pertinents à partir des signaux EEG. Afin d’optimiser ce retour neuronal, ma thèse propose d’abord une méthode statistique permettant de s’assurer de la qualité des signaux EEG acquis, ainsi qu’une méthode corrective d’artefacts, afin de pouvoir extraire une mesure pertinente de l’activité EEG reflétant le niveau de stress ou de relaxation de l’individu. Le développement d’un indice de neurofeedback pertinent et adapté à l’utilisateur est également proposé. A la suite de la constitution algorithmique d’un tel système, les caractéristiques d'apprentissage par neurofeedback ont pu être étudiées. En particulier, je montre qu'un apprentissage intersession semble se mettre en place et que chez les sujets stressés, des changements cérébraux s'opèrent dans la bande alpha durant les phases de repos. Finalement, par ces aspects méthodologiques, d’intégration logicielle et d’analyse longitudinale, cette thèse constitue les briques fondamentales d’un système de recommandation automatique adapté à l’utilisateur. Un tel système permettrait un suivi personnel des utilisateurs afin de leur proposer une stratégie préventive pour la gestion du stress.
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ان تقنية التغذية الراجعة العصبية تعد من ابرز التقنيات العلاجية الحديثة والمطورة القائمة على اليقظة الذهنية، فقد كانت هناك دراسات عدة تبحث في مدى تأثيرها على اعتبار انها شكل من اشكال الاشراط الفعال لنشاط الدماغ الكهربائي، التي يعزز النشاط الايجابي بالاثابة ويمنع ظهور النشاط السلبي، وتعمل على تغيير سطح خلايا الدماغ والذي يؤثر على فعالية الدماغ والتحسين من اداء المعالجات المعرفية فيه، ويمكن التعرف على أنماط مختلفة من النشاط الكهربائي من خلال وضع الأقطاب الكهربائية على فروة الرأس وتسجيل تلك الأنشطة القشرية لمناطق المخ القريبة منها -المعروفة باسم موجات الدماغ- ومن خلال السعات والترددات تم تصنيف مكونات التردد المختلفة في الدماغ إلى امواج دلتا وثيتا وألفا وبيتا وكاما ويمثل كل منهما وظيفة فسيولوجية معينة واي خلل فيها يمثل ما يسمى باعراض الاضطرابات النفسية المتنوعة لذلك فان اعادة تنظيم هذه الامواج يساعد في التعافي من هذه الاعراض. وهناك انواع مختلفة من التغذية الراجعة العصبية منها التغذية الراجعة العصبية السطحية تستعمل لتغيير سعة أو سرعة موجات دماغية في مواقع معينة من الدماغ والتغذية الراجعة العصبية القشرية البطيئة على تحسين اتجاه الإمكانات القشرية البطيئة وتوفر بيانات التغذية الراجعة العصبية ردود أو ملاحظات حول تدفق الدم إلى الدماغ اضافة الى انها تقدم مقارنة مستمرة لتغيرات النشاط الكهربائي في الدماغ بقاعدة بيانات منهجية لتوفير تغذية راجعة مستمرة، وتعد تقنية التصوير بالرنين المغناطيسي الوظيفي fMRI أحدث أنواع التغذية الراجعة العصبية لتنظيم نشاط المخ بناءً على لنشاط المناطق القشرية العميقة في المخ.
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Chapter
In this chapter, we provide a theoretical and empirically based understanding of antisocial and psychopathic women. We begin by clarifying the differences between psychopathy, sociopathy, and ASPD, and then provide a historical perspective of hysteria. While the underlying personality of the female psychopath is paranoid, malignant hysteria is their predominant personality style (Gacono & Meloy, 1994). Overviews of the Hare Psychopathy Checklist-Revised (PCL-R), Personality Assessment Inventory (PAI), and Rorschach are offered as a refresher for those experienced clinicians and as a resource for those that are not. Finally, we present group PAI and Rorschach data (also Trauma Symptom Inventory-2 [TSI-2]) for 337 female offenders including subsets of psychopathic (N = 124) and non-psychopathic (N = 57) females. We make note of the differences between female and male psychopaths.
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Objective Psychological interventions for post-traumatic stress disorder (PTSD) are not always effective and can leave some individuals with enduring symptoms. Little is known about factors that are associated with better or worse treatment outcome. Our objective was to address this gap. Method We undertook a systematic review following Cochrane Collaboration Guidelines. We included 126 randomized controlled trials (RCTs) of psychological interventions for PTSD and examined factors that were associated with treatment outcome, in terms of severity of PTSD symptoms post-treatment, and recovery or remission. Results Associations were neither consistent nor strong. Two factors were associated with smaller reductions in severity of PTSD symptoms post-treatment: comorbid diagnosis of depression, and higher PTSD symptom severity at baseline assessment. Higher education, adherence to homework and experience of a more recent trauma were associated with better treatment outcome. Conclusion Identifying and understanding why certain factors are associated with treatment outcome is vital to determine which individuals are most likely to benefit from particular treatments and to develop more effective treatments in the future. There is an urgent need for consistent and standardized reporting of factors associated with treatment outcome in all clinical trials.
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Background: Psychological therapies are the recommended first-line treatment for post-traumatic stress disorder (PTSD). Previous systematic reviews have grouped theoretically similar interventions to determine differences between broadly distinct approaches. Consequently, we know little regarding the relative efficacy of the specific manualized therapies commonly applied to the treatment of PTSD. Objective: To determine the effect sizes of manualized therapies for PTSD. Methods: We undertook a systematic review following Cochrane Collaboration guidelines. A pre-determined definition of clinical importance was applied to the results and the quality of evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Results: 114 randomized-controlled trials (RCTs) of 8171 participants were included. There was robust evidence that the therapies broadly defined as CBT with a trauma focus (CBT-T), as well as Eye Movement Desensitization and Reprocessing (EMDR), had a clinically important effect. The manualized CBT-Ts with the strongest evidence of effect were Cognitive Processing Therapy (CPT); Cognitive Therapy (CT); and Prolonged Exposure (PE). There was also some evidence supporting CBT without a trauma focus; group CBT with a trauma focus; guided internet-based CBT; and Present Centred Therapy (PCT). There was emerging evidence for a number of other therapies. Conclusions: A recent increase in RCTs of psychological therapies for PTSD, results in a more confident recommendation of CBT-T and EMDR as the first-line treatments. Among the CBT-Ts considered by the review CPT, CT and PE should be the treatments of choice. The findings should guide evidence informed shared decision-making between patient and clinician.
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Background: Despite the established efficacy of psychological therapies for post-traumatic stress disorder (PTSD) there has been little systematic exploration of dropout rates. Objective: To ascertain rates of dropout across different modalities of psychological therapy for PTSD and to explore potential sources of heterogeneity. Method: A systematic review of dropout rates from randomized controlled trials (RCTs) of psychological therapies was conducted. The pooled rate of dropout from psychological therapies was estimated and reasons for heterogeneity explored using meta-regression. Results:: The pooled rate of dropout from RCTs of psychological therapies for PTSD was 16% (95% CI 14–18%). There was evidence of substantial heterogeneity across studies. We found evidence that psychological therapies with a trauma-focus were significantly associated with greater dropout. There was no evidence of greater dropout from therapies delivered in a group format; from studies that recruited participants from clinical services rather than via advertisements; that included only military personnel/veterans; that were limited to participants traumatized by sexual traumas; that included a higher proportion of female participants; or from studies with a lower proportion of participants who were university educated. Conclusions: Dropout rates from recommended psychological therapies for PTSD are high and this appears to be particularly true of interventions with a trauma focus. There is a need to further explore the reasons for dropout and to look at ways of increasing treatment retention.
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Background: Post-traumatic stress disorder (PTSD) is a major cause of morbidity amongst active duty and ex-serving military personnel. In recent years increasing efforts have been made to develop more effective treatments. Objective: To determine which psychological therapies are efficacious in treating active duty and ex-serving military personnel with post-traumatic stress disorder (PTSD). Method: A systematic review was undertaken according to Cochrane Collaboration Guidelines. The primary outcome measure was reduction in PTSD symptoms and the secondary outcome dropout. Results: Twenty-four studies with 2386 participants were included. Evidence demonstrated that CBT with a trauma focus (CBT-TF) was associated with the largest evidence of effect when compared to waitlist/usual care in reducing PTSD symptoms post treatment (10 studies; n = 524; SMD −1.22, −1.78 to −0.66). Group CBT-TF was less effective when compared to individual CBT-TF at reducing PTSD symptoms post treatment (1 study; n = 268; SMD −0.35, −0.11 to −0.59). Eye Movement Desensitization and Reprocessing (EMDR) therapy was not effective when compared to waitlist/usual care at reducing PTSD symptoms post treatment (4 studies; n = 92; SMD −0.83, −1.75 to 0.10). There was evidence of greater dropout from CBT-TF therapies compared to waitlist and Present Centred Therapy. Conclusions: The evidence, albeit limited, supports individual CBT-TF as the first-line psychological treatment of PTSD in active duty and ex-serving personnel. There is evidence for Group CBT-TF, but this is not as strong as for individual CBT-TF. EMDR cannot be recommended as a first line therapy at present and urgently requires further evaluation. Lower effect sizes than for other populations with PTSD and high levels of drop-out suggest that CBT-TF in its current formats is not optimally acceptable and further research is required to develop and evaluate more effective treatments for PTSD and complex PTSD in active duty and ex-serving military personnel.
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