Understanding PTSD

PTSD stands for Post-Traumatic Stress Disorder. This condition is caused by exposure to trauma which could be either physical or emotional in nature and was experienced as life threatening. It can result after a single traumatic incident (e.g. a major car accident) or multiple exposures to a traumatic event (e.g. many episodes of abuse as a child). PTSD can look like someone is anxious, depressed, startled easily, or scared, but the symptoms are more complex than that. Someone with PTSD will usually avoid taking risks related to the traumatic event (e.g. avoid driving, or getting into a car). Someone struggling with PTSD may demonstrate moderate to severe symptoms of anxiety and depression.

Anxiety can manifest as emotional symptoms (feeling unmotivated and discouraged), physical symptoms (fatigue, fluctuations in weight, changes in appetite, pain in the body, etc.), behavioural symptoms (avoiding people and events, reduced interest in sex, reduction in self-care activities), and cognitive symptoms (struggling with concentration and alertness, issues with planning and organization, forgetting things, etc.). Depression can manifest as emotional symptoms (feeling hopeless, sad, uninterested in things they used to enjoy,), physical symptoms (fatigue, fluctuations in weight, changes in appetite, pain in the body, etc.), behavioural symptoms (avoiding people and events, reduced interest in sex, reduction in self-care activities), and cognitive symptoms (struggling with concentration and alertness, issues with planning and organization, forgetting things, etc.).

PTSD can also affect a person’s instrumental activities of daily living (IADLs) which can be simply defined as a person’s daily self care activities. Some IADLs include cooking, cleaning, communication, accessing transportation, laundry, shopping, and managing personal finances. PTSD is usually diagnosed by a clinical psychologist or psychiatrist, but can also be diagnosed by your family physician. It is usually diagnosed after the symptoms related to PTSD do not go away after 6 months.

Our Approach to PTSD

We start with a Clinical Intake Interview to review background history, medical history, identify specific symptoms and their severity, review previous assessments and interventions, and identify if any other assessments are required. The next step is to complete a QEEG (Quantitative Electroencephalogram) assessment to analyze your brainwave patterns. The best way to understand brain waves is to compare them to each section of an orchestra. Every section of an orchestra needs to work together to make sure the music sounds good. Sometimes one section of the orchestra is more dominant than the other, but all sections are necessary to produce beautiful music. In the same way all brain waves are necessary to balance each other out, complement each other, and become dominant when necessary. For example, when you need to analyze and engage in higher level thinking you want your brain to be dominant in faster brain wave patterns to accomplish this task. When you are getting ready for sleep you want your brain to gradually slow down and be dominant in slower brain wave patterns.

People who usually have PTSD may have similar brain wave patterns related anxiety. Their brain is stuck in a processing or analyzing mode and they find it tough to relax. They may also have a reduction in calm and alert brain wave patterns such as alpha and sensorimotor rhythm (SMR). These imbalance are usually more extreme in PTSD as the brain may be stuck in the fight or flight response. Their nervous system is excessively active and an increased level of fast brain wave patterns such as beta and high beta help to explain hypervigilance and sleep issues common in PTSD. Once we figure out what brain wave patterns are related to your symptoms we can design a personalized program to target and improve them. During each session we monitor your brain waves in real time and when there is greater balance of brain wave patterns we reward you with video and sound. These audio and visual rewards help train and guide your brain to have improved balance and improve your symptoms.

Sometimes clients require additional support in conjunction with neurofeedback training. Some options are psychotherapy and somatic experiencing therapy. Somatic experiencing is a highly recommended support as it is a type of therapy specifically targeting to improve symptoms directly related to trauma, PTSD, and abuse.

Research Articles on PTSD

Foster, D. S., & Thatcher, R. W. (2015). Surface and LORETA neurofeedback in the treatment of post-traumatic stress disorder and mild traumatic brain injury. In Z Score Neurofeedback (pp. 59-92).

This study is a report of an on-going project that provides treatment for US combat veterans. Both PTSD and mild-traumatic brain injury involves a wide range of possible neural dysregulations, and thus, the authors posit that maximal treatment outcome will result from optimal specificity of assessment and treatment. In this study, 11 cases are analyzed and it is found that Loreta Z-Score neurofeedback results in specific neurophysiological normalization in the regions of training and quantified progressive reduction in symptoms. Paired t-tests demonstrate learning occurred in every case. Cohen’s d analyses of current source density improvements quantified large effect sizes in 9 of 10 cases and a moderate effect size in one case.

Kolk, B. A., Hodgdon, H., Gapen, M., Musicaro, R., Suvak, M. K., Hamlin, E., et al. (2016). A randomized controlled study for neurofeedback for chronic PTSD. PLOS ONE, 14(4), e0215940. https://doi.org/10.1371/journal.pone.0215940.

This study was a randomized, waitlist controlled trial of brain/computer interaction, electroencephalogram neurofeedback training in patients with chronic PTSD to explore the capacity of neurofeedback to reduce PTSD symptoms and increase affect regulation capacities. 52 individuals with chronic PTSD were randomly assigned to neurofeedback or waitlist (control) groups. After 24 sessions of neurofeedback were conducted, it was found that participants in the neurofeedback group treatment showed significant improvements in PTSD symptomatology that had not responded to at least 6 months of trauma-focused psychotherapy, compared to the waitlist group that continued to receive treatment as usual.

Gapen, M., Kolk, B. A., Hamlin, E., Hirshberg, L., Suvak, M., & Spinazzola, J. (2016). A pilot study of neurofeedback for chronic PTSD. Applied psychophysiology and Biofeedback, 41(3), 251-261. The authors examine the reason behind why neurofeedback has made such little impact on approaches to clinical care, noting that designing research to measure clinical change in the real world presents itself as a barrier. As such, this paper offers a “proof-of-concept” pilot for the use of neurofeedback with multiply-traumatized individuals with treatment-resistant PTSD. After completing 40 sessions of neurofeedback training over the course of 2 weeks, the authors found that their protocol significantly reduced PTSD symptoms and preceded gains in affect regulation.

Reiter, K., Andersen, S. B., & Carlsson, J. (2016). Neurofeedback treatment and posttraumatic stress disorder: effectiveness of neurofeedback on posttraumatic stress disorder and the optimal choice of protocol. The Journal of Nervous and Mental Disease, 204, 69-77. doi: 10.1097/NMD.0000000000000418.

In this review, the authors reviewed the evidence on effectiveness and preferred protocol for neurofeedback treatments geared towards PTSD. After a systematic review of five major databases was undertaken, namely PubMed, PsychInfo, Embase, and Cochrane databases; 5 studies were singled out to form the basis of this review. From this, the authors conclude that neurofeedback is probably an efficacious for ptsd treatment.

Ghaziri, J., Tucholka, A., Larue, V., Blanchette-Sylvestre, M., Reyburn, G., Gilbert, G., . . . Beauregard, M. (2013). Neurofeedback Training Induces Changes in White and Gray Matter. Clinical EEG and Neuroscience, 44(4), 265-272. doi:10.1177/1550059413476031

In this study, Health university students were randomly assigned to the experimental group, sham group or control group. Participants in the experimental group trained to enhance beta waves at F4 and P4. Attentional performance and MRI data were recorded one week before training and one week after training. Higher scores on auditory and visual sustained attention were present in experiment group. Gray matter volume increases were detected in cerebral structures involved in this type of attention. This study constitutes the first empirical demonstration that neurofeedback training leads to microstructural changes in white and gray matter.

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