EEG Biofeedback Therapy as an Adjunct Treatment for PTSD
Condition: PTSD; Anxiety; Trauma; Sleep Disorders
MeSH terms: Sleep Wake Disorders
Study type: Interventional

Summary: 
      The proposed study, "Placebo-controlled study of EEG biofeedback therapy as an adjunct
      treatment for PTSD, evaluating symptoms and EEG dynamics", will investigate the brain
      dynamics associated with PTSD symptom reduction associated with EEG biofeedback therapy or
      sham EEG biofeedback in addition to treatment as usual at the Naval Medical Center, San Diego
      (NMCSD) OASIS program.

      EEG biofeedback treatment protocols for PTSD and other disorders have been developed and
      honed by private practice clinicians over the past 25 years, during which EEG biofeedback has
      become an increasingly popular adjunct therapy.

      The reported success of EEG biofeedback as a non-drug intervention with lasting efficacy
      warrants a clinical study investigating not only symptom reduction, but also the underlying
      neurobiological mechanism. To this end, we propose a study using high density EEG recordings
      before and after treatment for PTSD symptoms to determine which brain activities correlate
      with reported symptom changes.

      The proposed study could expand treatment alternatives for servicemen with PTSD. If EEG
      biofeedback is shown to improve symptom reduction over the placebo controlled condition, it
      would offer a non-pharmacological intervention that would avoid undesirable side effects, and
      accelerate recovery compared with the current standard of care.
    

Detailed description: 
      EEG biofeedback is an emerging alternative approach to treating PTSD, for which there is
      still insufficient evidence to assume unequivocal clinical utility. However, a 1991 report
      showed PTSD symptom reduction in 14 subjects receiving EEG biofeedback, as compared to 13
      subjects receiving traditional treatment (Peniston, 1991), and a recent case study of 2 PTSD
      patients receiving EEG biofeedback therapy also showed reduce symptom severity using a newer
      protocol and device (Othmer, 2009). Another recent study focused on the anxiety symptoms of
      PTSD and showed that EEG biofeedback significantly reduced anxiety compared to subjects not
      receiving treatment (Walker, 2009).

      EEG biofeedback has also been explored as a treatment for non-PTSD related anxiety disorders,
      with results showing significant changes in reported anxiety correlated with increased or
      decreased alpha-frequency (~8-12 Hz) power (Hardt, 1978). Similarly, alpha-frequency EEG
      biofeedback has been shown to reduce anxiety and to reduce heart rate reactivity to a
      stressor after 8 sessions of EEG biofeedback training (Rice, 1993). While EEG biofeedback has
      been shown to significantly change EEG power dynamics (Egner, 2004), it is still unclear if
      and how EEG biofeedback can effect long-term and complex changes in cognitive and/or
      emotional functioning.

      Some attention has been given to other types of biofeedback for the treatment for PTSD, such
      as heart rate variability (HRV) biofeedback, which may be relevant in understanding the
      background of biofeedback with respect to PTSD treatment. While one study reported no
      difference in symptom reduction between treatment as usual and treatment as usual plus HRV
      biofeedback (Lande, 2010), a handful of other studies have reported significant associations
      between HRV changes and PTSD symptoms. Specifically, increased HRV was significantly
      correlated with PTSD symptom reduction, which was more effective with respiratory sinus
      arrhythmia (RSA) (which affects HRV) biofeedback than with progressive muscle relaxation
      (Zucker, 2009). Furthermore, combat-related PTSD subjects showed lower resting HRV than
      controls, but training with HRV biofeedback increased PTSD subjects' HRV and simultaneously
      decreased their PTSD symptoms (Tan, 2011). Finally, a quantitative EEG study showed that an
      acute session of RSA biofeedback was associated with an increase in alpha-band power and
      reduced higher frequency beta-band power, suggesting a neural impact of RSA training and HRV
      regulation (Sherlin, 2010).

      Summary The proposed study of EEG biofeedback at the OASIS program will not only address the
      clinical efficacy, but also the brain activations associated with specific symptoms of PTSD
      through collection of high-density EEG data before and after EEG biofeedback treatment. These
      data will help elucidate the neural correlates of PTSD symptom expression as well as address
      the potential efficacy of EEG biofeedback therapy as an adjunct treatment for PTSD-like
      symptoms.
    

Intervention name(s): EEG biofeedback
Intervention type(s): Device
Intervention description(s): EEG data is collected from the scalp. Data is decomposed in real time and a portion of the signal is fed back to the subject via a vibrating stuffed animal and visual cues.
Other intervention name(s): EEG info device
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: EEG biofeedback; neurofeedback; therapy; adjunct