Adjusting your brain from the inside: Promising results of neurofeedback for treatment of PTSD
Can you alter your brain activity just by observing and thinking about it? While that may seem like an esoteric question, it is the central proposition of neurofeedback-based treatment regimes. Neurofeedback-based treatments operate on the concept that individuals can control their brain activity when given sufficient feedback. For example, individuals may be presented with a graph capturing their 'brain waves' and given the task of dampening the 'waves'. The individual will then think to alter the 'waves' and be provided with feedback based upon how their efforts have fared.
Recently, an international collaborative study facilitated by researchers within Western University employed neurofeedback-based techniques in individuals with Post-Traumatic Stress Disorder (PTSD). The study demonstrated that individuals could show more detailed regional control over their brains than previously thought.
PTSD is a multifaceted disorder usually onset by a traumatic event. The symptoms of PTSD can be debilitating to the individual. These symptoms include increased arousal, recurring memories, and avoidance of triggering situations. An estimated 9.2% of Canadians will experience PTSD during their lifetimes. Currently, treatments in PTSD focus on both pharmacological and therapeutic interventions.
The study titled "Differential mechanisms of posterior cingulate cortex downregulation and symptom decreases in post-traumatic stress disorder and healthy individuals using real-time fMRI neurofeedback" was conducted in part by the labs of Dr. Ruth A. Lanius and Dr. Richard W. J. Neufeld at Western University. The study combined a neurofeedback approach with exposure-based therapy. The study uses an emerging neurofeedback regimen based on functional magnetic resonance imaging (fMRI) technology.
Functional MRI harnesses the power of magnets to measure changes in blood flow in the brain in real-time. In principle, when a brain region is active, the neurons require oxygen and energy; in response, there is an increase in blood flow and blood oxygen levels to that region. By utilizing this principle, fMRI allows scientists to measure the changes in blood flow at a region-specific level and extrapolate approximate activity in the brain. Functional MRI has become a staple in neuroscientists' toolboxes to understand how the brain processes and responds to different stimuli.
In this study, participants were placed in a fMRI scanner and provided region-specific feedback. More specifically, feedback was provided about the activation of a brain region known as the posterior cingulate cortex (PCC). Located in a cluster near the brain's center, the PCC is involved in several brain processes, including memory retrieval and integration of information. It even forms part of a system of brain regions known as the default mode network (DMN). The aptly named 'default' mode network is active at baseline, when the brain is engrossed in thought, or recalling memories. Both the DMN and the PCC itself have been implicated in maladaptive symptoms of PTSD. For example, both have been shown to be overactive in trauma exposure and recall. Therefore, the researchers of this study proposed that using neurofeedback to train individuals to exert functional control over the PCC – more specifically to decrease activity - may help alleviate PTSD symptoms.
Left; an individual views a 'thermometer' that reflects the amplitude of their brain waves. The thermometer rises as the waves grow in amplitude, providing individuals with feedback.. Skull & brain graphic from Patrick J, Lynch (CC BY 2.5). Composite by Sam Mestern
To test this, researchers presented the individuals (while in the fMRI) with either a neutral or trauma-related word. Furthermore, individuals were provided with a real-time graph of PCC activation in the form of a 'thermometer' (with an additional tick representing the base PCC activation). Individuals were asked to perform 1 of 3 tasks; 1) regulate in which they attempted to decrease PCC activation using thought, 2) view in which they responded to the trauma word naturally, and 3) neutral in which they responded to a neutral word naturally.
The researchers found that individuals both with and without PTSD could downregulate PCC activation, showing that individuals can exert control over the PCC. Interestingly, despite both groups showing the ability to downregulate the PCC, the method of internal downregulation varied between individuals with PTSD and those without PTSD. Further studies are needed to understand the 'how' and 'why' this discrepancy in activation between the groups was observed. Furthermore, in accordance with the theory that the PCC is invoked in processing trauma, the researchers found increased activation in the PCC when individuals were presented with a traumatic stimulus vs a neutral stimulus.
Promisingly, the researchers did find that the neurofeedback training was beneficial in alleviating symptoms of PTSD. Following their time in the fMRI, participants were asked to rate their PTSD symptoms. Individuals with PTSD showed reduced reliving and distress symptoms following the training. Thus, the treatment presented in this study may represent a future method for the treatment PTSD.
However, neurofeedback is not without its limitations and controversies. Many studies regarding applications of neurofeedback (such as this one studying attention deficit/hyperactivity disorder) lack scientific rigor to draw any robust conclusions, with several studies reporting inconsistent or conflicting results, lacking in appropriate controls (placebo), or lack appropriate blinding. For example, some studies report similar performance in individuals provided with 'true' neurofeedback and individuals presented with arbitrary feedback stimulus. Thus, clinical applications of neurofeedback regimens should be approached with caution. This study is limited due to its lack of control and further lack of comparison to other currently accepted PTSD treatments. Much more study will be needed to validate neurofeedback as a potential clinical treatment for PTSD.
Overall, the study represents a first-of-its-kind demonstration of neurofeedback-based control of the PCC and its potential utility in countering symptoms of PTSD. However, further research is needed to validate the clinical usage of this treatment.
The Lanius and Neufeld labs at Western University continue their research into PTSD and associated disorders, helping to broaden our understanding of the neurobiological basis of these disorders and their impact on individuals.
Despite seeming potentially abstract on the surface, neurofeedback has shown to be potentially effective. However, much more research is needed before neurofeedback can be used in clinical settings. Regardless, this study demonstrated humans have more control over their internal brain activity than previously thought.