Neurofeedback for PTSD
Trauma affects more than just your thoughts: it changes your brain’s biology. After experiencing a traumatic event, your brain wants so badly to keep you safe that it works overtime, and that constant state of hypervigilance takes its toll.
Because the parts of your brain that are on the lookout for danger are always on alert, even the slightest sign of a threat can trigger an acute stress response. As a result, your memory and impulse control may be suppressed, and you are at risk of getting trapped in a prolonged state of strong emotional reactivity. The good news is that these changes in brain functioning are not irreversible.
Your brain can adapt, rewire, and learn from experience. This ability is called neuroplasticity, and it can help your brain reverse trauma’s damaging effects. Neuroplasticity allows neurons (nerve cells) in the brain to compensate for injury and adjust their activities in response to new situations or changes in your environment.
In his book The Body Keeps The Score, Bessel van der Kolk summarizes his four decades of experience studying the impact of trauma on the brain and explains how you can develop methods and experiences that utilize your brain's neuroplasticity.
When Trauma Develops Into a Disorder
After experiencing a traumatic event, your mind and body can go into an extreme level of shock. As a result, you might experience nightmares, fear, anxiety, and intrusive thoughts. These are all normal reactions to abnormal, traumatic events. For many people, these symptoms may eventually run their course, and normal life will resume. But, when symptoms don't gradually decrease, that trauma may progress to PTSD (post-traumatic stress disorder) and alter the way your brain functions.
PTSD (post-traumatic stress disorder) is an anxiety disorder caused by exposure to a traumatic event, often appearing after the event and characterized by feelings like guilt, isolation, irritability, difficulty sleeping, and difficulty concentrating.
Not everybody with PTSD has exactly the same symptoms or brain changes, but observable patterns can be understood and treated.
The Smoke Detector and the Watchtower
The brain's alarm system is a region of the brain called the amygdala, which Dr. Kolk refers to as the brain's smoke detector. The amygdala is primarily associated with emotional processes with a function to identify whether incoming input is relevant for survival.
When the amygdala senses a threat (for example, a person on the street who looks threatening), it recruits the stress-hormone system and the autonomic nervous system to orchestrate a whole-body response. This means a quicker heart rate, shallow breathing, sweating, and inability to think clearly.
Once the brain's alarm system is turned on, it automatically triggers a preprogrammed physical escape plan, which propels the body to run, hide, fight, or, on occasion, freeze.
If the amygdala is the smoke detector in the brain, think of the frontal lobes – and specifically the medial prefrontal cortex located directly above your eyes – as the watchtower, offering a view of the scene from above.
As long as you are not too distressed, your frontal lobes can restore your balance by helping you realize that you are responding to a false alarm and abort the stress response.
With PTSD, however, the critical balance between the amygdala (smoke detector) and the medial prefrontal cortex (watchtower) shifts radically, making it much harder for your brain to recognize that the alarm is likely unwarranted.
A Peek Into the Trauma-Affected Brain
If you were to look at an MRI image of a PTSD-affected brain, you'd see the front left cortex go dim and inactive, hampering the ability to reason and pay attention. You'd also see the right frontal cortex (home of emotions) flaring wildly, triggering a flood of emotions.
But if you were to measure that same brain’s brainwaves using EEG (a technology used to see electrical activity in the brain), you would also notice that the brainwaves are less coordinated than they should be. Because of brainwave dysregulation, someone with PTSD may have trouble filtering out irrelevant information and paying attention to what's going on in the present moment.
The brain produces five types of brainwaves: Delta, Theta, Alpha, Beta, and Gamma. Although all of these brainwaves are always active, some are amplified during different times of the day, depending on what it is you’re doing or what’s happening around you. With a healthy, well-balanced brain, the appropriate brainwaves will be dominant at the appropriate times.
If your brainwave activity has been impacted by PTSD, it's more than likely that your theta brainwaves, which should be dominant during "autopilot" states, are amplified when you should actually be focused or alert.
As a result, you may feel absent-minded, forgetful, easily distracted, and confused. For example, your everyday state of mind might cause you to feel like you're stuck in a sleepy trance, but in the back of your mind, you’re simultaneously wondering whether or not you’ve turned off the oven or locked the front door.
Neurofeedback for PTSD: Fixing Dysregulated Brainwaves
“Not being fully alive in the present keeps you more firmly imprisoned in the past.” – Dr. Bessel van der Kolk
Luckily, dysregulated brainwave patterns are not irreparable. They can be rewired and transformed thanks to neuroplasticity, aka your brain's natural ability to change, adapt and learn from experience. With a brain training technology called neurofeedback, you can improve neuroplasticity and train your brain to regulate your brainwaves so that you can achieve the desired brainwave state.
Neurofeedback is possible because of EEG, a technology that measures your brain activity in real time by placing electrodes (small metal discs) on the scalp. This provides immediate feedback about your brain's activity. It not only offers insight into how your brain operates, but also what you can do to improve its functioning.
Let’s say that your real-time brain activity measurements show that you are stressed out. During neurofeedback training, visual (games/videos) and/or auditory (sound effects/music) feedback let you know exactly when your mind is in an optimal state – and all in real time! This optimal state can be achieved by rewarding your brain each time its activity indicates a relaxed state.
For example, when playing games via the Myndlift app, you earn points every time your brain is in the desired state so, eventually, your brain may learn to regulate itself without that immediate reward. It's kind of like giving a dog a snack every time you need it to sit or stay so that, over time, they learn to do it even without the snack. The same concept applies to your brain – you can train it to be in the optimal state without that immediate feedback!
Eventually, the ability to regulate brainwaves can have a great impact on everyday situations. For example, you may find it easier to stay calm in stressful situations, like when you're struggling with difficult emotions and traumatic memories.
Alpha-Theta Neurofeedback Training
“The challenge in PTSD is to open the mind to new possibilities so that the present is no longer interpreted as a continuous reliving of the past.” – Dr. Bessel van der Kolk
One of the most commonly used neurofeedback protocols for PTSD is the alpha-theta protocol. This type of protocol aims to achieve balance and maintain the ideal amplification and frequency of alpha and theta brainwaves.
Theta brainwaves are slow waves that relate to dreamy, free-flowing, detached unconscious thought. They are dominant during “autopilot” states, and sometimes in deep meditative states.
Alpha brainwaves have a higher frequency than theta and are typically dominant during mindful activities. They represent non-arousal and help with mental coordination, calmness, alertness, mind/body integration, and learning.
With alpha-theta neurofeedback training, traumatic memories can be accessed during theta dominance and safely processed during alpha modulation. In other words, this type of protocol guides your brain through gentle transitions of alpha and theta dominant states. The goal is to help you reach a state of deep relaxation, where memories can safely resurface and, as a result, be processed.
This way, traumatic events may be safely reexperienced, and new associations fostered.
For example, a veteran can unlearn the association they have between the sound of a loud crack and gunfire. Instead, a new link can be created in which that same sound can come to be associated with Fourth of July fireworks at the end of a day at the beach with loved ones.
Can Alpha-Theta Reverse Hyperarousal Patterns? The Evidence Is Promising.
Researchers at the VA Medical Center in Fort Lyon, Colorado, used neurofeedback to treat twenty-nine Vietnam veterans with a history of chronic combat-related PTSD.
Fifteen of the men were randomly assigned to the alpha-theta training and fourteen to a control group that received standard medical care, including psychotropic drugs and individual and group therapy.
This study, published in 1991, had one of the best outcomes ever recorded for PTSD. The neurofeedback group had a significant decrease in their PTSD symptoms, as well as in physical complaints, depression, anxiety, and paranoia.
After the treatment phase, the veterans and their family members were contacted monthly for a period of thirty months. Only three of the fifteen neurofeedback-treated veterans reported disturbing flashbacks and nightmares. All three chose to undergo ten booster sessions; only one needed to return to the hospital for further treatment. Fourteen out of fifteen were using significantly less medication.
In contrast, every vet in the comparison group experienced an increase in PTSD symptoms during the follow-up period, and all of them required at least two hospitalizations. Ten of the comparison group also increased their medication use.
Neurofeedback can help change the way your brain functions and improve the quality of your life. It can alleviate PTSD symptoms and potentially help guide you to recall those memories with the recognition that they exist in the past and cannot put you in any more danger in the present.
If you choose to do neurofeedback with the goal of alleviating PTSD symptoms, it’s important to note that a key factor to the success of your training is remaining consistent. Luckily, that has been made easy with remote neurofeedback training. And you don’t have to go through it alone – you’ll have an experienced practitioner by your side ensuring you stay on track!