Neurofeedback: An Examination of Attentional Processes in Adults with Self-Reported PTSD Symptoms
Keywords:posttraumatic post disorder (PTSD), auditory processing, visual processing, neurofeedback, IVA-2 Continuous Performance Test
Novel, effective, and accessible therapeutic interventions for treating posttraumatic stress disorder (PTSD) symptoms are in demand given the significant physical and psychosocial impairment associated with the disorder. Although PTSD is largely treated with cognitive behavioral therapy (CBT), treatment resistance, or nonresponse rates, continues to remain high. Research has shown talk therapies can trigger the limbic system, keeping it in a continual state of fight or flight. Consequently, many trauma survivors seek alternative treatments, such as EEG neurofeedback training. This study explored the relationship between trauma-related symptoms (i.e., inattention and impulsivity) and visual and auditory functioning in a population of veterans and nonmilitary adults who reported previously being diagnosed with PTSD by a mental health clinician. Results suggest that EEG neurofeedback therapy is clinically effective for improving visual and auditory attentional functioning in both veterans and nonmilitary adults. Improved attentional functioning is believed to boost organizational skills, decision-making, frustration tolerance, and comprehension. This is important given that two-thirds of veterans who complete CBT programs remain in the clinical range for PTSD with notable attention deficits. Treatment outcome research, such as this study, is vital to improve the effectiveness of therapeutic interventions for persons diagnosed with PTSD, particularly within specific populations that have high nonresponse rates, such as veterans.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Arnsten, A. (2009). Stress signalling pathways that impair prefrontal cortex structure and function. Nature Reviews Neuroscience, 10(6), 410–422. https://doi.org/10.1038/nrn2648
Bomyea, J., & Lang, A. J. (2012). Emerging interventions for PTSD: Future directions for clinical care and research. Neuropharmacology, 62(2), 607–616. https://doi.org/10.1016/j.neuropharm.2011.05.028
Boscariol, M., Garcia, V. L., Guimarães, C. A., Montenegro, M. A., Hage, S. R. V., Cendes, F., & Guerreiro, M. M. (2010). Auditory processing disorder in perisylvian syndrome. Brain and Development, 32(4), 299–304. https://doi.org/10.1016/j.braindev.2009.04.002
Broderick, P. C. (2015). The life span: Human development for helping professionals (4th ed.). New York, NY: Pearson.
Butko, N. J., & Triesch, J. (2007). Learning sensory representations with intrinsic plasticity. Neurocomputing, 70(7–9), 1130–1138. https://doi.org/10.1016/j.neucom.2006.11.006
Choudhury, M., & Sanju, H. K. (2019). Central auditory processing disorder (CAPD) in schoolgoing children. Otolaryngology Open Journal, SE(1), S15–S19. https://doi.org/10.17140/OTLOJ-SE-1-104
Cloitre, M., Courtois, C. A., Ford, J. D., Green, B. L., Alexander, P., Briere, J., … van der Hart, O. (2012). The ISTSS expert consensus treatment guidelines for complex PTSD in adults. Journal of Traumatic Stress, 24(6), 615–627.
Crocq, M. A., & Crocq, L. (2000). From shell shock and war neurosis to posttraumatic stress disorder: A history of psychotraumatology. Dialogues in Clinical Neuroscience, 2(1), 47–55. https://doi.org/10.31887/dcns.2000.2.1/macrocq
da Silva-Sauer, L., de la Torre-Luque, A., Silva, J. S. C., & Fernández-Calvo, B. (2019). New perspectives for cognitive rehabilitation: Could brain-computer interface systems benefit people with dementia? Psychology and Neuroscience, 12(1), 25–37. https://doi.org/10.1037/pne0000154
DeAngelis, T. (2018). Tuning in to our amazing auditory system. Monitor on Psychology, 49(7), 64.
Feduccia, A. A., & Mithoefer, M. C. (2018). MDMA-assisted psychotherapy for PTSD: Are memory reconsolidation and fear extinction underlying mechanisms? Progress in Neuro-Psychopharmacology and Biological Psychiatry, 84(Part A), 221–228. https://doi.org/10.1016/j.pnpbp.2018.03.003
Fisher, S. F., Lanius, R. A., & Frewen, P. A. (2016). EEG neurofeedback as adjunct to psychotherapy for complex developmental trauma-related disorders: Case study and treatment rationale. Traumatology, 22(4), 255–260. https://doi.org/10.1037/trm0000073
Ghazanfar, A. A., & Schroeder, C. E. (2006). Is neocortex essentially multisensory? Trends in Cognitive Sciences, 10(6), 278–285. https://doi.org/10.1016/j.tics.2006.04.008
Haagen, J. F. G., Smid, G. E., Knipscheer, J. W., & Kleber, R. J. (2015). The efficacy of recommended treatments for veterans with PTSD: A metaregression analysis. Clinical Psychology Review, 40, 184–194. https://doi.org/10.1016/j.cpr.2015.06.008
Hammond, D. C. (2011). What is neurofeedback: An update. Journal of Neurotherapy, 15(4), 305–336. https://doi.org/10.1080/10874208.2011.623090
Herwig, U., Lutz, J., Scherpiet, S., Scheerer, H., Kohlberg, J., Opialla, S., … Brühl, A. B. (2019). Training emotion regulation through real-time fMRI neurofeedback of amygdala activity. NeuroImage, 184, 687–696. https://doi.org/10.1016/j.neuroimage.2018.09.068
Institute of Medicine. (2014). Treatment for posttraumatic stress disorder in military and veteran populations: Final assessment. Washington, DC: The National Academies Press. https://doi.org/10.17226/18724
Janarthanan, S. D. (2017). Visual processing disorder in children. Ophthalmology Open Journal, 2(2), 45–47. https://doi.org/10.17140/ooj-2-113
La Marca, J. P., Cruz, D., Fandino, J., Cacciaguerra, F. R., Fresco, J. J., & Guerra, A. T. (2018). Evaluation of artifact-corrected electroencephalographic (EEG) training: A pilot study. Journal of Neural Transmission, 125(7), 1087–1097. https://doi.org/10.1007/s00702-018-1877-1
Li, K., Kadohisa, M., Kusunoki, M., Duncan, J. A., Bundesen, C., & Ditlevsen, S. (2018). Distinguishing between parallel and serial processing in visual attention from neurobiological data. bioRxiv, 383596. https://doi.org/10.1101/383596
Litz, B. T., Berke, D. S., Kline, N. K., Grimm, K., Rusowicz-Orazem, L., Resick, P. A., … Peterson, A. L. (2019). Patterns and predictors of change in trauma-focused treatments for war-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 87(11), 1019–1029. https://doi.org/10.1037/ccp0000426
McReynolds, C. J., Bell, J., & Lincourt, T. M. (2017). Neurofeedback: A noninvasive treatment for symptoms of posttraumatic stress disorder in veterans. NeuroRegulation, 4(3–4), 114–124. https://doi.org/10.15540/nr.4.3-4.114
McReynolds, C., Britt, C., & Villalpando, L. (2019). Identifying auditory and visual processing difficulties in school-aged children with ADHD. In P. Cook (Ed.), Discovering New Educational Trends (V3): A Symposium in Belize, Central America (pp. 2–37). Newcastle upon Tyne, UK: Cambridge Scholars Publishing.
McReynolds, C. J., Villalpando, L. S., & Britt, C. E. (2018). Using neurofeedback to improve ADHD symptoms in school-aged children. NeuroRegulation, 5(4), 109–128. https://doi.org/10.15540/nr.5.4.109
Musiek, F. E., Baran, J. A., Bellis, T. J., Chermak, G. D., Hall III, J. W., Keith, R. W., … Nagle, S. (2010). Guidelines for the Diagnosis, Treatment and Management of Children and Adults with Central Auditory Processing Disorder. Reston, VA: American Academy of Audiology. Retrieved from https://audiology-web.s3.amazonaws.com/migrated/CAPD Guidelines 8-2010.pdf_539952af956c79.73897613.pdf
Panisch, L. S., & Hai, A. H. (2020). The effectiveness of using neurofeedback in the treatment of post-traumatic stress disorder: A systematic review. Trauma, Violence, & Abuse, 21(3), 541–550. https://doi.org/10.1177/1524838018781103
Quevedo, K., Liu, G., Teoh, J. Y., Ghosh, S., Zeffiro, T., Ahrweiler, N., … Paret, C. (2019). Neurofeedback and neuroplasticity of visual self-processing in depressed and healthy adolescents: A preliminary study. Developmental Cognitive Neuroscience, 40, 100707. https://doi.org/10.1016/j.dcn.2019.100707
Recanzone, G. H., & Cohen, Y. E. (2010). Serial and parallel processing in the primate auditory cortex revisited. Behavioural Brain Research, 206(1), 1–7. https://doi.org/10.1016/j.bbr.2009.08.015
Sandford, J., & Sandford, S. (2015). IVA-2 Integrated Visual and Auditory Continuous Performance Test manual. North Chesterfield, VA: BrainTrain, Inc.
Schaefer, M. L., Wong, S. T., Wozniak, D. F., Muglia, L. M., Liauw, J. A., Zhuo, M., … Muglia, L. J. (2000). Altered stress-induced anxiety in adenylyl cyclase type VIII-deficient mice. The Journal of Neuroscience, 20(13), 4809–4820. https://doi.org/10.1523/jneurosci.20-13-04809.2000
Serafini, G., Engel-Yeger, B., Vazquez, G. H., Pompili, M., & Amore, M. (2017). Sensory processing disorders are associated with duration of current episode and severity of side effects. Psychiatry Investigation, 14(1), 51–57. https://doi.org/10.4306/pi.2017.14.1.51
Shete, S., Beasley, T. M., Etzel, C. J., Fernández, J. R., Chen, J., Allison, D. B., & Amos, C. I. (2004). Effect of winsorization on power and type 1 error of variance components and related methods of QTL detection. Behavior Genetics, 34(2), 153–159. https://doi.org/10.1023/B:BEGE.0000013729.26354.da
Solberg Økland, H., Todorović, A., Lüttke, C. S., McQueen, J. M., & de Lange, F. P. (2018). Predicting audiovisual speech: Early combined effects of sentential and visual constraints. BioRxiv, 360578. https://doi.org/10.1101/360578
Taneja, N. (2017a). A mini review on differential overview of central auditory processing disorder (CAPD) and attention deficit hyperactivity disorder (ADHD). Otolaryngology Open Journal, SE(1), S20–S23. https://doi.org/10.17140/OTLOJ-SE-1-105
Taneja, N. (2017b). Comprehensive CAPD intervention approaches. Otolaryngology Open Journal, SE(1), S24–S28. https://doi.org/10.17140/OTLOJ-SE-1-106
Thomas, J., & Mack, M. (2010). Auditory processing disorder and reading difficulties. Victoria, Australia: Listen and Learn Centre. Retrieved from https://www.listenandlearn.com.au/wp-content/uploads/2014/10/research_APD1.pdf
Thorne, J. D., & Debener, S. (2014). Look now and hear what’s coming: On the functional role of cross-modal phase reset. Hearing Research, 307, 144–152. https://doi.org/10.1016/j.heares.2013.07.002
van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York, NY: Viking.
van der Kolk, B. A., Hodgdon, H., Gapen, M., Musicaro, R., Suvak, M. K., Hamlin, E., & Spinazzola, J. (2016). A randomized controlled study of neurofeedback for chronic PTSD. PLoS ONE, 11(12), e0166752. https://doi.org/10.1371/journal.pone.0166752
Van Eylen, L., Boets, B., Steyaert, J., Wagemans, J., & Noens, I. (2015). Executive functioning in autism spectrum disorders: Influence of task and sample characteristics and relation to symptom severity. European Child & Adolescent Psychiatry, 24(11), 1399–1417. https://doi.org/10.1007/s00787-015-0689-1
Vignoud, G., Venance, L., & Touboul, J. D. (2018). Interplay of multiple pathways and activity-dependent rules in STDP. PLoS Computational Biology, 14(18), e1006184. https://doi.org/10.1371/journal.pcbi.1006184
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