Therapists’ Experiences With Integrating Neurofeedback Into Therapy for Complex/Developmental Trauma


  • Anney Tsuji-Lyons, PhD, LMFT, CST National University
  • Mark White, PhD, LMFT



Trauma, complex, developmental, neurofeedback, therapy


Introduction. Trauma has been found to have a significant impact on the brain, particularly when it occurs during developmental years. Some studies have found neurofeedback to be effective for treating symptoms of complex/ developmental trauma. There is minimal guidance on integrating neurofeedback into therapy with this population. In this qualitative study, the researcher used interpretative phenomenological analysis to gain an understanding of trauma therapists’ experiences with integrating neurofeedback into their clinical work with complex/developmental trauma and how this impacts the therapeutic relationship. Methods. Sixteen mental health professionals who self-identified as specializing in complex/developmental trauma and used neurofeedback as part of their therapeutic approach participated in this study. Data collection consisted of a demographic survey and semistructured interviews. Results. Analysis revealed five superordinate themes: the process of learning neurofeedback; integrating neurofeedback into trauma therapy; grounded in neuroscience and focused on context; building awareness; and shift in dynamics. Conclusion. The results of this study offer practical suggestions for getting started with neurofeedback and integrating it into trauma therapy. Additionally, special considerations when practicing neurofeedback with complex/developmental trauma were identified, including shifts in the therapeutic relationship that occur with the addition of this modality.


Aroche, J., Tukelija, S., & Askovic, M. (2009). Neurofeedback in work with refugee trauma: Rebuilding fragile foundations. Biofeedback, 37(2), 53–55.

Askovic, M., & Gould, D. (2009). Integration of neurofeedback in the therapeutic work with torture and trauma survivors: A case study. Biofeedback, 37(2), 56–62.

Askovic, M., Watters, A. J., Aroche, J., & Harris, A. W. F. (2017). Neurofeedback as an adjunct therapy for treatment of chronic posttraumatic stress disorder related to refugee trauma and torture experiences: Two case studies. Australasian Psychiatry, 25(4), 358–363.

Bagdasaryan, J., & Quyen, M. L. V. (2013). Experiencing your brain: Neurofeedback as a new bridge between neuroscience and phenomenology. Frontiers in Human Neuroscience, 7, 1–10.

Baldini, L. L., Parker, S. C., Nelson, B. W., & Siegel, D. J. (2014). The clinician as neuroarchitect: The importance of mindfulness and presence in clinical work. Clinical Social Work Journal, 42, 218–227.

Bell, A. N., Moss, D., & Kallmeyer, R. J. (2019). Healing the neurophysiological roots of trauma: A controlled study examining LORETA Z-Score neurofeedback and HRV biofeedback for chronic PTSD. NeuroRegulation, 6(2), 54–70.

Berliner, L., Bisson, J., Cloitre, M., Forbes, D., Goldbeck, L., Jensen, T., Lewis, C., Monson, C., Olff, M., Pilling, S., Riggs, D., Roberts, N., & Shapiro, F. (2019). Posttraumatic stress disorder prevention and treatment guidelines: Methodology and recommendations. Oakbrook Terrace, IL: International Society for Traumatic Stress Studies.

Brandmeyer, T., & Delorme, A. (2013). Meditation and neurofeedback. Frontiers in Psychology, 4, 688.

Chapin, T. J. (2016). Developing a specialty in neurofeedback: Decision points. Journal of Mental Health Counseling, 38(2), 155–169.

Chiba, T., Kanazawa, T., Koizumi, A., Ide, K., Taschereau-Dumouchel, V., Boku, S., Hishimoto, A., Shirakawa, M., Sora, I., Lau, H., Yoneda, H., & Kawato, M. (2019). Current status of neurofeedback for post-traumatic stress disorder: A systematic review and the possibility of decoded neurofeedback. Frontiers in Human Neuroscience, 13, 233.

Choy, T., Baker, E., & Stavropoulos, K. (2022). Systemic racism in EEG research: Considerations and potential solutions. Affective Science, 3, 14–20.

Cloitre, M., Courtois, C. A., Charuvastra, A., Carapezza, R., Stolbach, B. C., & Green, B. L. (2011). Treatment of complex PTSD: Results of the ISTSS expert clinician survey on best practices. Journal of Traumatic Stress, 24(6), 615–627.

Currie, C. L., Remley, T. P. Jr., & Craigen, L. (2014). Treating trauma survivors with neurofeedback. NeuroRegulation, 1(3–4), 219–239.

Demos, J. N. (2019). Getting started with EEG neurofeedback (2nd ed.). New York, NY: Norton.

Dixon-Woods, M., Shaw, R. L., Agarwal, S., & Smith, J. A. (2004). Developing research: The problem of appraising qualitative research. Quality and Safety in Health Care, 13(3), 223–225.

Edwards, D. (2018). Childhood sexual abuse and brain development: A discussion of associated structural changes and negative psychological outcomes. Child Abuse Review, 27(3), 198–208.

Fisher, S. F. (2010). Special issue: Arousal and identity: Thoughts on neurofeedback in treatment of developmental trauma. Biofeedback, 38(1), 6–8.

Fisher, S. F. (2014). Neurofeedback in the treatment of developmental trauma: Calming the fear-driven brain. New York, NY: Norton.

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.

Frick, M. H., Rainey, H. T., Curtis, R., Li, Y., Simpson, M. (2018). Working with developmental trauma: Results of neurofeedback training with adolescent females and counseling implications. Journal of Behavioral and Social Sciences, 5(2), 96–106.

Gapen, M., van der 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.

Gerge, A. (2020). What neuroscience and neurofeedback can teach psychotherapists in the field of complex trauma: Interoception, neuroception, and the embodiment of unspeakable events in treatment of complex PTSD, dissociative disorders, and childhood traumatization. European Journal of Trauma & Dissociation, 4(3).

Hamlin, E. (2018). Growing the evidence base for neurofeedback in clinical practice. In J. J. Magnavita (Ed.), Using technology in mental health practice (pp. 101–122). Washington, DC: American Psychological Association.

Hammond, D. C. (2011). What is neurofeedback: An update. Journal of Neurotherapy, 15(4), 305–336.

Hammond, D. C., Bodenhamer-Davis, G., Gluck, G., Stokes, D., Harper, S. H., Trudeau, D., MacDonald, M., Lunt, J., & Kirk, L. (2011). Standards of practice for neurofeedback and neurotherapy: A position paper of the International Society for Neurofeedback & Research. Journal of Neurotherapy, 15(1), 54–64.

Harvey, R., Lin, I.-M., & Booiman, A. (2015). Special issue: Multicultural and diversity training considerations for biofeedback practitioners. Biofeedback, 43(4), 163–167.

Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3), 377–391.

International Society for Traumatic Stress Studies Guidelines Committee. (2018). ISTSS guidelines position paper on complex PTSD in adults. Oakbrook Terrace, IL: International Society for Traumatic Stress Studies.

Lanius, R. A., Frewen, P. A., Tursich, M., Jetly, R., & McKinnon, M. C. (2015). Restoring large-scale brain networks in PTSD and related disorders: A proposal for neuroscientifically-informed treatment interventions. European Journal of Psychotraumatology, 6(1), Article 27313.

Leddick, K. (2015). Integrating neurofeedback and psychoanalytic psychotherapy: A nonlinear dynamical systems approach to mind and brain. In J. Bresler & K. Starr (Eds.), Relational psychoanalysis and psychotherapy integration: An evolving strategy (pp. 118–135). New York, NY: Taylor & Francis.

Lin, L., Nigrinis, A., Christidis, P., & Stamm, K. (2015). Demographics of the U.S. psychology workforce: Findings from the American Community Survey. American Psychological Association Center for Workforce Studies.

Luctkar-Flude, M. F., Tyerman, J., & Groll, D. (2018). Exploring the use of neurofeedback by cancer survivors: Results of interviews with neurofeedback providers and clients. Asia-Pacific Journal of Oncology Nursing, 6(1), 35–42.

Marinova, Z., & Maercker, A. (2015). Biological correlates of complex posttraumatic stress disorder—State of research and future directions. European Journal of Psychotraumatology, 6, Article 25913.

Marzbani, H., Marateb, H. R., & Mansourian, M. (2016). Neurofeedback: A comprehensive review on system design, methodology and clinical applications. Basic and Clinical Neuroscience, 7(2), 143–158.

McFetridge, M., Hauenstein Swan, A., Heke, S., Karatzias, T., Greenberg, N., Kitchiner, N., & Morley, R. (2017). Guideline for the treatment and planning of services for complex post-traumatic stress disorder in adults. UK Psychological Trauma Society.

Meyer, O. L., & Zane, N. (2014). The influence of race and ethnicity in clients’ experiences of mental health treatment. Journal of Community Psychology, 41(7), 884–901.

Orndorff-Plunkett, F., Singh, F., Aragón, O. R., & Pineda, J. A. (2017). Assessing the effectiveness of neurofeedback training in the context of clinical and social neuroscience. Brain Sciences, 7(8), 95.

Othmer, S., & Othmer, S. F. (2017). The evolution of a trauma protocol over a quarter century. In A. Martins-Mourao & C. Kerson (Eds.), Alpha-theta neurofeedback in the 21st century: A handbook for clinicians and researchers (2nd ed., pp. 317–344). Murfreesboro, TN: Foundation for Neurofeedback and Neuromodulation Research.

Panisch, L. S., & Hai, A. H. (2018). The effectiveness of using neurofeedback in the treatment of post-traumatic stress disorder: A systematic review. Trauma, Violence, & Abuse, 21(3), 541–550.

Pietkiewicz, I., & Smith, J. A. (2012). A practical guide to using interpretative phenomenological analysis in qualitative research psychology. Czasopismo Psychologiczne - Psychological Journal, 20(1), 7–14.

Rogel, A., Loomis, A. M., Hamlin, E., Hodgdon, H., Spinazzola, J., & van der Kolk, B. (2020). The impact of neurofeedback training on children with developmental trauma: A randomized controlled study. Psychological Trauma: Theory, Research, Practice, and Policy, 12(8), 918–929.

Ross, D. A., Arbuckle, M. R., Travis, M. J., Dwyer, J. B., van Schalkwyk, G. I., & Ressler, K. J. (2017). An integrated neuroscience perspective on formulation and treatment planning for posttraumatic stress disorder: An educational review. JAMA Psychiatry, 74(4), 407–415.

Sar, V. (2011). Developmental trauma, complex PTSD, and the current proposal of DSM-5. European Journal of Psychotraumatology, 2(1), Article 5622.

Smith, J. A., Flowers, P., & Larkin. M. (2009). Interpretative phenomenological analysis: Theory, method, and research. London, UK: SAGE.

Smith, J. A., Jarman, M., & Osborne, M. (1999). Doing interpretative phenomenological analysis. In. M. Murray & K. Chamberlain (Eds.), Qualitative health psychology (pp. 218–240). Thousand Oaks, CA: SAGE.

The Biofeedback Certification International Alliance. (2016). Professional standards and ethical principles of biofeedback.

Thibault, R. T. & Raz, A. (2017). The psychology of neurofeedback: Clinical intervention even if applied placebo. American Psychologist, 72(7), 678–688.

Thomason, M. E., & Marusak, H. A. (2017). Toward understanding the impact of trauma on the early developing human brain. Neuroscience, 342, 55–67.

Thompson, M., & Thompson, L. (2016). Current practice of neurofeedback: Where we are and how we got there. Biofeedback, 44(4), 181–205.

Thornton, K. E. (2018). Perspectives on placebo: The psychology of neurofeedback. NeuroRegulation, 5(4), 137–149.

van der Kolk, B. A. (2005). Developmental trauma disorder: A new, rational diagnosis for children with complex trauma histories.

van der Kolk, B. A. (2014). The body keeps the score. New York, NY: Viking Penguin.

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), Article e0166752.

Van Nieuwenhove, K., & Meganck, R. (2019). Interpersonal features in complex trauma etiology, consequences, and treatment: A literature review. Journal of Aggression, Maltreatment, & Trauma, 28(8), 903–928.

Weiner, G. (2016). Evolving as a neurotherapist: Integrating psychotherapy and neurofeedback. In T. F. Collura & J. A. Frederick (Eds.), Handbook of clinical QEEG and neurotherapy (pp. 45–54). New York, NY: Routledge.

World Health Organization. (2019). Complex post traumatic stress disorder. International classification of diseases for mortality and morbidity statistics (11th Revision).

Zagorski, N. (2023). FDA clears neurofeedback intervention for PTSD. Psychiatric News, 58(8).






Research Papers