Neurofeedback as a Treatment for Traumatized Military Veterans

Soldier with head on clasped handsAs we prepare to celebrate our country’s upcoming Independence Day, it seems appropriate to speak about a complementary and alternative medicine (CAM) therapy, neurofeedback, which is currently being used to treat veterans who have symptoms of post-traumatic stress disorder (PTSD)1.

What is Neurofeedback?
Neurofeedback, also referred to as EEG biofeedback, provides information about the brain’s electrical activity via a computer program. This technique enables a clinician to tell whether one is asleep (delta), alert (mid-beta), anxious (high-beta), meditating (theta), or daydreaming (alpha), etc., by examining what brain frequencies predominate at a given time. Various disorders are associated with brain frequencies that are too fast or too slow for the type of activity in which one is engaged. As an example, in order to pay attention in school, one would want the predominant brainwave pattern to be mid-beta (faster, but not too fast), rather than theta (fairly slow). Admittedly, I am painting an oversimplified picture but it conveys the general idea.

How Does Neurofeedback Work?
Training with neurofeedback consists of attaching electrodes to the scalp to assess current brainwave activity. The computer then rewards brain activity that is in the desired frequency range (e.g., alpha, mid-beta, etc.). Rewards may come in the form of audible tones or changes in on-screen imagery and the like. Some programs reward the brain by playing a favorite DVD when one is in the desired range, stopping otherwise. In psychological terms, this is referred to as operant conditioning.

Much of the research support for neurofeedback has been for the treatment of ADHD; however, neurofeedback has also been used to treat other conditions, such as anxiety, headaches, and sleep disorders. To date, there has not been a tremendous amount of research on the above, and so the treatment is not yet widely accepted. Nonetheless, many people have experienced promising results from using neurofeedback.

Post-Traumatic Stress and Military Veterans
PTSD is a type of anxiety that occurs following exposure to an event where one’s life or safety, or the life or safety of another, is endangered. PTSD and other emotional difficulties have become of significant concern in veterans returning from war. This makes sense given that vets have experienced events most civilians would find unimaginable. Although the lifetime prevalence of PTSD among American men and women in the general population has been estimated at 3.6% and 9.7%, respectively, returning veterans’ estimates are considerably higher. Specifically, a large scale study of veterans deployed between 2001 and 2005 found that at least 18% had developed PTSD or major depression.2 In a national survey of Vietnam veterans, the lifetime prevalence rate of PTSD was nearly 31% for men and 27% for women3. These numbers are staggering and cause for serious concern.

The Impact of PTSD on Veterans and Their Families
Symptoms of PTSD include, but are not limited to having flashbacks of the trauma and avoiding situations that remind one of it, as well as feeling “wound up” or easily startled, irritable, or emotionally cut off from others. PTSD symptoms can interfere with sleep, as well as prevent one from enjoying things that were once pleasurable. People with PTSD may also experience uncomfortable physical symptoms, have difficulties in their close relationships, develop problems at work, and may use substances like drugs or alcohol in an effort to dull their emotional pain. Obviously, the cost to veterans and their families is significant. Family members may feel that the soldier who left is not the one who returned to them. Returning vets may feel unable to cope with the memories of what they experienced, have difficulty articulating their feelings, and fear they cannot be helped.

PTSD can be challenging to treat adequately, however, treatment is necessary to help sufferers begin to heal, try to regain normal functioning, and prevent further problems. According to Dr. Siegfried Othmer, who has generated much of the literature about this modality, neurofeedback training can help regulate the mind and body by rewarding the brain for moving into calmer states (reflected by a shift to a predominance of slower brainwave frequencies). Although more research is required to better understand the limits and potential benefits of neurofeedback for PTSD, preliminary research, published case reports, and anecdotal evidence suggest that this treatment is promising.

The New York State Psychological Association has information about accessing help for soldiers with PTSD, as well as their families:
http://www.nyspa.org/index.php?option=com_content&view=article&id=276:post-deployment-stress-helping-veterans-and-their-families&catid=119:stress&Itemid=509

To read a brief article or view a video about the military’s use of neurofeedback to treat PTSD, please visit:  http://www.thedaily.com/page/2011/06/20/062011-news-neurofeedback-1-6/

References:
1.) http://www.thedaily.com/page/2011/06/20/062011-news-neurofeedback-1-6/
2.) T.Tanielian and L.Jaycox, Eds. (2005) Invisible Wounds of War.  Rand Center for Military Health Policy Research.
3.) http://www.ptsd.va.gov/public/pages/fslist-PTSD-overview.asp

© Copyright 2011 by Traci Stein. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Rene Jennings

    June 24th, 2011 at 4:43 PM

    So this technique will help a person identify the brain frequency. And are we trying to condition and teach them how to control it? If it is so, then would this not have any implications? Because is it not like you have learnt to control something that is best left to function involuntarily??

  • Henni

    June 24th, 2011 at 6:17 PM

    This seems like it would be a challenging technique for just anyone to be able to understand and relate to. At least with talk therapy it does not seem like such a, you know, cjore, like you are having to study for a test. I think this is what this sounds like that it would be for me.

  • Anton Myerson

    June 25th, 2011 at 8:45 PM

    Question: how does one get their brain to activate the type of brainwaves that are preferred? I’m interested in how you actually trigger that DVD for example.

    Aside from meditation, I had assumed all the others were non-voluntary states of mind and beyond conscious control. I can’t simply think myself into a state of alertness that will produce mid-beta waves, can I?

    Or can I? This is all very intriguing.

  • janna

    June 26th, 2011 at 10:08 AM

    I see all of these articles on here about the best way to treat veterans. But who is coming up with all of the money for this? From everything else that I read veterans affairs budgets are facing the same slashes that other budgets across the board are facing. Who picks up the tab for that?

  • Traci Stein

    June 28th, 2011 at 7:13 AM

    Hello all, and thank you for your comments and questions. Let me try to address them here.

    We change which type of brain waves predominate all of the time, just by changing what we focus on,or how relaxed we are, etc. For example, when something is interesting to us, and we begin to pay more focused attention to it, we increase the percentage of brainwaves in that “paying attention” (or mid-beta) frequency. ADHD is one condition for which neurofeedback is more commonly used, and I think it will make for a clearer example here. When a child with ADHD has difficulty paying attention to something that he should be (like school), his predominant brain waves will tend to be in a range that is too slow for paying attention (more day-dreamy). So, the task then becomes one of training the child to learn to pay better attention by rewarding his brain when he is doing so. In one program, the screen may show a roller coaster that will only move forward when the child’s brainwaves show he is paying attention. The “success” of making the rollercoaster move is exciting or pleasing to the child, who pays better attention, making the rollercoaster move more smoothly and rapidly, etc. If the child gets distracted or bored, his brainwaves reflect this change and the rollercoaster stops. To make it move again, he has to pay attention again. Over time, the child becomes better at paying attention at will even when he is not hooked up to the computer.

    Our brains naturally enjoy this type of reward and learn to produce the desired brainwave more readily. Most people report enjoying the experience and don’t feel like they are working too hard.

    For people with PTSD, whose brains are on “high-alert” too much of the time, the computer rewards them for relaxing and calming down. This both helps them to recognize when they are more relaxed and learn to create this feeling when they choose to.

    With regard to funding, I do not have specific information about funding for the veterans study mentioned above. But it would seem to me that when people become healthier, and less anxious, they function better and can require fewer psychiatric services in the long-term. Some may even be able to return to work. And this saves taxpayer dollars over time.

    I hope these responses were helpful.

    You may also wish to search “neurofeedback” on youtube to view videos showing the technique as it is used for a variety of conditions.

  • Charles Horne

    June 29th, 2011 at 5:38 PM

    A big problem about PTSD is not solely the number of genuine sufferers, but those who fraudently claim to be suffering from it. Military personnel who came home from war? They’ll be likely to have it. The guy who was in a bus that got clipped in an accident? He hadn’t even noticed it happened but will make a claim anyway. That’s what creates a stigma around PTSD- liars and cheats.I hope those that genuinely need help get it.

  • Dionne Wagner

    June 29th, 2011 at 7:16 PM

    To my mind PTSD is similar to depression in that it makes you emotionally cut off, ruins your mood, and can make you turn to

    substance abuse to cope with it. In depression, it’s events that make you stressed out and upset at being unable to deal with the problems at hand. In PTSD, it’s the fact that your life was in danger and it changes you. That’s my understanding of it.

    What I don’t get is how a dr can distinguish what relates to what condition if the individual suffers from both when they are so similar.

  • Traci Stein

    June 30th, 2011 at 6:57 PM

    Charles and Dionne, I’d like to try to address both of your comments here.

    First, I’ll address Charles’ concern about people who falsely claim to have symptoms of a mental illness – otherwise known as malingering. Of course, there are people who will claim to have medical or psychiatric problems for personal gain of some sort. In my experience, however, I think this is more uncommon than not. Furthermore, even trained professionals (hopefully) try to avoid making snap judgments about the validity of patients’ concerns. At minimum we would perform a thorough diagnostic interview to get a clear sense what may be going on for someone before determining whether someone is malingering.

    We also need to take into account that not everyone is equally vulnerable to developing PTSD. People who have been traumatized previously or already have other psychological symptoms tend to be at greater risk following a traumatic event. The available research tells us that most people are fairly resilient, however. The higher rates we see in the military are due to several factors, among them that the challenges they face fairly frequently are far outside the scope of what most of us can imagine. Military personnel are also much more likely to experience repeated traumas, with each one potentially further straining their psychological resources. I am sure that being separated from their loved ones for months on end is an additional and very signficant stressor.

    Dionne, with regard to your question, people can become depressed for a number of reasons, not only in regard to a specific external event. And certainly someone can present with more than one type of illness or cluster of symptoms. As I mentioned above, performing a thorough diagnostic interview, and getting to know patients better in general, give us a clearer idea of what is contributing to their difficulties, as well as what treatments could be most helpful.

  • michael alwin

    July 2nd, 2011 at 7:38 PM

    Fascinating article, Traci, well done. I do wonder why we seem to be so vulnerable to PTSD and the like in these modern times. Look up old pictures of construction sites and you will see men on very, very narrow ledges and steel bars. What are these brave men doing up there, hundreds of feet off the ground where a fall would mean instant death? Eating sandwiches.

    I know a lady that I suspect could be diagnosed with PTSD after being mugged by a push and grab in the street one night, even though she wasn’t actually harmed save for a skinned knee when she stumbled and didn’t realize what had happened for a minute. However she cannot stop replaying it in her mind and thinking what could have happened if she had resisted. She was walking home alone.

    The most absurd case I heard about a claim of PTSD by a person who saw a car accident from a 20th floor office building in New York. Is there a part of our makeup now that’s increased our tendency to be more emotionally affected than in previous generations or are we simply more fearful of everything?

  • Traci Stein

    July 5th, 2011 at 5:32 PM

    Hi Michael,
    These are all important questions. A diagnosis of true PTSD requires meeting very specific criteria; someone may present with distressing symptoms but meet criteria for a different disorder or disorders. I’m not sure if the person you refer to above was given this diagnosis by a trained mental health professional, was self-diagnosed, or if this was the general consensus of friends or family; people often use the label to describe distressing symptoms that would not necessarily meet DSM-IV-TR criteria for PTSD.

    That aside, it would be difficult to say definitively whether people are more stressed now (and thus more vulnerable) or that there is more awareness about this particular disorder. I think PTSD symptoms have probably existed since the dawn of human civilization, however, in recent years we have identified clusters of symptoms that make up what we now refer to as the PTSD diagnosis. So, for one, we have a model for recognizing PTSD as such. Perhaps people are also more likely to pursue treatment than in the past? This would certainly increase the reported prevalence rate even if the percentage of PTSD in the population was really not so different. But you are correct in that modern life can be especially stressful in different ways than what previous generations experienced. It would be interesting to see what sociologists would say about this question.

    As I mentioned above, certain factors with regard to the psychological history and current health of the person experiencing the event are considered important in determining PTSD risk, as are the severity and type of the event, whether exposure was repeated or not, etc. For example, men are more likely to report PTSD symptoms in relation to being in combat or witnessing someone being harmed or killed. Women are more likely to report PTSD symptoms after rape or other sexual assaults. But this may have something to do with the fact that men are more likely to be in combat or other similar situations and women are more likely to be sexually assaulted (and also more likely to report a sexual assault if it occurs). Our personal histories, in addition to the presence of other distressing symptoms, would also affect the meaning we attribute to any specific stressful event. There is evidence linking having experienced childhood traumas to vulnerability to PTSD later on. Furthermore, the degree of social support one has can make a difference in how well someone fares after a trauma. So, the above likely account for some of the variation in terms of who does well and who develops clinically significant syptoms in response to a traumatic event or series of events. There is also speculation that biological factors are implicated in vulnerability to the disorder.

    Finally, I have seen the photograph to which you refer – your question is thought-provoking. One thought is that people who would find that situation potentially traumatic would probably look for a different type of job (and thus not be up there to begin with)….

    I hope this was helpful. Be well.

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