The Effectiveness of Using Neurofeedback in the Treatment of Post Traumatic Stress Disorder: A Systematic Review

Background and Purpose: Neurofeedback is an innovative treatment for Post-Traumatic Stress Disorder (PTSD) that is readily accessible to mental health therapists.  As a widespread mental health concern with potentially devastating long-term consequences on psychosocial functioning, PTSD can also adversely impact biophysiological processes, particularly those related to the brain.  Neurofeedback has shown promise in alleviating overall PTSD symptoms, including these underlying neurobiological consequences.  Successful results have been found among clients with PTSD who have not been responsive to prior treatment modalities.  While a strong base of clinical anecdotes and case studies support its success in treating PTSD, previous intervention studies on neurofeedback have been critiqued for lack of rigor and poor methodological design.  However, more recent interventions have been influenced by advances in neuroscience and technology.  The purpose of this study was to incorporate these developments in the field by conducting a systematic literature review evaluating the effectiveness of neurofeedback in the treatment of PTSD.  Methods: All studies with pre-experimental, quasi-experimental, experimental, and case-controlled designs published between 1950-2017 that reported primary results and used neurofeedback as a component of an intervention for PTSD were included.  Neurofeedback was defined as an intervention using any type of non-invasive biofeedback along with any form of real-time neuroimaging technology to train participants in the regulation of their brain functioning.  Participants consisted of adult men and women who were either of active military, veteran, or civilian status.  The primary outcome of interest was post-intervention reductions in PTSD symptoms, as measured by either validated behavioral assessments and screenings, a participant’s self-report, by the reports of informers such as spouses or family members, or by any combination of these.  Two reviewers independently conducted screening and data extraction, as well as coding of the articles meeting inclusion criteria.  Characteristics and results of all eligible studies were synthesized in a narrative format.  Results: The search yielded 10 articles that were included in the synthesis.  Neurofeedback demonstrated statistically significant improvements in at least one behavioral outcome measure of PTSD for the majority of participants receiving neurofeedback across all studies.  Generalizations, however, are limited by wide discrepancies in sample sizes, study designs, outcome measures, and the extent of reported results.  It was observed that more recent studies have incorporated the findings and methodological flaws of prior research to refine their own designs, thereby increasing the rigor in this field.   Conclusions and Implications: Neurofeedback continues to demonstrate promise as an intervention used to treat PTSD.  Intervention research in this area has shown improvement in terms of rigor, design, and breadth of reported results over time.  Future research in this area would benefit from continuing to prioritize randomized controlled trials with larger sample sizes and longitudinal follow-up results.