(WITHDRAWN) The Role of Mindfulness, Neurofeedback and Virtual Reality in the Treatment of Post-Traumatic Stress Disorder

Background. Post-Traumatic Stress Disorder (PTSD), a chronic mental illness with a debilitating prognosis, is characterized by emotional reactivity and challenges with emotion regulation. One common part of the brain that research has shown is impacted by PTSD is the amygdala. Down-regulation of limbic areas such as the amygdala may play a critical role in the effective recovery from traumatic stress. The present study sought to test a mindfulness-based intervention that involves virtual reality and limbic-targeted neurofeedback components to achieve symptom reduction in PTSD.

Method. Starting in 2018, individuals with a diagnosis of PTSD in the Los Angeles area were recruited to participate in a 15-session randomized control trial (N=31). Participants were randomized into two treatment groups that include one experimental group, electroencephalography limbic modulation index neurofeedback (N=15) and one control group, electroencephalography alpha/theta neurofeedback (N=16). Participants completed pre and post measures of PTSD: the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and PTSD Checklist for DSM-5 (PCL-5). An abbreviated PCL-5 was also measured at each individual neurofeedback session. Within-subjects t-tests were conducted to examine individual improvements by this treatment. A general power analysis for the neural and emotion regulation effects of neurofeedback was calculated based on preliminary results.

Results. PTSD measures among participants who were successful in decreasing limbic activity improved significantly more (M = -28.1, SD = 20.5) than participants unsuccessful in decreasing limbic activity (M = -12.9, SD = 10.87) (t(31) = 2.19, p < .05). Clinical improvement measured by PCL-5 was found to be significantly correlated with number of points decreased in post assessment relative to first assessment of PCL-5 (r(31) = .35, p < .05). We found a significant difference in neurofeedback success between first session (M = -0.3, SD = 0.76) and last session (M = -0.54, SD = 0.7) (t(31) = 2.47, p < .05).

Discussion. Down-regulation of limbic areas such as the amygdala appear to increase resilience to and coping with traumatic stress, thus playing an important role in reduction of PTSD symptomology. A general downward trend of PTSD symptomology over the course of 15 sessions displays the power of reinforcement and continuity of mindfulness strategies implemented by each participant. In addition to displaying the efficacy of limbic-targeted neurofeedback, this study finds the connection between implementing a mindfulness-based strategy and down-regulation of limbic activity related to PTSD. Social workers in areas of practice with a high prevalence of PTSD, such as Veterans Affairs centers and sexual trauma treatment centers, may benefit through the implementation of mindfulness-based treatment programs or limbic-targeted neurofeedback treatment sources with clients who have not portrayed a marked decrease of PTSD symptomology through traditional, therapeutic means.