Chapter 4 - Surface and LORETA Neurofeedback in the Treatment of Post-Traumatic Stress Disorder and Mild Traumatic Brain Injury

Abstract

A review of recent research utilizing neurofeedback in the treatment of post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) establishes the clinical efficacy of this approach and indicates that with improved methods good clinical outcome can be achieved in fewer sessions. Preliminary studies show that improved clinical outcome can be achieved in 10 sessions or less if a symptom checklist is used to identify nodes and connections between nodes related to anxiety, memory, and frontal lobe function using low-resolution EEG tomographic analysis (LORETA) Z-score neurofeedback (LZN). PTSD is becoming understood as a set of functional neural network disturbances through the advancement of increasingly accurate and available neuroimaging techniques. Likewise, these same techniques are contributing to the understanding and treatment of mTBI. Both PTSD and mTBI involve a wide range of possible neural dysregulations, and thus, maximal treatment outcome will result from optimal specificity of assessment and treatment. Combat veterans often suffer from both PTSD and mTBI resulting in numerous complex, difficult to treat, and often disabling symptoms. This study reports on an ongoing project providing treatment to US combat veterans utilizing the 3D tomographic electroencephalogram (tEEG) technique of LZN driven by a symptom checklist, functional neural network match (SCL–FNM) method. Eleven cases are analyzed, one with a single session showing increasingly large effects of successive 2-min training rounds on the current source density of a targeted cortical region of training. Each of the other 10 cases also demonstrates specific neurophysiological normalization in the regions of training along with specific quantified progressive reduction in symptoms. Paired t-tests demonstrate learning occurred in every case. Cohen’s d analyses of current source density improvements quantified large effect sizes in 9 of 10 cases and a moderate effect size in one case. A negative correlation between effect size and psychotropic medication was found along with a trend toward needing less medication as training progressed. These interactions between LZN and psychotropic drugs provide a rationale for optimal cooperation among the trainee, LZN trainer, and prescribing physicians to maximize treatment efficacy. LZN based on the SCL–FNM method is evidently both effective and specific in the treatment of PTSD and mTBI.