Neurofeedback training can help patients with PTSD control their amygdala reactivity, study finds

Scientists recently investigated the use of neurofeedback training to help individuals with post-traumatic stress disorder (PTSD) regulate activity in their amygdala, a brain region which plays a key role in fear responses. Their findings, published in Translational Psychiatry, showed that the participants who received neurofeedback training were able to gain better control over their amygdala activity after recalling traumatic events.

PTSD is a debilitating disorder characterized by symptoms such as re-experiencing traumatic events, avoiding triggers, changes in mood and cognition, and heightened arousal.

Previous studies have suggested that reducing amygdala activity could lead to symptom reduction in PTSD. Psychotherapy and MDMA treatments have shown promising results in decreasing amygdala activity and improving symptoms. Based on these findings, the researchers hypothesized that training individuals with PTSD to control their amygdala activity using neurofeedback could be an effective treatment approach.

“PTSD seems like a promising disorder to target via neurofeedback because it is a disorder in which unhealthy brain patterns are learned during or following trauma exposure,” said study author Michelle Hampson, a professor of radiology and biomedical imaging at Yale School of Medicine and editor of “fMRI Neurofeedback.”

“This suggests the circuitry giving rise to PTSD symptoms is plastic and can be altered via natural learning. For this reason, I was hopeful that neurofeedback would be effective at training the brain circuitry involved towards healthier function. Also, neurofeedback is an empowering mental health intervention that I believe will appeal to PTSD patients.”

The study was conducted as a double-blind, randomized clinical trial with a total of 24 participants with chronic PTSD. Participants were recruited through online advertisements and community outreach. They underwent screening using standardized clinical interviews to confirm the diagnosis of PTSD.

Personal traumatic experiences were collected from each participant, and audio clips were created to evoke memories of these traumatic events. The brain imaging sessions were conducted using a 3-Tesla MRI system, and real-time fMRI neurofeedback was provided using specialized software.

Participants were randomly assigned to either the active group or the control group. The active group received real neurofeedback based on their amygdala activity, while the control group received sham feedback matched to a participant from the active group.

Before the neurofeedback sessions began, both groups of participants had a strategy development session with a clinical psychologist who was unaware of their group assignment. The purpose of this session was to provide participants with individualized mental strategies that could help them reduce their amygdala activity and anxiety levels after recalling traumatic events during the neurofeedback training.

The strategies discussed during this session included mental strategies such as progressive relaxation, mindfulness, and reappraisal of emotions. These are common approaches that have been shown to be effective in managing anxiety and regulating emotions.

During the neurofeedback training sessions, participants were instructed to downregulate their amygdala activity while listening to their personalized trauma scripts. The training sessions consisted of three sessions with six runs per session.

Participants were instructed to assess the success of each mental strategy they employed based on the feedback signal they received. The feedback signal provided real-time information about their amygdala activity, allowing them to see how well they were able to downregulate their amygdala. This process of trial and error helped participants identify and practice the most effective strategies for themselves.

To assess the effectiveness of the neurofeedback training, participants completed tasks before and after the sessions to measure their control over amygdala activity. They also completed clinical assessments of PTSD symptoms at multiple time points. Resting-state functional connectivity of the amygdala was measured pre-training, post-training, and 30 days post-training.

The researchers found that participants who received the neurofeedback training demonstrated improved control over their amygdala activity after recalling traumatic events.

Both the active group (neurofeedback training) and the control group (no neurofeedback training) in this study showed reductions in PTSD symptoms. Although the active group showed greater improvements, the difference between the two groups was not statistically significant, which might be a result of the relatively small sample size.

“The finding that neurofeedback enabled participants to better control their amygdala activity following trauma exposure suggests that neurofeedback has promise for helping individuals with PTSD learn to control the brain circuitry involved in emotional processing of their traumas,” Hampson told PsyPost. “It is important to bear in mind that our study was a small, early stage research study and does not provide evidence of clinical efficacy.”

“However, the findings are consistent with a growing body of early stage research that suggests neurofeedback targeting amygdala activity has the potential to be developed into an effective treatment for PTSD. The promising results we are seeing in this early stage research should motivate larger, well-controlled clinical trials that, if successful, may establish clinical efficacy.”

The researchers also noted that the COVID-19 pandemic occurred during the study, which could have influenced the participants’ clinical progress.

“The nonspecific effects were surprisingly large: participants in both groups in the study showed substantial improvements in symptoms. It’s not clear if this was related to the intervention running during the pandemic. That is, perhaps participation was particularly therapeutic in the context of ongoing social isolation,” Hampson explained.

“On the other hand, the large symptom improvements seen for both groups may be a result of the trauma exposure aspect of our training protocol. Trauma exposure is known to be therapeutic, indeed, exposure therapy is the frontline treatment for PTSD. Our study had very limited levels of trauma exposure compared to traditional therapy, but perhaps these limited levels are still highly therapeutic?”

Further research with a larger sample size is needed to evaluate if neurofeedback provides specific clinical benefits beyond the non-specific effects of the intervention. “Large, well-controlled trials are needed to establish efficacy, and explore which individuals are most likely to benefit from this kind of intervention,” Hampson said.

The study, “Amygdala downregulation training using fMRI neurofeedback in post-traumatic stress disorder: a randomized, double-blind trial“, was authored by Zhiying Zhao, Or Duek, Rebecca Seidemann, Charles Gordon, Christopher Walsh, Emma Romaker, William N. Koller, Mark Horvath, Jitendra Awasthi, Yao Wang, Erin O’Brien, Harlan Fichtenholtz, Michelle Hampson, and Ilan Harpaz-Rotem.

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