The effect of PTSD on the brain, and what Neurofeedback can do.

I want to explain the impact of  PTSD on causing disregulation in brain functioning and how Neurofeedback can be used to train the brain to restore itself to self regulation and resiliency.

Various standard psychotherapeutic techniques have been used to treat the symptoms of Post Traumatic Stress Disorder (PTSD), often with minimal success. We first found this to be true of Vietnam veterans, but it is of particular concern now as we can expect that one third of the 1.6 million soldiers returning from the war zones in Iraq and Afghanistan will have serious symptoms of combat stress or PTSD.

To stay alive in a very dangerous environment, soldiers learn to be hypervigilant, to suppress emotions (no time in battle), and not to talk about doubts and emotions. In situations where the soldier and his unit have to face life threatening situations day after day, there is no time to acknowledge the physical or emotional impact of shock from explosions or the trauma of seeing ghastly injuries and death among your buddies. However, these events are recorded in memory deep in the brain stem. At the same time, to keep functioning, the soldier may suppress the traumatic event from conscious consideration or reflection.

The essential feature of PTSD that results from shock or event trauma is that the traumatic memory involves the mind and the body as a unitary entity. The event is encoded as a body memory as well as an explicit historical memory. This means that event memory is coupled to state memory, i.e. memory of the physiological state at the time.

Such coupling is commonplace, but is usually associated with emotionally meaningful events. In happy situations (first experience of a kiss, sex) the explicit memory may be linked to a pleasant body-feeling memory. In a trauma situation, the valence of all such memory is heightened, and the memory is encoded as a unitary experience involving both sensory and visceral systems. More importantly the impact of such intense trauma experience is that it becomes one-shot learning, whereby the body-mind then alters its response to threat from that time forward.

It remains in a threat posture at some level, and this exacts a cost in terms of our normal regulatory function. When the brain is in a state of hypervigilance, any action that resembles a threat can lead to a primitive survival response coming from deep within the brainstem.  The brain responding from fight-flight alarm response is effectively hijacked.  We then lose top-down cortical (rational) control because subcortical and brainstem-related mechanisms have taken charge. The more often the brain is triggered, the more difficult it becomes to re-install the original more subtle, more complex, and more integrated cortical control over our critical regulatory functions.

This is why addressing this as a problem of the mind (as in cognitive behavioral therapy) is often inadequate. Talking to the cortex has limited influence as long as the brainstem is in emergency mode. That primitive part of the brain driven by its own  internal mechanisms is not paying much attention to the cortex. And when such methods (EMDR, desensitization, etc.) do succeed, it is only because the physiological response was also changed during the process. After all, the brain’s self-recovery processes can be mobilized in a variety of ways.

We can, however, also take advantage of the opportunity to retrain our physiological response directly, bypassing the suffering and ailing mind. In Neurofeedback the real target in recovery from PTSD is our physiology.  We are indeed focusing on calming the over aroused and unstable limbic areas, as well as the emotional control centers of the brain.  It should not surprise us that this strategy actually works most of the time. Clinical experience with hundreds of returning combat Marines at Camp Pendleton has proven that with Neurofeedback the brain can train itself to return to its normal self regulatory function. During the sessions, the brain observes itself as it responds to visual, auditory, and kinesthetic feedback in a continuous loop. As the traumatized brain  responds to the reward and inhibit cues it gets via video images, it learns to calm (or defuse) its learned alarm response. The detailed symptom tracking done in the Camp Pendleton study, showed dramatic reductions of PTSD symptoms within 10 to 20 sessions of  Neurofeedback. More importantly as the brain reorganizes itself, it settles into stable and efficient functioning that affects both cognitive processing, physical well being,  as well as emotional control. The added benefit is that the brain having learned to calm itself, has also acquired resiliency to future stress. This is why the program at Camp Pendleton for returning soldiers is called Combat Stress Reset.

Acknowledgments:

Siegfried Othmer, Remediation of PTSD Symptoms Using Neurofeedback Training with Active Duty Service Members and Veterans. (Awaiting publication.) This is an analysis of the results of the study done initially with 400 combat Marines at Camp Pendleton in 2010. Results have now been tabulated for 500 Marines.