The role of neurofeedback in treating trauma

It’s my belief that Australian mental health services are failing to provide the best treatment for the more severely mentally disordered.

A radical review of causative factors is required. I maintain that the high, but largely ignored, prevalence of developmental trauma is the most likely undiagnosed cause. Five million Australian adults are estimated to have unresolved childhood trauma and abuse, with costs calculated at $24 billion.

Childhood maltreatment is the most important preventable risk factor for psychiatric disorder, according to Teicher, Gordon and Nemeroff (2021). As they say, “It is time for psychiatry to officially recognise these implications and to enact some essential changes.”

Developmental trauma

The interactions between an individual’s toxic environment and their genes and epigenetic factors causes evolutionary protective mechanisms to come into action, which help survival until puberty, to produce the next generation.

Brain structure and function is changed, so that the brains of traumatised people see the world differently. The effects of trauma are transdiagnostic, impairing cognition and executive functioning, with a dose-related effect on mental and physical health disorders.

Teicher et al recommend the inclusion of a Developmental Trauma Disorder diagnosis for severely dysregulated individuals of all ages undergoing mental health treatment and I agree.

Trauma informed care is important but it doesn’t actually repair brain function.

Neurofeedback

Technology, including functional magnetic resonance imaging (fMRI) and quantitative electroencephalography (QEEG), now enables psychiatrists to examine the organ we treat and to devise effective brain settling methods that repair brain function and heal developmental trauma.

Comparing a person’s EEG with a normative database shows up the differences in brainwave activity that need to be treated.

Operant conditioning, using gentle biofeedback methods like EEG neurofeedback, can reverse the effects of brain structural and functional changes, enabling talking and medication therapies to work better. People can get on with their lives with better performance and more confidence, especially those at the severe end of the spectrum.

Following a controlled study applying neurofeedback to traumatised children, Professor Bessel van der Kolk recommended neurofeedback facilities at every school.

But qEEG informed neurofeedback is not widely available in Australia, especially for treating trauma. However, pockets of success are proving encouraging.

Refugee trauma treatment success

The NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS) treats 7500 traumatised refugees, of all ages, every year, and introduced qEEG and neurofeedback in 2003.  The outcomes have been very positive, especially for the most severely traumatised.  For example, former child soldiers from Africa have been able to settle in class and complete their education. Once the fear-driven brain has calmed, psychotherapies, body work and social therapies work so much better! Crucially, the improvements in performance are virtually permanent — the brain does not want to reverse into chaos.

Treatment-resistant schizophrenia

At the headspace Early Psychosis Youth Service in Western Sydney, we found that almost all the young people accepted into the program had experienced significant developmental trauma.  A small case series (n=13) applying qEEG analysis and EEG neurofeedback has provided excellent results, enabling reduced anxiety, depression and substance use, plus increased social confidence, cognitive and executive functioning. Two young people had been diagnosed with treatment-resistant schizophrenia, despite over four years of treatment with the world best practice first episode of psychosis treatment program (Orygen Youth Health EPPIC model). Both did really well in the case series, including stopping the use of illicit drugs.

Interestingly, all the qEEGs recorded were abnormal when compared with a normative database, revealing evidence of disorders not otherwise found and indicating changes in medication. Lower doses of medication were required with fewer side effects. QEEG follow-up showed objective evidence of improved brain function, compared to the normative database, and those changes are virtually permanent.

Time to bring change

To offer neurofeedback to the general population, more clinicians need to learn these skills. Currently, there are only 56 internationally certified neurofeedback practitioners in Australia, with 19 certified as Supervisors. Twenty people have a qEEG Diploma in Australia. Only a minority work with trauma, which requires additional skills and personal support.

It’s time to enact change in the way we treat severe mental health disorders. We need the courage to seriously invest in a pathway to implement the knowledge we have, and train practitioners.

*Associate Professor Roger Gurr, MB BS DPM MRC Psych, FRANZCP is the Clinical Director of headspace Early Psychosis in Western Sydney. He also holds a Conjoint Appointment in Psychiatry, Western Sydney University Faculty of Medicine and is the Board Chair for the NSW Service for the Treatment & Rehabilitation of Torture & Trauma Survivors (STARTTS). He was awarded the NSW Government Human Rights Medal in 2021.

Image caption: iStockphoto.com/RyanJLane