Neurofeedback for the Remediation of Trauma in Disaster Victims
By Siegfried Othmer, Ph.D., Chief Scientist, The EEG Institute
Introduction and Summary
What makes the resolution of traumas so problematic to the mental health practitioner is the fact that trauma appears to be physiologically encoded in a variety of body systems. Trauma does not merely reside in historical memory. This means that verbal or cognitively-based means of addressing the traumatic memory do not reach what may be the core issues that sustain the trauma experience. The inability of verbal therapeutic techniques to touch these core issues means that trauma work is often itself re-traumatizing. It has even become axiomatic within the field that the resolution of traumas can only occur via such a painful route.
Recent work has taken us far beyond such conceptions. The implications are profound, and they
should bear fruit in the management of the recent trauma experience to the largest degree possible.
Since these ideas are relatively recent, many in the mental health field are only beginning to
become aware of the efficacy of the recommendations contained herein. The rewards of such an
approach, however, should be a significant reduction in time and resources required for trauma
resolution.
In recent years, a number of techniques have surfaced which give promise of addressing the physiological
aspects of traumatic memories. Because of their novelty, the relative dearth of controlled research
to date and the fact that we are only beginning to understand the mechanism by which these startling
results are obtained, these techniques are still mired in controversy in spite of an ever-growing amount
of supportive clinical data that continues to emerge.
The model is that trauma is encoded in functional brain networks. Via the central nervous system
the memory is registered in peripheral physiology as well, so that ultimately the entire body
bears the memory. The good news is that this phenomenon can be better understood in terms of
functional change rather than fundamental structural damage to the system. It has also been learned
that memory is not absolute, but contingent, and hence it can be retroactively modified. The
work of trauma recovery is one of transitioning the trauma experience from one that is viscerally
felt in all body systems to one that merely resides in historical memory, like all other recallable
events in one’s life.
Neurofeedback is a gentle technique that appraises where the brain is at the moment, and guides
it gradually to a different functional state. This can serve three roles successively, all relevant
to the trauma experience. In the first instance, it can take the person struggling with a recent
traumatic event to “safe harbor” in the moment. Over the longer term, repeated trainings
can re-stabilize the physiology, so that sleep is restored, cognitive function recovered, anxiety
and depression remediated. Finally, neurofeedback can be used to bring the person to internal
focus, where the trauma event can be re-visualized non-traumatically and hence re-scripted. Neurofeedback
does not abort the natural grieving process. It is not an analgesic for the trauma experience.
Rather, it supports the physiology during the natural grieving process so that the person does
not get stuck in dysfunctional states. Ultimately it facilitates a natural healing process.
The technique is heavily instrumentation-based. The advantage is that it is non-language based,
and it makes minimal cognitive demand on the person. Even pre-verbal children can be successfully
treated. On the other hand, the technique does require some specialized training in its administration.
The Frequency Basis of Brain Functional Organization
Unfortunately, none of the material we present make any sense at all unless there is an understanding of brain functioning that is just now coming into view in the neurosciences. This is the field of “electrophysiology,” the understanding that the brain must organize itself in the bio-electrical domain as well as the neuro-chemical domain. We have to take a moment to present the skeleton of that view.
There is an emerging realization that the brain, like much of nature, is organized on the basis of frequency. Different frequencies in the brain subserve different control functions. A disregulated physiology often manifests in disturbed brain activity, which can in turn be seen in altered patterns of frequency distribution. Whereas the whole issue of the “operating system” of the brain is just now coming under study in the neurosciences, in the clinical world this “reality” has already led to a variety of therapeutic techniques. Because the model for such brain behavior is not yet universally acknowledged, these techniques are currently outrunning the understanding of the practitioners involved.
The techniques at issue include Eye Movement Desensitization and Reprogramming (EMDR), repetitive Transcranial Magnetic Stimulation (rTMS), Thought Field Therapy (TFT) or Emotional Freedom Technique (EFT), Audio-Visual Stimulation (AVS), Holotropic Breathwork, acupuncture, and EEG biofeedback or neurofeedback. All of these appeal to the brain directly or indirectly, and all except for TFT/EFT and acupuncture are frequency-based. That is, they all promote certain brainwave frequencies that appear to have healing potential.
We do not intend to make a case of all of these methods, but they do constitute independent
strands of evidence in support of the principle that an appeal to brain self-regulation in the
frequency domain can help to resolve trauma. EMDR typically involves brain stimulation at very
low frequencies, in the range of 2-6 Hertz, and it involves shifting attention from right to
left hemisphere at those frequencies. RTMS is used for the remediation of depression, and usually
involves the magnetic stimulation of certain cortical regions at mid-frequencies of nominally
15 Hz. Audio-Visual Stimulation can occur over the whole range of EEG frequencies from 0-40 Hz,
but most commonly involves the lower frequency regime (<20 Hz). Holotropic Breathwork involves
hyperventilation to the point at which the brain depletes in CO2, which results in vasoconstriction
followed by a decrease in EEG dominant frequency to the low range of delta and theta (0-4Hz,
and 4-8 Hz, respectively). Acupuncture commonly elicits brainwave activity in the alpha band,
as the body’s internal analgesic mechanisms are engaged. And neurofeedback generally reinforces
EEG frequencies less than 20 Hz. In trauma work, the lower frequency range (<12Hz) is emphasized.
Neurofeedback (EEG Biofeedback): The Process
In neurofeedback information about certain EEG frequencies is made available to the brain, which is asked to act upon that information in an operant conditioning paradigm. Gradually, the functional state of the brain changes to be more consistent with the selected frequency. In practice, three electrodes are mounted on the scalp with conductive paste in order to detect the EEG. The EEG signal is processed through an amplifier and computer to derive information about the specific frequencies of interest. In general, we simply determine how big the EEG signal is at each of these important frequencies. We then convert that information into a more abstract visual representation such as a geometric figure, which is shown back to the person. The trainee is asked simply to change the size of the figure, or the speed or brightness of an object that encodes the EEG information. Through repeated challenges and rewards, the brain is operantly conditioned to a more appropriate operating point (homeostasis). Over time, the brain acquires the ability to move more adroitly in altering its own state. It becomes more stable, if necessary, but also more flexible and resilient. It simply works better as a self-regulatory system, with potential benefit for a variety of psychological, psychiatric, and neurological issues. With a better-regulated system, a variety of symptoms simply fall away. It appears as if disregulation was itself the problem!
Even within a single session, the changes brought about can effect some relief of immediate symptoms such as headache or migraine. It can even bring some recovery from unrelieved depression, or even from impulses toward suicide, or from a susceptibility to panic. Over the course of the first few sessions, the training can be helpful with sleep onset anxiety, nightmares, and other sleep disturbances of childhood. There will be continuing remediation of headaches syndromes, stomach pain, and recovery from anxiety and depression; from panic anxiety and suicidality; from behavioral disturbances that may be exacerbated by childhood depression; and from the rages and mood swings that characterize Reactive Attachment Disorder.
The training in physiological stabilization occurs predominantly at intermediate EEG frequencies, in the range of 12-19 Hz. These frequencies predominate in the management of physiological arousal while we are functioning in daily life. The training in this frequency range is referred to as SMR/beta training. After stabilization of physiological (autonomic) function has been achieved in this regime, the time will come (not necessarily right away) when the traumatic memory will need to be addressed. This can likewise be accomplished with the same technique.
Lower EEG frequencies go along with lower levels of physiological arousal. We are concerned here with frequencies of 12 Hz and below. This training is generally referred to as alpha/theta training. Neurofeedback reinforcement can be used as a gentle induction technique that moves the person to low levels of arousal. This is accompanied by a change from external focus to an orientation toward interior states. Additionally, the accessing of memories appears to be facilitated. In this state of low activation, even the review of a traumatic memory may not kindle a traumatic response. In this manner, a separation begins to occur between the memory event and physiological reactivity. The trauma is being defanged.
The other techniques mentioned above which are being used in the service of trauma recovery are Holotropic Breathwork, EMDR, and AVS. Hypnotherapy should also be included in this list. A significant point of distinction between these processes and neurofeedback is that the latter is almost totally self-directed. That is to say, it is state change that brings about the change in the EEG that we are rewarding. If the state change is being resisted for one reason or another, it will simply not occur. Or if the person encounters a troubling experience during this process, then the process simply aborts. By contrast, all of the available alternatives listed above represent a kind of “forced march” of the brain into low-frequency states whether the person wishes to or not. It is quite possibly the absence of choice here that brings about so much continuing trauma in the recovery process. Such traumatic misadventures are commonplace in all of the above alternatives to neurofeedback. It is also possible that neurofeedback has the considerable advantage of being completely non-verbal. It allows the natural healing processes to assert themselves in a protected environment and in a regressed state. It may strain credulity for us to assert that trauma recovery can now take place essentially non-traumatically, i.e. without significant abreactions, but that is our experience with neurofeedback.
A Plan of Action
Neurofeedback training should be made available to trauma victims of the September 11 disaster. This includes those who work with victims. A first application would be to immediate symptom relief for the symptoms of disregulation, principally of the autonomic nervous system. This might involve a sequence of six training sessions. A second objective is physiological stabilization for more deep-seated disregulations of autonomic function, so that people can simply carry on with life with greater effectiveness. This may require an additional twenty training sessions. A subsequent objective, undertaken at the appropriate time and place, would allow the technique to be used in the service of trauma recovery. This would be undertaken by an appropriately trained professional, one who could provide the supporting psychotherapy and other support services. This part of the process may require from four to forty sessions. The latter might be needed in the case of an established case of Post-Traumatic Stress Disorder.
Initially mental health professionals presently trained in this technology may be mobilized as volunteers. However, in order to make such services widely available, it is highly advantageous to conduct a professional training course in neurofeedback to the health professionals (nurses, clinical social workers, etc.) who will provide the service in the available settings.
A single professional can conduct up to sixteen training sessions per day with a single instrument in an institutional setting. With two professionals, three instruments can be managed, for a throughput of nominally 50 sessions per day. With this kind of capability, the net burden on the mental health staffing can be considerably eased. Quite simply, in a resource-limited situation, the delivery of neurofeedback services should become a priority.