Medication is one of the most common treatments for PTSD, yet research suggests it works only about half the time
This weekend I was reading a gripping story in New York Times Magazine about Sam Siatta, an Afghanistan War veteran, and his harrowing struggle with addiction and his involvement in the criminal justice system when I stopped mid-sentence. After going into an inpatient rehab program at a V.A. hospital and being diagnosed with depression, alcohol addiction, and PTSD, he’d been given a prescription for Xanax to help with his PTSD. Knowing that it has been proven that drugs like Xanax do nothing to help PTSD and can even make it worse, I was shocked (Bostwick et al., 2012). In fact, The U.S. Army Medical Command put out a monster of a memo years ago stating that benzodiazepines like Xanax carry a “D-level recommendation” for treatment of PTSD, meaning their harms outweigh their benefits, and that they “should be avoided” (Coley, 2012). A meta-analysis in 2015 came to this same conclusion and found that, nevertheless, the drugs were still widely prescribed for PTSD (Guina et al., 2015) and not many know that there is an alternatives treatment for PTSD.
Even when PTSD-sufferers are prescribed drugs that are actually effective, they don’t always work. Two types of serotonin reuptake inhibitors, which are typically used for depression and slow down the brain’s process of recycling serotonin (a neurotransmitter important to mood), have been shown to work only about 50% of the time with PTSD. When you consider that one-fifth of veterans like Sam suffer from the disorder and that up to 22 vets take their own lives every day, the need for a good alternative treatment for PTSD to replace the status quo is clear as day. Luckily, neurofeedback is a promising one.
What is neurofeedback?
Neurofeedback is a technology-based treatment method that teaches someone how to self-regulate their brain’s patterns better by delivering real-time information about their electrical brain activity (brain waves like alpha and theta). We liken neurofeedback to exercise for the brain. The analogy works because neurofeedback training changes brain waves gradually by reinforcing the patterns we are trying to improve and discouraging those that are abnormal or problematic. This is all made possible by our brain’s neuroplasticity that involves actual physical changes in brain structure (a little like building muscle). All you have to do is show up a few times a week and pay attention. Many of our clients report that the experience is like playing a video game.
What does it have to do with PTSD?
PTSD symptoms are troubling because they feel out of control. This is largely because a part of the brain system, called the hypothalamic-pituitary-adrenal axis (HPA Axis), is actually dysregulated. The HPA Axis is essentially our brain’s fight-or-flight system. It turns on our sympathetic nervous system by releasing hormones like cortisol to get us “ready for action.” When the HPA Axis is functioning normally, cortisol levels are supposed to gradually decrease throughout the day, hitting a low towards the beginning of the sleep cycle and then increasing through the night towards arousal and waking up. Simple, right?
But in PTSD sufferers, the HPA Axis’s thermostat is all over the place and the system reacts excessively to environmental and internal stressors like noise, lights, memories, and more. That’s why PTSD sufferers display pretty specific symptoms – highly exaggerated stress responses like panic and fear that are difficult to predict and highly disruptive to daily life.
Neurofeedback helps by conditioning the brain to better regulate the HPA Axis. This is done in two different ways: 1) increasing the brain’s own ability to regulate itself by building up areas important for control (like the prefrontal cortex) and 2) also turning down overall activity in areas related to stress. The result is a brain that has less sympathetic activation to begin with AND that can better regulate the HPA Axis when it does get activated.
Research on neurofeedback & PTSD
Research that demonstrates neurofeedback works for PTSD is encouraging and continues to grow. A handful of very recent studies have showed that 3-5 months of twice-weekly visits for neurofeedback training were successful in greatly reducing—if not eliminating altogether—PTSD symptoms (Gapen et al., 2016 & Kolk et al., 2016). The benefits included improved emotional regulation, decreased anxiety, less frequent PTSD trigger events, and, for many patients, reduced need for medication (Simkin et al., 2014). Since these studies involved both veteran and non-veteran samples the results suggest that neurofeedback is useful regardless of the source of the trauma.
The Alternatives approach
Here at Alternatives we use neurofeedback protocols that have been shown to reduce PTSD symptoms and improve cognitive control. In addition, we incorporate biofeedback training that reduces the activation of the HPA Axis and returns the body to a more relaxed baseline. Through treating scores of patients with (and without) co-occurring addictive disorders we’ve developed a strong command of trauma-related care. Yet the most important facet of our work is this: we customize established protocols to individual needs in order to get the best results possible.
Some of our clients see improvement in as little as one week while others take three to four weeks to notice a real difference. But in nearly all cases, substantial improvement in trauma-related symptoms is observed within 10 sessions. And the improvements gained with neurofeedback are typically long-term changes, meaning clients continue to experience reduced symptoms long after they are done training. That’s an incredible advantage for neurofeedback over medication, even when it does work. If you’re someone who’s struggled with PTSD in spite of medication, know that there is hope out there and neurofeedback may be the right alternative for you.
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Benzodiazepines not recommended for patients with PTSD or recent trauma. (2015, July 14). Retrieved January 17, 2017, from https://www.sciencedaily.com/releases/2015/07/150714093816.htm
Bernardy, N. C. (2013). The Role of Benzodiazepines in the Treatment of Posttraumatic Stress Disorder (PTSD). PTSD Research Quarterly ,23(4).
Bostwick, J. R., Casher, M. I., & Yasugi, S. (2012). Benzodiazepines: A versatile clinical tool. Current Psychiatry ,11(4), 54-64. Retrieved from http://www.mdedge.com/currentpsychiatry/article/64686/anxiety-disorders/benzodiazepines-versatile-clinical-tool/page/0/3
Coley, H. A. (2012). Policy Guidance on the Assessment and Treatment of Post-Traumatic Stress Disorder (PTSD) (United States, Department of the Army , Department of Defense).
Gapen, M., Kolk, B. A., Hamlin, E., Hirshberg, L., Suvak, M., & Spinazzola, J. (2016). A Pilot Study of Neurofeedback for Chronic PTSD. Applied Psychophysiology and Biofeedback,41(3), 251-261. doi:10.1007/s10484-015-9326-5
Guina, J., Rossetter, S. R., Derhodes, B. J., Nahhas, R. W., & Welton, R. S. (2015). Benzodiazepines for PTSD. Journal of Psychiatric Practice,21(4), 281-303. doi:10.1097/pra.0000000000000091
Kolk, B. A., Hodgdon, H., Gapen, M., Musicaro, R., Suvak, M. K., Hamlin, E., & Spinazzola, J. (2016). A Randomized Controlled Study of Neurofeedback for Chronic PTSD. Plos One,11(12). doi:10.1371/journal.pone.0166752
Simkin, D. R., Thatcher, R. W., & Lubar, J. (2014). Quantitative EEG and Neurofeedback in Children and Adolescents. Child and Adolescent Psychiatric Clinics of North America,23(3), 427-464. doi:10.1016/j.chc.2014.03.001
Tanielian, T. L., & Jaycox, L. (2008). Invisible wounds of war: psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: RAND.