Project Description:
Standard treatments for adolescents with Posttraumatic Stress Disorder (PTSD) have an exposure component that can be challenging to engage in for youth with impaired affect regulation skills. Exposure of the feared object/context in the absence of danger to overcome anxiety/distress associated with the traumatic event has been shown to be the most effective component of PTSD treatments. Thus, while exposure-based treatments are effective, they are only effective when youth can fully engage in the exposure, and are most effective when a caregiver is fully involved in the treatment process. This can present many barriers to effective clinical care. For example, youth in foster care often have complexities in their cases that prevent or stall caregiver involvement in their treatments. Additionally, exposure therapies require that a worst traumatic event be identified, which can be challenging for youth who have multiple chronic traumatic events coupled with stressful life events. This can also be difficult for youth who experienced traumatic events at very young ages (0-5), when their memories of the traumatic event have faded, but residual symptoms, like hypervigilance and affect dysregulation, continue to cause functional impairments. Further, processing thoughts and emotions associated with traumatic events may be especially challenging for youth with intellectual disabilities1 (Lemmon & Mizes, 2002). Thus, a treatment that does not rely on exposure may be especially helpful for these cases. A potential candidate is electroencephalographic (EEG) biofeedback, called neurofeedback (NF). One randomized trial (RCT) waitlist controlled (WLC) of NF in adults with treatment-resistant PTSD (N = 52) who had multiple traumatic events found efficacy for NF for PTSD. Specifically, the authors found that after 24 sessions of NF (2 per week for 12 weeks), a significant proportion of participants who received NF no longer met criteria for PTSD (16/22; 72%; van der Kolk et al., 2016). The effect size in this study was comparable to the effect of evidence-based treatments for PTSD (d = -2.33 within, d = -1.71 between groups; van der Kolk et al., 2016). Research on EEG biomarkers and PTSD has found elevated cortical activation, leading to lower alpha brain wave activity, and higher theta/alpha ratio (Keizer, Verment, & Hommel, 2010; Kropotov, Grin-Yatsenko, Ponomarev, Chutko, Yakovenko, & Nikishena, 2005; Jokic-Begic & Begic, 2003). The RCT of NF trained participants to decrease bandwidths of delta and theta (2-6 Hz), and high beta (22 36 Hz), and to increase alpha (10-13 Hz), which was based on prior studies assessing NF for adult PTSD (Keizer et al, 2010; Kropotov et al., 2005). Only one study to date has assessed QEEG for children (6-15 years old) with histories of traumatic events wherein delta/theta was measured at 2 7 Hz and alpha was measured at 12- 15 Hz (Huang-Storms et al., 2006). Participants in the adult NF study started with 12-minute increments and gradually increased to 30-minutes based on each persons improvement scores after each session. Given that the authors found that 2 sessions per week for 12 weeks was effective, and since there have been no treatments of NF for adolescents, we are proposing to assess the efficacy of NF for adolescents with PTSD using the same design as the adult study. Based on these two RCTs, and since there have been no treatments of NF for adolescents, I am proposing to assess the efficacy of NF for adolescents with PTSD for 30 sessions at 12-24 minutes per session. Hypotheses include that NF will improve parent- and child-rated PTSD symptoms (primary outcome) at endpoint and one-month follow-up compared to baseline.
Unserved or Under-served Populations:
Racial or Ethnic Minorities, Disadvantaged Circumstances, Geographic Areas
Primary Target Audience Geographic Descriptor:
Single-County, Mulit-County, Regional
