In this presentation we will explore the benefits of using Electroencephalogram (EEG) at the NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS) in the assessment, treatment and outcome evaluation of refugees experiencing trauma related complex and chronic symptoms. Preliminary data identifying dysfunctional brain patterns related to post-traumatic stress symptoms and data supporting the effectiveness of Neurofeedback interventions aimed to reduce symptom distress and improve executive and cognitive functioning as an adjunct to trauma counselling will be presented. We will also examine how clinical practice can be enhanced when targeted clinical research is introduced.
Participants consisted of 30 adult clients with significant symptoms of PTSD referred to STARTTS' Neurofeed- back Clinic. The participants were split into two groups. Fifteen participants received in average 25 neurofeed- back training sessions while 15 participants continued to receive counselling treatment while on the waiting list for neurofeedback. The clients receiving neurofeedback were taught to enhance alpha brainwave activity and/or sensory-motor rhythm activity to promote calm and relaxed states. Pre- and Post-treatment Assessments. The clients receiving neurofeedback were compared at baseline and post neurofeedback treatment. The participants on the waiting list were assessed at baseline and again after 3 months of counselling. Symptoms Self-reported symptoms were obtained using the following instruments: Harvard Trauma Questionnaire for assessment of post-traumatic stress symptoms, and the Hopkins Symptom Checklist-25, Depression and Anxiety Scales Cognition -- Behaviour Participants completed two different assessments of cognitive performance. Digit Span (WAIS III) was used to probe working memory. The Visual Continuous Performance Task (GO/ NO-GO task) was administered during EEG recording to assess working memory, sustained attention and response inhibition. Event Related Potential (ERP) assessment GO/ NO-GO task consisting of 400 trials (20 minutes) was used during the EEG recording to measure brain responses to visual and auditory stimuli.
Neurofeedback participants completed an average of 24 neurofeedback sessions over 10 weeks in addition to counselling. Waiting list participants received in average 20 counselling sessions over the period of three months. The post neurofeedback treatment test results compared to the baseline measures indicated significant reduction in symptoms of post-traumatic stress, anxiety and depression and improvement in cognitive performance. The results of the participants on the waiting list showed minimal or no change. In addition, the analysis of ERP data showed a significant increase in P300 waveform following neurofeedback therapy, indicating improvement in cognitive control. This study contributes to establishing neurofeedback as an adjunct intervention to counselling to achieve changes in trauma related symptoms. A control study on a larger sample is warranted. Comprehensive assessment that includes subjective and objective measures can help us choose the effective interventions and evaluate treatment outcomes.
Funding & No Conflicts Declaration
This pilot study was conducted using data collected in our routine clinical work. The authors declare no conflicts of interest related to this study.