Peniston, E. G., & Kulkosky, P. J. (1991). Alpha-theta brainwave neurofeedback for Vietnam veterans with combat-related post-traumatic stress disorder. Medical Psychotherapy, 4(1), 47–60. https://neuro-wave.com/wp-content/uploads/2021/04/Peniston-PTSD.pdf

Type of Study: Randomized controlled trial
Number of Participants: 29

Population:

• Age — Mean=36.12 years (BWT group only)
• Race/Ethnicity — Not specified
• Gender — Not specified
• Status — Participants were Vietnam combat veterans with PTSD.

Location/Institution: Fort Lyon VA Medical Center

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to assess personality changes of Vietnam combat veterans with posttraumatic stress disorder (PTSD) after either traditional treatment or alpha-theta brainwave neurofeedback therapy (BWT) [now called EEG Neurofeedback]. Participants were randomly assigned to either traditional medical treatment (TC) or BWT. Measures utilized include the Minnesota Multiphasic Personality Inventory (MMPI). Results indicate that BWT showed decreases in MMPI T-scores on clinical scales labeled hypochondriasis, depression, hysteria, psychopathic-deviate, masculinity-femininity, paranoia, psychasthenia, schizophrenia, hypomania. and social introversion-extroversion. The traditional medical control group showed decreases in T-scores only on the scale labeled Schizophrenia. All BWT patients initially receiving psychotropic medication reduced their dosages after treatment, but only one of the TC patients reduced their dosage. At 30 months, all TC patients had relapsed. In contrast only three of the BWT patients relapsed. Limitations include the small sample size and reliance on a single self-report measure.

Length of controlled postintervention follow-up: 30 months

van der 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), Article e0166752. https://doi.org/10.1371/journal.pone.0166752

Type of Study: Randomized controlled trial
Number of Participants: 52

Population:

• Age — Mean=44.40 years
• Race/Ethnicity — 76% White/Caucasian, 9% Black/African American, 9% Multi-Ethnic, 4% Other, and 2% Native American
• Gender — 76% Female and 24% Male
• Status — Participants were patients with chronic PTSD.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the efficacy of EEG Neurofeedback training (NF) to increase affect regulation and reduce posttraumatic stress disorder (PTSD) symptoms in adults with multiple trauma exposures and treatment resistant PTSD. Participants were randomized to either NF or to a waitlist control group (WL). Measures utilized include the Traumatic Events Screening Inventory, Clinician Administered PTSD Scale (CAPS), Davidson Trauma Scale (DTS), and Inventory of Altered Self-Capacities (IASC). Results indicate that participants had experienced an average of 9.29 different traumatic events. Posttreatment, a significantly smaller proportion of NF participants met criteria for PTSD than the WL condition. Measures of tension reduction activities, affect dysregulation, and affect instability exhibited a significant Time x Condition interaction. The effect sizes of NF are comparable to those reported for the most effective evidence-based treatments for PTSD. Limitations include the length of follow up; small sample size; the study did not examine to what degree clinical changes are correlated with specific alterations in EEG, or other neural activation patterns; and the NF protocol targeted R temporal lobe EEG patterns.

Length of controlled postintervention follow-up: 1 month.

Bell, A. N., Moss, D., & Kallmeyer, R. J. (2019). Healing the neurophysiological roots of trauma: A controlled study examining LORETA z-score neurofeedback and HRV biofeedback for chronic PTSD. NeuroRegulation, 6(2), 54–54. https://doi.org/10.15540/nr.6.2.54

Type of Study: Randomized controlled trial
Number of Participants: 23

Population:

• Age — Mean=43.73–44.58 years
• Race/Ethnicity — Not specified
• Gender — Not specified
• Status — Participants were adults with chronic PTSD.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effectiveness of LORETA z-score neurofeedback (LZNF) training [now called EEG Neurofeedback] for altering current source within three neural networks: default mode (DMN), salience (SN), and central executive (CEN) and reducing symptoms associated with posttraumatic stress disorder (PTSD). Participants were randomized to either LZNF or to heart rate variability biofeedback (HRVB). Measures utilized include the PTSD Checklist for DSM-V (PCL-5), the Beck Anxiety Inventory (BAI), and EEG and HRVB recordings. Results indicate that the LZNF group showed very large, statistically significant decreases in symptoms on the PCL-5 and the BAI. The HRVB group also showed very large decreases on the PCL-5 and medium effects on the BAI. Between-group comparisons showed medium to large effects of group type in favor of LZNF, although not statistically significant. LZNF responders demonstrated very large, statistically significant decreases in abnormal z-scores within all targeted networks. Limitations include a small sample size, lack of generalizability due to limited sample demographics, and lack of clear controlled postintervention follow-up.

Length of controlled postintervention follow-up: None.

Nicholson, A. A., Ros, T., Densmore, M., Frewen, P. A., Neufeld, R. W., Théberge, J., Jetly, R. & Lanius, R. A. (2020). A randomized, controlled trial of alpha-rhythm EEG neurofeedback in posttraumatic stress disorder: A preliminary investigation showing evidence of decreased PTSD symptoms and restored default mode and salience network connectivity using fMRI. NeuroImage: Clinical, 28, Article 102490. https://doi.org/10.1016/j.nicl.2020.102490

Type of Study: Randomized controlled trial
Number of Participants: 72

Population:

• Age — 21–59 years
• Race/Ethnicity — Not specified
• Gender — 66 Female
• Status — Participants were adults with chronic PTSD.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to provide mechanistic evidence underlying clinical improvements by examining changes in network connectivity via functional magnetic resonance imaging (fMRI). Participants were randomized to either alpha-rhythm EEG-NFB [EEG Neurofeedback] or to a sham-control group. Both groups were also compared to a non-treatment comparison group consisting of healthy participants with no posttraumatic stress disorder (PTSD). Resting-state fMRI scans were collected pre- and post-NFB intervention for both the experimental and sham-control PTSD groups. Measures utilized include the Clinician Administered PTSD Scale (CAPS) and fMRI imaging. Results indicate that there was a significant main effect of time in the absence of a group × time interaction for PTSD severity. There were also significantly decreased PTSD severity scores in the experimental NFB group only when comparing post-NFB 3-month follow-up scores to baseline measures. There was evidence to suggest a shift towards normalization of default mode neural network (DMN) and salience neural network (SN) connectivity post-NFB in the experimental group only. Both decreases in PTSD severity and NFB performance were correlated to DMN and SN connectivity post-NFB in the experimental group. Critically, remission rates of PTSD were significantly higher in the experimental group (61.1%) as compared to the sham-control group (33.3%). Limitations include the length of follow-up and a lack of significant group differences on CAPS scores when comparing PTSD experimental and sham-control groups post-NFB and at the 3-month follow-up.

Length of controlled postintervention follow-up: 3 months.

Leem, J., Cheong, M. J., Lee, H., Cho, E., Lee, S. Y., Kim, G. W., & Kang, H. W. (2021). Effectiveness, cost-utility, and safety of neurofeedback self-regulating training in patients with post-traumatic stress disorder: A randomized controlled trial. Healthcare, 9(10), Article 1351. https://doi.org/10.3390/healthcare9101351

Type of Study: Randomized controlled trial
Number of Participants: 22

Population:

• Age — 20–55 years
• Race/Ethnicity — 100% Korean
• Gender — 2 Male
• Status — Participants were Korean adults with PTSD

Location/Institution: Wonkwang University Sanbon Hospital

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to assess the effectiveness, cost-utility, and safety of 16 sessions of neurofeedback on people with posttraumatic stress disorder (PTSD) for eight weeks. Participants were randomly assigned to neurofeedback [now called EEG Neurofeedback] or to a waitlist control group. Measures utilized include the Korean Version of the PTSD Checklist – 5 (PCL-5-K), Impact of the Event Scale-Revised Korean Version (IES-R-K), Clinical Global Impression-Improvement Scale (CGI-I), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Insomnia Severity Index (ISI), Hwa-Byung Scale (HBS), Core Seven Emotions Inventory Short Form (CSEI-S), Mentalizing the Rooms of Mind (MRM), Quality of Life (QOL), Short Form Health Survey-36 (SF-36), EuroQoL-5 Dimension (EQ-5D-5L), and a study-developed survey measuring program costs. Results indicate that PCL-5-K levels improved more in the neurofeedback group than in the control group. The change value was significantly improved in the neurofeedback group. Secondary outcomes such as anxiety, depression, insomnia, and quality of life were also improved. In an economic analysis using EuroQol-5D, the incremental cost-per-quality-adjusted life-year was approximately $15,600, indicating acceptable cost-utility. There were no adverse events in either group. Limitations include the small sample size; length of follow-up; and early termination of the study due to COVID-19, thus treatment response data for the waitlist control group after the completion of the waiting period was not acquired.

Length of controlled postintervention follow-up: 4 weeks.