Neurofeedback Augmentation in the Treatment of Chronic Post-Traumatic Stress Disorder Symptoms in Adult Refugees

Abstract

The traumatic journey of refugees—marked by displacement, persecution, and loss—often results in chronic post-traumatic stress disorder (PTSD), which is frequently resistant to standard treatments. This thesis examined the effectiveness of neurofeedback therapy (NFT), combined with trauma counselling, in treating chronic, treatment-resistant PTSD in refugees. It also investigated whether reduced cognitive control contributes to PTSD and whether the P3 event-related potential (ERP) could serve as a marker of clinical, cognitive, and neurophysiological outcomes.

A systematic review and meta-analysis evaluated existing evidence on NFT. A clinical database was developed from clients treated at STARTTS, all meeting DSM-5 criteria for chronic PTSD. Clients were assessed using the Harvard Trauma Questionnaire (HTQ) and Clinical Global Impression (CGI) before and after treatment. Treatment quality was also evaluated. Electroencephalography, including a Go/NoGo paradigm, was used to assess cognitive control. ERP waveforms included the P3d and Slow Positive Wave (SPW).

Significant reductions in PTSD symptoms, especially dysphoric and anxious arousal, were observed—greatest in clients receiving high-quality NFT. Improvements in cognitive control, shown by normalised P3d amplitudes, correlated with fewer omission errors and reduced reaction time variability. Higher SPWd amplitudes at baseline differentiated responders from non-responders, indicating predictive value.

These findings support the integration of NFT with trauma counselling for chronic PTSD in refugee survivors. Clinical gains were linked to improved cognitive control and normalisation of ERP markers, underscoring the value of ERPs in monitoring and predicting NFT outcomes. The results contribute to refining trauma treatment by incorporating neurophysiological assessments into therapeutic protocols.