President & CEO, The Atlas Institute for Veterans and Families
Dr. Andrew Nicholson
Director of Clinical Research, The Atlas Institute for Veterans and Families
The burden of posttraumatic stress disorder in Canada is disproportionately carried by veterans. Neurofeedback research is offering new ways to lighten that load.
Canadian veterans knew when they signed up that the work would be inherently stressful. They knew the country was asking them and their families to take on a significant burden, with significant risks. They chose to serve for their country anyway. And so, when they return with operational stress injuries like posttraumatic stress disorder (PTSD), it’s essential that appropriate tools be available to them for healing, for recovery, and for reintegration into civilian life.
The successful treatment of PTSD specifically has long been a puzzle. This debilitating mental health condition—characterized by emotional dysregulation, hypervigilance, flashbacks, insomnia, memory loss, and painful emotional states—disproportionately affects veterans, whether the trauma they were exposed to came through combat duties or in relation to other factors such as discrimination or military sexual trauma. Roughly 13 per cent of Canadian Regular Force veterans have been diagnosed with PTSD, compared to a baseline of just 1 per cent in the general Canadian adult population.
And, while currently available treatment options for PTSD — including psychotherapy, prolonged exposure therapy, and pharmaceutical interventions — work for some patients, roughly 40 per cent fail to respond to treatment, while 1 in 3 drop out of treatment. This is only exacerbated by the fact that PTSD so often co-occurs with other conditions like major depressive disorder and substance use disorders, which bring their own complexities to the treatment journey.
Adding to Current Treatment Options for Veterans with PTSD
So long as this treatment gap exists, veterans and their families will continue to be profoundly affected by the ongoing ramifications of operational stress injuries like PTSD, which can be devastating. “PTSD can be quite debilitating, with quality of life significantly impacted,” says Fardous Hosseiny, President and CEO of the Atlas Institute for Veterans and Families. “And there is increased risk of suicide. We want to ensure that the basket of PTSD treatment options available to veterans and their families is as rich and varied as possible because, unfortunately, it often takes trying a few of them to find something that works.”
New research, fortunately, shows a novel non-invasive and non-pharmaceutical therapy with incredibly promising results. This treatment, known as EEG neurofeedback therapy, is not only effective and well-tolerated, it can also be seamlessly integrated in conjunction with existing therapies across the spectrum of co-occurring conditions.
A Brain-Computer Interface for Mental Health
The potential of neurofeedback as a treatment path for PTSD was established in a clinical trial recently completed by several researchers in the PTSD field, including Atlas Institute Director of Clinical Research Dr. Andrew Nicholson, Dr. Ruth Lanius of Western University and Dr. Thomas Ros of the University of Geneva.
The trial involved using electrodes to passively measure the electrical activity of the brain and provide real-time feedback to trial participants, who would then attempt to modulate their brain activity in order to move a graphic across a screen or bring a picture into focus. In essence, it provided a game-like interface for learning to regulate and control internal mental states.
“We know that certain areas of the brain are dysregulated in the context of PTSD,” explains Dr. Nicholson. “Over the course of neurofeedback therapy, individuals learn to train their brain to refocus or regulate brainwaves in more balanced and helpful ways when triggers happen in the moment. That way, the triggers don’t result in unhelpful thoughts, emotions, moods, and behaviours. Neurofeedback provides the opportunity for individuals to train their brains in the same manner as one might work out muscles at the gym.”
One of the key characteristics of PTSD is a chronic state of hypervigilance—being essentially stuck in fight or flight mode—and this has long been known to be detectable on EEG as a marked reduction in alpha brain waves, the same alpha waves that are normally associated with a state of relaxation. Remarkably, after just a few sessions of neurofeedback therapy, alpha waves among the participants rebounded to healthier levels, and this measurable improvement in brain activity was corroborated by improvements in PTSD symptoms and severity.
Over the course of neurofeedback therapy, individuals learn to train their brain to re-focus or regulate brainwaves in more balanced and helpful ways when triggers happen in the moment.
“We found significant decreases in PTSD severity scores in the active neurofeedback group and not in the placebo group,” says Dr. Nicholson. “Over 60 per cent of participants actually no longer met the diagnostic criteria for PTSD after the trial. We’re really very excited about these findings. I think it provides a lot of hope for people that are struggling with PTSD, especially those with treatment-resistant cases.”
Homegrown Solutions for Homegrown Heroes
Having been a partner in the first phase of this international research project, the Atlas Institute will be taking on a lead role in the next phase. The Atlas Institute works to bridge the divide between research and practice, ensuring that veterans and their families can access the best possible mental health care. To this end, they’re investing heavily in advancing treatment innovation.
“We’re after new knowledge,” says Hosseiny. “This means working with others in partnership, but also coming back to do clinical and applied research here at the institute. What’s critically important though is that the research has real world applicability, so we also have invested heavily in what we do to ensure the knowledge comes to life and consequently makes a difference to the community that can benefit from it.”
Canada has long been a world leader in neuroscience research, and for this groundbreaking therapy to be developed within our borders is particularly meaningful for Canadian veterans and their families. Hosseiny emphasizes that the context of the Canadian veteran is unique, as is the Canadian health care system, and it’s therefore essential to show that new treatments can work within this Canadian context. It’s critical also that barriers to access be removed, so that this new therapy can be mobilized for widespread clinical availability as soon as possible.
While there remains work to do in addressing the gaps in mental health care for veterans and their families, the promise of neurofeedback as a therapy for PTSD offers a much needed ray of hope for those who chose to serve despite the cost—and who now bear the weight of that service on their shoulders—the horizon of the possible is growing broader.
“Recovery is not only possible,” says Hosseiny. “It can actually be quite attainable, with access to the right treatments and services in a timely manner.”
To learn more visit, atlasveterans.ca/neurofeedback