Posttraumatic Stress Disorder (PTSD): Level 4 – Efficacious

Posttraumatic stress disorder (PTSD) is a psychophysiological disorder characterized by chronic sympathetic nervous system activation, persisting perceptual/sensory vigilance for threats, and recurrent distressing memories of a traumatic event. Persons with PTSD frequently experience intrusive memories, nightmares, and flashbacks lived as if in the present moment. Many also exhibit a persisting negative emotional state, including fear, anger, guilt, and shame (Badour et al., 2017; Moss, 2017). PTSD often produces significant disability, lowered quality of life, and functional impairment (Alonso et al., 2004). The syndrome and symptoms of PTSD have been reported since the early 1800s and described under various diagnostic labels as exhaustion, irritable heart, Da Costa syndrome, and shell shock. Kardiner (1941) described the condition as a physioneurosis, a disorder that is both physiological and psychological. The psychophysiological basis of PTSD calls for psychophysiologically based interventions. Bessel van der Kolk has highlighted the problems in PTSD with affect regulation and called for mind–body interventions such as yoga and neurofeedback (NF) to enhance affective self-regulation (van der Kolk, 2014; van der Kolk et al., 2014, 2016). The purpose of this article is to review the published research on applications of biofeedback (BFB) and NF treatment of PTSD. Much of the research on this topic is still exploratory; several studies were conducted to show the viability of specific protocols. Accordingly, the review will include pilot studies, quasi-experimental studies, and randomized controlled studies. There is an emerging body of research on whether BFB or NF training before combat deployment or before childbirth can prevent the development of PTSD (Hourani et al., 2016; Pyne et al., 2019; Schlesinger et al., 2020). This important research will not be reviewed here.