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EEG Neurofeedback as Adjunct to Psychotherapy for Complex Developmental

Trauma-Related Disorders: Case Study and Treatment Rationale

Article in Traumatology · May 2016

DOI: 10.1037/trm0000073

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 Traumatology © 2016 American Psychological Association
2016, Vol. 22, No. 4, 255–260 1085-9373/16/$12.00
http://dx.doi.org/10.1037/trm0000073

EEG Neurofeedback as Adjunct to Psychotherapy for Complex

Developmental Trauma-Related Disorders: Case Study
and Treatment Rationale

Sebern F. Fisher Ruth A. Lanius and Paul A. Frewen

Northampton, Massachusetts Western University

The present clinical case study describes the long term treatment of “Bea”, a survivor of repeated and
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

complex developmental trauma, via trauma-focused psychotherapy combined with electroencephalog-

This document is copyrighted by the American Psychological Association or one of its allied publishers.

raphy (EEG) neurofeedback. Bea’s case is described alongside a brief introduction to a rationale for
including EEG neurofeedback as an intervention for complex developmental trauma-related disorders.
Future research directions are discussed.

Keywords: neurofeedback, electroencephalography (EEG), complex posttraumatic stress disorder

(PTSD), dissociation

Bea’s husband was overwhelmed and fearful for his wife. Bea Bea when she walked into the bedroom, screamed at him, and it
had been suicidal, self-harming and essentially unable to function stopped. However, Bea’s mother subsequently either no longer
at work or at home since the birth of their second child nearly 20 remembered the event or refused to acknowledge it. In addition to
years earlier. She suffered daily flashbacks, often in public places, this incident, Bea was orally raped repeatedly by her maternal
a reality that served to further humiliate this already deeply shame- step-grandfather and a neighborhood boy. Bea’s siblings believed
stricken woman. Bea experienced dissociative states in the form of the incidents concerning her grandfather—another sibling had
trauma-related altered states of consciousness (TRASC; Frewen & experienced this as well— but refused to accept the incident with
Lanius, 2015) daily in response to stressors that threatened to her father. As a result, several years into beginning a previous trial
overwhelm her. In early sessions, usually in response to her own of psychotherapy, Bea ended all contact with her family. As an
narrative, she could be seen to “disappear from behind her eyes;” adolescent, Bea repeatedly witnessed violent interactions between
it seemed clear that she could no longer hear her therapists’ speech. her parents who finally divorced. After her father left, he failed to
She cried often for hours each day and, in her own words, “Anx- maintain contact with his children. Bea described her mother as
iety, is like breathing.” She slept during the day, fearing to sleep at quick to shame her and neither supportive or warm. In addition,
night due to posttraumatic nightmares. The level of distress and she described her brother as filled with rage, an alcoholic from a
TRASC to which Bea fell to experiencing at any reference to her young age, and in chronic problems with the law.
history was so overwhelming as to require her therapist to conduct Bea’s presenting problems were PTSD, depression, dissocia-
her initial clinical assessment with her husband rather than directly tion, self-abusive behavior, and an inability to work. Upon initial
with Bea. assessment she was taking an antipsychotic, a mood stabilizer
Later confirmed by Bea herself, her husband described Bea as
(anticonvulsant), a selective serotonin reuptake inhibitor, a selec-
the second child of four children, born to a mother with a history
tive serotonin and norepinephrine reuptake inhibitor, and a benzo-
of severe psychological trauma including family disruption, being
diazepine, as well as medications for irritable bowel syndrome and
lashed with a bull whip, and being sexually touched on at least one
high blood pressure; over the course of her illness she had tried
occasion by her father, a military veteran with longstanding alco-
many other medications. Furthermore, her husband believed that
holism and probable posttraumatic stress disorder (PTSD). Bea’s
psychotherapy had only made her worse. She had received psy-
paternal uncle was also a certified pedophile, a fact suggesting the
chodynamic therapy for 5 years and for the 14 years before this she
possibility that there was sexual abuse in the grandparent genera-
tion. Bea’s mother witnessed her father’s sexual molestation of had been part of a dialectical behavior therapy (DBT; Linehan,
1993) program involving both individual and group therapy fo-
cused on developing her emotion regulation skills. Bea’s husband
was very concerned that the present treatment would require
This article was published Online First May 30, 2016. talking about her traumas because, in his words, “whenever she
Sebern F. Fisher, Private Practice, Northampton, Massachusetts; Ruth A. does, she falls apart.” In general, he reported that he had seen little
Lanius, Departments of Psychiatry and Neuroscience, Western University;
change in Bea after 19 years of psychotherapy, except for her to
Paul A. Frewen, Departments of Psychiatry, Neuroscience, and Psychol-
ogy, Western University. become worse. Bea, however, credited DBT with teaching her
Correspondence concerning this article should be addressed to Paul A. strategies that had kept her out of hospital for the 6 years prior to
Frewen, Room B3-264, University Hospital, 385 Windermere Road, Lon- beginning the present treatment (Bea was hospitalized three times
don, Ontario, Canada N6A 5A5. E-mail: [email protected] in the past for near lethal overdoses of her psychotropic medica-
255
 256 FISHER, LANIUS, AND FREWEN

tions and self-injury including biting herself, cutting, and gouging abnormalities in traumatized persons (Fisher, 2014). NFB or brain
her eyes, as well as long periods of mutism). To date, psychother- wave training is computerized biofeedback to the frequency do-
apy and medications, however, appeared to have accomplished main of brain functioning and has a long history (e.g., Hardt &
little more than this: they had kept her alive, but had not helped her Kamiya, 1978; Kamiya, 1968, 2011; Sterman, 2000; Wyrwicka &
to feel that it was worthwhile to live. Bea stated, “I come to Sterman, 1968). As described in numerous nontechnical sources
therapy to stay alive for my children. No other reason.” (e.g., Demos, 2005), NFB involves presenting to participants a
It seemed clear that further psychotherapy alone would likely be “picture” of targeted EEG amplitudes or coherence in real time,
insufficient to fully treat the trauma-related problems with which typically on a computer screen via visual feedback, as well as
Bea had long suffered. Clinician SF thus decided that it was through auditory feedback (e.g., consistency or volume of a tone).
necessary to target affect-regulation directly by training the ner- With such feedback participants learn to directly increase or de-
vous system. At the onset of their work together in 2008, SF crease EEG amplitudes of their own volition, including within the
introduced Bea to what was then and currently remains a novel context of ongoing mindfulness meditation practice. In fact,
intervention: electroencephalography (EEG) neurofeedback. To- whereas research participants are rarely provided specific guidance
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

day, following long-term treatment combining EEG neurofeed- regarding how to self-regulate their EEG, depending on the targets
This document is copyrighted by the American Psychological Association or one of its allied publishers.

back (NFB) and psychotherapy, Bea is free of all symptoms of of training, certain strategies are likely to be more beneficial than
PTSD and psychiatrically discharged without medications. She others; for example, one study found that engaging in positive
could not have anticipated such an outcome or the effect it would imagery was often an effective strategy in up-regulating alpha
have on her sense of self. It is that journey that this article will amplitudes particularly in the left relative to the right hemisphere
address. (Nan et al., 2012).
Referring to the history of NFB as a psychophysiological inter-
EEG NFB: Treatment Rationale for vention, it was discovered in the late 1960s that cats could learn to
control induced seizures through operant conditioning of their
Trauma-Related Disorders
brain waves (Wyrwicka & Sterman, 1968): They were rewarded
Different EEG frequency bands are widely known to be asso- with food every time they made the stabilizing frequency of 12–15
ciated with different cognitive-affective and basic physiological Hz, now called the sensory motor rhythm or SMR. NASA funded
functions. In general, alpha (8 –11 Hz) oscillations, historically this study because astronauts orbiting the earth were having sei-
associated with general states of relaxed alertness, are further zures after inhaling the fumes from rocket fuel and their exposure
known to play a role in internal attention. By contrast, delta (0 –3 could not be prevented; since they could not be given drugs, the
Hz) waves are seen during normal sleep but are also common in astronauts had to learn to prevent errant brain wave activity and
the waking brains of those who have suffered traumatic brain indeed this proved feasible through NFB. In fact, after successful
injury, as are higher amplitude theta frequencies (4 –7 Hz), the work with cats and then with monkeys, Sterman (2000) was able
latter often observed during the transition between waking and to take people with intractable seizures off the psychosurgery
sleeping as well as during deep, hypnogogic states. Finally, beta waitlist with NFB training; not one of his patients returned for
(12–36 Hz) and gamma (⬎36 Hz) waves are often increased psychosurgery. Using green and red lights as feedback, these
during focused, goal-oriented cognitive activity. patients, like the cats and monkeys before them, were able to learn
Studies of persons with trauma-related disorders reveal func- to increase the amplitude of 12–15 Hz EEG oscillations and, in the
tional abnormalities in frontal, temporal, and parietal cortices process, to control their seizures.
linked to different EEG frequency bands. However, findings There are many different models for understanding the treat-
across studies are heterogeneous to date, possibly reflecting dif- ment effects of NFB, none of which are sufficient in themselves to
ferent phenotypes, for example, differing between high-arousal fully explain this highly complex phenomenon. For example,
versus low-arousal (or dissociative) subtypes (e.g., Lanius et al., Gruzelier (2009) discussed the role of alpha-theta NFB in regulat-
2010). For example, elevated high beta (25–36 Hz; Begić, Hotujac, ing long distance alpha-theta oscillations and impacting creative
& Jokić-Begić, 2001; Cohen et al., 2013), low alpha (8 –11 Hz), performance and working memory. NFB of alpha oscillations has
and high peak alpha frequency (Wahbeh & Oken, 2013) may be also been shown to improve cognitive performance for functions
markers of chronic hyperarousal and hypervigilance, whereas theta negatively affected in traumatized persons including for short-term
oscillations may be associated with dissociative states (Giesbrecht, and working memory (Escolano, Aguilar, & Minguez, 2011; Nan
Jongen, Smulders, & Merckelbach, 2006; Krüger, Bartel, & et al., 2012), mental rotation (visuospatial ability; Hanslmayr,
Fletcher, 2013). In fact, in a large nonclinical population, McFar- Sauseng, Doppelmayr, Schabus, & Klimesch, 2005; Zoefel, Hus-
lane and colleagues (2005) showed that participants exposed to ter, & Herrmann, 2011), processing speed and executive function
early life stress evidenced reduced power across all EEG bands, as (Angelakis et al., 2007). One of the most useful models for clinical
well as increased peak alpha frequency. More recent literature is application, called the arousal/regulation model, was developed
turning to the investigation of functional connectivity (Kim et al., by Susan and Siegfried Othmer (2008) and emphasizes NFB as an
2012; Lee et al., 2014) and signal complexity (Bob & Svetlak, intervention for regulating hyperarousal, hypoarousal, and so-
2011; Chae et al., 2004; Hopper et al., 2002) as biomarkers of the called “instability” of the central and autonomic nervous systems.
long-term effects of complex developmental trauma histories. As but one example of a NFB protocol for lowering central
An important and novel question is whether cutting-edge ad- arousal, EEG-alpha enhancement NFB is an intervention originally
vances in neurotechnology, specifically brain-computer interfaces developed on the basis of research showing that longterm mind-
such as EEG NFB that analyze EEG data in real time, can be fulness meditation practitioners frequently exhibited high EEG-
effectively harnessed to guide the brain toward regulation of EEG alpha amplitude relative to the general population, thus suggesting
 EEG NEUROFEEDBACK AS ADJUNCT TO PSYCHOTHERAPY 257

its role in relaxation and wellbeing (e.g., review by Cahn & Polich, PTSD, 17 of whom completed 40 sessions of treatment, and
2006). However, whereas mindfulness meditation practice modu- evidenced medium-to-large effect size decreases in self-reported
lates EEG-alpha activity only indirectly, through attentional pro- PTSD symptoms (d= ⫽ .69, 34% variance) and affect dysregula-
cesses, EEG-alpha NFB aims to do so directly. tion (d= ⫽ 1.01, 25% variance), with the change in PTSD symp-
Despite the fact that the efficacy of alpha NFB for reducing toms found to partially mediate the change in affect dysregulation.
anxiety has been established for decades (Hardt & Kamiya, 1978), However, acknowledging the heterogeneity of EEG findings in
and effects for improving cognitive function are also increasingly group studies of traumatized persons, we would argue that an
well documented (e.g., Hanslmayr, Sauseng, Doppelmayr, Scha- individualized approach to NFB treatment is likely to be most
bus, & Klimesch, 2005; Zoefel et al., 2011), surprisingly little successful, specifically, as guided by patient self-reports and quan-
research has evaluated NFB as a treatment for PTSD. A promising titative EEG data acquired in response to initial treatment. Al-
early line of research by Peniston and Kulkosky demonstrated in though requiring further validation through the conduct of system-
both prepost and randomized trials that eyes-closed alpha-theta atic studies, clinical experience suggests that there are at least two
NFB reduced PTSD symptoms relative to treatment as usual in major EEG abnormalities exhibited by persons with complex
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

male inpatients with combat-related PTSD with or without comor- developmental trauma-related disorders: (a) excess slow wave
This document is copyrighted by the American Psychological Association or one of its allied publishers.

bid alcoholism (Peniston & Kulkosky, 1989; Peniston, Marrinan, activity of the delta (0 –3 Hz) and/or theta (4 –7 Hz) bands, and (b)
Deming, & Kulkosky, 1993). These findings were replicated in the excess fast wave or high beta (22–36 Hz) activity; in fact, certain
Cri-Help Study with alpha-theta brain wave training of 121 vol- persons reveal both abnormalities. As such, clinical experience
unteers with poly drug abuse in a rehabilitation facility; at 12 suggests the efficacy of protocols rewarding frequencies between
month follow-up, 71% of those treated by NFB were abstinent as 10.5–13.5 Hz, or 9 –12 Hz, and inhibiting excess slow wave (0 – 6
compared with 44% of the controls (Scott, Kaiser, Othmer, & Hz) and fast wave (high beta, 22–36 Hz) frequencies, with the
Sideroff, 2005). primary intention of lowering an overaroused nervous system
More recently, researchers demonstrated that a single session of (Fisher, 2014). Regarding electrode placement, Table 1, based on
EEG alpha-NFB also improved subjective emotional state and Fisher (2014), describes several treatment protocols that may be
modulated functional MRI (fMRI) resting-state connectivity relevant to the treatment of persons with complex developmental
within the fMRI Default Mode Network (DMN) and Salience trauma-related disorders; the clinical and neurophysiological ef-
Network (SN) in 21 individuals (18 women) with PTSD related to fects of such interventions, varying by location and target fre-
childhood-interpersonal trauma. Here, alpha desynchronization quency, require evaluation in randomized controlled trials.
NFB was associated with a significant increase in resting-state It is important to acknowledge that a specific EEG biomarker
alpha amplitudes post-NFB that was correlated with increased for trauma and stressor-related disorders has yet to be discovered
calmness, greater SN connectivity with the right insula, and en- and, given the complexity of the human brain and the heteroge-
hanced DMN connectivity with bilateral posterior cingulate, right neity of response to psychological trauma, is perhaps unlikely to
middle frontal gyrus, and left medial prefrontal cortex. These ever be. In other words, we take the position that every individu-
findings may be important insofar as they implicate neural net- al’s brain wave patterns are unique and, while quantitative brain
works shown to be dysfunctional in persons with PTSD in prior maps (qEEGs) are often obtained as a means of identifying an
research both during a resting state (DMN [Bluhm et al., 2009; individual’s pattern of dysfunction compared to a database of
Lanius et al., 2010; Qin et al., 2012; Sripada, King, Welsh, et al., normally functioning brains, such assessments do not always yield
2012b; Zhou et al., 2012] and SN [Rabinak et al., 2011; Sripada, information that is clinically useful, which was unfortunately true
King, Garfinkel, et al., 2012a; Sripada, King, Welsh, et al., 2012b]) in Bea’s case. As such, and not dissimilar with psychotherapy in
and in response to symptom provocation paradigms including this respect, the practice of NFB often takes the form of a dance
exposure to reminders of traumatic memories (Etkin, & Wager, between hypothesis generation and evaluation, the latter taking
2007; Hayes, Hayes, & Mikedis, 2012; Patel, Spreng, Shin, & into account both subjective and objective EEG data in response to
Girard, 2012; Sartory et al., 2013). Although promising, these treatments provided.
results are based on only a single session of NFB alone, and the
long-term objective neurophysiological (EEG and fMRI) and neu-
EEG NFB Therapy: The Case of Bea
rocognitive outcomes of alpha-NFB for PTSD remain to be eval-
uated. Bea did not have a documented history of seizures but some-
Beyond alpha-NFB training, what is generally known about the thing akin to that kind of violent storm seemed likely to be
brain regions underlying the symptomatology of complex devel- occurring in her brain. As is often the case for patients like Bea,
opmental trauma-related disorders can be used to guide the devel- her long list of medications included mood stabilizers which, it
opment of NFB-treatment protocols for these disorders; for exam- will serve as a reminder, are referred to as anticonvulsants when
ple, treatments targeting the function of the medial temporal lobes prescribed by a neurologist. Such medication regimes, at least
may partly address aberrant amygdala function, memory problems, implicitly, suggest that severely traumatized persons like Bea are
and dysregulation of primary process affective consciousness fre- being understood by psychiatrists to suffer from something akin to
quently observed within persons with PTSD. Indeed Gapen et al. seizure activity.
(2016) found preliminary support for protocols rewarding 12–15 Perhaps consistent with this conceptualization, during the first
Hz (sensory motor rhythm) interhemispherically at temporal sites 10 months of the clinical intervention, Bea would frequently
(T3-T4) and particularly at right temporoparietal cortex (T4-P4), explode or implode during therapy sessions as evidenced by self-
with accompanying theta (4 –7 Hz) and upper beta (22–36 Hz) harming and reckless behavior. She frequently asked for ice to
inhibition. Such findings were observed in 23 individuals with calm or ground herself, an intervention that she had learned from
 258 FISHER, LANIUS, AND FREWEN

Table 1
Electrode Placements of Potential Efficacy in Neurofeedback Treatment of Persons With Complex Developmental
Trauma-Related Disorders

Placement Hemisphere Rationale and treatment targets

C4 or C4-P4 RH General assessment and training of frequencies associated with emotional and psychosomatic function
T4-P4 RH Subcortical limbic “fear” circuitry directly (e.g., right amygdala)
T4-F8 RH Emotional and embodied self-awareness (e.g., mediated by right insula)
T6-P4 RH Embodied self-awareness (e.g., mediated at right temporoparietal junction); may also be relevant to reading of facial
expression
FpO2 RH Prefrontal cortical inhibition of limbic “fear” circuitry (e.g., over right amygdala)
FpO1 LH Reward processing (e.g., orbitofrontal cortex, striatum)
P5 LH Intrusive verbal mentation / voice hearing (e.g., mediated by auditory association cortex; Wernicke’s area)
Fz Midline Conceptual and embodied self-awareness mediated by dorsomedial and ventromedial prefrontal cortex; Prefrontal/
Cingulate inhibition of limbic “fear” circuitry (e.g., amygdala)
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Pz Midline Conceptual and embodied self-awareness and episodic memory (e.g., mediated by posterior cingulate/precuneus)
This document is copyrighted by the American Psychological Association or one of its allied publishers.

T3-T4 Interhemispheric Bilateral central “instability” possibly underlying emotion dysregulation (e.g., panic attacks) and migraine headaches
Note. Electrode placements typically refer to those of the Standard International 10 –20 system excepting FpO1 and FpO2 (above left and right eyelids).
First electrode site indicates training site and second reference site; single electrode placements use same side earlobe as reference or right in case of training
at midline. It is important to note that all protocols are based largely only on clinical experience and therefore should be considered experimental;
randomized controlled trials to evaluate efficacy and ensure nonrisk are needed. RH ⫽ right hemisphere; LH ⫽ left hemisphere.

DBT. Invariably she left therapy sessions sobbing, often driving We would argue that the goal of NFB is for the brain to learn its
directly to a convenience store to binge on what we colloquially own capacity for regulation in the frequency domain (Fisher,
refer to as “junk food.” Bea also frequently sought comfort from 2014). By contrast, as Bea’s case and so many others suggest,
her husband although it became increasingly evident from joint medications fail to offer the brain the same opportunity for learn-
sessions that, although well-meaning and supportive, he rarely ing. When she arrived for treatment, one might conceptualize
knew how to help her. Bea’s brain as practicing its own regulation errors repeatedly, with
NFB sessions typically took the form of Bea sitting in a chair these errors manifesting as her symptoms. In comparison, NFB can
and playing a video game, for example, completing a picture be thought of as guiding her brain back to its unforgotten capacity
divided in the form of a grid, a maze, or racing a spaceship, for regulation and, as it did, her symptoms began to fade. Most
without use of her hands, but rather entirely with her brain. In other importantly, as her brain learned to self-regulate, Bea began to
words, success in the game was calibrated to Bea’s real-time EEG gain self-regulation over fear, shame, and rage. Interestingly, as
such that she would gain points when she succeeded in increasing she quieted these emotional states, she experienced less dissocia-
the amplitude of the frequencies that should, in theory, help to tion and a more robust sense of herself began to emerge. It is
calm her neurophysiological state, while decreasing the amplitude possible that by quieting the repetitive firing of the circuitry of
of frequencies presumably related to dysfunction (e.g., Demos, emotional processing, NFB can help weaken the experience of a
2005), in Bea’s case high amplitude slow wave (delta and theta) traumatized identity; as arousal levels reorganize and quiet at the
activity. The treatment was delivered within a independent practice neuronal level, affect also organizes and quiets, and so do the
setting, with sessions typically being about one hour and consisting narratives that these states give rise to and reinforce. Accordingly,
of about 15–30 min NFB, with the remaining time spent in set-up clinical experience suggests that even the most fixed aspects of
and traditional talk therapy. personality and personality disorder can begin to reorganize.
Her clinician (SF) followed the symptomatic picture of high and Within the first 10 sessions of NFB treatment Bea reported
unstable arousal to train her brain, and many NFB protocols were significant changes. She noticed that she did better on a business
employed during the long course of Bea’s treatment. One of the trip than she or her husband had expected. She found it easier “to
advantages of NFB training is the requirement for ongoing assess- socialize with strangers.” She reported that it took her less time to
ment of progress and evaluation of protocols (International Society recover after “emotional eruptions” than it had in the past, and that
for Neurofeedback & Research, 2013); Bea or Bea’s husband she even surprised herself by laughing. In psychotherapy, she
would report on her response to each training session. Generally began to talk about her history spontaneously, and over the course
speaking, the training focused on her right temporal and parietal of several months, Bea stopped all self injurious behavior and
lobes at frequencies that she reported were calming to her and, dissociative episodes virtually ceased. She was, after only seven
although assessed only informly, the goals were to diminish her sessions, able to interrupt a posttraumatic flashback that began
level of ambient fear and reactivity, the intensity of her anxiety, when a man inadvertently bumped into her, another telling sign of
anger, and shame, episodes of dissociation, and the number and the an apparent treatment effect. Her nightmares became less frequent
intensity of flashbacks that she experienced, as well as the amount and less disturbing to her, corresponding with greater ease in
of time it took for her to recover from flashbacks. Further, changes initiating sleep. She was able to stay at work longer and nap less
in objective measures such as sleep onset and maintenance, need during the day. In fact, by Session 10, she reported that she
for antianxiety medications, frequency and intensity of nightmares, sometimes had a strange feeling of “no anxiety.” These periods
and regularity in bowel function were also tracked informally as themselves provoked a new kind of anxiety that, by her descrip-
treatment indicators. tion, was more “existential in nature.” As much as she welcomed
 EEG NEUROFEEDBACK AS ADJUNCT TO PSYCHOTHERAPY 259

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core of her symptom formation, and that resolution of these symp- graduates. Journal of Nervous and Mental Disease, 194, 362–368.
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(Fisher, 2014). Gruzelier, J. (2009). A theory of alpha/theta neurofeedback, creative per-
Research since the late 1960s demonstrates that both animals formance enhancement, long distance functional connectivity and psy-
and humans can learn NFB (Kamiya, 1968, 2011; Sterman, 2000; chological integration. Cognitive Processing, 10(Suppl. 1), S101–S109.
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Wyrwicka & Sterman, 1968). To date, however, despite increasing
Hanslmayr, S., Sauseng, P., Doppelmayr, M., Schabus, M., & Klimesch,
acknowledgment of the effects of early trauma and neglect on the
W. (2005). Increasing individual upper alpha power by neurofeedback
development and function of the human brain, little systematic improves cognitive performance in human subjects. Applied Psycho-
research has examined the potential efficacy of NFB in the treat- physiology and Biofeedback, 30, 1–10. http://dx.doi.org/10.1007/
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trial. Cases like Bea’s, however, suggest that such research is long alographic alpha feedback seen only in high anxiety subjects. Science,
overdue. 201, 79 – 81. http://dx.doi.org/10.1126/science.663641
Hayes, J. P., Hayes, S. M., & Mikedis, A. M. (2012). Quantitative meta-
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EEC alpha-theta brainwave synchronization in Vietnam theater veterans
with combat related posttraumatic stress disorder and alcohol abuse. Received November 12, 2015
Advances in Medical Psychotherapy: An International Journal, 6, 37– Revision received March 16, 2016
50. Accepted March 29, 2016 䡲

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