- Brain Circuitry Related to Context Processing Involved in PTSD
- By Jason von Stietz, M.A.
- October 31, 2016
Why are some individuals vulnerable to PTSD when others are not? Researchers at University of Michigan theorize that dysregulation in the brain’s circuity related to context processing, hippocampal-prefrontal-thalamic circuitry, is at the core of PTSD. The theory was discussed in a recent article in Medical Xpress:
All experts in the field now agree that PTSD indeed has its roots in very real, physical processes within the brain - and not in some sort of psychological "weakness". But no clear consensus has emerged about what exactly has gone "wrong" in the brain.
In a Perspective article published this week in Neuron, a pair of University of Michigan Medical School professors—who have studied PTSD from many angles for many years—put forth a theory of PTSD that draws from and integrates decades of prior research. They hope to stimulate interest in the theory and invite others in the field to test it.
The bottom line, they say, is that people with PTSD appear to suffer from disrupted context processing. That's a core brain function that allows people and animals to recognize that a particular stimulus may require different responses depending on the context in which it is encountered. It's what allows us to call upon the "right" emotional or physical response to the current encounter.
A simple example, they write, is recognizing that a mountain lion seen in the zoo does not require a fear or "flight" response, while the same lion unexpectedly encountered in the backyard probably does.
For someone with PTSD, a stimulus associated with the trauma they previously experienced - such as a loud noise or a particular smell—triggers a fear response even when the context is very safe. That's why they react even if the noise came from the front door being slammed, or the smell comes from dinner being accidentally burned on the stove.
Context processing involves a brain region called the hippocampus, and its connections to two other regions called the prefrontal cortex and the amygdala. Research has shown that activity in these brain areas is disrupted in PTSD patients. The U-M team thinks their theory can unify wide-ranging evidence by showing how a disruption in this circuit can interfere with context processing and can explain most of the symptoms and much of the biology of PTSD.
"We hope to put some order to all the information that's been gathered about PTSD from studies of human patients, and of animal models of the condition," says Israel Liberzon, M.D., a professor of psychiatry at U-M and a researcher at the VA Ann Arbor Healthcare System who also treats veterans with PTSD. "We hope to create a testable hypothesis, which isn't as common in mental health research as it should be. If this hypothesis proves true, maybe we can unravel some of the underlying pathophysiological processes, and offer better treatments."
Liberzon and his colleague, James Abelson, M.D., Ph.D., describe in their piece models of PTSD that have emerged in recent years, and lay out the evidence for each. The problem, they say, is that none of these models sufficiently explains the various symptoms seen in patients, nor all of the complex neurobiological changes seen in PTSD and in animal models of this disorder.
The first model, abnormal fear learning, is rooted in the amygdala - the brain's 'fight or flight' center that focuses on response to threats or safe environments. This model emerged from work on fear conditioning, fear extinction and fear generalization.
The second, exaggerated threat detection, is rooted in the brain regions that figure out what signals from the environment are "salient", or important to take note of and react to. This model focuses on vigilance and disproportionate responses to perceived threats.
The third, involving executive function and regulation of emotions, is mainly rooted in the prefrontal cortex - the brain's center for keeping emotions in check and planning or switching between tasks.
By focusing only on the evidence bolstering one of these theories, researchers may be "searching under the streetlight", says Liberzon. "But if we look at all of it in the light of context processing disruption, we can explain why different teams have seen different things. They're not mutually exclusive."
The main thing, says Liberzon, is that "context is not only information about your surroundings - it's pulling out the correct emotion and memories for the context you are in."
A deficit in context processing would lead PTSD patients to feel "unmoored" from the world around them, unable to shape their responses to fit their current contexts. Instead, their brains would impose an "internalized context"—one that always expects danger—on every situation.
This type of deficit, arising in the brain from a combination of genetics and life experiences, may create vulnerability to PTSD in the first place, they say. After trauma, this would generate symptoms of hypervigilance, sleeplessness, intrusive thoughts and dreams, and inappropriate emotional and physical outbursts.
Liberzon and Abelson think that testing the context processing theory will enhance understanding of PTSD, even if all of its details are not verified. They hope the PTSD community will help them pursue the needed research, in PTSD patients and in animal models. They put forth specific ideas in the Neuron paper to encourage that, and are embarking on such research themselves.
The U-M/VA team is currently recruiting people with PTSD - whether veterans or not - for studies involving brain imaging and other tests.
In the meantime, they note that there is a growing set of therapeutic tools that can help patients with PTSD, such as cognitive behavioral therapy mindfulness training and pharmacological approaches. These may work by helping to anchor PTSD patients in their current environment, and may prove more effective as researchers learn how to specifically strengthen context processing capacities in the brain.
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- Is Neurofeedback Effective? The Washington Post Reviews Clinical Work, Research, and Personal Experiences
- By Jason von Stietz
- January 30, 2015
The media shined a light on the neurofeedback field in a recent article in the Washington Post. Many clinicians have developed expertise treating a variety of psychiatric disorders. Some researchers are unsure there is enough evidence to support the claims of neurofeedback practitioners. However, leading neurofeedback researchers point to the field’s recent studies as evidence. Arlene Karadis discussed the clinical work and research of neurofeedback experts and the personal experiences of their patients in a recent article:
In September 2013, Chris Gardner went from kicking and spinning as a black belt in taekwondo to being locked in a world where he could not follow conversations — or even walk his dog. The 58-year-old Vienna, Va., resident had just had brain surgery to remove a large tumor, and the operation affected his mobility and cognition.
After nine months of physical and occupational therapy, he’d made little progress. So he tried neurofeedback, hoping this controversial treatment would improve his balance and mental processes.
Neurofeedback — a type of biofeedback — uses movies, video games, computers and other tools to help individuals regulate their brain waves. A patient might watch a movie, for example, while hooked to sensors that send data to a computer. A therapist, following the brain activity on a monitor, programs the computer to stop the movie if an abnormal number of fast or slow brain waves is detected or if the brain waves are erratic, moving rapidly from fast to slow waves.
The stop-and-start feedback, repeated over and over in numerous sessions, seems to yield more-normal brain waves. Researchers who endorse the technique say they don’t know exactly how it works but they say the changes in brain waves result in improved ability to focus and relax.
Neurofeedback, which is also used for post-traumatic stress disorder and attention-deficit hyperactivity disorder, has been around since the 1960s. Some research has found it promising. Other studies have been inconclusive, and some have shown no positive outcomes.
The most solid data concern ADHD, especially a recent trial involving 104 children published in March in the Journal of Pediatrics. Those who received neurofeedback had improvements in attention and impulse control, while those who did not receive the therapy did not. These improvements persisted after six months. The authors concluded that neurofeedback may be a “promising attention training treatment for children with ADHD.”
Gardner had read that the technique could aid in recovery from brain injuries.
“I was skeptical. But I was desperate. I felt like I was wrapped in miles of cotton and could not reach through it to touch or feel anything,” said Gardner, an electronic technology consultant. His doctor was projecting a two-to-three-year recovery period, based on Gardner’s slow progress nine months after surgery.
By his ninth neurofeedback session, he was driving, taking power walks and working from home.
Neurofeedback treatments vary. In Gardner’s case, he sat in a chair while tiny, pulsed signals were sent to his brain. Research suggests that these signals enable the brain to revive its communication channels, which can become impaired after a brain injury.
“I couldn’t feel anything” while the treatments were underway, Gardner said. “I just sat there with my eyes closed. My therapist explained that the pulses basically reboot the brain.”
Better focus and relaxation can seemingly help improve or eliminate such conditions as migraines (imbalanced brain waves are associated with certain symptoms like pain) and anxiety.
He has just completed the last of 10 treatments. “I am not 100 percent. I probably won’t stand on my head or get on a roller coaster. But I can do almost everything I couldn’t do before,” said Gardner, who’s back to his martial arts.
“Do most people become totally normal? No. But they improve,” said Michael Sitar, a Bethesda psychologist certified in neurofeedback. He uses it to treat depression, ADHD, chronic pain and some other conditions.
“I find [that] people with focus problems can switch tasks easier. Kids who repeat themselves and who are emotionally labile become calmer and don’t repeat as much,” Sitar said. “With some complicated cases, like bipolar disorder, people may get by on less medication. Though less common, there are documented cases of nonverbal people who become verbal.”
Like riding a bike
Deborah Stokes, an Alexandria psychologist, compares neurofeedback to riding a bike: It’s non-conscious learning, based on the feedback, that, with repetition, can be long-lasting, she said.
“We don’t know exactly how neurofeedback works,” she said. “It’s a process where if clients get out of their own way, they relax. Over time, they get the desired brain pattern, feel calm and function better. This encourages them to stay with it.” Her team sees 30 patients a week.
Thomas Nicklin, whose family was living in Alexandria, saw Stokes for debilitating migraines. A year and a half after beginning a drug regimen prescribed by a neurologist, he was not getting better.
Nicklin, a teenager who was in boarding school, did 45 neurofeedback sessions over three months last year.
“Over time, Thomas went from three or four blinding migraines a week, vomiting and daily pain, to no symptoms,” said his mother, Pat Nicklin.
Silver Spring psychologist Robb Mapou is among the skeptics.
“I have not seen enough well-controlled, rigorous studies in most conditions for which it is recommended to show, definitively, that neurofeedback is effective. I also think there are other therapeutic factors that can contribute to an individual’s outcome, such as discussing their problems with a therapist.”
Michelle Harris-Love, a neuroscience researcher at the MedStar National Rehabilitation Network in Washington, agrees.
“I believe it is applied in some situations where we do not have enough information on the cause of a disorder or how recovery happens,” she said.
But Rex Cannon, past president of the International Society for Neurofeedback and Research, based in McLean, Va., cited nearly 200 peer-reviewed published articles that indicate neurofeedback’s effectiveness. This includes a meta-analysis of 10 studies on epilepsy patients: Although they had not responded to medications, they had a significant reduction in seizures after neurofeedback treatment. And a study on migraine patientsreported, “Neurofeedback appears to be dramatically effective in abolishing or significantly reducing migraine frequency in the great majority of patients.”
Patients usually have sessions two or three times a week, for a total of 10 to 40. Most sessions are 30 to 60 minutes long. They can be expensive — from $50 to $130 each. Some insurance policies cover neurofeedback, depending on the diagnosis.
Practitioners who use neurofeedback for medical and psychological disorders must have health-care degrees and are regulated by state agencies.
About 1,850 professionals have been certified through the Biofeedback Certification International Alliance. To earn that credential, they must undergo 36 hours of study in neurophysiology and related topics, complete a mentoring program to learn clinical skills and pass a standardized exam.
Mary Lee Esty, a Bethesda clinical social worker, has a small study underway treating veterans with PTSD. In an earlier study of seven veteranswho used neurofeedback, she reported, the results were promising.
“These people [in the early study] initially had minimal function. They could not work, and many attempted suicide,” she said. “One is getting a PhD now. One has a full scholarship when he could not read after his head injury. All of them are doing well.”
Other studies describe results of the therapy in a similar way, as promising but requiring further examination.
Esty, who received a National Institutes of Health grant for an earlier study of brain-injured patients, has used neurofeedback to treat more than 2,500 people, mainly with brain injuries or PTSD. In her most recent and still ongoing study, she collaborates with the Uniformed Services University of the Health Sciences, which gives participants in her program post-treatment evaluations.
“I am in this collaboration because I want to get the hard data out there,” Esty said.
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- Pentagon's Brain-Powered Video Games Might Treat PTSD
- By Jason von Stietz
- July 8, 2014
Could neurofeedback effectively treat PTSD in veterans or is the reductions of symptoms the result of the placebo effect? Researchers at the Naval Academy in San Diego announced plans for an upcoming clinical trial comparing neurofeedback treatment to a sham controlled procedure in a sample of 80 patients. Wired discussed the study in a recent article:
“When the brain sees itself interacting with the world, it becomes interested in that,” Dr. Siegfried Othmer, chief scientist at LA’s EEG Institute and responsible, along with his neurobiologist wife Sue, for “The Othmer Method” — a specific approach to neurofeedback being used in the military trial — told me last year. ”Likewise, when it sees the signal on-screen and realizes it’s in charge, it becomes interested. You might not notice, but the brain takes notice.”
The realm of brain plasticity is relatively new, but neurofeedback actually isn’t. The procedure first gained notoriety in the 1960s as a treatment for everything from migraine headaches to bed-wetting. Still, in part because of a paucity of mainstream scientific research, the approach has long been relegated to the realm of bunk science. “I think the practice has gotten ahead of the science,” Dr. Andrew Leuchter, a professor at UCLA’s Semel Institute for Neuroscience and Human Behavior, told me. “It wouldn’t be surprising … if much of the benefit was attributable to the placebo response.”
Despite such mainstream skepticism, neurofeedback is already being used by several military doctors and psychologists. Maj. Michael Villaneuva — nicknamed “The Wizard” by his patients — has performed NF on several hundred active-duty soldiers, and even brought his game console and electrodes on a deployment to Afghanistan this year. And Dr. Jerry Wesch, who leads a PTSD recovery program at Fort Hood, describes the results of his own neurofeedback trials on patients as “jaw dropping.”
Upwards of a thousand former soldiers have also tried neurofeedback, thanks toHomecoming 4 Veterans, a non-profit started by the Othmers that offers free NF to veterans through a network of 200 practitioners nationwide. The two are also responsible for training Villaneuva and other military docs in the art of NF.
Already, the Othmers are confident that the military’s clinical trial, expected to kick off in December, will yield positive results. And they hope that the trial, once complete, lends more credence to the therapy they’ve helped pioneer. “I think the trial could be huge, not only with [medical] academia, but for clinicians,” Sue tells Danger Room. “They’re often wary of adapting procedures that haven’t seen evidence-based study. So this checks off an important box.”
But the trial won’t be easy: Controlled tests of processes, rather than pharmaceuticals, are notoriously tough. That’s because designing and executing a “sham” procedure is much more difficult than, say, just doling out sugar pills instead of the real drug.
Then again, for soldiers who credit neurofeedback with their recovery from PTSD, the execution or academic impact of a clinical trial is hardly the most important thing. “How it works doesn’t matter to me,” Staff Sgt. Justin Roberts, who underwent the process at Fort Hood, told me. “Just as long as it does.”
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- "Better Treatment, Prevention of Concussions Underway" "ABC7 News"
- By Jason von Stietz
- June 2, 2014
According to ABC7, News High Performance Neurofeedback (HPN) is currently used to treat veterans with PTSD and brain injuries. HPN Neurologic is conducting nationwide clinical trials are now underway examining the use of HPN for the treatment of brain injuries in the treatment of retired NFL players.
Retired NFL player Kenny Greene, who played safety for the St. Louis Cardinals, spoke to ABC7 News. Greene stated, “there’s a huge population of guys that have had injury, brain trauma, that are dealing with the consequences.” Football is a rigorous and contact sport. In spite of protective gear, such as a helmet and pads, injuries are often an inevitable part of the sport.
Joe Odom, who played linebacker for the Buffalo Bills, is one of many retired NFL players who suffers the consequences of football related brain injuries. Fortunately, Odom has found neurofeedback to be an effective treatment. Odom told ABC7 News that HPN was “he only thing that has consistently and immediately relieved a lot of the issues.”
Co-Investigator of the HPN nationwide clinical trials, George Rozelle, was quoted by ABC7 News as saying, “Up until now we have been very limited with what we can do with post concussive injuries. And this type of neurofeedback system can be applied to all forms of head injury. From kids playing youth sports to pro athletes and veterans suffering from blast injuries.”
HPN clinical trials involve the use of blood testing, extensive baseline testing, a complete neurological exam, qEEG, and Diffusion MRI. For more information about HPN Neurologic and their nationwide study Click Here
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