Healing the Neurophysiological Roots of Trauma: A Controlled Study Examining LORETA Z-Score Neurofeedback and HRV Biofeedback for Chronic PTSD

Introduction: Posttraumatic stress disorder (PTSD) has been linked to abnormalities within three neural networks: default mode (DMN), salience (SN), and central executive (CEN).  This study examined the effectiveness of LORETA z-score neurofeedback (LZNF) training for altering current source within these networks and reducing symptoms associated with PTSD.  Methods: Twenty-three adults with chronic PTSD were randomly assigned to 15 sessions of either LZNF (n = 12) or heart rate variability biofeedback (HRVB; n = 11).  Psychosocial and physiological assessments were completed at baseline and postintervention.  Results: The LZNF group showed very large, statistically significant decreases in symptoms on the PTSD Checklist for DSM-V (PCL-5; p = .003, d = 2.09) and Beck Anxiety Inventory (BAI; p = .003, d = 2.13).  The HRVB group also showed very large decreases on the PCL-5 (p = .006, d = 1.40) and medium effects on the BAI (p = .018, d = 0.76).  Between-group comparisons showed medium to large effects of group type in favor of LZNF (PCL-5 d = 0.57; BAI d = 0.94), although not statistically significant.  LZNF Responders (n = 9) demonstrated very large, statistically significant decreases in abnormal z-scores within all targeted networks (DMN p = .012, d = 0.96; SN p = .008, d = 1.32; CEN p = .008, d = 1.33).  Conclusion: The positive outcomes of this study provide preliminary evidence to support LZNF training as a specific, effective, and tolerable intervention for adults with chronic PTSD.