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by Bo Joyner
HQ Air Force Reserve Command Public Affairs
8/1/2008 - ROBINS AFB, Ga. -- (Editor's note: The
following story presents information on a new treatment for people
diagnosed with post-traumatic stress disorder. This is but one of
several options available for PTSD victims. Although an Air Force
Reservist, through his civilian work with the Federal Bureau of
Prisons and private practice as a clinical psychologist, has been
involved in utilizing this treatment, the Air Force Reserve does
not officially endorse it in any way. In addition, the Reservist
does not stand to benefit financially from this article. Reservists
who are diagnosed with PTSD should consult their doctors regarding
a course of treatment that is appropriate for them. By publishing
this article, the Citizen Airman staff seeks only to provide information
that educates and informs its readership about a serious medical
issue affecting a large segment of the military population.)
Having been exposed to horrible and often life-threatening experiences,
it's not surprising that many American service members returning
from duty in Iraq and Afghanistan are experiencing symptoms of post-traumatic
stress disorder.
The Department of Veterans Affairs' National Center
for PTSD estimates that up to 11 percent of veterans of the Afghanistan
war and up to 20 percent of veterans of the Iraq war suffer from
the disorder. With the total number of American service members
who have deployed in support of Operations Enduring Freedom and
Iraqi Freedom totaling more than 1 million, officials estimate more
than 100,000 Soldiers, Marines, Sailors and Airmen will require
long-term mental health care to deal with PTSD in the years to come.
While most of these service members will be treated
in traditional ways -- with medications and/or cognitive behavioral
therapy -- there are some new and innovative PTSD treatment options
available. Dr. David Tharp, a clinical psychologist, is one of a
growing number of mental health professionals who think neurofeedback
could provide significant relief to many men and women suffering
from PTSD.
"Neurofeedback is not an 'end-all, be-all' by
any means, and more research definitely needs to be conducted,"
said Dr. Tharp, who is a major in the Air Force Reserve. "But,
there are people around the country who are seeing amazing results
after just a few neurofeedback sessions."
As a Reservist, Dr. Tharp is a staff psychologist
assigned to the U.S. Air Force Academy in Colorado Springs, Colo.
In civilian life, he works as a home-based primary care psychologist
for the Veterans Administration in Alexandria, La.
Before assuming his position with the VA in January, he worked for
seven years as a psychologist at the Federal Prison Camp in Bryan,
Texas, where he successfully used neurofeedback to treat inmates
suffering from a variety of mental illnesses. In addition, he founded
the Texas Neurofeedback Center in College Station, Texas, where
he successfully treated patients with brain dysfunctions, including
attention deficit hyperactivity disorder, anxiety, sleep disorders
and PTSD. (Full disclosure: Dr. Tharp is no longer associated with
the Texas Neurofeedback Center or any other private practice.)
What is PTSD?
The Netwellness Web site defines PTSD as "a psychiatric disorder
that may occur following a traumatic event, such as a natural disaster,
terrorist incident, military combat, violent personal assault or
serious accident."
"People suffering from PTSD may experience nightmares
or flashbacks, have trouble sleeping, or feel detached from life
in general," according to the Web site. "Left untreated,
PTSD can lead to further problems, including depression, alcohol
or drug abuse, or marital and other personal relationship problems,
as well as possible job loss."
It's likely that people have been suffering from PTSD
for centuries. Historical medical literature mentions PTSD-like
symptoms dating back to the Civil War. Also, combat veterans from
World War II and Holocaust survivors were documented as having suffered
from PTSD-like symptoms.
The term post-traumatic stress disorder was coined
in 1980 as a result of research into the condition after the Vietnam
War. While it is generally thought of in connection with military
combat, PTSD is not limited to war veterans. It affects men and
women, adults and children, from all social and economic backgrounds.
Mental health professionals estimate about 8 percent
of Americans will experience PTSD at some point in their lives.
During any given year, it is estimated that about 5.2 million people
age 18-54 suffer from PTSD.
Women are twice as likely as men to develop PTSD,
and people who have spent time in a war zone are at a greater risk
of experiencing the disorder.
For years, one-on-one or group therapy was the primary
means of treating PTSD. More recently, mental health professionals
began prescribing medications to help people suffering from the
disorder. Now, researchers are looking at different treatments,
including neurofeedback.
What is neurofeedback?
"Neurofeedback is essentially the process of giving the brain
feedback or information about how to better respond to stimuli,"
Dr. Tharp said. "People under intense traumatic experiences
or under long-term stress will actually alter their brain waves.
These altered brain waves can be beneficial during combat or in
other stressful situations. However, they also produce elevated
baselines that appear to create the symptoms we are trying to alleviate:
depression, anxiety, startle reflex, etc."
Take a soldier going door to door in Baghdad, for
example.
"Naturally, this person is going to have an enhanced
startle reflex and hyperarousal," Dr. Tharp said. "If
you are on point and your life depends on you being able to detect
an insurgent before he detects you, hyperarousal can save your life."
Over time, brain wave patterns of a person in this
type of situation can change. But they may not change back to a
more normal state when the person returns home. Dr. Tharp believes
neurofeedback can help the electrical activity in the brain return
to normal.
"Neurofeedback gives feedback to the neuronal
network," Dr. Tharp said. "It tells the brain it is not
functioning correctly. Similar to how trial and error is involved
in learning to ride a bike, once the brain 'gets it,' the neuronal
network puts you on autopilot, and you just respond normally."
So, how does neurofeedback get the brain back to "autopilot"?
Using sensors on the scalp and advanced computer technology, the
patient's brain wave activity is compared to what is considered
normal brain wave activity. Instant feedback is provided when the
brain is not operating efficiently. While the patient watches a
TV screen, the sensors drive simple video imagery to engage and
focus the brain, gently nudging it to increase or decrease specific
bands of brain wave activity.
"We can do this with a movie or a video game,"
Dr. Tharp said. "As the patient plays the game or watches the
movie, we monitor his brain wave activity. When the brain activity
stays within the normal range, the person is rewarded (the game
continues to operate normally, for example). When the brain wave
activity falls outside normal ranges, the brain gets instant feedback
that it is not operating efficiently."
To provide this feedback, the video game or movie
may pause or slow down, or the sound may go off, for example.
Soon, the brain "learns" to operate within
the normal brain wave activity ranges, and the patient often shows
marked improvement.
In a case study, the Neurofeedback Center of Virginia,
located in Falls Church, detailed the case of a 30-year-old woman
diagnosed with PTSD who was unwilling to take medications and reported
that talk therapy had only been "somewhat helpful." Her
symptoms included hyper-vigilance, sleep disruption, nightmares,
extreme muscle tension, residual depression and growing agoraphobia
-- fear of leaving her home.
After several neurofeedback sessions, the patient
reported her sleep had improved, and her tension had "melted
away." Overall, she was "feeling calmer." The woman
was eventually able to return to the workplace and reported she
was "adjusting well" at work.
Neurofeedback traces its roots back to 1954, when
scientist W.R. Hess identified states of arousal in brain waves
and noted the waves' impact on humans. In the late 1960s, lab researcher
Barry Sterman measured brain waves in cats and found that he could
train the animals to relax by providing a reward when they produced
more brain wave activity in a certain range.
In continued experiments, it was revealed these same
cats were more resistant to seizures than cats that had not been
trained. Mr. Sterman's research was subsequently applied to humans,
leading to the discovery that the brain can "train" itself
to improve many conditions.
"When some people hear the word 'neurofeedback,'
they think of something like shock therapy, but, actually, it's
the opposite," Dr. Tharp said. "The sessions are painless.
The sensors we use simply monitor brain wave activity; they are
not used to send any kind of signal to the brain. We use outside
stimuli to let the brain know when it is not operating efficiently.
"Over time, we are able to get the person's brain
waves back into a more normal range, and we find their problematic
symptoms are either greatly reduced or eliminated altogether."
The doctor said he has seen neurofeedback provide
relief for a wide range of mental problems.
"One of the great things about neurofeedback
is that the research shows its effects are long lasting," Dr.
Tharp said. "Once we train the patient's brain, it tends to
remain trained.
"There may be a need for occasional booster sessions, but the
results may last longer than current medications, which help alleviate
some symptoms but need to be taken repeatedly because as the medications
wear off, the symptoms return."
The most common medications currently used to treat
PTSD are antidepressants known as selective serotonin reuptake inhibitors
that raise the level of serotonin in the brain and generally help
people feel less sad and worried. While these medications act on
the chemical activity in the brain, neurofeedback attempts to make
corrections to the electrical activity.
Cognitive behavioral therapy, another common current
treatment for PTSD, aims at helping a patient change the way he
thinks about trauma and its aftermath. A therapist helps the patient
identify thoughts about the world and himself that are making him
feel afraid or upset. The therapist tries to help the patient replace
these thoughts with more accurate and less distressing thoughts.
"The problem here is people often are reluctant
to talk about the situation that is causing their problems,"
Dr. Tharp said. "Also, CBT focuses on cognition or thinking
as it relates to behavior, but the trauma that results in PTSD is
seeded at a more emotional level. You can tell a person to think
about not reacting to a stimulus in a certain way, but when emotions
are involved, it's not always easy to do."
Another benefit of neurofeedback is there are no known
side effects, Dr. Tharp said. Also, neurofeedback may help mental
health professionals identify people who are not being truthful
about their PTSD symptoms.
"You can't fake a brain wave," Dr. Tharp
said.
But, more importantly, neurofeedback may provide critical
help for people who have put their lives on the line for their country.
"PTSD can be a debilitating condition, but help
is available, and there are some exciting new treatment options
out there," Dr. Tharp said. "For many, neurofeedback may
hold the key to returning to a happy and more fulfilling life."
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