The long-term costs of traumatic stress: intertwined physical and psychological consequences

The gradual emergence of symptoms following exposure to traumatic events has presented a major conceptual challenge to psychiatry. The mechanism that causes the progressive escalation of symptoms with the passage of time leading to delayed onset post-traumatic stress disorder (PTSD) involves the process of sensitization and kindling. The development of traumatic memories at the time of stress exposure represents a major vulnerability through repeated environmental triggering of the increasing dysregulation of an individual’s neurobiology. An increasing body of evidence demonstrates how the increased allostatic load associated with PTSD is associated with a significant body of physical morbidity in the form of chronic musculoskeletal pain, hypertension, hyperlipidaemia, obesity and cardiovascular disease. This increasing body of literature suggests that the effects of traumatic stress need to be considered as a major environmental challenge that places individual’s physical and psychological health equally at risk. This broader perspective has important implications for developing treatments that address the underlying dysregulation of cortical arousal and neurohormonal abnormalities following exposure to traumatic stress.

The application of neurofeedback to post traumatic stress disorder (PTSD) in returning veterans is described herein and is illustrated with two case histories. Initially, frequency-based electroencephalogram training was employed to promote functional recovery, in the manner of the traditional sensorimotor rhythm/beta approach. An optimization procedure was employed in which the reinforcement frequency is tailored to the client on the basis of symptom response, with particular regard for the regulation of arousal. Low frequencies, down to .01 Hz, have been found especially useful in the remediation of post traumatic stress disorder. This training was complemented with traditional alpha-theta work as pioneered at the Menninger Foundation and by Peniston. The objective here is experiential, because prior traumas typically are revisited in a nonforced, nontraumatic manner. The benign witnessing of traumas consolidates the experience of safety for which the prior training laid the groundwork. Collectively, this approach has been found to be much better tolerated than traditional exposure therapies. In addition, it is helpful in the shedding of substance dependencies that are common in treatment-resistant PTSD

Electroencephalographic (EEG) biofeedback has been in use since the early 1970’s for treatment of anxiety disorders and a variety of psychosomatic disorders. Early work conducted by researchers such as Kamiya and Kliterman focused on alpha wave biofeedback (Kamyi & Noles, 1970). Much of this initial research associated changes in EEG state with different states of consciousness (Basmajian, 1989). Researchers learned that certain tasks, such as mental arithmetic, reduce or suppress alpha wave production. Furthermore, researchers found that these changes in brain activity were positively correlated with changes in electromyographic (EMG) activity and skin temperature. This finding was significant in that it suggested that brainwave activity could be operantly conditioned in the same manner as EMG or temperature. Alpha waves are smooth, high amplitude waves in frequency range of 9-13 Hertz (Hz). Alpha wave biofeedback was explored by some researchers, as a treatment adjunct for alcohol abuse (Passini, Watson, and Dehnel, 1977). There were two theoretical rationales: first, investigators had reported that EEGs of alcoholics were “deficient in alpha rhythms and alcohol use induced more alpha wave activity (Pollock, Volavka, Goodwin, et al., 1983). Clinicians speculated that alcoholics might drink less if they could be taught to produce more alpha waves (Jones & Holmes, 1976). Secondly, many alcoholics and other drug abusers reported using alcohol or other drugs to relax. Thus, biofeedback training was proposed as a way teach alcoholics an alternative to using alcohol to relax. Alpha training did not, however, appear to be of benefit to most alcohol abusers because they were unable to learn to increase their production of alpha waves.