Real-time fMRI Neurofeedback and PTSD: Efficacy in Symptom Relief and Neural Circuit Restoration

Background: Posttraumatic stress disorder (PTSD) is recognized by the DSM-V as resulting from exposure to a traumatic event and the subsequent, prolonged experience of intrusive symptoms, avoidance behavior, altered cognitive functioning and hyperarousal. Current treatments often do not provide relief from symptoms and there is a need for neuro-scientifically informed interventions. Methods: Through the review of all available studies using real-time fMRI neurofeedback (rt-fMRI-NF) as a treatment for PTSD, the efficacy of this therapeutic intervention was analyzed in order to make specific recommendations for the neurofeedback protocols of future studies. Results: Evidence demonstrated successful reduction in symptom severity and normalizing changes in aberrant neurocircuitry in several studies. The strongest results came from research investigating the use of positive emotion enhancement training (PEET) with amygdala upregulation, emotion induction and regulation training (EIRT) with posterior cingulate cortex (PCC) downregulation, and cognitive reappraisal training (CRT) with lateral prefrontal cortex (PFC) upregulation. Conclusions: The changes in neurocircuitry and symptomatology observed after rt-fMRI-NF suggests that this non-invasive therapeutic intervention could be an efficacious treatment for PTSD. Further studies with larger sample sizes and a double-blind experimental design are needed in order to narrow in on its potential for clinical use