INVESTIGATING THE NEURAL MECHANISMS AND THERAPEUTIC EFFECTS OF FMRI- AND EEG-BASED NEUROFEEDBACK IN POST-TRAUMATIC STRESS DISORDER

Abstract

Post-traumatic stress disorder (PTSD) is a prevalent and debilitating condition that often develops following trauma. Concerningly, many individuals struggle to tolerate or fully respond to existing first-line treatments. Although PTSD is associated with widespread disruptions in brain function—including hyperactivity and altered connectivity in regions such as the amygdala and posterior cingulate cortex (PCC) during both rest and trauma-related processing—this rapidly expanding neurobiological understanding has yet to be fully translated into clinical care. This dissertation investigates neurofeedback, a non-invasive method that provides real-time information about neural activity to support targeted self-regulation, as a neurobiologically informed adjunctive intervention for PTSD. Across a series of studies, it examines the therapeutic effects and underlying neural mechanisms of both functional magnetic resonance imaging (fMRI)- and electroencephalography (EEG)-based neurofeedback, the two predominant neurofeedback modalities. The findings demonstrate that individuals can learn to modulate PTSD-associated neural alterations and achieve meaningful reductions in symptoms following neurofeedback training. In addition, this work delineates the neural mechanisms associated with several distinct neurofeedback protocols and evaluates key methodological factors that shape both neural and therapeutic outcomes. Together, these studies advance a mechanistic understanding of how neurofeedback exerts its therapeutic effects in PTSD and provide empirical support for its use as a promising adjunctive treatment.