Effectiveness of Neurofeedback Enhanced Trauma Treatment for Adolescents in Residential Treatment

Overview: This study examines the effectiveness of neurofeedback in treating trauma symptomatology among adolescents in residential treatment with histories of trauma and juvenile justice involvement. Research implications include expanding brain-based services among child welfare and juvenile justice agencies, and future longitudinal research tracking the manifestation of behaviors associated with trauma histories.Proposal text:

Background: A complex relationship exists between trauma, toxic stress, and brain architecture, with significant adversity causing developmental disruptions that lead to lifelong impairments in physical and mental health, educational achievement, economic productivity, and longevity. Youth in residential treatment and justice-involved youth disproportionately experience complex trauma, with rates up to 90%. The neuroscientific changes that occur in the brain as a result of trauma are significantly correlated with high-risk behaviors and are likely to increase stress, anger, and impulsivity while inhibiting youth from engaging in effective coping and problem-solving. Treating the effects of trauma and preventing future justice involvement is important as juvenile crime comprises the largest proportion of all crime. Scientific advances in the effects of trauma, the plasticity of the adolescent brain, and the neuroscience of adolescent behavior have the potential to change rehabilitation approaches for justice-involved youth. Neurofeedback (NFB) is an intervention guided by quantitative encephalography (qEEGs) that identifies and changes abnormal patterns of brainwave activity that are contributing to poor physical and/or mental health.

Objectives: The objectives of this study were to: 1) examine if changes in brainwave activity (measured by qEEGs) as a result of NFB, will correspond to positive changes in problem behaviors (measured by the YSR), and 2) identify if NFB was more effective than treatment-as-usual in reducing problem behaviors.

Methods: This researcher partnered with a residential treatment facility to conduct a secondary data analysis on their quasi-experiment of LORETA Z-score NFB in reducing symptoms of internalizing and externalizing behaviors. The sample consisted of 42 diverse youth ages 11-18 who have trauma histories as indicated by the Trauma Symptom Checklist Screening Form (TSCC) and juvenile justice-involved histories. NFB was administered twice a week for 15 weeks (30 sessions total). Subjects completed a qEEG and Youth Self Report (Achenbach & Rescorla, 2001) at baseline, sessions 15 and 30, and one-month follow-up.

Results: Repeated measures analysis of variance (RMANOVA) were conducted on the 10 subscales of the YSR. Results showed there was a significant interaction effect for anxious/depressed (F(df=3, 105) = 7.22, p < .001, η2 = .171), withdrawn/depressed (F(df=3, 102) = 13.514, p < .001, η2 = .284), social (F(df=2.53, 88.55) = 4.19, p = 0.012, η2 = 0.107), thoughts (F(df=3, 105) = 6.689, p < 0.001, η2 = 0.160), rule breaking (F(df=2.15, 75.11) = 3.24, p = 0.042, η2 = 0.085), and externalizing behaviors (F(df=3, 105) = 6.65, p < 0.001, η2 = .160). There was a significant main time effect for attention (F(df=2.71, 94.95) = 2.84, p = 0.047, η2 = 0.075) and internalizing behaviors (F(df=3, 105) = 4.027, p < 0.001, η2 = 0.103). There were no significant main effects for somatic complaints or aggression.

Conclusion: Results indicate that NFB was more effective than treatment-as-usual in treating a wide range of internalizing and externalizing behaviors as measured by the YSR. Implications of this research include the expansion of brain-based services for traumatized youth across other residential treatment campuses, and nationally across child welfare and juvenile justice systems.