European Journal of Trauma & Dissociation 4 (2020) 100164

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Research Paper

What neuroscience and neurofeedback can teach psychotherapists in

the fieid of complex trauma: Interoception, neuroception and the
embodiment of unspeakable events in treatment of complex PTSD,
dissociative disorders and childhood traumatization
Anna Gerge
Alborg Universitet Humanistiske Fakultet, 9220 Aalborg, Denmark

A R T I C L E I N F O A B S T R A C T

Article history: Some reflections are given on neuroplasticity and traumatization. Today, we know that the verbal
Received 27 November 2019 narrative of a traumatic event rarely is sufficient to resolve more complex mental traumatization. The
Received in revised form 21 April 2020 ultimate goal of phase-oriented trauma therapy (Herman, 1992) is integration of the often-fragmented
Accepted 30 April 2020
sensory and emotional elements of nonverbal memory. Otherwise, the nonverbal experience fragments
may remain for many years after traumatic experiences, sometimes lifelong. Therefore, it is important
Keywords: that psychotherapy activates curiosity and joy and at the same time soothes and lowers feelings of fear,
Neuroplasticitet
shame, self-hatred and suspicion. We need to offer methods that lead to more stable windows of
Neurofeedback
Neuroception
tolerance (Siegel, 1999) and activate positive states and resources. Then patients can be active and
Reregulation investigative and thus can change their brains and their lives. How the posttraumatic conditions can be
Effectiveness in traumatherapies eased and ultimately healed is reflected on in relation to the neurofeedback (Niv, 2013; Kirk et al., 2016),
as an example of a method aiming at implicit regulation.
C 2020 Elsevier Masson SAS. All rights reserved.

1. What neurofeedback therapy can add to the treatment of
complex PTSD
Neurofeedback is a non-invasive treatment method based on
EEG-biofeedback aiming at reestablishing the regulative capacity
of the brain, and reduce symptoms related to over- or understi-
mulation. The clinical applications of neurofeedback originate
from the 1960s. Although there is still much that we do not know
about the mechanisms in Neurofeedback therapy (NFT), NFT
sometimes seems to help where other methods have failed in
achieving desired results.
This, as we do not yet know very much about how our brains
work though, we are beginning to see patterns regarding the
traumatized brain in psychotherapy.
1.1. Complex PTSD and the importance of installing a neuroception of
safety
When childhood relational experiences, through neglect or abuse,
have resulted in attachment deficits, the person feels increasingly
E-mail address: anna@insidan.se
threatened, even in neutral situations. In complex mental traumati-
zation DSO (Disturbances in Self Organization [DSO]; Karatzias et al.,
2016) is prevalent in addition to the symptoms of PTSD (relapses,
avoidances, permanently altered thought patterns and increased
tension). DSO involves difficulties in regulating emotions and
relationships, and a negative self-image. These problems arise
because of changes in brain activities of individuals with complex
traumatization (Teicher & Samson, 2016). With an increasing degree
of traumatization, the difficulties in regulating themselves further
increase and the personality can begin to divide due to dissociation.
Unintegrated aspects of the inner worlds of dissociative patients are
particularly important to calm and regulate. In addition, after
experiencing traumatic events, especially those caused by other
significant persons or when the patient was very young, the world is
also experienced through a different nervous system than before the
trauma occurred (Schore, 2009; Teicher & Samson, 2016; Van der
Kolk, 1994, 2016; Van der Kolk, McFarlane, & Weisaeth, 1996). A
person with such experiences may have a much harder time trying to
adapt to the evidence-based psychotherapy methods – if these are
not tailored to the patient’s available window of tolerance (Siegel,
1999) and regulatory capacity.
According to Bessel van der Kolk (2016) and Stephen Porges
(2000, 2011), many of the psychiatric patients’ brains are driven by

https://doi.org/10.1016/j.ejtd.2020.100164
2468-7499/ C 2020 Elsevier Masson SAS. All rights reserved.
2 A. Gerge / European Journal of Trauma & Dissociation 4 (2020) 100164
fear. Therefore, it is important to help them change on implicit
levels, that is, on preverbal levels. We do not know exactly how
this works. It may be that the therapy offers an opportunity for an
accelerated information processing, a better collaboration
between the hemispheres of the brain (Cozolino, 2002). It can
also be through an activation of the orientation response, so that
the patients do not enter into trauma-related inner contexts so
easily. Thus, collapse can be avoided. In addition, effective
psychotherapy for traumatized patients, needs to help them to
activate previously dysregulated and dysregulating sensory
information, not yet integrated. Then, unintegrated experiences
that belong to previously overwhelming experiences can be
processed and stored in new, more optimal, ways (Nader et al.,
2013; Lane et al., 2015; Nijenhuis, 2017). We need to find
methods that not only reduce specific PTSD symptoms but can
also contribute to a general improvement in self-regulation,
especially through the network systems. Even though there is not
yet sufficient evidence for NFT as a treatment for PTSD, it is
important to explore new opportunities as there are too few
effective and evidence-based PTSD treatments, especially for
persons with complex traumatization.
Many traumatized people’s brains are trapped in rigid response
patterns, especially if they have attachment deficits (Fisher, 2014;
Fonagy & Luyten, 2015). A hypothesis could be that NFT, and other
methods that aim at implicit regulation, adds to a heightened
neuroplasticity for such patients. We can then help their brains
become more flexible and efficient. Often a person experiences
more vivid dreams after a few sessions with NFT, and relaxation-
responses are common. We can at the moment only speculate
about what mediates these changes.
To suffer complex PTSD (Herman, 1992; Powers et al., 2017)
entails great difficulties with regulating tension, emotions and
having good boundaries with other people. In complex PTSD, there
is an extensive symptomatology in addition to the PTSD
symptoms. Even with simple PTSD, patients need help to calm
the amygdala, the fear center of the brain. Amygdala is generally
calmed by an active and conscious emotion regulation, controlled
by prefrontal parts of the brain. Thus, it is important to increase the
regulatory capacity of traumatized patients.
To suffer from a post-traumatic condition can be described as
living with a disrupted narrative about oneself. Ongoing mental
and physical processes then become scary triggers. In complex
mental traumatization a reduced ability to regulate, leads to the
person avoiding getting in touch with how and what they are
feeling. It also becomes difficult to calm oneself (Liotti, 2009;
Lyons-Ruth et al., 2016; Schore, 2003, 2009, 2012, 2014) and the
self-soothing capacity is eroded (Krystal, 1988). Therefore, it
becomes important to offer concrete methods to reach and calm
patients and their dysregulated midbrains.
According to the theory of structural dissociation (Van der
Hart, Nijenhuis, & Steele, 2006; Van der Hart & Moscowitz, 2018),
such information that the traumatized person avoids coming into
contact with, may be dissociated into emotional parts, EP’s. These
are perceived as strange and nasty to the apparently normal part
of the personality, the ANP. In this way, parts of the personality
can carry tension or emotional information that other parts avoid
contact with. Avoidance strategies may have been developed and
consolidated early on in childhood and can be automatic and
unconscious. A trauma-related dissociation can also be expressed
as somatoform dissociation (Nijenhuis, 1999/2004). In these
cases, it becomes important to install a neuroception of security
(Porges, 2011) that reaches the person as a whole – and which
reaches down into the midbrain and out into the body.
Furthermore, in complex traumatization, the entire body needs
to be calmed.
2. Some preliminary evidence for neurofeedback therapy in the
treatment of post-traumatic conditions
Van der Kolk has described positive effects of NFT in PTSD
patients (2014). He has, together with colleagues, also conducted
several studies showing that neurofeedback can be helpful for
patients with complex PTSD, where the method seems to calm the
amygdala and reduce people’s trauma-related problems and
symptoms. Gapen et al. (2016) conducted a study with patients
with chronic complex PTSD, whom were considered to be almost
therapy resistant, at least based on previously used methods. They
each had more than ten years of therapy prior to the study, had had
their symptoms longer than that, and had often been traumatized
during childhood. NFT gave good results on all PTSD symptoms,
despite using only the two most stabilizing NFT positions during
the training. Similar results have been seen in other studies
(Othmer & Othmer, 2009). This may suggest that it is primarily
self-regulation, increased neuroplasticity and the recapture of
function of the brain’s functional network that are important in the
healing of PTSD.
Another research group has used NFT to examine the brain’s
functional networks in people who have developed long-term
PTSD after being traumatized in childhood (Kleutsch et al., 2014).
They describe that fewer PTSD symptoms appear to be due to
increased activity in the default mode network, DMN in these
patients. They also describe an increased experience of calmness in
their research-subjects. One finding in the study is that there was
an improvement already after one session with NFT. Kleutsch and
colleagues (2014) wrote that the resilience of the brain, including
the ability to change, is strengthened by NFT.
2.1. Possible mechanisms of action
Something that is likely to be helpful when conducting NFT is
the ongoing attention training, which helps the patient to
experience enough control during the proceeding change
process. Several other therapy methods also contain this
important building block, for example the use of the orienting
response in EMDR (Shapiro, 2018; Shapiro & Silk Forrest, 1997)
and in art therapy (Gerge et al., 2019) and the use of dual
awareness in clinical hypnosis (Cardeña, 2000; Cardeña &
Spiegel, 1991; Cardeña, Alarcón, & Capafons et al., 1998;
Cardeña, Maldonado, Van der Hart et al., 2000), potentially
leading to an empowering of the patient. In this way, ‘‘old’’ brains
can learn new strategies. Otherwise, there is a risk of symptoms
returning when treatment is ended, as the brain has not learned
to function in a different way. Returning of symptoms can apply
to psychotherapy that does not target the dysregulation, and – to
an even greater extent – medication, which may only keep the
symptoms away as long as the medication is taken, but not
afterwards.
In NFT, patients can sometimes reduce their medication,
perhaps because their regulatory ability increases. Of course,
not all patients’ needs for medication are affected in the same
way. Occasionally, NFT contributes instead to the medications
finally having effect (see the example with Sofie in Chapter 12;
NFT, Gerge, 2018a). van der Kolk (2016) stated that neuro-
feedback can help traumatized children and adults, who are
severely disorganized after being subjected to abuse and/or
neglect, to normalize their brainwaves. After treatment, they
can deal with emotions, be attentive and focused on play,
learning, friendliness and meeting their goals. They also
describe how PTSD patients who had such difficulties that they
could not benefit from conventional psychotherapy benefited
from NFT.
 A. Gerge / European Journal of Trauma & Dissociation 4 (2020) 100164
3. Why it is difficult to help those who are dysregulated
After an overwhelming event that goes beyond what a person
can process and integrate, lasting traumatization may occur (Van
der Kolk, 1994). The condition that follows can include intrusive
memories, avoidance, concentration difficulties, memory impair-
ments, negative changes in thought patterns and increased
vigilance. The dysregulation that the traumatized human brain
suffers is very painful. Therefore, it can be said that it is not really
the once overwhelming event, but rather the ongoing dysregula-
tion, that is the problem for persons with PTSD. This leads to
changes in brain functions and structures. For example, we know
that prolonged experiences of intense fear affect the brain’s
function. In addition, important structures in the midbrain are
affected – amygdala overreacts and hippocampus shrinks. In
persons with childhood traumatization, these patterns become
even more prominent.
In a study of how attachment memories affect dissociative
patients, EEG connectivity was used as an outcome measure
(Farina et al., 2014). Connectivity is defined as the degree to which
different brain areas share mutual information. The researchers
found that the research-subjects with childhood traumatization
differed from their matched controls. Thirteen patients with
dissociative disorders and thirteen age- and gender-matched
healthy control subjects were told autobiographical memories in
relation to the Adult Attachment Interview (AAI). Their EEG pattern
was recorded with eyes closed before and after the AAI interview.
In the control group, the attachment memories contributed to an
increase in brain waves and connectivity, especially in the high-
frequency EEG bands. When comparing the dissociative patients
with their controls, there was a significant difference between how
their brains reacted. The traumatized and dissociative individuals
did not receive an increase in connectivity after AAI. This means
that thinking about oneself led to an information breakdown.
In a later study (Farina et al., 2018), compared subjects with
high mental ability and low degree of self-reported psychopatho-
logical symptoms with subjects with reduced mental ability and
more psychopathological symptoms. The researchers found a
decrease in EEG connectivity in the more symptom-burdened
group. Simply put, one can say that their brains could process
information about themselves to a lesser extent than the subjects
in the more affluent group. The difference between the groups was
greatest between their respective right and left medial frontal
lobes, the left medial frontal lobe and the right anterior cingulate
cortex, the latter being an important part of the default mode
network, DMN. These structures are also important for our
attention. In addition, the more points the people got on a
mentalization scale they filled in, the more connectivity they
showed in the Default Mode Network (DMN), i.e. right and left
medial frontal lobes and the girdle winding. By contrast,
interpersonal sensitivity, depression, and psychoticism were
negatively associated with DMN connectivity. To sum up, the
more symptoms the less shared mutual information in the DMN.
The researchers noted that the lack of emotional regulation in
subjects with mentalizing problems may be due to the fact that the
anterior cerebral cortex is unable to regulate deeper levels in the
brain. This leads to both internalization problems (difficulties to
think about oneself and endure internal states) as well as
behavioural problems.
3.1. Amygdala and PTSD
Persons with PTSD have increased activity in the amygdala. This
applies even more to those with complex PTSD. Increased
amygdala activity leads to an increased degree of avoidance. This
3
affects the brain’s activity during exposure treatment. This in turn
affects the efficiency of the treatment negatively. Even simple PTSD
involves difficulties in extinguishing threat memories. An increas-
ing degree of traumatization leads to the treatment effect of
various CBT methods, for example trauma-focused cognitive-
behavioral therapy and exposure therapy, becoming more fragile
and therefore less durable. This constitutes a paradox – the more
traumatized people are, the harder it will be for them with the
evidence-based methods.
3.2. Hippocampus and PTSD
The hippocampus is important for emotion, memory and
learning ability, and helps us sort information and send it to the
cortex for cortical consolidation. Under prolonged stress, the
hippocampus shrinks and loses memory-sorting function. This is
partly because the stress hormone cortisol damages the hippo-
campus. This contributes to difficulties in handling painful
memories, concentration difficulties and a reduced ability to
process experiences. Under severe mental stress, the person is
increasingly avoiding being in contact with his inner experiences.
A phobia for the inner world has been developed that makes it
difficult to process what you have been through and to make use of
the evidence-based psychotherapy methods. Persons living under
severe mental stress experience major problems with fatigue,
memory disturbances and a reduced perception of time and space.
This is due to changes in the hippocampus (Corrigan & Hull, 2015;
Meng et al., 2016), which are both structural and functional
(Roozendaal, McEwen, & Chattarji, 2009).
3.3. Amygdala, hippocampus and prefrontal cortex
Other parts of the brain also work less effectively in traumatized
persons. For example, emotion-regulation becomes difficult. The
prefrontal cortex, which is important for our regulatory capacity,
decreases in volume. In experiments, Milad and colleagues (2009)
have shown that already two days after a trauma, PTSD patients
have more amygdala activity and less activity in the prefrontal
regions and hippocampus than healthy controls. Thus, they will
have a harder time processing information, remembering and
thinking about the traumatic event, compared to non-traumatized
individuals. Milad and colleagues (2009) stated that PTSD patients
had functional changes in hippocampus, which led to a less
efficient capacity to store new experiences compared with healthy
subjects. Experiences that could extinguish threatening trauma
memories did not affect the intrusive memories as they should.
Thus, the traumatized patients had difficulties to understand when
they actually were safe. A conclusion that can be drawn from this,
is that it will be more difficult if we try to help complex PTSD
patients with exposure techniques.
This also explains something that both those with PTSD and
their therapists repeatedly have seen; patients with PTSD
experience reality as more frightening than others do. Their world
looks more frightening. Today, we know from research that they
also have more limited support from past experiences and that
their ability to calm down is impaired. The amygdala, which is very
close to the midbrain hippocampus, is constantly active, and stress
hormone-induced activation in the basolateral nucleus of the
amygdala regulates explicit and declarative memory storage in
other brain regions (Ferry, Roozendaal, & McGaugh, 1999).
Amygdala has unique features of structural and functional
plasticity that impacts memories of emotionally arousing and
fearful experiences, with the aim of consolidating cued fear
memory, that might lead to pathological consequences – chronic
and severe stress (Roozendaal et al., 2009). For the traumatized
4 A. Gerge / European Journal of Trauma & Dissociation 4 (2020) 100164
person, almost everything will be perceived as threatening – as the
amygdala continuously overreacts and disturbs the functions of
hippocampus and anterior cingulate cortex.
4. What is NFT doing?
NFT seems to strengthen the brain’s network and people’s
regulatory capacity. Therefore, NFT becomes interesting as a PTSD
treatment. Above all, NFT seems to contribute to relieving the
stress on the midbrain. Then the amygdala can resume its
important function and adequately register threats in the present,
and also assess when it is safe in the environment, including in
interpersonal interaction. For this to happen, the amygdala also
needs to be calmed down and regulated by the more cognitive
abilities of prefrontal regions. In one experiment, NFT was used to
study amygdala regulation (Nicholson et al., 2017). The partici-
pants were connected to NFT-equipment. They had their traumatic
memories activated based on individually developed trauma
triggers. Then they were asked to calm their trauma symptoms
while they could see their own brain activity. The researchers
could see that it was primarily the activity of the amygdala that
was affected by the treatment.
The connection between the amygdala and the prefrontal
cortex is strengthened by conscious emotion regulation, which in
turn facilitates emotion regulation. These relationships have been
described regarding the injuries and fragility that occur in the
brain’s ability to regulate in connection with traumatization
including attachment deficits (Farina et al., 2014; Schore, 2003,
2009; Siegel, 1999, 2015; Teicher & Samson, 2016). Among others,
Fisher (2017), Nijenhuis (2017) and Schore (2014) have described
aspects of therapy processes leading to overcome traumatization,
and development of an acquired secure attachment pattern.
4.1. To reverse traumatization
For a person who previously functioned, it is a loss of control to no
longer be able to regulate the emotional life. A negative spiral occurs.
More activated trauma memories trigger more perceived loss of
control, the person begins to avoid the inner experiences more and
more and also current experience. More and more experiences become
triggering – and so it goes on. Life becomes increasingly limited.
This dysregulation of the mid-brain and the experience of loss
of control add to the difficulties in interpersonal communication
for people with PTSD. Since they are constantly looking out for
threats, it becomes very tiring to be with other people. They live in
a state of hypervigilance. Even when alone, they suffer from the
increased vigilance and a fear of companions. This results in great
existential loneliness. PTSD changes the brain and complex PTSD
and pathological dissociation change the brain even more.
Therefore, it is important that we continue to look for methods
that can help our patients become more regulated at the midbrain
level – so that they after treatment can benefit from evidence-
based methods and other forms of potentially effective psycho-
therapies. Supposedly, only then can their threat memories
become extinguished in a lasting way.
Their integrated narrative can then help them understand that
their difficulties are over. Before being stabilized, neither a
relational therapeutic approach, interpretations, or exposure will
be particularly effective in work with patient with complex
traumatization. It is only after adequate stabilization that they can
make use of phase 2 work–trauma-processing (Herman, 1992).
Most methods can be used in both stabilization and trauma-
processing – if they are adapted to the patients’ windows of
tolerance (Siegel, 1999). Neurofeedback seems to be a valuable
method in the stabilization phase.
5. What determines when treatment works or does not work?
The assumptions about the mechanisms behind NFT in
treatment of PTSD are based on the following model: In severe
posttraumatic conditions the prefrontal cortex cannot calm and
regulate the patient’s emotions. This impacts the hippocampus’
memory-sorting function. Then it becomes difficult to attenuate
the increased reactivity of the amygdala, and the person may also
experience neutral or potentially pleasant experiences as threat-
ening. Cisler et al. (2014) showed that when the brain’s functional
network works less effectively, then the amygdala onset is
stronger. It thus becomes more difficult to achieve good treatment
results the more amygdala stands on red alert.
The brain’s functional networks are affected by psychological
traumatization. To be effective, treatment needs to lead to a more
optimal connection within and between the functional networks,
including these between the amygdala, hippocampus and the
prefrontal regions. With effective trauma processing, the amygdala
becomes more regulated (calmer) and prefrontal cortex can
function better and process information more adequately.
In other words, from what we are beginning to know about how
we humans think, feel and process information, it seems to be
more important than we previously thought, to strengthen the
collaboration between the brain’s functional networks and the
brains regulatory capacity. Probably this needs to be more in focus
when treating posttraumatic conditions. Taking this into account,
we can avoid that the most affected patients are met by a
treatment that is slow and ineffective precisely because of the
severity of their symptoms (Chou et al., 2018).
Schulze et al. (2018) have shown in a large meta-analysis on
negative affect processing in borderline personality disorder,
major depression, and PTSD that patients with BPD and PTSD had a
limbic hyperactivation compared to healthy controls. The study
also showed a reduction in the parts of the brain that control
regulatory processes. Clinically depressed patients showed de-
creased amygdala activation compared to controls. In addition,
there were overlapping abnormal patterns in the brains of the
individuals, regardless of which of the three diagnoses they
suffered from. Among other things, an overactivation of the right
medial cingulate gyri, i.e. the girdle winding was recognised. This is
a structure that is important for our ability to pay attention,
perceive pain and regulate emotional and memory-related
processes. It also affects executive functions.
5.1. The importance of adding the experience of regulation to
psychotherapy
Many different forms of psychotherapy contribute to experiences
that become healing. The therapeutic process in psychodynamic
psychotherapy can over time provide experiences that give rise to
new characteristics (Perry & Bond, 2012, 2017) and more mature
defences (Minges, Solomonov, & Barber, 2017). In particular,
experience-based therapies such as body-oriented therapy, EMDR
and art-based psychotherapies can contribute to changed and re-
established narratives through; (a) activating flow and positive
experiences (Csikszentmihalyi, 1989, 2014; Wilkinson & Chilton,
2013) and (b) calming experiences in altered states of consciousness
(Gerge, 2018b). This leads to (c) increased access to internal images
and (d) memory reconsolidation through activation of nonverbal
memory (Gerge, 2018c). This occurs in many different experiential or
experience-based therapies, and may also include neurofeedback. An
important mechanism of action in these therapies is likely to involve
the working memory. Trauma processing occurs when old memories
are reactivated and linked to a new emotional experience that
contains the experience of mastery. This creates space for old
memories to be stored again, with new meaning.
 A. Gerge / European Journal of Trauma & Dissociation 4 (2020) 100164
Within the EMDR theory, our memories are thought to be a
central executive system for coordination and integration stored in
different subsystems. During EMDR treatment (and perhaps also
NFT), memories in the visuospatial system are activated. This is
crucial as we orient ourselves in the outside world to help us
discern shapes and contours, distances, motions and objects’
relationships to each other. A double focus, so-called ‘‘Dual
awareness’’, affects memory storage by focusing on external
impressions that seem to reduce the stress that the person might
otherwise experience when in contact with trauma-related
memory material. It enables a cognitive restructuring and the
memory can be stored in a new way. Thus, EMDR is believed to
promote an adaptive information process by stimulating the
processing system and help in moving the maladaptively stored
information so that a memory consolidation can occur.
Farina and colleagues investigated the importance of eye
movements for desensitization and processing in EMDR, a method
that we know improves the integration of traumatic memories
(Farina et al., 2015). They measured, among other things, the
variability of EEG coherence and heart rhythm variability, HRV,
before and after EMDR sessions, while allowing patients to activate
their traumatic memory. Thirteen EMDR sessions with six patients
with post-traumatic stress disorder were investigated. The
researchers saw that HRV patterns were normalized, i.e. increased,
after EMDR. EEG coherence also increased. The results suggest that
EMDR leads to an integration of dissociated aspects of traumatic
memories and thus a reduction of symptoms of increased tension.
Neurofeedback training, like other experiential therapy
methods, seems to offer the patient plenty of experience of being
able to manage themselves. It is possible that the method does not
really affect information processing, but instead raises the basic
regulatory capacity. This in turn affects how new information can
be integrated.
A more optimal storage of information also contributes to an
increased experience of self-regulation. Patients’ experiences of
mastery and of being able to calm and regulate themselves seem to
increase the effect of imaginative exposure, restructuring and
meaning-making in the empirically supported psychotherapies for
trauma-related disorders, such as trauma-focused KBT and EMDR
(Schnyder et al., 2015). Possibly the experience of mastery is a
prerequisite for all effective psychotherapy. Interestingly enough,
NFT can be combined with evidence-based methods such as EMDR.
5.2. The necessity of being anchored here and now to approach events
there and then
Remembering is a creative process. Every time we remember
something, we actually remember it in a new way (LeDoux, 2002;
LeDoux & Brown, 2017). At the same time, the ongoing activation
of the orientation response can contribute to ‘‘dual awareness’’,
supposedly a necessity for effective working through of traumatic
experiences. This means that the person can focus on two
experiences at the same time, ie to be anchored here and now
and experience the current moment with its impressions and
sensations, and at the same time process what she/he previously
has been through and how that has affected the person. Probably
this also is an important part of what makes the NFT method
effective.
6. Neurofeedback therapy in stabilization and trauma-
processing
In the following, the value of neurofeedback in psychotherapy
will be elucidated, based on how the method can help to initially
calm and regulate traumatized patients in phase 1 work,
5
stabilization. Neurofeedback therapy can be used to further
facilitate processing, a processing that later on is initiated through,
for example, EMDR therapy. How neurofeedback can be used as a
support in phase 2 work, trauma-processing, is also addressed.
After phase 1 work, after softening the fear of the inner world,
other people and trauma triggers, and after the regulatory capacity
has been increased, phase 2 work can start with the patient better
anchored here and now – with him-/herself and the therapist –
AND with access to the experiences that were previously
experienced as overwhelming. This may include, for example,
that the person under ongoing NFT is encouraged to contact or
express previous experiences. This can also be conducted through
Ego State work (Gerge, 2013; Watkins, 1978; Watkins & Watkins,
1997; Watkins & Barabasz, 2008) or EMDR during an ongoing
neurofeedback-session.
Methods such as NFT also promotes interoception, that is, our
ability to register sensory impressions that come from the body’s
interior. Continuously being asked about how it feels in the body
during NFT, getting electrodes put on the head and removed at the
end of the session, also help to make the psychotherapist’s care
more ‘‘real’’. Patients’ experience of security and their capacity for
self-comfort and self-regulation (Gerge, 2018a; Krystal, 1988) can
thus be increased. Therefore, it is interesting that patients after NFT
describe that they are more present, maybe they are more
embodied. The experience of regaining access to greater regulatory
capacity provides greater access to resources and coping capabili-
ties. This activates the experience of mastery, provides new
associations and contributes to new emotional information being
linked to previous experiences.
7. Summary
For PTSD patients NFT can be helpful in restoring self-
regulation, as well as facilitating and enabling patients with a
more complex traumatization to ultimately benefit from psycho-
therapy. Then both people with recent traumatization and those
with decades of increased tension in the midbrain can have this
tension alleviated. In addition, effective psychotherapy for
complex traumatized patients needs to help enable them to once
more endure processing their dysregulation and what made them
dysregulated. Then what actually happened before and belongs to
previously overwhelming experiences can be stored in new, more
optimal, ways, and patients with brains focused on survival, that
constantly look for threats, can stop fighting the demons of
yesterday. Amazingly, people who have been traumatized, and
lived with the impact of longstanding traumatization, can regain a
more healthy and restful self-regulation with the help of NFT,
among other methods, due to our neuroplasticity that seems to be
heightened through NFT. It is built into our nervous systems that
our brains can change quickly – both by traumatic circumstances
and by restful and recovering experiences.
Disclosure of interest
The author declares that she has no competing interest.
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