NEUROFEEDBACK FOR AFFECT DYSREGULATION AND IMPAIRMENT IN EXECUTIVE FUNCTIONING Hilary Hodgdon, Ph.D. & Ainat Rogel, Ph.D.

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1 NEUROFEEDBACK FOR AFFECT DYSREGULATION AND IMPAIRMENT IN EXECUTIVE FUNCTIONING Hilary Hodgdon, Ph.D. & Ainat Rogel, Ph.D.

2 OUR WORKSHOP What it is: - Discuss affect regulation and executive function - Discuss the basics of biofeedback and neurofeedback - Present research findings from two studies (child and adult) - If we have time live demonstration What it is not: - An in depth tutorial on neurofeedback and how to use it with clients

3 HOW FAMILIAR ARE YOU WITH NEUROFEEDBACK? Using your smartphone (or dumbphone): Text: HILARYHODGDO140 to once to join the poll Text your response: 1. What s neurofeedback? 2. I have some basic working knowledge 3. I use NFB regularly in my clinical practice 4. I am a neurofeedback wunderkind

4 TRAUMA SHAPES DEVELOPMENT Child maltreatment is a severe stressor that.produces a cascade of physiological, nuerochemical and hormonal changes which can lead to enduring alterations in brain structure and brain function. (Hart & Rubia, 2012) traumatic and neglectful experiences during childhood cause abnormal organization and function of important neural systems in the brain, compromising the functional capacities mediated by these systems. (Perry, 2006)

5 Emotion Behavior Regulation Cognition Physiology

6 Still Face: Early Regulation

7 Context CT Multiple Chronic DEVELOPMENTAL UNFOLDING Self-Regulation Behavioral Control Biology Attachment Cognition Dissociation Self-Concept

8 LIMBIC SYSTEM Amygdala: Intense emotions (aggression, fear). Threat detection. Emotional perception and learning. Cingulate Cortex: Hippocampus: Learning consolidation of information from short to long term memory. Spatial navigation Regulation of attention and behavior. Motivation. Error detection. Emotional processing.

9 NEOCORTEX Frontal Lobe: Executive functions. Language. Motor functions. Parietal Lobe: Integration of sensory information. Temporal Lobe: Auditory perception. Language comprehension. Memory storage. Language processing. Somatosensation. Occipital Lobe: Visual perception.

10 Executive Function Change is the essential process of all existence

11 EXECUTIVE FUNCTIONS Executive functions (EF) are critical in the regulation of attention, inhibition, and goal attainment. Indices of EF are disrupted among maltreated children: Attention Inhibition Cognitive Flexibility Disrupted EF associated with volumetric reductions in the prefrontal cortex, striatum and caudate nucleus. Ultimately, disruptions in EF undermine ability to adapt to changing environmental demands.

12 Regulation in Action The Marshmallow Test

13 Transdiagnostic Factor? 273 polyvictimized youth in residential care Caregiver trauma = physical, sexual & psychological maltreatment, DV, impaired caregiving, neglect, separation, loss Hodgdon et al (under review)

14 BUILDING REGULATION

15 BRAIN PLASTICITY

16 NEUROFEEDBACK

17 NFB TRAINING FOR ADULTS WITH CHRONIC PTSD

18 EF IN PTSD PTSD is characterized by: Attentional bias to threat Deficits in sustained attention Difficulty switching sets (i.e. cognitive flexibility) Trouble with inhibition

19 METHOD 24 sessions of twice weekly EEG biofeedback (Neurofeedback) vs. TAU waitlist control Inclusion criteria: Current PTSD diagnosis (CAPS) In weekly therapy Stable medication regimen Exclusion criteria: History of seizure. Prior NFB Benzodiazepine mediation TBI, substance abuse, psychosis, bipolar or unstable medical condition

20 METHOD Sample N=52 (28 NFB, 24 WL) Age: M=44.34, SD= % female, 80.9% Caucasian 4 evaluation time points - baseline, mid-treatment (after session 12), post-treatment and at one month follow up. NFB protocol EEG Spectrum T4-P4 placement Inhibition of Theta and High Beta Reward SMR Participants were assessed at the beginning of every session for any side effects or observed improvement.

21 MEASURES Traumatic Events Screening Inventory (TESI) Clinician Administered PTSD Scale (CAPS) Behavior Rating Inventory of Executive Function Self Report (BRIEF) WebNeuro computer administered neuropsychological test Impulsivity Attention Information processing Memory

22 LIFETIME TRAUMA EXPOSURE Minimum # of exposure types = 3; Maximum # of exposure types = 12 Mean # of exposure types = 6.74, SD = 3.35

23 BRIEF

24 BRIEF Factor Structure Monitor Meta- Cognition Organization of Materials Plan/Organize Working Memory Initiate

25 METACOGNITION

26 METACOGNITION SUBSCALES

27 BRIEF Factor Structure Emotional Control Behavioral Regulation Shift Inhibit

28 EMOTION REGULATION SUBSCALES

29 WEBNEURO

30 STEN scores range from 1 to 10 with a mean of 5.5. Lower scores indicate difficulties with functioning, higher scores indicate a strength. Brain Resource, LTD, 2010, v1.7

31 STEN Scores for the Study Sample Range: Information Processing Efficiency = 1-8.5, Impulsivity = 1-9.5

32 IMPULSIVITY

33 IMPULSIVITY

34 INFORMATION PROCESSING EFFICIENCY Stroop Color Word Interference Trail Making Task

35 INFORMATION PROCESSING EFFICIENCY

36 SOME THOUGHTS NFB training is associated to improved self-reported executive function as it is expressed in day-to-day life. Changes in performance based measures of impulsivity and information processing were observed only for participants who were in the impaired range at baseline. Measuring different EF constructs? Efficiency of cognitive processing in highly structured context vs. Success of goal pursuit in day-to-day life Deficits in EF may represent a transdiagnostic factor underlying many clinical presentations observed among trauma impacted individuals Future research examine changes in EF as a mediator of treatment effects.

37 ACKNOWLEDGEMENTS Trauma Center Research Team Bessel van der Kolk, Principal Investigator Joseph Spinazzola, Co-Investigator Regina Musicaro, Project Coordinator Ainat Rogel, Interventionist Ed Hamlin, Project Supervisor Mark Gapen, Project Supervisor Andrea Carsona, Evaluator and Interventionist Janice Subblefield-Tave, Interventionist Daphne Marlena, Evaluator and Interventionist Anna Kharaz, Evaluator Michael Suvak, Data analyst