ORIGINAL RESEARCH article
Front. Psychiatry
Sec. Anxiety and Stress Disorders
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1567809
Enhanced Cognitive Control Following Neurofeedback Therapy in Chronic Treatment-Resistant PTSD Among Refugees: A Feasibility Study
Provisionally accepted
Mirjana Askovic1*
Sejla Murdoch1
Rene Mayer-Pelinski2Anna Jane Watters1James Elhindi3Jorge Aroche1
Yury (Juri) Kropotov4
Anthony W.F. Harris5- 1New South Wales Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Sydney, Australia
- 2Research & Development, BEE Medic GmbH, Ottendorf-Okrilla, Germany
- 3Western Sydney Local Health District, Sydney, New South Wales, Australia
- 4N.P.Bechtereva Institute of the Human Brain (RAS), Saint Petersburg, Russia
- 5The University of Sydney, Darlington, Australia
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Background: Post-traumatic stress disorder (PTSD) is a debilitating condition affecting 3.9% of the global population, with refugee populations experiencing particularly high prevalence rates (23-42%). Cognitive control deficits are a core feature of PTSD and a significant factor in treatment resistance, which affects 25-60% of cases. Methods: This study examined the effects of neurofeedback therapy (NFT) on PTSD symptoms and cognitive control in forty-seven refugees with chronic treatment-resistant PTSD. Pre-and post-treatment assessments included the Harvard Trauma Questionnaire (HTQ), event-related potential (ERP) and behavioural parameters recorded during a cued Go/No-Go task. Over a median of twenty-six sessions across 7 months, clients received individualised NFT integrated with trauma counselling. Post-treatment, clients were categorised into Responders and Non-Responders, with responders defined as those achieving a clinically significant reduction in PTSD symptoms (≥0.5-point decrease on the HTQ). Results: Responders (n=22) demonstrated normalised P3d amplitude, indicative of improved cognitive control. In contrast, non-responders (n=25) exhibited minimal changes in ERP measures. Non-responders showed greater abnormalities in the Slow Positive Wave (SPW) at baseline suggesting more compromised late-stage cognitive processing. Discussion: These findings suggest that NFT can alleviate PTSD symptoms in refugees with chronic treatment-resistant PTSD. Treatment response was associated with a normalisation of the P3d waveform suggestive of enhanced cognitive control. The baseline SPW predicted treatment response. Further research should incorporate randomised controlled trials and larger, multi-centre samples to enhance robustness and generalisability.
Keywords: Neurofeedback, Refugee trauma, Chronic Posttraumatic stress disorder, eventrelated potentials, cognitive control, neuromarkers
Received: 28 Jan 2025; Accepted: 15 Jul 2025.
Copyright: © 2025 Askovic, Murdoch, Mayer-Pelinski, Watters, Elhindi, Aroche, Kropotov and Harris. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mirjana Askovic, New South Wales Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Sydney, Australia
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