Amygdala-related electroencephalogram neurofeedback as add-on therapy for treatment-resistant childhood sexual abuse posttraumatic stress disorder: feasibility study

Naomi B. Fine*, Liat Helpman, Daphna Bardin Armon, Guy Gurevitch, Gal Sheppes, Zivya Seligman, Talma Hendler, Miki Bloch

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Aim: Childhood sexual abuse (CSA) among women is an alarmingly prevalent traumatic experience that often leads to debilitating and treatment-refractory posttraumatic stress disorder (PTSD), raising the need for novel adjunctive therapies. Neuroimaging investigations systematically report that amygdala hyperactivity is the most consistent and reliable neural abnormality in PTSD and following childhood abuse, raising the potential of implementing volitional neural modulation using neurofeedback (NF) aimed at down-regulating amygdala activity. This study aimed to reliably probe limbic activity but overcome the limited applicability of functional magnetic resonance imaging (fMRI) NF by using a scalable electroencephalogram NF probe of amygdala-related activity, termed amygdala electrical-finger-print (amyg-EFP) in a randomized controlled trial. Method: Fifty-five women with CSA-PTSD who were in ongoing intensive trauma-focused psychotherapy for a minimum of 1 year but still met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) PTSD criteria were randomized to either 10 add-on sessions of amyg-EFP-NF training (test group) or continuing psychotherapy (control group). Participants were blindly assessed for PTSD symptoms before and after the NF training period, followed by self-reported clinical follow-up at 1, 3, and 6 months, as well as one session of amygdala real-time fMRI-NF before and after NF training period. Results: Participants in the test group compared with the control group demonstrated a marginally significant immediate reduction in PTSD symptoms, which progressively improved during the follow-up period. In addition, successful neuromodulation during NF training was demonstrated. Conclusion: This feasibility study for patients with treatment-resistant CSA-PTSD indicates that amyg-EFP-NF is a viable and efficient intervention.

Original languageEnglish
Pages (from-to)19-28
Number of pages10
JournalPsychiatry and Clinical Neurosciences
Issue number1
StatePublished - Jan 2024


FundersFunder number
European Union's Horizon 2020 Framework Programme for Research and Innovation945539
National Institute of Psychobiology for Israel Young Investigator
The Innovation Authority – Kamin Program
Brain and Behavior Research Foundation
National Alliance for Research on Schizophrenia and Depression26302
Israel Science Foundation2923/20, 2107/17
Tel Aviv Sourasky Medical Center


    • PTSD
    • childhood abuse
    • fMRI
    • limbic activity
    • neuromodulation


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