Integration of limbic self-neuromodulation with psychotherapy for complex post-traumatic stress disorder: treatment rationale and case study

Naomi B. Fine*, Ellie Neuman Fligelman, Nora Carlton, Miki Bloch, Talma Hendler, Liat Helpman*, Zivya Seligman, Daphna Bardin Armon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Treatment Rationale: Exposure to repeated sexual trauma, particularly during childhood, often leads to protracted mental health problems. Childhood adversity is specifically associated with complex posttraumatic stress disorder (PTSD) presentation, which is particularly tenacious and treatment refractory, and features severe emotion dysregulation. Augmentation approaches have been suggested to enhance treatment efficacy in PTSD thus integrating first-line psychotherapy with mechanistically informed self-neuromodulation procedures (i.e. neurofeedback) may pave the way to enhanced clinical outcomes. A central neural mechanism of PTSD and emotion dysregulation involves amygdala hyperactivity that can be volitionally regulated by neurofeedback. We outline a treatment rationale that includes a detailed justification for the potential of combining psychotherapy and NF and delineate mechanisms of change. We illustrate key processes of reciprocal interactions between neurofeedback engagement and therapeutic goals. Case Study: We describe a clinical case of a woman with complex PTSD due to early and repetitive childhood sexual abuse using adjunctive neurofeedback as an augmentation to an ongoing, stable, traditional treatment plan. The woman participated in (a) ten sessions of neurofeedback by the use of an fMRI-inspired EEG model of limbic related activity (Amygdala Electrical-Finger-Print; AmygEFP-NF), (b) traditional weekly individual psychotherapy, (c) skills group. Before and after NF training period patient was blindly assessed for PTSD symptoms, followed by a 1, 3- and 6-months self-report follow-up. We demonstrate mechanisms of change as well as the clinical effectiveness of adjunctive treatment as indicated by reduced PTSD symptoms and improved daily functioning within this single case. Conclusions: We outline an integrative neuropsychological framework for understanding the unique mechanisms of change conferring value to conjoining NF applications with trauma-focused psychotherapy in complex PTSD.

Original languageEnglish
Article number2256206
JournalEuropean Journal of Psychotraumatology
Issue number1
StatePublished - 2024


FundersFunder number
European Union’s Horizon 2020 Framework Programme for Research and Innovation945539
National Institute of Psychobiology for Israel Young Investigator
Brain and Behavior Research Foundation
National Alliance for Research on Schizophrenia and Depression26302
Israel Science Foundation2923/20, 2107/17


    • Childhood sexual abuse (CSA)
    • complex post-traumatic stress disorder (CPTSD)
    • emotion regulation (er)
    • neurofeedback
    • self-regulation


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