Complex PTSD and Neurofeedback A Case Study. https://myneurva.com/

1. An Occupational
Hazard-Severe
Combat Related
PTSD
Dr. Fred Starr, MD, FAACAP

2. 38-Year-Old
Male Case
from 2008
Active Career Special Forces Operator
Referred to practice “in strict confidence” by an individual from
DoD.
Did not use Tri-care, paid out of pocket.
Used false Name, had office cleared of patients, drove around the
block and parked far away to ensure not being followed.
Married father with two small children.
Actively Deploying to Afghanistan, Iraq and other places.
Is aware he has active severe PTSD.
Severe sleep psychodrama wakes up choking partner, violence
towards self and others, severe suicidal ideation with intent and
plan, completely numb, plays Russian Roulette with Service
Revolver and other intense reckless behavior in extreme sports
(Free-Solo Climbing).
Prescribed multiple psych medication with inconsistent compliance.
Alcohol use, Marijuana use, Pain medication abuse.

3. Pre-NFB Complaints and Brainscan
The pattern seen in severe combat related PTSD looks
different than someone who gets PTSD as a child and
probably represents a different disorder. There is
specific dysregulation in the posterior sensors in very
fast beta.

4. Traumatic Brain Injury Detected

5. On Interview…
Subject has been in the military since the age of 18. He is on active duty and may be deployed at
any time of day or night. Describes himself as a “professional killer” and “an asset.” Is exhibiting
severe depersonalization, paranoia, and is hearing voices. Feels cut off from humanity and wants
to die, says he is staying alive for his children.
PCL-M: Score 81/85 (Severe PTSD)
GAD-7: Score 21/21 (Severe Anxiety)
PHQ-9: 25/27 (Severe Major Depressive Episode; with psychosis)
Bipolar Screening: Positive
Insomnia: 27/27 (Severe Insomnia)
TBI Screen: Positive 90%
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6. What is Combat PTSD?
Post Traumatic Stress Disorder occurs when an individual experiences an overwhelming event,
causing a cascade of stress hormones to damage the body and brain.
Combat Related PTSD is typically associated with adult onset.
Changes in the brain include loss of cortical tissue, thickening of fear networks, and reduction
of volume in memory networks.
PTSD is the most underdiagnosed disorder in psychiatry and may be prevalent in as many as 20
out of every 100 Veterans in the outpatient psychiatric population.
Symptoms overlap with every other psychiatric disorder.
PTSD is closely associated with Obesity, Hypertension, Heart Disease, and Diabetes.
Traumatic Brain Injury often co-occurs with PTSD.

7. What is TBI?
Traumatic Brain Injury (TBI) occurs when mechanical force to the skull causes the brain to shift and shear
inside it’s casing.
It is typical for closed head injuries to go unnoticed at first or undiagnosed.
Individuals usually fail to report an injury on initial questioning.
TBI can cause slowing of thoughts and reactions, poor memory, mood changes, and commonly interferes
with sleep.
TBI rarely clears up on its own and is very often mistaken for another disorder as the injury usually happened
in the distant past from the presentation of symptoms.
May be associated with Chronic Traumatic Encephalopathy (CTE) and later in life may develop to Dementia
and/or Parkinson's Disease.
Medications may alleviate some symptoms, but there is no magic bullet.

8. Measured Improvement After 40
Sessions of NFB
Before After

9. TBI Before and After 40 Sessions NF
Training

10. Client’s Reported Improvement
40 Sessions-20 Sessions Default Mode/ 20
Sessions Alcohol Reduction Protocol
Before:
PCL-M: Score 81/85 (Severe PTSD)
GAD-7: Score 21/21 (Severe Anxiety)
PHQ-9: 25/27 (Severe Major Depressive
Episode; with psychosis)
Bipolar Screening: Positive
Insomnia: 27/27 (Severe Insomnia)
TBI Screen: Positive 90%/ Moderate
After:
PCL-M: Score 35/85 (Negative PTSD)
GAD-7: Score 10/21 (Mild Anxiety)
PHQ-9: 3/27 (No Depression Noted)
Bipolar Screening: Negative
Insomnia: 27/27 (Subthreshold Insomnia)
TBI Screen: Positive 80%, Mild Range of
Severity

11. Over 6 weeks, subject completed 40 Sessions (2 Doses) of Z-Score
Neurofeedback directed at the specific sensor sites, and Penniston-
Kultoksky Alpha-Theta Brainwave Training Protocol
6 sessions hand temperature bio-feedback
20 Sessions Alpha Theta Neuro meditation with eyes
closed, hand temperature biofeedback and soothing tones
Drinking declined and ceased. Sleep and Anxiety improved.
Still having cognitive issues with memory and attention
Completed additional 20 sessions of Z-Score NF.
The patient was satisfied with the treatment. Suicidality
decreased, mood improved, and anxiety was greatly
reduced. Alcohol use stopped completely
He was redeployed…

12. Present Day
Alcohol use stopped. Improved Mood and
Anxiety
Improved Sleep