EEG-based neurofeedback in post-traumatic stress disorder assessed in Sweden

In Sweden, the County Councils are grouped into six healthcare regions to facilitate cooperation and to maintain a high level of advanced medical care. One of them is Västra Götaland County Council with its Health Technology Assessment (HTA) Center, which aimed to work for continuous development of knowledge-based care in the region and ensure that healthcare is supported by science and evaluation. In addition, it should follow up on the development of evidence-based healthcare nationally, and internationally.

On the 16th of April of 2019, Västra Götaland HTA-Centre has published an HTA report for electroencephalography (EEG)-based neurofeedback as a treatment for post-traumatic stress disorder (PTSD). The objective of this HTA was to assess whether EEG-based neurofeedback is an effective treatment for patients with PTSD compared with sham neurofeedback, other therapy or no treatment. Measures of self-harm and suicidal thoughts, PTSD symptoms, level of functioning, and health-related quality of life were considered critical outcomes for decision-making. The degree of sick leave, medication use, complications and patients’ experience of the treatment were deemed to be essential outcomes.

The following conclusions were provided:

• No study evaluated EEG-based neurofeedback versus sham neurofeedback, and hence a placebo effect cannot be excluded. Based on three small RCTs, with several study limitations and imprecision, it is uncertain whether EEG-based neurofeedback compared with no treatment or standard treatment reduces PTSD symptoms post-treatment in adult patients with PTSD (very low certainty of evidence)
• It is also uncertain whether EEG-based neurofeedback treatment results in any difference in suicidal thoughts, level of functioning, or medication use compared with no or other treatment (very low certainty of evidence)
• Health-related quality of life, sick leave, and patients’ experience of treatment were not studied in the RCTs, and information on complications was sparse
• Equipment costs and training needs for implementation of EEG-based neurofeedback are modest

See the full report in Swedish and English here.

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