Amygdala EFP Neurofeedback Effects on PTSD Symptom Clusters and Emotional Regulation Processes

Background: Post-traumatic stress disorder (PTSD) manifests through distinct symptom clusters that can respond differently to treatments. Neurofeedback guided by the Amygdala-derived-EEG-fMRI-Pattern (Amyg-EFP-NF) has been utilized to train PTSD patients to regulate amygdala-related activity and decrease symptoms. Methods: We conducted a combined analysis of 128 PTSD patients from three clinical trials of Amyg-EFP-NF to evaluate effects across symptom clusters (as assessed by CAPS-5 subscales) and on emotion regulation processing (evaluated by the ERQ). Results: Amyg-EFP-NF significantly reduced severity across all PTSD symptom clusters immediately post-treatment, with improvements maintained at three-month follow-up. The arousal and reactivity cluster showed continued significant improvement during follow-up. Combined effect sizes were large (η²_p = 0.23-0.35) across all symptom clusters. Regression analysis revealed that emotion regulation processes significantly explained 17% of the variance in symptom improvement during the follow-up period. Conclusions: Reduction of PTSD symptoms following Amyg-EFP-NF occurs across all symptom clusters, with emotional regulation processes potentially serving as an underlying mechanism of action. These results support Amyg-EFP-NF as a comprehensive treatment approach for PTSD that continues to show benefits after treatment completion.