Real-Time EEG-Derived Amygdala Neurofeedback for Post-Traumatic Stress Disorder: A Clinical Case Series

Background: Post-traumatic stress disorder (PTSD) affects millions globally, with 40-50% of patients not responding adequately to first-line treatments. Prism neurofeedback, an FDA-cleared electroencephalography (EEG)-based system targeting amygdala-derived biomarkers, has demonstrated efficacy in randomized controlled trials (RCTs) and multicenter studies. Real-world implementation data from community clinical practice remain limited. Objective: To evaluate clinical outcomes and patient-developed self-regulation strategies of Prism neurofeedback in patients with PTSD in community clinical practice. Methods: Retrospective case series of 28 consecutive patients with PTSD treated with Prism neurofeedback in a community psychiatry practice. The primary outcome was change in PTSD Checklist for DSM-5 (PCL-5) from baseline to end of treatment. Results: Twenty-one of 28 patients (75.0%) completed treatment. Mean PCL-5 reduction was 37.0 ± 18.2 points (Cohen's d = 2.03). Response rates were 100% for any improvement and 90.5% for clinically significant improvement (≥10-point reduction). Five patients (23.8%) achieved excellent response with ≥50-point reduction. Limited follow-up data (1-3 months post-treatment) were available for three patients; two of three (67%) exceeded their end-of-treatment gains. Four patients receiving booster sessions showed continued improvement. Limitations: The uncontrolled, retrospective design precludes causal attribution of improvements to the intervention versus placebo effects or regression to the mean. The 25% early discontinuation rate may introduce attrition bias. Durability data are available for only three patients. Conclusions: This case series provides real-world evidence supporting the feasibility and potential clinical utility of Prism neurofeedback in community practice, with outcomes comparable to controlled studies and preliminary evidence of durable treatment effects. These findings complement existing RCT evidence by demonstrating successful implementation outside research settings.