Old Dominion University ODU Digital Commons Counseling & Human Services Theses & Dissertations Counseling & Human Services Summer 2011 Treating Trauma Survivors with Neurofeedback: A Grounded Theory Study Based on the Practices of Experienced Mental Health Professionals Christine L. Currie Old Dominion University Follow this and additional works at: https://digitalcommons.odu.edu/chs_etds Part of the Counseling Psychology Commons, Mental and Social Health Commons, and the Neurosciences Commons Recommended Citation Currie, Christine L.. "Treating Trauma Survivors with Neurofeedback: A Grounded Theory Study Based on the Practices of Experienced Mental Health Professionals" (2011). Doctor of Philosophy (PhD), Dissertation, Counseling & Human Services, Old Dominion University, DOI: 10.25777/pzb3-he46 https://digitalcommons.odu.edu/chs_etds/47 This Dissertation is brought to you for free and open access by the Counseling & Human Services at ODU Digital Commons. It has been accepted for inclusion in Counseling & Human Services Theses & Dissertations by an authorized administrator of ODU Digital Commons. For more information, please contact [email protected]. TREATING TRAUMA SURVIVORS WITH NEUROFEEDBACK: A GROUNDED THEORY STUDY BASED ON THE PRACTICES OF EXPERIENCED MENTAL HEALTH PROFESSIONALS by Christine L. Currie B.A. May 1973, Connecticut College M.A. August 2005, Regent University A Dissertation Submitted to the Faculty of Old Dominion University in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF PHILOSOPHY COUNSELOR EDUCATION AND SUPERVISION OLD DOMINION UNIVERSITY August 2011 Approyj Laurie Craigen (Methoddta^ist) Timothy Grothaus (Member) II ABSTRACT TREATING TRAUMA SURVIVORS WITH NEUROFEEDBACK: A GROUNDED THEORY STUDY BASED ON THE PRACTICES OF EXPERIENCED MENTAL HEALTH PROFESSIONALS Christine L. Currie Old Dominion University, 2011 Dissertation Chair: Dr. Theodore P. Remley, Jr. Neuroscience, the mental health field, and the concept of trauma as an underlying factor in mental and physical disorders have been inextricably linked since the inception of the mental health professions. Numerous quantitative studies have indicated that neurofeedback may be effective in ameliorating trauma symptoms; however, there is a paucity of research exploring the factors that produce those positive outcomes. The purpose of this qualitative grounded theory study was to explore the factors and processes that influence treatment outcomes when neurofeedback is used with trauma survivors. Thirty interviews were completed with ten experienced mental health and neurofeedback professionals identified through a nomination process with a snowball sampling method. For this study a wide definition of trauma was used that included traumatic brain injury, the DSM-IV-TR (2000) criteria for posttraumatic stress disorder, and the seven symptoms associated with complex trauma (Courtois, 2008; Courtois & Ford, 2009; Herman, 1992, 1997). Research results indicate that the neurofeedback practitioner is central to the treatment process, that practitioner therapeutic skills are crucial to positive neurofeedback outcomes, and that counseling and neurofeedback may effectively complement each other in trauma treatment. iv DEDICATION This dissertation is dedicated to my husband Mark, who endured long separations on different continents to that I could pursue my dream, and to my four grown children Madeleine, Grace, David, and Daniel. Thank you all for encouraging, challenging, and loving me through many circumstances and changes. V ACKNOWLEDGEMENTS I was never alone throughout the dissertation process, and I am grateful to the many people who have helped and encouraged me along the way. To my family, who gave me constant encouragement to finish the program. To my excellent dissertation committee. My thanks to Dr. Theodore Remley, my dissertation chair, for helping me to choose both a methodology and a topic so well suited to my professional interests, for giving me honest feedback, and for keeping me on track throughout the process. I am grateful to Dr. Laurie Craigen, my methodologist, for always being available and for encouraging me to struggle with the material and to trust the process. Thank you also to Dr. Timothy Grothaus, who took the time to be thorough in order to provide valuable suggestions. To the neurofeedback practitioners who agreed to participate in this study and to those who nominated them. I developed a profound respect for you as pioneers in a new field, risk- takers open to new paradigms, generous with your time, experience, and knowledge. You have inspired me to be a better educator and a better clinician. I feel that I have walked among giants. I would like to express gratitude to Monica Dahl, Mary Lee Esty, Elsie Ferguson, Sebern Fisher, Lanier Fly, Hanno Kirk, Joan Ordmandy, Siegfried Othmer, Sue Othmer, Michael Sitar, Deborah Stokes, and Rebecca Thomas for their contributions to this study. To my I excellent research team: Penny Makris, Rebecca McBride, Elizabeth Prosek, Mary Sanderfer, and Cheryl Shiflett. You supported me, challenged me, and allowed me to process, all at the right times. I owe special thanks to my research partner, Cheryl Shiflett, who spent extra hours with me analyzing transcripts and allowing me to personally process the information that I received in the interviews when I needed to do that. To all my friends and relatives who told me that they were proud of me. vi To all the excellent professors at Old Dominion University. Each of you added to my professional knowledge and gave me specific encouragement all along the way. You created a supportive professional atmosphere that made completion of this doctoral degree possible. And to Dawn Hall, who provided me with much practical help and encouragement. I am grateful to all of you. vii TABLE OF CONTENTS ABSTRACT ii DEDICATION iv ACKNOWLEDGEMENTS v TABLE OF CONTENTS vii LIST OF TABLES xi LIST OF FIGURES xiii CHAPTER ONE: INTRODUCTION 1 Overview: Researcher Connection to the Topic 1 Summary of Relevant Literature 2 Conceptual Framework 6 Rationale for the Study 8 Research Questions 9 Definitions of Terms 9 Overview of Methodology 14 Summary 15 CHAPTER TWO: LITERATURE REVIEW 16 Introduction 16 Trauma 17 Neuroscience 25 Neurofeedback 32 Trauma, Neuroscience, and the Counseling Profession 42 Summary 43 viii CHAPTER THREE: METHODOLOGY 44 Introduction 44 Rationale for Using Qualitative Methodology 46 Researchable Problem 51 Research Protocol 53 Research Plan 62 Data Collection Procedures 66 Data Analysis 73 Verification Procedures 76 Summary 80 CHAPTER FOUR: FINDINGS AND INTERPRETATIONS 81 Introduction 81 Overview of Data Collection 81 Participant Profiles 83 Group Profile 83 Individual Profiles 87 Participant #1: "Sarah" 88 Participant #2: "Charles" 101 Participant #3: "Gaylen" Ill Participant #4: "Julia" 127 Participant #5: "Marian" 138 Participant #6: "Helen" 152 Participant #7: "David" 161 ix Participant #8: "John" 170 Participant #9: "Shirley" 180 Participant #10: "Barbara" 188 Participant Themes 199 Summary 225 Grounded Theory 225 Research Subquestions 231 Final Concept Map 238 CHAPTER FIVE: DISCUSSION 239 Findings 240 Comparison to Existing Literature 244 Limitations 252 Implications 254 Suggestions for Future Research 256 Personal Reflection 257 Summary 258 CHAPTER SIX: MANUSCRIPT SUBMISSION 259 Abstract 260 Background 261 Method 262 Results 264 Discussion 277 References 282 X REFERENCES 286 Appendix A 300 Institutional Review Board Exemption 300 Appendix B 301 Letter to Neurofeedback Providers for Nomination Process 301 Appendix C 303 Letter to Neurofeedback Providers: Request to Participate in Study 303 Appendix D 304 Informed Consent 304 Appendix E 307 Consent to Record Form 307 Appendix F 308 Demographics Inventory 308 Appendix G 311 Interview Protocol 311 Vitae XI LIST OF TABLES Table 4.1 84 Demographic Overview of Participants 84 Table 4.2 86 Demographic Overview of Participants: Professional Information 86 Table 4.3 100 Analysis of Participant #1: "Sarah" 100 Table 4.4 110 Analysis of Participant #2: "Charles" 110 Table 4.5 126 Analysis of Participant #3: "Gaylen" 126 Table 4.6 137 Analysis of Participant #4: "Julia" 137 Table 4.7 151 Analysis of Participant #5: "Marian" 151 Table 4.8 160 Analysis of Participant #6: "Helen" 160 Table 4.9 169 Analysis of Participant #7: "David" 169 Table 4.10 179 Analysis of Participant #8: "John" 179 Table 4.11 187 Analysis of Participant #9: "Shirley" 187 xii Table 4.12 198 Analysis of Participant #10: "Barbara" 198 xiii LIST OF FIGURES Figure 4.13 238 Final Concept Map 238 1 CHAPTER ONE INTRODUCTION Overview: Researcher Connection to the Topic I have lived in Moscow, Russia for most of the past 18 years, during an unusual time of political upheaval and social change that has been sometimes dangerous and always unpredictable. I have experienced the murder of a friend; an attempted government coup and the ensuing martial law; numerous terrorist bombings in metro stations and shopping malls where my family and I routinely travel; and terrorist bombs planted in the basements of apparently random apartment buildings, precipitating the organization of neighborhood watches in some areas. In two separate events, terrorists held and subsequently murdered hostages in a popular city theatre as well as in a school located to the south of where my family and I lived. As a staff member at an international school, I participated in meetings where we planned safe routes and safe houses for children in the event of