Exploring expectations of neurofeedback treatment among trauma-affected refugees

Abstract

Background

The use of Neurofeedback (NF) to assist individuals in learning to regulate their brain wave activity has shown promising results in reducing symptoms of posttraumatic stress disorder (PSTD). However, few studies have focused on the patients’ understandings of NF and even fewer explore the perspective of refugees.

Purpose

To evaluate NF treatment for trauma-affected refugees by focusing on their expectations and understanding of NF.

Methods

This qualitative study was a part of a mixed method study carried out at an outpatient mental health centre in Denmark, offering 34 trauma-affected refugees 12 sessions of NF. In this qualitative study, a subsample of seven participants was interviewed. Using in-depth semi-structured interviews, the participants’ thoughts and expectations prior to participating in NF treatment were examined. The analysis was carried out in four steps, using a hermeneutic and phenomenological approach.

Results

The analysis resulted in two themes: (1) Rationale and working mechanisms of NF and (2) Motivators for participating in the study.

Conclusion

The findings show that NF treatment for trauma affected refugees was challenged by difficulties in communicating the message about the NF equipment capabilities as well as the expected treatment outcome. These challenges included e.g. health professionals’ ability to explain and the participants’ cultural frame of reference. This is consistent with previous research, showing that compared to the native population, the dissemination of health information to refugees is more difficult and comprehensive. Further studies on how to ensure mutual understanding of the content of NF and expected treatment outcome are needed.

Trial registration

ClinicalTrials.gov ID: NCT05055037. Retrospectively registered on the 06/07-2021.

Keywords:

• Refugees
• trauma
• neurofeedback
• pTSD
• qualitative research

Acknowledgements

The authors would like to thank the participants in the interview study and the involved personnel at CTP for their contribution to this paper.

Authors’ contributions

SZ and HLA designed the qualitative study and analysed the data. Supervised by HLA, SZ wrote the interview guide and SZ conducted the interviews. SZ, HLA, EV and JC were all involved in the interpretation and discussion of data. SZ wrote the manuscript with editing and revisions suggested by HLA, EV and JC. Both SZ and EV functioned as NF therapists. All authors have read and approved the final manuscript.

Ethical approval

The NF study was approved by The Danish National Committee of Health Research Ethics (H-18040354), thus all methods were carried out in accordance with these guidelines and regulations. All participants’ interests were considered and protected through the research process. As only participants from the mixed method NF study were eligible interview candidates, a separate consent form was already obtained on the basis of thorough oral and written information. Seven of the 34 included participants from the mixed method study were chosen to receive a brief verbal introduction to the nature and purpose of the qualitative study. If the participant could not speak Danish, the information was translated and given by an interpreter. All participants were subsequently thoroughly informed about ensured confidentiality and anonymity and the voluntary nature before they gave their oral and written informed consent for participation in the qualitative study. Furthermore, the participants were informed that they had the right to withdraw from the study at any time without any consequences for their treatment at CTP.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets analysed during the current study are not publicly available due to them containing information that could compromise the privacy of research participants, but are available from the corresponding author on reasonable request.

Additional information

Funding

This study was funded by Lundbeck Foundation [grant number: F-61171-19-27] and Jascha Fonden [grant number: 6969]. The funding bodies did not have any role in the design of the study, data collection, analysis, or interpretation of data, nor writing of the manuscript.