Behavioral Health Brief: Retraining the Brain
What Role Do Social Workers Play?
Social workers use a wide range of theories and therapeutic modalities to assess, intervene, and advocate for clients who have experienced traumatic events. However, current social work theories and evidence-based practices often exclude neuroscientific approaches when conceptualizing trauma treatment. This represents a gap in social work knowledge as research suggests that the relationship between trauma, toxic stress, and brain architecture is complex, with significant adversity causing developmental disruptions that lead to lifelong impairments in physical and mental health, educational achievement, economic productivity, and longevity.1-5
When trauma and toxic stress occur, the psychopathology and behavior that can manifest as a result is significant. Toxic stress can have serious impacts on brain architecture, causing loss of brain cells, damage to brain cell connections, enlargement or shrinking of certain parts of the brain, and hyperactivity of areas of the brain such as the amygdala, hippocampus, and prefrontal cortex.5 Trauma can also further inhibit or delay certain aspects of brain maturation and development, can disrupt attachment patterns,6 and diminish the ability to self-regulate. A dysregulated brain has a reduced ability to respond to specific demands, and the discontinuity of brainwaves can lead to faulty processing and communication between the brain and the nervous system.7
Trauma can also affect reward and motivation, distress tolerance, and executive systems, where both emotion and information processing occur.8 Many researchers have found that the changes that occur in both the central (brain) and peripheral (autonomic) nervous system are likely to increase stress reactivity, anger, and impulsivity while reducing the ability to inhibit these reactions and engage in effective problem solving.9 Thus, there’s a critical need for the development and testing of neuroscientific, trauma-informed interventions to reduce the effects of toxic stress before irreversible damage to brain architecture and functioning is done.10
Although the negative effects of trauma are numerous, one of the most promising aspects of the young developing brain is the flexibility of its circuitry to adapt and form new connections after experiencing adversity.11,12 Increasingly, neuroscience has demonstrated adolescent brain plasticity and adolescents’ capacity for change and rehabilitation. Giedd defines adolescent plasticity as the ability to change in response to the environment by modifying the communication networks that connect brain regions.10 This plasticity allows for significant increases in adolescents’ ability to socialize and think but also leaves them vulnerable to the adoption of risky behaviors and serious mental disorders. For adolescents who have experienced trauma, the promise of harnessing the potential of this plasticity is critical for neuroscientific, trauma-informed interventions to be implemented.
One such neuroscientific intervention is neurofeedback, a form of electroencephalogram (EEG) biofeedback that allows us to identify the electrical activity of the brain and change unwanted patterns that may be contributing to poor physical and/or mental health.7 Neurofeedback serves as a mirror for what is occurring in the brain so that it can learn to correct itself and resync neural networks. Often, computers and games are used through brain-computer interfaces that help reteach the brain to use the most efficient brainwaves during specific activities.13 Neurofeedback is strengths-based as it normalizes negative connections in the brain while increasing the benefits of the positives leading to optimal connectivity. Low-resolution electromagnetic tomography (LORETA) is a type of neurofeedback protocol that allows the clinician to target cortical and subcortical structures, providing a comprehensive view of brain functioning and specific anatomical locations to train. Anatomical locations are referred to as Brodmann areas and are correlated with the 10-20 system of EEG scalp electrode placements. Based on which functional hubs or Brodmann areas are dysregulated or exhibiting atypical activation, neurofeedback can be optimized to regain homeostasis and network connectivity within those areas.
Previous research has shown that neurofeedback has been found not only to improve neurological functioning but also to have global effects on cardiovascular, gastrointestinal, immune, and endocrine systems.8 In their comprehensive review of neurofeedback studies, Marzbani et al found that neurofeedback was effective in treating ADHD, schizophrenia, insomnia, learning disabilities, drug addiction, autism, epilepsy, depression, anxiety, and somatic pain.13 It’s also important to note that as of 2019, more than 3,000 clinicians have used z-score neurofeedback, which converts raw EEG data to z-scores to compare results with a normative database of brains depicting no psychopathology or neurological disorders. Z-scores are a helpful standardized measure to use when conducting statistical analyses and comparisons, as well as to individualize neurofeedback protocols to train z-scores above or below the standard deviation back to normal (z=0). None of these studies have published or reported any adverse statistics with this approach.14
My dissertation research examined the effectiveness of LORETA z-score neurofeedback in treating trauma symptomatology and internalizing and externalizing behaviors among justice involved youth in residential treatment. Within my study, neurofeedback was compared with treatment-as-usual, which consisted of individual and group therapies, nursing, psychiatry, and recreational therapy. Results showed that neurofeedback was more effective than treatment-as-usual at treating sexual concerns and that during the four measurement time points, it was more effective at treating the fantasy subtype of dissociation as measured by the Trauma Symptom Checklist for Children15 and anxious/depressed, withdrawn-depressed, thought, rule-breaking, social, and externalizing behaviors as measured by the Youth Self-Report.16 For some of these subscales, up to 28.4% of the variance in behavioral change can be attributed to neurofeedback. Although further longitudinal research is necessary, these initial findings provide empirical evidence to support the expansion of brain-based services for youth with histories of trauma exposure.
Social workers are uniquely positioned to be involved in interdisciplinary and collaborative neuroscientific work as we enhance other disciplines through our orientation in a biopsychosocial and ecosystems framework. The profession of social work offers a strengths-based, person-in-environment, and ecological systems approach, allowing researchers not only to identify individuals’ presenting problems but also to determine how functioning across multiple domains and systems is impacted. Without addressing factors in an individual’s environments (ie, social, familial, economic), that individual’s behavior cannot be understood completely or adequately. Integrating scientific advances in the behavioral and social sciences, as well as those in neuroscience and genetics, can lead to a more unified and comprehensive approach by which effective interventions can be developed to enhance lifelong outcomes in learning, behavior, and health.
As clinicians, we can bridge the gap between neuroscience and practice by incorporating neuroscientific and trauma-informed approaches into screening, assessments, and interventions. Understanding and accounting for the effects of trauma and toxic stress on the developing brain can lead to more individualized treatment planning that addresses a person’s overall functioning in their environment from a neurobiopsychosocial approach. Interventions that are trauma-informed and guided by neuroscience may lead to cognitive, mental health, and behavioral regulation within this population as youth develop skills to lessen emotional reactivity, engage in future oriented behavior, and build positive relationships with peers.
As social workers engage and collaborate with other disciplines, we can also incorporate an antiracist and social justice-based framework into our interdisciplinary work. Such a framework is innovative to other disciplines and can collectively change the way we view trauma interventions for youth and how we work to change systems, policies, and practices that are leading to traumatic events occurring in the first place. Further, we can advocate for increased representation of diverse samples and culturally grounded methodology in research that leads to increased data-driven advocacy and translation of findings for marginalized groups and communities.
Social workers also can emphasize the importance of topics in neuroscience being taught within schools of social work. They can adopt a neurobiopsychosocial approach that encompasses all parts of human behavior and functioning. Such an approach not only can increase our understanding of our clients and how they interact within various systems but also can increase our ability to develop individualized and targeted treatment plans based on their unique neurological needs. The exclusion of neuroscience from social work curriculums can limit a social worker’s confidence and competence in entering this collaborative work. Thus, social workers should advocate for the inclusion of special topics courses on neuroscience within social work curriculum.
Social workers can gain the skills and tools necessary to engage in neuroscientific work. Research in neuroscience and economics suggests investing in empirically sound interventions targeted for adverse childhood experiences and adolescent development will generate a significant financial payoff. With advances in science-driven treatment, we can heal the effects of trauma and create healthier, more productive members of society.
Details on training and certification for neurofeedback can be found on the Biofeedback Certified International Alliance website at www.bcia.org.
— Lindamarie Olson, PhD, LMSW, received her BSW at the University of South Carolina in 2017 with Leadership Distinction in Diversity and Social Advocacy. She entered an advanced standing dual master’s/PhD degree program at the University of Houston Graduate College of Social Work and received her master’s degree with a clinical specialization in 2018 and her PhD in 2023. Olson has clinical experience working with at-risk children and adolescents in both the child welfare and juvenile justice systems. She was a National Institute of Justice Graduate Research Fellow and recipient of the Phi Kappa Phi Dissertation Fellowship. She’s presented her research at national and international conferences and has helped write multiple state, federal, and international grants regarding mental health, child welfare, and juvenile diversion programs. Olson’s research focuses on intervening with at-risk youth to reduce their initial contact with the justice system and to limit their ongoing involvement in the system. Her intervention research will explore and examine the effects of trauma and neuroscience on cognitive, mental health, and behavioral change within this population.
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