Integrating Biofeedback into Psychotherapy for Acute PTSD: A Pilot Study Following the October 7th Attacks

Background: The extreme acts of violence on October 7, 2023 in southern Israel caused a dramatic surge in trauma and PTSD cases, creating an urgent need for expanded therapeutic options, particularly for mind-body self-regulation. This pilot study investigated integrating the Reflect Orb, an intuitive biofeedback tool, into the psychotherapy of survivors affected by direct trauma and ambiguous loss. Aim: To preliminarily evaluate the feasibility and the psychological and physiological impact of integrating biofeedback into psychological therapy for individuals presenting with PTSD symptoms. Method: A 10-week longitudinal design was employed with eight adult patients (75% female, mean age 46.87) who experienced extreme trauma on October 7 and were already undergoing therapy. Following a two-week baseline (two evaluations), therapists integrated biofeedback with the Reflect Orb for at least 5 minutes at the start of six consecutive sessions. Follow-up evaluations occurred twice over the two weeks post-intervention. Measures included psychological scales (HAM-A, DASS-21, PCL-5, GHQ-12), sleep quality (MSQ), and clinician satisfaction. Physiological stress, defined as time spent in physiological arousal during sessions, was extracted from the device. Quantitative and qualitative approaches were used for analysis. Results: Average trends indicated clinically meaningful improvements from baseline to follow-up. Notable findings included a 6-point reduction in HAM-A scores (moderate to mild anxiety) and a 17-point reduction in PCL-5 scores (crossing the threshold for PTSD diagnosis). DASS-21 scores showed alleviated depression and anxiety (moderate to normal), while GHQ-12 and MSQ (sleep quality) scores also improved. Physiologically, average stress time during Orb practice decreased from 62% to 48%. Significant correlations emerged between reduced physiological stress and reductions in reported anxiety, depression, and PTSD avoidance symptoms. Clinicians reported high satisfaction. Conclusion: Biofeedback appears to be a feasible and beneficial addition to psychotherapy for PTSD following acute trauma. These findings are noteworthy as improvements occurred within a short period, exceeding progress made during both the baseline period and preceding standard therapy. These substantial improvements in both physiological self-regulation and psychological well-being warrant further investigation.