Key Takeaways
- Neurofeedback is a therapy that uses real-time brain activity to help someone learn to change that activity on their own.
- During a Prism session, an electroencephalogram (EEG) headset, which reads electrical activity from the brain, and an interactive on-screen simulation work together to reflect the patient's stress response back to them as it happens.
- A typical Prism session is comfortable, drug-free, and does not require the patient to describe or relive their trauma.
- Prism differs from medication and trauma-focused talk therapy because it trains a physical skill in the brain rather than adjusting brain chemistry or processing the traumatic memory directly.
- Diamond Edge TMS is an expert provider of transcranial magnetic stimulation (TMS) therapy in Vancouver, Washington, and Prism fits alongside a patient's broader post-traumatic stress disorder (PTSD) care plan. Schedule an appointment with Dr. Jerald Block to see if it's the right addition.
What Is Neurofeedback, and How Does It Use Real-Time Brain Activity?
Neurofeedback is a type of therapy that measures brain activity and shows it back to the patient, usually as a picture or a sound, so the brain can learn to shift that activity in a healthier direction. It works like any skill built through practice and feedback: the clearer and faster the feedback, the faster the brain learns which patterns to repeat.
Biofeedback, the broader category neurofeedback belongs to, has long been used to help people gain more control over involuntary body functions like heart rate and muscle tension. Neurofeedback applies that same idea to the brain itself, using tools like EEG to read electrical brain activity in real time.
How the EEG Headset and Interactive Simulation Work Together
During Prism training, the patient wears a non-invasive EEG headset. This headset reads an EEG and searches it for a specific, validated brain signal. That mathematically-derived signal is mapped to output from the amygdala, the brain region responsible for the body's stress and fear response. The EEG is passive and nothing is sent into the body. The headset only reads activity that's already happening in the brain. As a result, there are next to no side effect cautions associated with an EEG. The only warning I give is that some people can have an allergic reaction to the cream used to conduct the signal from the scalp to the device. It is very, very rare but, theoretically possible..
Once that signal is captured, it is processed and fed into an interactive on-screen simulation. The image one sees is that of a security camera’s view of a cartoonish ER waiting room (or the platform of a train station). In the simulation, the following happens: if one’s amygdala fires past a set-point, a “person” stands up, walks around, and starts talking more loudly. Conversely, as you calm, the screen-people sit down and murmur more quietly.
In my experience, people can get most of the avatars to sit for a short period. But, when one of them stands, panic sets in. Then, a horde of ER-folks rise and start talking among themselves. The challenge is to calm your mind so that they sit down and remain seated and quiet. As I like to say to my patients, “your goal is to use your mind to make the people sit down and shut up!”
Over several minutes, the task can be both boring and challenging. It is sort of akin to gamified meditation that is both FDA-certified, measurable, and monitored. Importantly, the skills learned in the EEG lab are immediately accessible to you outside, in the real world.
What a Typical Prism Session Looks Like, Start to Finish
A Prism session at Diamond Edge TMS generally follows a simple, predictable structure:
- The patient is fitted with the EEG headset in a private, comfortable setting.
- A short calibration period allows the system to establish the patient's baseline brain signal.
- The patient engages with the interactive simulation five times for about 3-minutes each cycle, practicing mental strategies to calm the on-screen scene.
- The session wraps up with a review of their performance in each cycle and overall and trending. There is no recovery time needed, so patients can drive themselves and return to their day right away.
A full course of Prism typically spans about 15-sessions over eight weeks, giving one time to build and reinforce their calming strategies. In 2023, the U.S. Food and Drug Administration (FDA) cleared Prism as an adjunctive PTSD treatment (a treatment used alongside other care). The FDA cleared it through its 510(k) process, which shows that a device is similar in safety and use to one already on the market. The decision was based on a clinical study of patients with chronic PTSD conducted through GrayMatters Health, the company that developed Prism.
How Prism Differs From Medication or Trauma-Focused Talk Therapy
Prism vs. Medication vs. Trauma-Focused Talk Therapy
| Approach | How It Works | What It Requires of the Patient |
|---|---|---|
| Prism Neurofeedback | Trains the brain to regulate its own amygdala-based stress signal using real-time feedback | Wearing an EEG headset; no discussion of the trauma itself required |
| Medication | Adjusts brain chemistry to help manage symptoms | Ongoing use; effects can include side effects common to psychiatric medications |
| Trauma-Focused Talk Therapy | Processes the traumatic memory directly, often through structured recall and/or EMDR | Willingness to describe or revisit details of the traumatic event |
Each of these approaches can play a role in PTSD care, and they aren't mutually exclusive. Many patients continue psychotherapy or medication while adding Prism. Prism is FDA-cleared specifically as an adjunctive treatment, which means it's designed to be used alongside other care, not as a stand-alone replacement for it.
How Prism Fits Alongside a Patient's Broader PTSD Care Plan
Because Prism doesn't require patients to describe or relive their trauma, it can be a starting point for people who have avoided trauma-focused therapy (talk therapy that works directly with the memory of the trauma) for that reason, as well as an addition for people already in treatment. At Diamond Edge TMS, Dr. Jerald Block reviews each patient's history and current care during a consultation, then helps map out whether Prism, TMS, psychotherapy, medication management, or some combination makes the most sense.
Diamond Edge TMS serves people, whether they be working folks, college students, military members, first responders…whomever. We accept a wide selection of insurances or self-pay. Most of our patients use BC/|BS, United, Aetna, or TRICARE. Dr. Block is a board-certified psychiatrist and Army combat veteran. Coverage can differ by treatment, so ask the team what applies to Prism.
Start Prism Neurofeedback Therapy at Diamond Edge TMS
Prism gives the brain a direct, measurable way to practice calming its own stress response, without medication side effects and without having to retell the traumatic event. As the first and only clinic in Oregon and Southwest Washington offering Prism, Diamond Edge TMS gives Vancouver-area patients a new option for PTSD care.
To see whether Prism could fit into your PTSD treatment plan, request an appointment with Diamond Edge TMS or read more about Prism for PTSD.
Frequently Asked Questions
How does neurofeedback work for PTSD?
Neurofeedback reads a specific pattern of brain activity and reflects it to the patient in real time, usually through visual feedback. For PTSD, this typically means training control over the amygdala's stress response, so the brain gradually learns to bring that response down on its own.
What happens during a typical Prism session?
The patient wears a comfortable EEG headset while interacting with an on-screen simulation. As their brain's stress signal quiets, the scene responds, giving the patient real-time feedback on the strategies that work.
Do I have to talk about my trauma during Prism sessions?
No. Prism uses a neutral, non-trauma-based simulation, so patients never have to describe or relive the traumatic event during training.
How is Prism different from TMS?
TMS uses magnetic pulses to stimulate specific brain regions and is FDA-cleared for depression and obsessive-compulsive disorder (OCD). Prism works differently. It measures brain activity and teaches the patient to change it, rather than stimulating the brain directly. Diamond Edge TMS offers both, and Dr. Block can help determine which is the better starting point.
How many Prism sessions are typically needed?
Most patients complete a course of Prism sessions per week, over roughly eight weeks (15 sessions). Your specific plan will depend on your history, which Dr. Block will review during a consultation.
