Since the murderous onslaught of Hamas terrorists on October 7 and the war in Gaza since then, post-traumatic stress disorder has reached epidemic proportions among Israeli soldiers and many civilians.
There is no quick cure, but numerous researchers have suggested ways – from service dogs to psychedelics – many of them not scientifically proven – to relieve the mental health condition that’s caused by an extremely stressful or terrifying event, either being part of it or witnessing it.
The debilitating symptoms include vivid flashbacks; re-living aspects of what happened; intrusive thoughts or images; nightmares; pain, nausea, or sweating; and distress at real or symbolic reminders of the trauma.
Now, for the first time, the US Food and Drug Administration has cleared a neuromodulation device for treating PTSD. The Haifa-based company GrayMatters Health says Prism is the world’s first non-invasive self-neuromodulation device for post-traumatic stress, which trains patients to regulate activity in the part of the brain that controls fear and emotions.
Prism uses biomarker technology developed by Prof. Talma Hendler, a leading neuroscientist and psychiatrist at Tel Aviv University and founding director of the Sagol Brain Institute at the Tel Aviv Sourasky Medical Center.
During Prism treatment, a computer simulation and electroencephalograph (EEG) cap – looking like a bathing cap but with special sensors attached – creates an environment where patients engage in a non-trauma-based experience to help them learn to control their PTSD symptoms. When a patient does this repeatedly, they learn the mental strategy that moves their emotional system to a calmer state.
The technique is not performed by a psychiatrist, but by a trained technician or social worker, helping to ease the long wait lists for psychiatric consultation.
Israeli clinics using Prism are at Tel Aviv Sourasky Medical Center, Rambam Healthcare Campus, Sheba Medical Center, Barzilai Medical Center, Natal, Maale HaCarmel Mental Health Center, the Omer Porat Center, the Eyal Center, the Beit Halochem centers in Haifa and Nahariya, and the Neuroactive clinic. Prism is available at clinics in 24 locations across the US, from Brooklyn to Seattle.
The PTSD patient usually undergoes 15 sessions of 45 minutes each in a clinic, twice weekly for about eight weeks. Hendler told The Jerusalem Post in an interview that clinical trials have already proven that the beneficial effect is present for at least six months, but booster sessions may be prescribed.
This personalized, non-trauma-based, and non-medication treatment helps patients gain a sense of control over their PTSD symptoms and their lives, according to GrayMatters Health. A multi-center clinical study showed that three months after the 15-session regimen, 67% of patients overall enjoyed clinically significant symptom improvement, including sleep, and 32% experienced remission.
The company says that side effects like tiredness or mild headaches in some users are negligible and pass quickly on their own.
Using biology to fight PTSD
The system helps patients recognize and implement mental strategies that lower a digital biomarker derived from signals from a small region of the brain, called the amygdala, that is linked with the limbic system. The amygdala is a paired structure, with one almond-shaped section located in each hemisphere of the brain near the center of the temporal lobe. This brain region plays a crucial role in emotional processing, including fear, memory formation, and decision-making, often working in conjunction with other parts of the brain like the hippocampus and prefrontal cortex.
Once patients are fitted with the EEG cap, animated characters are viewed on a computer screen. The patient learns to control them with their mental strategy – a thought, memory, or feeling. When the patient lowers the level of the digital biomarker, the characters on the screen gradually take their seats and lower their voices. Step by step, patients discover which thoughts or feelings help them regulate overactivity in the amygdala, thus gaining a general sense of control.
“The patient gets positive feedback from Prism when he or she is able to lower the amygdala-derived biomarker,” Hendler continued, “and this has a calming effect.”
Hendler said that she started working on the technology many years before October 7.
“About 25 years ago, I led studies of IDF soldiers who underwent functional MRI (fMRI) scans before and after combat situations. We found that the soldiers who had more amygdala activity before going to the battlefield developed more PTSD symptoms and thought that hyper-activation of the amygdala could be a marker for possibly developing psychopathology after trauma,” Hendler recalled. “We thought that modulation could be used to change amygdala activity and help the soldiers.
“But fMRI is very expensive, she said, “and it’s hard to put patients in this device. So we applied machine learning models to predict the fMRI amygdala data using only EEG signals.”
The FDA cleared Prism in March 2023 for the treatment of adults, followed recently by coverage by the Defense Ministry, which covers the cost for soldiers.
The beneficial effects of Prism have been shown to continue even after the patient has completed treatment, Prof Hendler noted, as they gain a skill to use in their daily life.
Hendler has mentored over 50 post-doctoral, doctoral, and master’s students, published over 130 articles, and lectured at more than 75 domestic and international meetings and conferences since 2010.
The TAU psychiatrist expects that within five years, there will be more potential indications for Prism, such as personality disorders and addictions. “It’s even possible that people will be able to train themselves at home, using artificial intelligence.”
She concluded that she has a very satisfied feeling that her invention can influence people positively.
“It doesn’t replace talk therapy but is complementary.”