Research studies Completed studies

Completed studies

The Atlas Institute undertakes large-scale research studies in partnership with our lived experience network, researchers and community organizations. Our completed research studies, along with their results and related resources, are listed below.

Anxiety Depression Mental health Neurofeedback Posttraumatic stress disorder (PTSD)

A tale of two targets: Examining the differential effects of posterior cingulate cortex- and amygdala-targeted fMRI-neurofeedback in a PTSD pilot study

Lay Summary

This study investigated how brain training through functional MRI (fMRI)-neurofeedback could help individuals with PTSD downregulate hyperactivity in specific brain areas associated with trauma.
- fMRI-neurofeedback is a technique that shows real-time brain activity, allowing individuals to learn how to reduce hyperactivity in specific brain regions.
- Downregulation is a process by which hyperactivity to trauma cues is stabilized.
The study aimed to understand whether targeting the posterior cingulate cortex (PCC) vs. amygdala through fMRI-neurofeedback leads to better outcomes for reducing posttraumatic stress disorder (PTSD) symptoms like reliving traumatic events or emotional distress.
- Amygdala: an area of the brain associated with emotional responses and fear/anxiety
- PCC: an area of the brain associated with the self-reflection system that is related to dysregulated self-related emotional processing in PTSD
Targeting the PCC reduced activity in several brain areas involved in trauma processing, such as those related to emotional and visual responses.
- This was associated with improvements in PTSD symptoms, including less reliving of traumatic memories and reduced emotional distress during a single neurofeedback session.
Targeting the amygdala showed no unique reductions in brain activity linked to trauma processing (i.e. no reductions over and above those seen in the PCC group).
- The neurofeedback session did not significantly improve PTSD symptoms.
These results highlight the potential of targeting the PCC as a promising approach for improving PTSD symptoms through neurofeedback. They provide a foundation for future research to further optimize neurofeedback therapy for individuals with PTSD.

Scientific Summary

Functional MRI (fMRI)-based neurofeedback (fMRI-NFB) is a non-invasive technology that enables individuals to self-regulate brain activity linked to neuropsychiatric symptoms, including in posttraumatic stress disorder (PTSD). Selecting which brain region to regulate using neurofeedback is primarily informed by of the specific neurobiological changes observed in the participant population. For example, there is a strong link between PTSD symptoms and multiple functional disruptions in the brain, including hyperactivity within both the amygdala and posterior cingulate cortex (PCC) during trauma-related processing. As such, previous fMRI-NFB studies have trained individuals with PTSD to downregulate neural activity in these regions. However, the differential effects of neurofeedback target selection on PTSD-related neural activity and clinical outcomes have not previously been investigated.

This study aimed to compare whole-brain activation and changes in PTSD symptoms between PTSD participants (n=28) that trained downregulate activity within either the amygdala (n=14) or the PCC w(n=14) while viewing personalized trauma words.

For the PCC, as compared to the amygdala group, this study showed decreased neural activity in several regions implicated in PTSD psychopathology during target region downregulation using fMRI-NFB. Conversely, for the amygdala, as compared to the PCC group, there were no unique reductions in decreases in neural activity (i.e. no reductions over and above those seen in the PCC group). Amygdala downregulation was not associated with significantly improved PTSD symptoms, whereas PCC downregulation was associated with reduced reliving and distress symptoms over the course of a single fMRI-NFB training session.

Led by Atlas Institute for Veterans and FamiliesIn Partnership With University of Ottawa, Western University, McMaster University

Media analysis Suicide prevention Veterans in the media

Media coverage of Canadian Veterans, with a focus on posttraumatic stress disorder and suicide

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Lay summary

The aim of this study was to assess the tone and content of Canadian media coverage of military Veterans, with a focus on posttraumatic stress disorder (PTSD) and suicide, by documenting and analyzing media coverage, examining common themes and articles related to PTSD and assessing the extent to which guidelines for responsible reporting on suicide were followed.

Scientific summary

The overarching aim of this study was to assess the tone and content of Canadian media coverage of military Veterans, with a focus on PTSD and suicide. The first objective was to document and analyze common themes, content and temporal patterns in Canadian media coverage of Veterans per se. The second objective was to examine common themes and content in the subset of articles having PTSD as a theme. The third objective was to assess adherence to guidelines for responsible reporting on suicide in the subset of articles having suicide as a theme.

Led by Douglas Mental Health University InstituteIn Partnership With Atlas Institute for Veterans and Families

Media analysis Suicide prevention Veterans in the media

Veterans’ mental health and media analysis study

Veterans in the media: Assessing Canadian newspaper coverage of the Lionel Desmond murder-suicide (Whitley & Carmichael, 2022)

Lay summary

This project aims to assess how Veterans’ mental health and suicide has been reported in the media over time. Another goal of the project is to create interventions, such as media guidelines, that can help educate and inform journalists about key issues related to Veterans’ mental health and suicide. The project also aims to look at the impact of these interventions on media reporting over time.

Scientific summary

This project aims to assess the tone and content of media coverage of Veterans’ mental health and suicide over a multi-year period; create interventions that can help educate and inform journalists about Veterans’ mental health and suicide issues; and examine change over time in coverage, particularly any change after rolling out the interventions.

Led by Douglas Mental Health University InstituteIn Partnership With Atlas Institute for Veterans and Families

Families and friends Posttraumatic stress disorder (PTSD)

Clinical trial showing neurofeedback training can help reset brainwaves and help with emotional regulation in people with PTSD

Homeostatic normalization of alpha brain rhythms within the default-mode network and reduced symptoms in PTSD following a randomized controlled trial of EEG neurofeedback (Nicholson et al., 2023)

Increased top-down control of emotions during symptom provocation working memory tasks following a RCT of alpha-down neurofeedback in PTSD (Shaw et al., 2023)

Lay summary

This clinical trial assessed the effectiveness of electroencephalography (EEG) neurofeedback as a treatment tool to help individuals with PTSD reset brain waves that may over- or under-function in the aftermath of traumatic experiences.
Study participants receiving neurofeedback showed significantly decreased PTSD severity scores after treatment, with a remission rate of over 60% at the three-month follow-up.
There were no participants who dropped out of the study, suggesting that neurofeedback therapy is both accessible and well tolerated.
Findings from the EEG portion of the study report that neurofeedback brain training resulted in a “rebound” of alpha brain waves within the same areas of the brain that showed decreased alpha before the intervention. Increasing alpha waves is important because it has been repeatedly shown that decreased alpha waves are highly associated with PTSD symptoms (from the Nicholson et al., 2023 paper).
Findings from the functional magnetic resonance imaging (fMRI) portion of the study report that neurofeedback brain training improves engagement of cognitive (i.e., processing thoughts and making decisions) and emotional control brain areas when a person is completing memory tasks that trigger emotion because of trauma. (from the Shaw et al., 2023 paper).

Scientific summary

Post-traumatic stress disorder (PTSD) affects many people worldwide and can be difficult to treat with traditional therapies like talk therapy or medication. However, recent research has shown that a technique called neurofeedback may be an effective treatment option for PTSD. Neurofeedback is a type of brain training that can directly target the neural mechanisms that underlie PTSD. Research has shown that PTSD may be linked to disrupted patterns in the brain’s alpha rhythms – a particular type of brain wave. By using neurofeedback to target alpha waves and help the brain to learn how to regulate them more effectively, individuals may be able to reduce their PTSD symptoms and improve overall functioning.

In our study, we conducted a 20-session, double-blind, randomized controlled trial of alpha-rhythm neurofeedback among individuals with PTSD. Participants who received this neurofeedback intervention demonstrated effective recalibration of alpha waves in the brain (Nicholson et al., 2023). Importantly, among these participants, we also observed significantly decreased PTSD severity scores post-treatment and at a three-month follow-up. Indeed, at this point, we observed a PTSD remission rate of 60%, which is aligned with gold-standard PTSD treatments. Additionally, after completing neurofeedback training, participants showed enhanced engagement of top-down cognitive and emotional control centers during tasks that require emotion regulation due to trauma triggers (Shaw el al., 2023). Taken together, results from study show that alpha-rhythm targeted neurofeedback training has the capacity to rescue functional brain impairments that are closely related to the manifestation and maintenance of PTSD symptoms.

Led by Atlas Institute for Veterans and Families

Depression Posttraumatic stress disorder (PTSD)

Study showing that people with PTSD experienced reduced reliving and distress symptoms as a result of fMRI-based neurofeedback targeting an area of the brain associated with emotion, thinking about oneself and memory

Posterior cingulate cortex targeted real-time fMRI neurofeedback recalibrates functional connectivity with the amygdala, posterior insula, and default-mode network in PTSD (Lieberman et al., 2023)

Lay summary

This study aimed to investigate the effectiveness of fMRI-based neurofeedback training in helping people with PTSD to regulate and strengthen an area of the brain associated with emotion, thinking about oneself and memory. This area of the brain is called the posterior cingulate cortex or PCC.
During neurofeedback, neural activity is measured and presented to participants in real-time, allowing them to self-regulate brain activity.
The study showed that participants experienced reduced PTSD symptoms, such as reliving the experience and feeling distress as a result of neurofeedback training.
fMRI scans showed neurofeedback can reset brain network connectivity that can be compromised for people with PTSD and that ultimately contribute to symptoms associated with disrupted memory, emotional difficulties, and altered thinking and thoughts about oneself or others.
Results support PCC-targeted neurofeedback as a way to heal brain networks disruptions that contribute to PTSD symptoms.

Scientific summary

In recent years, functional neuroimaging research has found that PTSD symptoms are associated with altered connectivity within brain networks, including the default mode (DMN) and salience networks (SN). Importantly, emerging research has found that a technique called neurofeedback has shown promise in its capacity to recalibrate altered DMN and SN dynamics and reduce associated PTSD symptoms. During neurofeedback, neural activity is measured and presented to participants in real-time, allowing them to self-regulate brain activity.

In this project, we targeted the therapeutic regulation of the posterior cingulate cortex (PCC; a primary hub of the DMN) using real-time functional magnetic resonance imaging (fMRI)-based neurofeedback among participants with PTSD. We found that PTSD participants were able to successfully downregulate PCC activity and showed reduced reliving and distress symptoms during a trauma provocation paradigm. Additionally, during neurofeedback-mediated regulation, we observed increased connectivity between the PCC and critical DMN and SN hubs. Taken together, these results support the use of PCC-targeted neurofeedback as a way to heal PTSD-associated alterations in brain network connectivity and facilitate improved emotion regulation abilities in PTSD.

Led by Atlas Institute for Veterans and Families

Moral distress Moral injury Peer support

The role of peer support in responding to moral injury in public safety personnel

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Lay summary

The purpose of this project was to understand whether and how potentially morally injurious events (events that don’t align with or violate one’s moral or ethical beliefs and lead to important emotional responses) and the concepts of moral distress and moral injury are relevant to public safety personnel, including paramedics, communications officers, and equipment and supply technicians.
This project also aimed to uncover the potential impacts of those experiences, as well as if and how peer support is helpful in making sense of them.
Lastly, the project explored how peer support programs could focus on moral distress and moral injury in their curriculum. By learning more about how these personnel make sense of, and cope with, potentially morally injurious events with the support of their peers, we aimed to equip these peers to provide that support.

Scientific summary

Attention to the potential for moral injury in healthcare, public safety and related frontline occupations has grown over the past decade and has increased dramatically since the start of the COVID-19 pandemic. Individuals in these roles are exposed to a variety of endemic and potentially traumatic stressors, and they frequently face situations that may result in moral injury. The application of the construct of moral injury in different frontline contexts indicates that there is an urgent need to better understand the nature and effects of potentially morally injurious events (PMIEs) in specific populations such as public safety personnel (PSP), where the concept has not been widely applied. This project aimed to: (1) identify what categories of events PSP might experience as morally challenging, distressing or PMIEs, (2) examine the contextual factors that limit or enable them to act in accordance with their values,(3) explore how PSP make sense of and cope in the face of these events, (4) determine if and how PSP engage peers as part of this process, and (5) identify if there are skills, competencies or practices that can enhance peer support for PSP who have been exposed to such events.

Led by Atlas Institute for Veterans and FamiliesIn Partnership With the Royal Ottawa Mental Health Centre

Brain imaging Moral injury Posttraumatic stress disorder (PTSD)

Improving machine-learning-driven development and identification of PTSD phenotypes

Lay summary

The purpose of this project was to find new, measurable biological signs that would help describe the way in which PTSD uniquely presents itself in an individual. The project met this goal by using brain-imaging technology. Information from this project may be used to create new individualized PTSD treatments.

Scientific summary

Characterizing the complex nature of each PTSD patient’s presentation poses a difficult challenge given the heterogeneous nature of PTSD symptoms. This is especially relevant for more complex PTSD symptom profiles, including moral injury. Recent efforts in neuroimaging-based machine learning have demonstrated the possibility of characterizing PTSD phenotypes using neuroimaging markers combined with the first-person experience of individuals experiencing PTSD. Our project built upon this body of work by studying the changes in neural activity underlying moral injury using simultaneous electroencephalogram (EEG)-functional magnetic resonance imaging (fMRI) biomarkers.

Collected concurrently, the fMRI signal will help identify the regions of interest that correlate with moral injury at great spatial resolution, while the EEG signal will be used to identify the finer temporal variations occurring at these regions of interest. These measures will provide crucial information about the brain changes associated with the first-person experience of moral injury. Such advances will be critical to our understanding of moral injury and will facilitate a personalized treatment approach to moral injury. Furthermore, this work will be an important step in reducing the stigma of mental illness by allowing the invisible injury of moral injury to become visible.

Led by McMaster University In Partnership With the University of Western Ontario, Atlas Institute for Veterans and Families

Intimate partner violence

Informing responses to intimate partner violence in military or Veteran populations within Canada

Lay summary

The purpose of this project was to review recent knowledge on how many people experience intimate partner violence (IPV) in their lifetime, specifically among military or Veteran groups. It also aimed to explore how Canadian service providers identify, prevent and treat IPV among military personnel and Veterans. This work will help health service providers identify and respond to IPV effectively.

Scientific summary

Intimate partner violence (IPV) refers to behaviour that occurs within an intimate relationship and causes physical, psychological or sexual harm, and includes physical, sexual and psychological abuse, as well as controlling behaviour. IPV victimization and perpetration may be elevated among active duty personnel and Veterans, and in the context of military experiences including deployment and reintegration, combat exposure and post-traumatic stress. This project addressed the intersection of IPV and military or Veteran status, and considered this in a Canadian context. It reviewed best quality evidence, from Canada and other countries, regarding the prevalence of IPV among active duty personnel and Veterans, as well as responses in military- and Veteran-specific health services. The project was informed by a cross-sector advisory group at the Atlas Institute that supported the development of this new program of research on IPV in military and Veteran populations.

Led by Phoenix Australia Centre for Posttraumatic Health In Partnership With Atlas Institute for Veterans and Families

Clinical assessment Moral injury

Moral injury outcome scale (MIOS)

Lay summary

The purpose of this project is to create a scale that measures moral injury for clinicians and researchers. It will do this by using data from a study on moral injury within military personnel and Veterans in Australia, Canada, the United Kingdom, and the United States.

Scientific summary

The Moral Injury Outcome Scale (MIOS) Consortium aims to develop and validate a content-valid international measure of moral injury as a multidimensional outcome. The psychometric development process comprises three phases. Phase I entailed the collection of multicultural, international, and multi-context phenomenological data about the lasting impact of potentially morally injurious events from service members, Veterans, clinicians, and Chaplains. Qualitative coding of the data produced content-valid operational definitions of domains of impact, which guided the generation of potential scale items and resulted in the initial MIOS. In Phase II, the MIOS was administered to service members and Veterans, and the data collected are being analyzed to trim the item set of the scale and to ensure internal consistency. In Phase III, the final MIOS will be tested for construct validity.

Led by Boston UniversityIn Partnership With Veterans Administration — Boston, Phoenix Australia, Operational Stress Injury Clinic – The Royal Ottawa, Atlas Institute for Veterans and Families

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