The TOP program operates under a memorandum of understanding between the United States Marine Corps and East Carolina University. The Marines that participate in the program are members of the Wounded Warrior Battalion East at Camp Lejeune, in Jacksonville, North Carolina, and they all suffer from PTSD, TBI, or both.
In its first year, more than a dozen Marines have participated in the program. On average, four or five Marines at a time travel to ECU’s campus every Thursday to undergo training in Russoniello’s lab. A second training session is offered on Mondays at Camp Lejeune to provide the required amount of training. The program typically requires eight to 12 training sessions, but the Marines are welcome to remain in the program as long as they choose to.
The Marine Corps commitment to PTSD rehabilitation, especially to new approaches to treatment, is evidenced by its involvement with ECU. Never before has the Marine Corps reached out to an academic institution for assistance in this field. Traditionally the Marine Corps has relied on the traditional treatments of PTSD: counseling and medication.
The TOP program uses biofeedback technology to help Marines and Navy Corpsmen control their autonomic and central nervous systems.
“We have the medical piece. We have the pain management piece. That is kind of the traditional set,” said Lieutenant Colonel Tom Siebenthal, Wounded Warrior Battalion East commander. “We want to wean the Marines off of that, to not rely on the medications. And so we see [the TOP Program] as a beautiful opportunity to go another direction.”
The tenent of the Wounded Warrior program is to provide assistance to injured service personnel and their families until they either return to duty, are medically discharged, or successfully readjust to civilian life. Russoniello believes his program can do just that by helping the Marines and Navy Corpsmen learn to appropriately process prior traumatic experiences and rebuild positive relationship skills.
"It is important for people in general, and these Marines in particular, to know that PTSD is real, that there are people who understand this condition, that there are effective interventions, and that they can succeed in life in spite of it,” he said.
In the program, a training circuit comprising several biofeedback modalities is used to teach the participants to control their own autonomic and central nervous systems. In addition to the biofeedback modalities used for cognitive retraining, counseling is used for relationship and resiliency training.
“Being exposed to trauma in war has a tendency to make both the autonomic and central nervous systems dysfunctional,” said Russoniello. “They experience a number of symptoms—they can’t sleep, they have feelings of depression, feelings of agitation, anger, and so forth—that are the result of having these systems not functioning right.”
Before a soldier can start training, an initial assessment is given to help identify the types of issues he might have. That information is used to determine which biofeedback treatments should be applied.
Heart rate variability (HRV) is the first modality the participants will work with. According to Russoniello, HRV allows the Marines to “see” their autonomic nervous system. A small ear clip transmits data from the participant to a computer monitor that shows his heart rate as it encounters sympathetic, or stress, activity. Marines are taught a regimented breathing process that is effective in lowering the heart rate and then witness the effects the process has on them.
Galvanic skin response (GSV) measures the dilation of sweat glands through sensors placed on the participant’s fingertips. It uses the same concept as a polygraph, or lie detector. It has the advantage of being tied to cognition, so Marines can be asked questions and then see from a graph on the screen, the level of stress the question caused.
Electroencephalagraphy (EEG) measures and records the electrical activity of the brain. Science’s understanding of brainwaves is in its infancy, but according to Russoniello, brainwaves may hold the key to not only successful treatment of PTSD and TBI, but a myriad of disorders including paralysis and ALS.
“The brainwave activity, that stuff is phenomenal,” he said. “Brainwaves, as we start to understand them, have a coherence to them in terms of stress and behavior. And that spells for a whole different world in the next few years. We know for instance, that theta waves are tied into the limbic system, or emotion. So what we tend to try to do then is bring down theta. As a result, people start to control their emotions a little bit better.”