Anxiety and Neurofeedback
Anxiety disorders are one of the most common problems that we face today, particularly given the impact of COVID on everyday life. It is often useful to distinguish anxiety from stress, with anxiety being the subjective psychological experience of worrisome thoughts or fears, combined with noticeable discomfort in the body (often in the chest area). Anxiety is often experienced when there is no immediate event considered to be a stressor.
On the other hand, stress is experienced with a range of symptoms, such as anger, frustration, irritability, fatigue and poor sleep but all in the context of some identifiable stressor. A job interview, a deadline or even preparing for a party would be good examples of potentially stressful events, where the ‘stress’ is relieved once the event has passed.
In either event, both stress and persistent anxiety have many negative effects on the body, with an often unrecognized negative impact upon the brain. The many well-documented neurobiological consequences of chronic stress or anxiety are without question.
Upon the digestive and in addition to affecting the immune system, hormones, the progression of various diseases, and exacerbation of various symptoms, anxiety also has direct neurobiological consequences. Strong research evidence indicates that there are functional brain abnormalities associated with anxiety. Stress hormones have been linked to neuronal remodeling, excitotoxic damage, and neuroanatomical changes to the hippocampus and basolateral amygdala (McEwen et al, 2012). Alpha electroencephalography (EEG) recordings have revealed right frontal lateralization in anxious aroused patients as compared to healthy control populations (Mathersul, Williams, Hopkinson & Kemp, 2008). Given the biological predispositions of this disorder, the main method of treatment is drug therapy combined with various psychotherapies, although some evidence currently suggests that medication may not be as effective in treating these conditions as has often been believed (Hughes & John, 1999). Changes in the brain that bind to this disorder suggest the utility of therapy such as neurofeedback in regulating anxiety. This method aims to alter the activity and amplitude of alpha waves of anxiety patients. In individuals experiencing anxiety, the alpha range is targeted to optimize a state of relaxed wakefulness, often through alpha/theta training.
Neurofeedback Training and Anxiety
Some studies have shown the efficacy of neurofeedback in treating anxiety resulting in decreased anxiety. Medication prescribed for anxiety treats symptoms but does not treat the source of the problem in the brain. A specific part of the brain is the source of the problem and crucial to treating anxiety with the help of the neurofeedback method. This method allows the transformation of the brain, rather than just masking the symptoms. Neurofeedback relies on the assumption that, by providing real-time information on brain activity, individuals can extend their conscious control and learn how to regulate their own brain activity (Thibault, Lifshitz & Raz, 2016). Also, research has shown that people are better able to control their body functions when they have more information about these functions. Feedback maintains that humans can voluntarily control their bodies (Faridnia, Shojaei & Rahimi, 2012).
Neurofeedback training focuses on developing arousal awareness to improve control of the central nervous system and also improves the balance between sympathetic and parasympathetic nervous system activities, often leading to balance in the autonomic nervous system. One of the results of balanced nervous system activity is the optimum level of arousal and anxiety. This optimum level is essential as their intensity affects the quality of other functions. Neurofeedback is a systematic, conscious focus of psychological energy and an effective method for treating anxiety. Neurofeedback reduces anxiety by regulating the central nervous system by creating optimal waves that have a beneficial effect on the balance of the autonomic nervous system and its physiological responses, such as heart rate and anxiety. With the help of neurofeedback, we can teach the brain to change unwanted habits without resistance and negative thoughts. While other methods attempt to create new behavioral patterns, neurofeedback training focuses on irregular behavioral patterns that lead to anxiety symptoms. This method raises the awareness of the individual and makes them aware of themselves, their body, and the environment. Moreover, it teaches an individual to remain calm in stressful situations.
Since neurofeedback regulates brain function, it decreases anxiety, optimizing decision making, increasing creativity, helping with memory, and increasing attention and brain-body coordination. Simplified, neurofeedback training trains the brain to reduce the rate of fast waves and to re-train the brain for “SELF-REGULATION”. That is to develop the ability to increase brain speed when there are justifiable reasons for this, such as an increase in mental effort in response to the tasks that the individual performs, or to decrease the speed when the individual is at rest. In this way, the brain is no longer “stuck” in a state of increase in speed, but adapts the speed of work to the needs of the individual and the symptoms of anxiety diminish and disappear over time.
Effectiveness of Neurofeedback on Anxiety
Back in 1970 and 1980, began to appear the first studies about the connection between neurofeedback and anxiety after the discovery of Kamiya (1969) that alpha waves can be treated. And even then, neurofeedback studies focused on providing different levels of brain waves (alpha and theta waves) to anxious patients.
One of the earliest such studies was a study conducted by Passini et al. (1977) using 10 hours of alpha neurofeedback training, comparing 25 anxiety patients (23 of whom were alcoholics) with a control group of 25 anxiety patients (22 were alcoholics). Alpha neurofeedback training produced significant changes in anxiety compared to the control group. An 18-month follow-up of these patients was published, with nearly identical results of lower anxiety as a result of neurofeedback (Watson CG, Herder J, Passini F, 1978). Another study produced similar results: a study was conducted at the Royal College of Music in London to evaluate the ability of alpha-theta neurofeedback to improve music performance in high-talented musicians when performed under stressful conditions in which their performance is assessed (Egner and Gruzelier, 2003). Compared with the five alternative treatment groups, only the neurofeedback group that underwent training to increase alpha and theta resulted in improved actual music performance under stress.
Neurofeedback has shown good research support for its effectiveness in treating anxiety (Moore, 2000). Moore (2000) is one of the first who has reviewed the literature on the neurofeedback treatment of anxiety disorders. He identified eight studies of generalized anxiety disorder, three studies with phobic anxiety disorder, two studies of OCD, and one report on the use of neurofeedback with PTSD. All studies used only brief neurofeedback training but nonetheless, positive changes as a clinical outcome were obtained. The best results were found in studies dealing with phobic disorders. Moore concluded in his review that training to improve alpha and theta waves had effects and were effective treatments for anxiety disorders. He also concluded that neurofeedback for phobic anxiety was eligible for probably effective treatment.
In addition to the studies that Moore reviewed and found positive outcomes of neurofeedback treatment, there are other studies that have addressed the link between this method and anxiety. NF has been used to lower anxiety symptoms in a diverse population, so few studies have addressed the relationship between neurofeedback training and athlete anxiety. These studies were conducted on swimmers, tennis players, skiers, and Olympic athletes, and showed better performance through neurofeedback in three major areas: athletic performance, cognitive performance, and artistic performance. The purpose of these studies was to reduce anxiety in two main ways: to reduce muscle tension using electromyographic biofeedback and to condition brain wave activity through neurofeedback. Finally, the results indicated that neurofeedback was applicable in the following conditions: assisting athletes in learning how to control motor levels and helping to control their emotions and mood changes (Galloway & Lane, 2005). Tanis (2008) conducted a study on the effect of bio/neurofeedback training on the anxiety of 18 handball athletes. After testing, they were divided into groups: those with normal levels of anxiety and those who needed treatment. Seven biofeedback sessions were conducted with the treatment group using a manual sound stress reducer and home use device. Treatment results showed less anxiety in the treatment group compared to the control group. Mahini (2010) conducted a study on the effectiveness of neurofeedback training in chess anxiety. Twenty-four members of the national chess team signed up for the study. All respondents ranged in age from 15 to 35 and had at least five years of participation in national leagues. The assessment was performed in the form of pretest-posttest before and after neurofeedback training. The results of the multivariate analysis of covariance showed that changes in anxiety in the experimental group were significant compared with the control group.
A robust body of research documents that there are biological predispositions that often exist for anxiety disorders. In treating these conditions, neurofeedback may offer alternatives to invasive treatments such as medication, ECT, and intense levels of transcranial magnetic stimulation. Based on the above-mentioned studies, we can say that neurofeedback is an effective treatment. When anxiety disorders are individually assessed (phobic anxiety, generalized anxiety, or PTSD), neurofeedback qualifies as likely effective treatment. While neurofeedback therapy is still in its initial stages of development, it has the full potential to provide an alternative to the conventional method of anxiety treatment by preventing patients from feeling distressed during the course of treatment, especially for patients with PTSD.
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