Neurofeedback training for anxiety
Anxiety is a complex disorder with distinct physiological patterns observed in EEG and fMRI studies that comes with disparate manifestations of emotional and behavioural symptoms.
Anxiety or anxiety related-conditions are usually accompanied by symptoms such as restlessness, fear, sleep disruption, and difficulty focusing. Physical symptoms like increased heart rate, breathing difficulties, high blood pressure and excessive sweating are also common.
Training the Alpha frequency and its effect on anxiety symptoms
Although EEG patterns can vary greatly, research has suggested that targeting alpha brain waves through neurofeedback can be an effective treatment for anxiety symptoms.
Alpha brain waves (8-13 Hz) are associated with a state of relaxation and peacefulness and are predominantly located in the occipital lobe during relaxation with eyes closed.
Individuals with anxiety typically exhibit decreased alpha waves and increased beta waves in the brain.
With neurofeedback alpha training, it is possible to increase posterior alpha brainwaves to relieve anxiety-related symptoms and stress by producing a calming effect.
Several studies have used neurofeedback alpha training to increase alpha brain waves and have reported a significant reduction in anxiety symptoms, with some studies demonstrating long-lasting therapeutic effects (Rice et al., 1993; Banerjee et al., 2017; Moore 2000)
Alpha-Theta training for anxiety and depression
Besides alpha training, researchers have also investigated the effects of theta and alpha/theta training on anxiety. Theta brain waves are known to play a role in sleep, memory, emotion, and creativity. The alpha/theta protocol is specifically designed to alleviate stress and anxiety by increasing relaxation and promoting healing from trauma reactions (Marzbani et al., 2016).
Research has shown that alpha/theta neurofeedback training can decrease depression and anxiety in individuals with alcoholism and address post-traumatic stress disorder symptoms (Saxby et al., 1995).
Additionally, a study involving individuals with generalized anxiety disorder (GAD) found that increasing alpha and theta waves in the occipital areas lead to increased global functional levels and a reduction in GAD symptoms (Dadashi et al., 2015).
The effectiveness of alpha-theta neurofeedback may be attributed to its ability to help individuals cope with anxiety and anxiety-provoking situations. Furthermore, targeting lower frequencies such as alpha/theta through neurofeedback may have a direct impact on core neurocognitive networks, leading to broad symptom improvements (Niv, 2013).
Studies show that healthy people are able to regulate their brain activity in various brain regions related to emotion regulation, including the amygdala, anterior insula, and anterior cingulate cortex.
The beneficial effects of neurofeedback has been shown in increased positive emotion experiencing in patients with depression and in decreased anxiety in patients with anxiety disorders.
Symptom reduction following NF training has been also reported in patients with PTSD, BPD, and schizophrenia.
Summary of research in the field:
Neurofeedback training for alleviating Anxiety symptoms
Research tables and summary: by our trainer- Maria Vittoria Zulli
Hardt, J. V., & Kamiya, J. (1978). Anxiety change through electroencephalographic alpha feedback seen only in high anxiety subjects. Science (New York, N.Y.), 201(4350), 79–81. https://doi.org/10.1126/science.663641
Rice, K. M., Blanchard, E. B., & Purcell, M. (1993). Biofeedback treatments of generalized anxiety disorder: preliminary results. Biofeedback and self-regulation, 18(2), 93–105. https://doi.org/10.1007/BF01848110
Sittenfeld, P., Budzynski, T., & Stoyva, J. (1976). Differential shaping of EEG theta rhythms. Biofeedback and self-regulation, 1(1), 31–46. https://doi.org/10.1007/BF00998689
Moore N. C. (2000). A review of EEG biofeedback treatment of anxiety disorders. Clinical EEG (electroencephalography), 31(1), 1–6. https://doi.org/10.1177/155005940003100105
Banerjee, S., & Argáez, C. (2017). Neurofeedback and biofeedback for mood and anxiety disorders: A review of Clinical Effectiveness and guidelines. Canadian Agency for Drugs and Technologies in Health.
Passini, F. T., Watson, C. G., Dehnel, L., Herder, J., & Watkins, B. (1977). Alpha wave biofeedback training therapy in alcoholics. Journal of clinical psychology, 33(1), 292–299. https://doi.org/10.1002/1097-4679(197701)33:1+<292::aid-jclp2270330166>3.0.co;2-l
Follow up study:
Watson, C. G., Herder, J., & Passini, F. T. (1978). Alpha biofeedback therapy in alcoholics: an 18-month follow-up. Journal of clinical psychology, 34(3), 765–769. https://doi.org/10.1002/1097-4679(197807)34:3<765::aid-jclp2270340339>3.0.co;2-5
Kerson, C., Sherman, R. A., & Kozlowski, G. P. (2009). Alpha suppression and symmetry training for generalized anxiety symptoms. Journal of Neurotherapy, 13(3), 146–155. https://doi.org/10.1080/10874200903107405
Chen, C., Xiao, X., Belkacem, A. N., Lu, L., Wang, X., Yi, W., Li, P., Wang, C., Sha, S., Zhao, X., & Ming, D. (2021). Efficacy Evaluation of Neurofeedback-Based Anxiety Relief. Frontiers in neuroscience, 15, 758068. https://doi.org/10.3389/fnins.2021.758068
Dadashi, M., Birashk, B., Taremian, F., Asgarnejad, A. A., & Momtazi, S. (2015). Effects of Increase in Amplitude of Occipital Alpha & Theta Brain Waves on Global Functioning Level of Patients with GAD. Basic and clinical neuroscience, 6(1), 14–20.
Hou, Y., Zhang, S., Li, N., Huang, Z., Wang, L., & Wang, Y. (2021). Neurofeedback training improves anxiety trait and depressive symptom in GAD. Brain and behavior, 11(3), e02024. https://doi.org/10.1002/brb3.2024
Saxby, E., & Peniston, E. G. (1995). Alpha-theta brainwave neurofeedback training: an effective treatment for male and female alcoholics with depressive symptoms. Journal of clinical psychology, 51(5), 685–693. https://doi.org/10.1002/1097-4679(199509)51:5<685::aid-jclp2270510514>3.0.co;2-k
Cheon, E. J., Koo, B. H., & Choi, J. H. (2016). The Efficacy of Neurofeedback in Patients with Major Depressive Disorder: An Open Labeled Prospective Study. Applied psychophysiology and biofeedback, 41(1), 103–110. https://doi.org/10.1007/s10484-015-9315-8
Wang, Lin, I.-M., Fan, S.-Y., Tsai, Y.-C., Yen, C.-F., Yeh, Y.-C., Huang, M.-F., Lee, Y., Chiu, N.-M., Hung, C.-F., Wang, P.-W., Liu, T.-L., & Lin, H.-C. (2019). The effects of alpha asymmetry and high-beta down-training neurofeedback for patients with the major depressive disorder and anxiety symptoms. Journal of Affective Disorders, 257, 287–296. https://doi.org/10.1016/j.jad.2019.07.026