This article was written by our trainer Maria Vittoria Zulli
Targeting Anxiety Symptoms
Recreational drugs can cause short and long-term anxiety 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. Stimulant drugs such as amphetamines and cocaine can exacerbate anxiety symptoms by speeding up heart rate and contributing to paranoia, which can worsen anxiety symptoms. Even after discontinuing drug use, anxiety symptoms can persist. However, treatments like neurofeedback can help alleviate drug-induced anxiety symptoms by targeting the underlying neurological changes.
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. 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)
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 generalised 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).
Click here for data tables summarising the research in the field of Neurofeedback for alleviating anxiety symptoms
Targeting Depression Symptoms
The use of recreational drugs can lead to changes in the brain that can contribute to the development of depression. Cocaine, heroin, and mind-altering drugs such as PCP and MDMA can cause symptoms of depression either immediately or after prolonged drug use. Drug-induced depression is characterised by feelings of helplessness, hopelessness and intense sadness. It can be a persistent condition that lasts for several weeks or months.
At an electrophysiological level, depression appears to be associated with a difference in alpha activity between the right and left prefrontal cortex, known as alpha asymmetry. Alpha activity is inversely correlated with brain activity; increased alpha waves indicate decreased activation in the corresponding brain area, while decreased alpha activity indicates an increase in brain activity (Choi et al., 2011). In cases of depression, there is typically more left prefrontal alpha activity than right prefrontal alpha activity, indicating less activation in the left frontal area (Bruder et al., 1997; Stewart et al., 2011).
The left frontal hemisphere is associated with more positive affect (emotions), motivation and memories (Stewart et el., 2011), while the right frontal hemisphere is more involved in negative emotions, withdrawal behaviour, and comorbid depression and anxiety (Mathersul et al., 2008). Because of the frontal alpha asymmetry observed in depression, individuals may be less aware of positive emotions while being more in touch with the negative emotions associated with the right hemisphere. Moreover, when the left hemisphere is ‘stuck’ in an alpha idling rhythm, there is a deficit in positive affect and an increase in withdrawal behaviour.
A literature review conducted by Dias and Deusen (2011) revealed that Alpha inter-hemispheric asymmetry and Theta/Beta ratio within the left prefrontal cortex were the most commonly used neurofeedback protocols for depression and had positive results during training.
The alpha inter-hemispheric approach teaches individuals to increase alpha activity in the right prefrontal cortex and decrease alpha activity in the left prefrontal cortex, which has been shown to effectively treat depressive symptomatology (Choi et al., 2011; Peeters et al., 2014). The Theta/Beta, on the other hand, focuses on reducing Theta activity (4-8 Hz) in relation to Beta (15-28 Hz) in the left prefrontal cortex. Beta activity is related to executive cognitive control and motivational functions, which are negatively affected by depression. By increasing Beta activity in the left hemisphere, there can be an improvement in executive functioning (Dias et al., 2011). However, beta brain waves (13-28 Hz) are associated with anxiety, and given the close relationship and comorbidity of depression and anxiety, careful programming is necessary to prevent a training protocol for depression from leading to anxiety by increasing Beta.
Dias and Deusen also introduced a novel protocol that combined the training demands of Alpha asymmetry and increased Beta/Theta ratio in the left prefrontal cortex. Their approach involved decreasing high beta activity (Beta 3: 23-38 Hz) in both hemispheres to prevent anxiety and increasing Beta 1 (15-20 Hz), specifically in the left hemisphere. This method yielded a decrease in both depression and anxiety symptoms. Additionally, the Alpha/Theta protocol, which was previously discussed in the anxiety section, is also frequently used to alleviate symptoms of depression and anxiety (Cheon et al., 2016).
Click here for data tables summarising the research in the field of Neurofeedback for depression and mood disorders
Targeting Psychosis symptoms
Drug-induced psychosis occurs when an individual experiences episodes of hallucinations, delusions and paranoia as a direct consequence of substance abuse. The use of certain drugs, such as cannabis, cocaine, methamphetamine, LSD, and MDMA, are commonly associated with inducing psychotic symptoms. The symptoms of psychosis may differ depending on the type and dosage of the drug consumed, and heavy or excessive use may result in prolonged symptoms.
Individuals with psychosis experience a disconnection from reality, altered thinking, hallucinations, delusions and difficulties with emotional regulation and language. There is limited research available on the effects of Neurofeedback on a specific psychotic disorder - schizophrenia. Evaluating the literature on EEG and qEEG in schizophrenia is challenging due to the illness’s heterogeneity and the variety of medications and dosage levels used. However, despite these differences, there is considerable agreement in the literature that EEGs are often characterised by decreased or absent alpha activity (8-13 Hz) and/or increased beta (13-10 Hz), delta (1-3 Hz) and theta (3-8 Hz) activity (Small et al., 1984; Morihisa et al., 1983; Sponheim et al., 1994). The observed decrease in alpha activity may indicate a dysfunction in subcortical-cortical mechanisms.
Other studies have reported increased slow activities such as delta waves (Morihisa et al., 1984). Delta waves (0.5-4 Hz) are normally observed during sleep, and their appearance during waking hours can be indicative of psychopathology such as schizophrenia. Compared to healthy subjects, people with schizophrenia show more abnormal and intense slow-wave delta activity in the frontal and central regions during wakefulness (Rockstroh et al., 2007; Fehr et al., 2003). Negative symptoms of schizophrenia, such as anhedonia, avolition, and blunted affect, have been associated with delta waves, particularly in temporal areas, along with decreased alpha and increased beta activity (Gattaz et al., 1992). Increased theta activity, on the other hand, has been associated with vivid hallucinatory experiences. Neurofeedback protocols that inhibit both theta and beta may be beneficial in modifying hallucination, anxiety and tension, which have been associated with high beta activity (Gruzelier, 2000)
Furthermore, there is a prevalent theory that schizophrenia is characterised by neural disconnection, particularly within fronto-temporal networks, with greater emphasis on the left hemisphere than the right (Das et al., 2007). Functional EEG studies have provided evidence of abnormalities in the left hemisphere and impairments in interhemispheric communication in individuals with schizophrenia. For instance, studies have reported more left-lateralized resting EEG alpha, indicating reduced activity in the left-hemisphere (Flor-Henry, 1976; Flor-Henry et al., 1982; Gordon et al., 2010). Neurofeedback training has proven effective in treating disconnection syndromes through the application of coherence (i.e., connectivity) training (Schummer, 2008; Walker et al., 2007). A study conducted on a 21-year-old male with schizophrenia demonstrated that neurofeedback coherence training significantly reduced cognitive and emotional symptoms, along with a reduction in medication (Schummet et al., 2013).
Positive results have been reported in the available research on the effects of neurofeedback on schizophrenia. Surmeli and colleagues (2012) observed significant improvements in both positive and negative symptoms after neurofeedback training. Similarly, Bolea (2010) found improvements in schizophrenia symptoms that were sustained over a 2-year follow-up period. In another study, 47 outpatient schizophrenia subjects who completed individualised qEEG-derived neurofeedback training showed significant improvements in positive and negative symptoms (Surmeli et al., 2012).
Despite the challenges posed by negative symptoms, successful applications of EEG in schizophrenia research as one main example of psychotic disorders, suggest that self-regulation of physiological processes may still be achievable for some individuals with the condition. With careful monitoring and reward of motivation, neurofeedback may prove to be a promising avenue for the treatment of schizophrenia symptoms.
The following tables display studies examining the impact of neurofeedback on schizophrenia symptoms.
Full list of references for this article can be found here