People with lifelong anxiety disorders often have genetic polymorphisms that cause abnormal activation of various neural circuitry and changes in neurotransmission, provoking excessive fear. While fear in appropriate situations such as getting attacked by a lion is beneficial in that it helps us survive by giving us superhuman abilities (e.g. endurance, strength, thinking), many people with anxiety disorders are unable to turn off this primal fear response. Those diagnosed with anxiety are unable to control their brain’s fear response.
One technique that may help give anxiety sufferers more control over their fear-response is called neurofeedback. Neurofeedback is a practice that involves training a person to consciously correct abnormal electrical activity (brain waves) in the brain, some of which is likely contributing to their preexisting anxiety. With consistent neurofeedback training, a person can learn how to “shut off” anxiety-promoting brain waves and replace them with those promoting calmness and relaxation.
Most individuals with anxiety are typically thought to display abnormally fast, beta wave activity compared to those without the condition. That said, brain wave activity cannot be generalized as being always too fast among those with anxiety – it depends on the individual. By working with a practitioner to determine deficiencies and surpluses of certain brain wave frequencies, and consciously altering them, neurofeedback could serve as a viable Xanax alternative.
Neurofeedback for Anxiety Disorders (The Research)
The research involving neurofeedback for the treatment of anxiety disorders is relatively scarce. Most studies have small sample sizes and weren’t conducted with placebo-controlled, double-blind, randomized designs. Despite limitations associated with the current body of research, most evidence suggests therapeutic efficacy of neurofeedback for the treatment of anxiety.
2015: It is well-known that people can suffer from a variety of phobias defined as irrational fears of an object or situation. An individual will typically go great lengths to avoid various fear-inducing situations despite the fact that there is generally minimal or no actual danger associated with these objects or situations. One of the most common phobias is “arachnophobia” or the irrational fear of spider encounters.
Various psychotherapeutic techniques such as systematic desensitization can help a person cope with or overcome this type of phobia, but researchers wanted to investigate the effect of neurofeedback in potentially treating arachnophobia. In this study, they utilized fMRI neurofeedback, a newer technique that isn’t associated with targeting brain waves. MRI neurofeedback is associated with targeting activation of specific regions within the brain.
In other words, a person is hooked up to an fMRI machine and is trained to consciously regulate activity in certain parts of the brain that influence arachnophobia. The neurofeedback conducted targeted the left dorsolateral prefrontal cortex along with the right insula. This study involved a total of 18 females classified as having arachnophobia.
The study design was considered randomized, controlled, and single-blinded. The participants receiving neurofeedback targeted activation of the left dorsolateral prefrontal cortex and the right insula. Those assigned to serve as a control group were told to come up with their own “intuitive” coping strategy.
Results from the study showed that individuals receiving neurofeedback had lower levels of anxiety compared to the control group. Individuals receiving neurofeedback were able to consciously downregulate activation of the right insula (via cognitive reappraisal). Researchers noted that the effect from the fMRI neurofeedback was sustained long after the training, suggesting possible long-term therapeutic efficacy for the treatment of phobias.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/26106309
2014: A publication in 2014 analyzed the science of neurofeedback and noted that there is limited literature associated with this intervention. While the technique has been discussed for those with mood disorders, addiction, ADHD, traumatic brain injuries (TBIs), and anxiety disorders – the research is severely lacking. One proposed application of futuristic neurofeedback research is in predicting responses to medications.
By recording brain waves prior to treatment with a medication like an SSRI for anxiety and after a therapeutic response has been achieved, researchers will be able to document neuroelectrical changes. Perhaps EEG neurofeedback could help facilitate these neuroelectrical changes without the need of a pharmacological intervention. In any regard, QEEG analyses have potential to significantly improve psychiatric treatment outcomes for those with anxiety and other psychiatric conditions (e.g. depression).
- Source: http://www.ncbi.nlm.nih.gov/pubmed/24975621
2014: A case study was presented analyzing the efficacy of neurofeedback in treating symptoms associated with alcohol dependence syndrome. The individual was 39 years of age and was documented as having alcohol consumption problems spanning over 14 years. This individual experienced: poor sleep, aggression, abusive behavior, and was noted as having engaged in roaming-behavior.
Using a multi-channel device, this individual received 10 sessions of neurofeedback at intervals of 3 to 4 times per week. Each neurofeedback session was documented as lasting approximately 40 minutes. Before the training, the patient’s cognitive performance, depression, and anxiety symptoms were noted.
It is also important to note that the patient was taught a progressive relaxation technique to aid in self-directed ability to relax without the need of a therapist. Pre-treatment assessment with the Hamilton Anxiety Scale revealed that the patient’s anxiety scored an “11.” Following neurofeedback training, the patient’s anxiety had dropped to a “6” on the same test.
Based on previous research, alpha rhythm biofeedback training was effective at reducing State and Trait Anxiety scores compared to a control group. Therefore it shouldn’t come as much of a surprise that this individual experienced a noticeable reduction in anxiety from neurofeedback training. In addition to the anxiety reduction, his cognitive performance improved and depressive symptoms lessened.
Despite the fact that this study was aimed at investigating the efficacy of neurofeedback for alcohol dependence syndrome, the fact that this protocol also improved anxiety is promising. Those with anxiety may find that neurofeedback is an effective intervention, especially if anxiety is stemming from alcohol dependence. More research is necessary to expand upon the anxiolytic potential of neurofeedback.
- Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4361982/
2013: Researchers sought out to test whether fMRI neurofeedback could help individuals suffering from anxiety. The publication suggested that the goal of using fMRI neurofeedback was to alter brain connectivity patterns (as measured by resting-state fMRIs) to reduce contamination anxiety. The neural correlate associated with contamination anxiety is activity within the orbitofrontal cortex.
They then sought to target the orbitofrontal cortex by training individuals to alter connectivity patterns in this region. A total of 23 participants enrolled in the study, with 12 receiving neurofeedback, and 11 receiving a sham-neurofeedback treatment. By the end of the study, a total of 10 individuals had completed neurofeedback (four 90 minute sessions), while a matching 10 had completed the sham neurofeedback intervention.
The participants receiving neurofeedback learned how to consciously manipulate their orbitofrontal cortex activity. The neural changes stemming from fMRI neurofeedback appeared to be lasting rather than transient. The results showed decreased activity in areas of the brain associated with emotional processing including regions such as the insula, hippocampus, parahippocampus, the right amygdala, etc.
Increases in connectivity were noted in regions of the prefrontal cortex associated with cognitive control and regulation of emotions (e.g. the right lateral prefronal cortex). Those receiving neurofeedback had significant reductions in contamination anxiety compared to those who received the sham intervention. This study suggests that fMRI neurofeedback has significant [long-lasting] therapeutic potential for individuals with all types of anxiety.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/23632454
2012: In 2012 a study was published documenting the preliminary efficacy of “low energy” neurofeedback systems (LENS). This is a new form of neurofeedback that involves using invisible radio frequency waves that are approximately 4,000 times weaker than the radio-frequency waves emitting from your cell phone. This study specifically focused on determining the efficacy of LENS for stress, anxiety, and cognitive function among medical students.
Researchers conducted a double-blind, placebo-controlled, randomized study with 20 medical students ages 25 to 58. The 20 participants were divided into two groups: a LENS neurofeedback group (10 participants) or the sham-neurofeedback group (the other 10 participants). The neurofeedback sessions were conducted over a duration of 7 weeks. Prior to neurofeedback, participants’ level of stress, anxiety and cognitive function were measured with: Perceived Stress Scale (PSS), State and Trait Anxiety Inventory (STAI), Wechsler Abbreviated Scale of Intelligence (WASI), and others.
Results suggested no significant benefit from LENS (low energy neurofeedback systems) compared to the sham-neurofeedback intervention. Researchers note that a larger sample size is warranted to better understand the efficacy of LENS. This study provides evidence to suggest that LENS may not be an effective form of neurofeedback for anxiety, stress, or intelligence.
- Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3373531/
2011: In a study analyzing the efficacy of neurofeedback for depression, researchers proposed an evaluated a new treatment protocol focused on decreasing anxiety. They employed a traditional protocol of asymmetrical alpha training, which has shown promise in treating depression along with targeting theta/beta ratios in the left-prefrontal cortex. The newly proposed protocol also added the focus of downregulating Beta-3 rhythms.
The purpose of Beta-3 downregulation was to alleviate possible symptoms of anxiety that may occur with depression and/or ma contribute to depression. This newly devised protocol may provide relief to those suffering from anxiety and comorbid depression or vice-versa.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/21568194
2010: A study was designed to analyze the effect of EEG neurofeedback for the treatment of anxiety symptoms. This particular study was conducted in a military Command Hospital and included 100 patients with psychiatric conditions. Anxiety levels of all patients were recorded with the Hamilton Anxiety Scale and Taylor’s Manifest Anxiety Scale.
A total of 50 patients received alpha neurofeedback sessions 5 times per week for 8 weeks in addition to pharmaceutical treatments. The remaining 50 patients were treated solely with pharmaceutical anxiolytics. The level of anxiety in the 100 patients was recorded after 4 weeks, and after 8 weeks of treatment.
Results indicated that those dealing with mixed anxiety and depressive symptoms responded better to pharmaceutical interventions compared to neurofeedback. However, there was a notable difference between sexes in that female patients actually demonstrated superior responses to alpha neurofeedback compared to medication. Authors of the study concluded that alpha neurofeedback is nearly as effective as pharmaceutical drugs to treat anxiety symptoms, and may be most effective in females.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/22174533
2005: A review of neurofeedback’s efficacy for the treatment of anxiety and related disorders (e.g. OCD, PTSD, depression) was conducted in 2005. Researchers pointed out that neurofeedback has shown therapeutic promise and may serve as an alternative intervention for those who fail to respond to psychiatric drugs. It was noted that neurofeedback is non-invasive and isn’t associated with any significant side effects.
Some individuals with OCD were reported to have different patterns of brain activity including: excess alpha and frontal excess beta OR excess theta in frontal and posterior temporal regions. Among individuals with anxiety disorders, panic disorders, and PTSD – the left prefrontal cortex often is abnormally activated, with too much alpha activity; it is “stuck.” The report also highlighted several studies analyzing neurofeedback for treating phobias.
One study discovered that enhancing alpha rhythms had significant reductions in test anxiety compared to both a control group and a relaxation group. Neurofeedback is capable of increasing alpha production up to 78% in some individuals, and this significant increase is associated with significant decreases in anxiety. These anxiolytic benefits from neurofeedback extend well-beyond those derived from placebos.
At this time, researchers concluded that neurofeedback should be classified as a “possibly efficacious treatment.” There seems to be clear evidence that EEG neurofeedback can reduce anxiety levels, especially among those suffering from phobias. Increasing alpha rhythms and decreasing left prefrontal alpha may simultaneously improve mood while yielding an anxiolytic effect.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/15564054
2000: In the early 2000s, neurofeedback protocols were investigated for the treatment of anxiety disorders. Researchers noted that enhancing alpha rhythms, theta rhythms, or combined alpha-theta rhythms resulted in significant reductions of anxiety. Suppressing alpha waves was also noted as an effective intervention, but not as effective as the aforementioned interventions.
Authors of this report highlight the fact that research is necessary to determine neurofeedback efficacy compared to a placebo for the treatment of anxiety. They also suggested a need to study: various durations of treatment, focus on specific types of anxiety, the number of EEG sites and rhythms being targeted, and whether individuals are also taking medications. Despite these early recommendations, these differences still haven’t been thoroughly assessed due to lack of research.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/10638346
1977: In the late 1970s, researchers determined the effect of alpha rhythm neurofeedback among individuals with alcohol dependence. A total of 25 participants received neurofeedback and were compared to a matched control group that didn’t receive neurofeedback. Anxiety levels were recorded with the State-Trait Anxiety scale.
Neurofeedback sessions were performed for 10 hours at a time. The group of individuals receiving alpha rhythm neurofeedback were able to produce more alpha wave activity than the control groups. They also were noted as improving more on the measures of anxiety as indicated by the State-Trait Anxiety scale.
The alpha rhythm training was considered efficacious for the treatment of anxiety, but failed to treat other comorbidities. Researchers suggest that the improvements in anxiety could be related to a placebo effect. That said, this study provided some preliminary evidence to suggest neurofeedback may be beneficial for those with anxiety.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/13088
Does the research suggest neurofeedback is safe and effective for anxiety?
The majority of research analyzing the effect of neurofeedback for the treatment of anxiety has shown promise. It appears that both EEG neurofeedback and fMRI neurofeedback are effective options for reduction various types of anxiety. While this article is focused mostly on EEG neurofeedback, it is important to consider the therapeutic potential of fMRI neurofeedback – especially when considering it could be combined with EEG-based interventions in the future.
No study reported significant neurofeedback side effects or adverse reactions, indicating that the technique is likely safe. The only study failing to find significant benefit was one that incorporated LENS (low energy neurofeedback systems) which is a lesser-utilized form of neurofeedback. Most evidence suggests that protocols stimulating increases in alpha production are helpful for anxiety.
Potential Benefits of Neurofeedback for Anxiety
There are many potential benefits associated with utilizing neurofeedback for anxiety. The most notable benefits include: developing the ability to consciously regulate brain waves, reducing anxiety without the usage of drugs, and the possibility of a sustained anxiolytic effect over a long-term.
- Brain wave regulation: Shifting brain waves in certain regions (sites) of your brain is not a conscious skill that can be developed without some sort of feedback. You don’t know what electrical activity is occurring in certain regions of your brain without an EEG. An EEG neurofeedback system teaches you to regulate your brain waves in certain regions to reduce symptoms of anxiety.
- Less reliant on medications: Many people with anxiety disorders are reliant on medications. Not only do these medications cost money, but they take a toll on our neurophysiology over an extended period of time. For example, it is known that long-term usage of benzodiazepines is linked to dementia and permanent memory impairment (many are dangerous psychiatric drugs). By targeting your anxiety with a non-pharmaceutical intervention, you don’t need to worry about side effects.
- Low risk: While poor neurofeedback training has potential to inflict harm (e.g. training the wrong rhythm and/or site), working with an experienced practitioner will reduce risk of adverse effects. Compared to pharmaceutical drugs, there are no known long-term risks associated with neurofeedback.
- Neurotransmission: It should be considered highly plausible that alteration of electrical activity within the brain influences neurotransmitter levels. Since the body and brain are complex systems, altering electrical activity may influence arousal and ultimately change concentrations of neurotransmitters and hormones.
- Non-drug intervention: Many people taking pharmaceutical drugs for anxiety don’t like the side effects nor the discontinuation symptoms. Neurofeedback isn’t associated with any severe side effects nor debilitating withdrawals. This is a non-drug intervention that targets a unique (potential) cause of anxiety (brain waves).
- Regional regulation: Utilizing fMRI neurofeedback, people can learn how to alter regional activation and connectivity. Preliminary research suggests that fMRI neurofeedback is highly effective in treating those with various types of phobias (irrational fears). Results indicate that individuals can learn to consciously control brain connectivity and significantly reduce anxiety.
- Sustained efficacy: Neurofeedback is associated with sustained long-term efficacy. In other words, once you learn how to consciously alter your brain waves and/or regional activation, you don’t forget this skill. You may need to brush up on the skill every so often, but follow-up evidence has revealed that efficacy of neurofeedback in treating anxiety is maintained.
- Targeting electrical activity: Most people falsely assume that the only aspect of a psychiatric condition (e.g. anxiety) that can be targeted is “chemical-based.” Targeting neurochemistry does not always need to be done with pills aimed to elevate or decrease concentrations of neurotransmitters. Altering neuroelectrical activity with neurofeedback serves as a unique, alternative intervention.
Limitations of Existing Research: Neurofeedback for Anxiety
There are many limitations associated with neurofeedback research. To get a better understanding of whether neurofeedback is effective for anxiety, it is important to consider these limitations in future research. Examples of various limitations include: differences in training protocols, subtypes of anxiety, and differences in type of neurofeedback.
- Anxiety measures: It would be beneficial to utilize a similar set of primary and secondary measures for anxiety. These measures should be specific to the type of anxiety being studied. For a group of individuals suffering from social phobia, a social phobia-specific evaluation should be utilized whereas those suffering from generalized anxiety would be evaluated with different measures.
- Anxiety subtypes: There are many different subtypes of anxiety, and even among individuals with a specific subtype (e.g. social anxiety) there may be variation in brain wave activity. The variation among those with a specific subtype means that neurofeedback protocols may need to be tweaked to fit those with a particular subtype.
- Individual differences: It is also important to consider individual differences even among multiple individuals with the same type of anxiety (e.g. social phobia). These individuals may fit the same diagnosis, but have different brain wave abnormalities. Therefore an emphasis for utilizing QEEG (quantitative electroencephalograph) readings to personalize treatment should be considered essential. Most current research fails to address individualized neuroelectrical differences.
- Lack of research: While there is some evidence to support the efficacy of neurofeedback for anxiety, there isn’t a lot. Most of this research is considered small-scale to the point that clinical efficacy cannot be fully established. While most findings suggest that neurofeedback provides benefit for those with anxiety – these findings have yet to be replicated with larger scale studies.
- Participants: The participants in studies analyzing neurofeedback for anxiety tend to be different in terms of age and diagnoses. It is important to determine whether neurofeedback may be more effective for certain age groups, sexes, etc. – compared to others.
- Sample sizes: Most studies incorporate a small number of participants. The fact that nearly every study is small-scale, results cannot be considered as significant as those that would be derived from a larger-scale trial. Studies in the future should utilize significantly more participants so that results garner heightened credibility.
- Study designs: Designs utilized for most neurofeedback studies are not randomized, placebo-controlled, and double-blinded. In order for a therapeutic technique to gain credibility, it needs to be put through rigorous testing with a stringent design. In the future, stricter designs should be implemented with larger samples.
- Training protocols: There are many potentially therapeutic neurofeedback protocols for anxiety. Some of these protocols involve increasing slow waves such as alpha and theta, while others may attempt to reduce high beta. It is important to determine whether certain protocols are more universally effective (or safer) than others, and also whether personalized neurofeedback based on QEEG readings is superior than devised protocols for anxiety.
- Types of neurofeedback: There are many different types of neurofeedback. This article primarily focused on EEG-based neurofeedback, but documented results from a couple fMRI neurofeedback studies. Types of neurofeedback should be compared in terms of efficacy and/or investigated for potential synergistic efficacy in the treatment of anxiety.
Will neurofeedback cure your anxiety?
Neurofeedback may not serve as a natural cure for anxiety, but it has significant potential to alleviate symptoms. Many people think that they can only treat their anxiety with pharmaceutical drugs, but this perspective is short-sighted. Anxiety disorders are generally subject to significant individual variation and symptoms vary based on the specific type of anxiety and person.
Nearly every person with anxiety is likely to have brain wave abnormalities (or connectivity abnormalities). Anxiety disorders are complex in that they are influenced by: genetics/epigenetics, regional abnormalities, environment, nutrition, and electrical activity (brain waves). For some people, brain wave abnormalities may be a bigger contributing component to anxiety compared to others.
By utilizing various forms of neurofeedback (EEG, fMRI, etc.), these abnormalities can be corrected, thus helping reduce anxiety symptoms. For some people, the relief will be so profound, that they’ll view neurofeedback as a “cure.” For other individuals, neurofeedback will provide symptomatic relief, but they won’t feel “cured.”
Another group of people may find that neurofeedback provides no significant relief. It’s all chalked up to individual variation, the competency of the neurofeedback practitioner, and whether your anxiety is significantly influenced by brain waves.
Are all neurofeedback protocols for anxiety the same?
No, not all neurofeedback protocols for anxiety are the same. While many focus on increasing alpha waves, some individuals with anxiety may have excess alpha activity in certain regions such as the left prefrontal cortex. Assuming that all neurofeedback protocols for a particular diagnosis should be the same is extremely problematic.
To get a better understanding of a person’s neuroelectrical activity, a neurofeedback practitioner should always conduct a QEEG (both eyes-open and eyes-closed). A QEEG will determine a person’s unique brain wave signature and will help a practitioner understand regions and brain waves that are most likely contributing to feelings of anxiety. Without a QEEG, a practitioner is completely “guessing” as to what brain waves (at certain sites) are likely to provide most substantial benefit.
- Alpha waves: Many people with anxiety benefit from protocols training the production of alpha rhythms. An increase in alpha rhythms is usually associated with an increase in both physical and psychological relaxation. It should be mentioned that some individuals with anxiety struggle with excess alpha activity (particularly in the left prefrontal region).
- Theta waves: In some cases, uptraining (increasing) theta waves is beneficial for anxiety. Increasing both alpha and theta in a combined training protocol may also provide some benefit for those suffering from anxiety. If alpha blocking occurs, anxiety may be heightened in some individuals, but may also worsen depending on the region and individual.
- Beta waves: Individuals with anxiety tend to overproduce beta frequencies. Excess beta waves throughout the brain can cause many different types of anxiety. By reducing certain frequencies within the beta range (e.g. Beta-3), a person may feel noticeably less anxious.
Can neurofeedback reduce the need for anti-anxiety medications?
Some people may notice a decreased need for pharmaceutical anxiolytic medications following neurofeedback. This could be due to the fact that correction of abnormal brain waves significantly reduced the individual’s level of anxiety. Some people may find that their anxiolytic drugs provide increased “kick” after they’ve completed neurofeedback training.
This could be due to the fact that the neurofeedback is working in synergy with the medication: the neurofeedback corrected brain waves, while the medication provided chemical relief. It should also be considered that neurofeedback training elicited a cascade effect on arousal that in turn altered production of neurotransmitters. Therefore a person may experience greater effect from their medication following neurofeedback.
Some people may even be able to discontinue their medication as a result of dramatic reductions in anxiety symptoms as a result of neurofeedback. While many people assume that their medication “tolerance” has been reduced from neurofeedback, this is unlikely to have occurred. What really occurred is likely to have been an increase in anxiolytic effects from neurofeedback, resulting in subjectively interpreted tolerance reduction.
Have you used neurofeedback for anxiety?
If you’ve engaged in neurofeedback training in effort to reduce anxiety, be sure to share your experience in the comments section below. Mention the type of anxiety you had, whether a QEEG was conducted prior to training (and what it showed). Also note thing like: the number of neurofeedback sessions you endured (and the length), the specific protocol implemented for your anxiety (e.g. brain waves targeted and sites), and whether you noticed significant improvement.