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Statistics show that approximately 30% of adults have experienced anxiety-related symptoms at least once in their lives. In fact, it has been confirmed that in 2019, 301 million people were diagnosed with anxiety disorders. Studies have also shown that they are more common in women, while the symptoms often appear during childhood or adolescence.

While anxiety is typically treated with psychotherapy and medication, therapists and scientists are currently investigating the possibility of using other methods as alternatives. As such, today we'll discuss the potential of neurofeedback for anxiety.

Key Takeaways

• Neurofeedback therapy is a non-invasive method that helps individuals retrain their brainwave patterns to alleviate symptoms of anxiety, often requiring at least 20 sessions for optimal results.

• Anxiety disorders can significantly disrupt daily life, so neurofeedback targets underlying brainwave dysfunctions to promote emotional regulation and improve overall well-being.

• Research has shown that neurofeedback can provide long-term relief from anxiety symptoms with minimal side effects, so it may be an effective alternative or complementary therapy to conventional anxiety treatment.

What Is Neurofeedback?

Neurofeedback therapy is a non-invasive biofeedback method that is targeted at brain activity in order to help individuals balance their brainwave patterns - or, in other words, learn how to change their reactions for the better based on real-time feedback.

Conventionally, neurofeedback is done through Electroencephalography (EEG), which implies the use of electrodes placed on one's scalp. But this is not the only neurofeedback technology - fNIRS and fMRI are equally effective, except that they measure the patient's blood flow and oxygenation instead of brainwaves.

Yet again, conventionally, neurofeedback is performed only in clinical settings. However, thanks to technological progress, it can also be done at home using various consumer-grade neurofeedback devices. But there's an important thing to consider - at-home devices are not medical devices and should not replace medical treatment. If you plan to use neurofeedback for anxiety, you should only do so under the supervision of a healthcare professional experienced in administering neurofeedback therapy. We'll get into more details about this below.

How Does Neurofeedback Work?

The science behind neurofeedback is called operant conditioning, which is basically the ability to change our behavior by associating it with positive or negative outcomes. It is believed that we are much more inclined to repeat actions linked to a positive outcome, and that's exactly what neurofeedback teaches us. Moreover, neurofeedback also works thanks to the brain's neuroplasticity - the ability to reorganize and adapt.

Here's an example. Before your neurofeedback session, which is aimed at improving your stress response, the therapist places the EEG sensors on your scalp. These sensors monitor the electrical activity in your brain, meaning your brainwaves (you'll learn more about them below). Then, you need to engage in some kind of activity - let's suppose you'll be watching a video. When you get too tense, the sensors register an increase in a particular brainwave, and the movie stops. It starts again only when you relax and that particular brain wave activity is reduced. This way, you associate relaxation with a positive outcome, and you're more likely to reproduce it in the future.

What Are Brainwaves?

Brainwaves are electrical impulses produced in our central nervous system, activated by the millions of neurons that communicate with each other.

There are five types of brain waves, and each is associated with different states and feelings. This is why analyzing brainwave patterns can be a useful tool in managing various mental health conditions, including anxiety. As such, these are the five types of brainwaves:

• Delta waves, which are activated when we're asleep; they are associated with deep relaxation and recovery.

• Theta waves, which are activated when we're deeply relaxed and feeling sleepy.

• Alpha waves, which are activated when we're calm and relaxed but fully awake.

• Beta waves, which are activated when we're alert and mentally engaged in an activity.

• Gamma waves, which are activated when we're extremely focused.

We'll explain in a bit why these brain waves matter so much when neurofeedback is used for anxiety, but first - let's define anxiety and discuss what physiological reactions it causes.

What Is Anxiety?

Anxiety is a natural response to stress. It is a natural feeling of fear and uneasiness, causing people to sweat, feel extremely tense, and experience a rapid heartbeat. You may feel anxious:

• Before a work interview

• Before taking a test

• Before an important event in your life

• When you have a problem that needs to be solved

Feeling anxious once in a while is absolutely normal. When this feeling doesn't go away, occurs too frequently, is extremely intense, or appears in regard to everyday situations, anxiety takes a different form and becomes an anxiety disorder. Anxiety disorders include:

• Generalized anxiety disorder

• Specific phobias

• Separation anxiety disorder

• Social anxiety disorders

...and others. These conditions can interfere with people's daily activities and negatively impact their relationships with others, as well as their self-worth. Patients with moderate to severe anxiety often report quality-of-life impairments greater than those associated with chronic physical conditions. These disorders can stem from various factors, including genetics, brain chemistry, and life experiences. They are also a higher risk for people with certain personality traits or physical health conditions like thyroid problems.

Anxiety Symptoms and Brain Wave Activity

Each person reacts differently to anxiety, but the most common symptoms are:

• Rapid heart rate, which is caused by the activation of the sympathetic nervous system that regulates the release of adrenaline and cortisol from the adrenal glands.

• Breathing problems, which can intensify during a panic attack

• Increase in blood pressure

• Dizziness

• Pale skin caused by reduced blood flow

• Muscle aches and other physical pain, caused by your preparedness to withstand a possible threat

• Irritability

• Extreme fatigue and poor sleep

• Upset stomach

Science has shown that people suffering from anxiety disorders have a hyperactive limbic system, which consists of brain structures that produce instincts like the need to eat, drink, and reproduce. The amygdala is part of the limbic system, and it plays a role in the way we experience emotions. The amygdala also controls the fight-or-flight response. It is extremely useful in emergencies but detrimental when activated in normal situations that otherwise wouldn't be perceived as threatening. In other words, in patients with an anxiety disorder, the amygdala basically gets stuck in this high-alert state.

When this fight-or-flight response is activated, the brain produces high beta waves, which are linked to agitation and anxiousness, and decreased alpha; theta and delta waves are usually low in patients with anxiety. In this case, the therapeutic approach is to increase alpha brain waves.

Does Neurofeedback Actually Work for Anxiety?

Now that we've covered everything we need to know about neurofeedback and anxiety, we return to the question that is of interest to us - does neurofeedback training help with anxiety? The short answer is - yes, neurofeedback can potentially help with anxiety. Let's see how!

Before starting neurofeedback - at a clinic, that is, because it is not recommended to do neurofeedback for anxiety without the supervision of a specialist - you'll likely get a brain map (qEEG), which is basically a map of your brain wave activity. This is an important tool that helps your therapist find the dysregulation in your brain. Based on your brain map, the therapist will elaborate a neurofeedback protocol that targets specific brainwaves. These steps are of the essence for optimal results.

As such, during your neurofeedback sessions, which last approximately 30 minutes, the real-time feedback you'll get will be based on that protocol, this way targeting exactly what needs to be balanced. After an average of 20-40 sessions (depending on your protocol), you may be able to control brain activity (thus reduce anxiety) without any neurofeedback equipment.

Naturally, this is what the science says - ultimately, each patient is different, and each patient reacts differently to neurofeedback, which is why it may not be the best solution for everyone. Or, at least, it should only be performed as a complementary therapy. Plus, the outcome is directly linked to the therapist's experience in the field, so it's of the essence to work with a qualified professional.

Neurofeedback for Anxiety - Scientific Evidence

Here are the results of some studies focused on neurofeedback therapy for anxiety:

• The authors of "Neurofeedback Treatment for Depression and Anxiety" concluded that drug treatments are "only mildly more effective than placebo" for patients with anxiety, and neurofeedback has the potential to become an alternative therapy.

• A study has reported that two patients diagnosed with anxiety disorders were symptom-free one year after finishing a 30-session neurofeedback treatment.

• A study published in 2017 concluded that the use of frontal alpha asymmetry neurofeedback can be associated with a reduction of symptoms of anxiety.

• A study published in 2012 focuses on understanding if neurofeedback can be used to reduce anxiety in elite female swimmers. The authors concluded that this therapy is indeed effective.

• A study published in 2016 focuses on understanding if neurofeedback can help reduce anxiety in cancer patients. The participant had been previously diagnosed with pelvic cancer and had undergone 20 neurofeedback sessions during which anxiety was measured. Noteworthy improvements in symptoms were observed both during and after the sessions.

Other Types of Neurofeedback for Anxiety

Besides EEG neurofeedback, there are also functional near-infrared spectroscopy (fNIRS) neurofeedback and functional magnetic resonance imaging (fMRI) neurofeedback. Both technologies focus on measuring blood flow and oxygenation instead of brainwaves. This method is just as effective as EEG; it simply focuses on measuring a different type of brain activity. fNIRS and fMRI are usually used only for research purposes because they can be quite expensive as treatments.

While research on the effects of fNIRS and fMRI technologies on patients with anxiety is limited, there's definitely potential. For example, one study concluded that fMRI can have a facilitating effect on anxiety regulation in people with spider phobia. Another study discusses the effects of fNIRS targeting the dorsolateral prefrontal cortex in patients with social anxiety disorder and concludes that it can be useful in managing social anxiety symptoms.

Benefits of Neurofeedback for Anxiety Disorders

Neurofeedback therapy offers several benefits for patients diagnosed with anxiety disorders:

• It is a non-invasive, medication-free method. Unlike medication, which can have multiple side effects, neurofeedback helps individuals learn to regulate their emotional responses without the need for pharmaceuticals.

• It can provide long-term symptom relief. Some studies have shown that patients were symptom-free even one year after completing neurofeedback sessions.

• It can enhance overall well-being and cognitive functions since neurofeedback is not used only for anxiety. It is also used as a wellness practice that helps people regulate their emotions, manage stressful situations better, and even improve sleep patterns.

• It has few to no side effects as long as it's performed correctly and the protocol is adjusted accordingly.

Combining Neurofeedback with Other Therapies

Neurofeedback is most effective when used alongside other therapies in a comprehensive approach to treating anxiety. For example, patients can use other types of biofeedback besides EEG neurofeedback. Biofeedback helps them learn more about other physical symptoms like increased heart rate, elevated body temperature, and muscle tension.

Cognitive behavioral therapy (CBT) is an effective psychological therapy that helps patients alleviate symptoms associated with anxiety. It focuses on changing the patient's thinking patterns. For instance, during CBT, you may learn to recognize the thoughts that make you feel anxious and reevaluate them.

Last but not least, anxiety disorders can also be treated with medication, including antidepressants, which should be prescribed by your doctor.

Don't forget about other coping strategies, like breathing exercises, the 333 rule (identifying 3 objects, 3 sounds, and moving 3 body parts), meditation, yoga, and exercising.

Can You Use At-Home Neurofeedback Devices for Anxiety?

You should not use at-home neurofeedback devices to treat anxiety-related symptoms without talking to your doctor. These wearable devices are designed to be used for wellness practices. Most are not medical devices and do not substitute medical advice and treatment.

Having said that, at-home neurofeedback devices like Mendi are useful for people who want to improve overall well-being. At-home neurofeedback can be beneficial for those experiencing occasional anxiety in various moments of their life by helping them enhance their emotion regulation abilities and stress management skills.

Frequently Asked Questions

What is the 3-3-3 rule for anxiety?

The 333 rule for anxiety can help you stay in the moment when you're feeling anxious. You have to identify 3 objects around you, then 3 sounds. Ultimately, move 3 body parts. This will prevent anxious feelings from overwhelming you.

How many neurofeedback sessions do you need for anxiety?

It is estimated that patients diagnosed with anxiety may need at least 25-30 sessions for long-term effects. This number highly depends on the treatment protocol, which may be adjusted in the process.

Does brain mapping help with anxiety?

Brain mapping can help with anxiety because it tells your therapist more about the dysregulation in your brain wave patterns. This helps establish a personalized neurofeedback protocol.

How does neurofeedback help with anxiety?

Neurofeedback assists in alleviating anxiety by correcting dysfunctional brain patterns and fostering a balanced state, ultimately modifying the brain's electrical activity associated with anxiety for lasting relief.

Are there any side effects of neurofeedback therapy?

Neurofeedback therapy generally has minimal side effects, thus being regarded as a safer alternative to medication for anxiety relief. However, the neurofeedback protocol must be adjusted for your particular needs.

Can neurofeedback be combined with other therapies?

Yes, neurofeedback can be effectively combined with therapies such as biofeedback and cognitive behavioral therapy (CBT) to improve treatment outcomes. This integrated approach offers a more comprehensive strategy for managing mental disorders like anxiety or post-traumatic stress disorder.