Anxiety, PTSD and Panic Disorders

Hammond, D. C. (2003). QEEG-guided neurofeedback in the treatment of obsessive compulsive disorder. Journal of Neurotherapy, 7(2), 25-52. Introduction. Blinded, placebo-controlled research (e.g., Sterman, 2000) has documented the ability of brainwave biofeedback to recondition brain wave patterns. Neurofeedback has been used successfully with uncontrolled epilepsy, ADD/ADHD, learning disabilities, anxiety, and head injuries. However, nothing has been published on the treatment of obsessive-compulsive disorder (OCD) with neurofeedback. Method. Quantitative EEGs were gathered on two consecutive OCD patients who sought treatment. This assessment guided protocol selection for subsequent neurofeedback training. Results. Scores on the Yale-Brown Obsessive-Compulsive Scale and the Padua Inventory normalized following treatment. An MMPI was administered pre-post to one patient, and she showed dramatic improvements not only in OCD symptoms, but also in depression, anxiety, somatic symptoms, and in becoming extroverted rather than introverted and withdrawn. Discussion. In follow-ups of the two cases at 15 and 13 months after completion of treatment, both patients were maintaining improvements in OCD symptoms as measured by the Padua Inventory and as externally validated through contacts with family members. Since research has found that pharmacologic treatment of OCD produces only very modest improvements and behavior therapy utilizing exposure with response prevention is experienced as quite unpleasant and results in treatment dropouts, neurofeedback appears to have potential as a new treatment modality. 

 

Hardt, J. V., & Kamiya, J. (1978). Anxiety change through electroencephalographic alpha feedback seen only in high anxiety subjects. Science, 201, 79-81. Subjects who were either high or low in trait anxiety used alpha feedback to increase and to decrease their electroencephalographic alpha activity. The alpha changes were tightly linked to anxiety changes, but only in high anxiety subjects (for whom anxiety was reduced in proportion to alpha increases, and was increased in proportion to alpha suppression). Low trait-anxiety subjects were superior at both enhancement and suppression training, but their alpha changes were not related to anxiety changes. In both groups, anxiety changes were generally unrelated to either resting levels or changes in frontalis electromyograms and respiration rate. These results suggest that long-term alpha feedback training (at least 5 hours) may be useful in anxiety therapy. 

Huang,-Storms, L., Bodenhamer-Davis, E., Davis, R., & Dunn, J. (2006). QEEG-guided neurofeedback for children with histories of abuse and neglect: Neurodevelopmental rationale and pilot study. Journal of Neurotherapy, 10(4), 3-16. Background. Poor self-regulation of arousal is central to the behavioral difficulties experienced by children with traumatic caretaker attachment histories. EEG biofeedback teaches children to self- regulate brain rhythmicity, which may in turn affect global improvements in the areas of attention, aggression, impulse control, and trust formation. Research literature reports successful use of neurofeedback for children with ADHD, autism, asthma, stroke, and migraine. This study extends current research by investigating the effectiveness of neurofeedback in reducing behavioral problems commonly observed in abused/neglected children. Methods. Treatment records of twenty adopted children with histories of removal from their biological home by Child Protective Services were obtained from a private neurofeedback practice. All of the children were assessed prior to treatment using the Child Behavior Checklist (CBCL) and the Test of Variables of Attention (TOVA) and again after 30 sessions of individualized, qEEG-guided neurofeedback. Results. T-test analysis of pre- and post-scores on the CBCL showed significant changes in the areas of externalizing problems, internalizing problems, social problems, aggressive behavior, thought problems, delinquent behavior, anxiety/depression, and attention problems (p < .05). TOVA omission error, commission error, and variability scores also improved significantly following neurofeedback training (p < .05). Some pre-treatment qEEG patterns common to this group of children were identified. Conclusions. The CBCL and TOVA score improvements observed in this study indicate that neurofeedback is effective in reducing behavioral, emotional, social, and cognitive problems in children with histories of neglect and/or abuse. 

Kerson, C., Sherman, R.A., Kozlowski, G.P. (2009). Alpha suppression and symmetry training for generalized anxiety disorders. Journal of Neurotherapy,13(3) 146-158. Alpha suppression and symmetry training for generalized anxiety symptoms. Journal of Neurotherapy 13(3), 146 – 155. Introduction. Twenty-eight anxious adults were assessed for frontal lobe alpha asymmetry, a brain state associated with depression and anxiety. Fifteen of the 28 exhibited significant asymmetry and 12 agreed to participate in a biofeedback program addressed at reducing frontal alpha asymmetry. Method. The program consisted of earlobe temperature biofeedback (ETB) and two forms of neurofeedback, alpha suppression and alpha symmetry training. Individuals were instructed to warm their right earlobe for six sessions, and half succeeded, though success was not required to advance to the next stage of training. For subsequent EEG training, two anterior sites were selected on the basis of poor alpha coherence. Individuals were trained to reduce alpha magnitude at these sites by 10% for 30 min or more, which took from 6 to 16 sessions to achieve. Once successful with alpha suppression, individuals were trained to improve alpha symmetry between the sites by 15% for 30 min or more. Results. This feat took 8 to 32 sessions to achieve, and eventually all eight individuals were able to reduce alpha asymmetry. The State–Trait Anxiety Inventory (STAI) was used to measured anxiety levels after each training type and both state and trait scores significantly improved by a 6-month follow-up. Conclusion. Participants also completed a daily shortened version of the STAI, which indicated that anxiety improved after neurofeedback but not after ETB. 

Kleutsch, RC., Ros, T., Theberge, J., Frewen, PA., Calhoun, VD., Schmal, C., Jetly, R. & Lanius, RA. (2014). Plastic modulation of PTSD resting state networks and subjective wellbeing by EEG neurofeedback. Acta Psychiatry Scand Aug:130(2). 123-36. OBJECTIVE: Electroencephalographic (EEG) neurofeedback training has been shown to produce plastic modulations in salience network and default mode network functional connectivity in healthy individuals. In this study, we investigated whether a single session of neurofeedback training aimed at the voluntary reduction of alpha rhythm (8-12 Hz) amplitude would be related to differences in EEG network oscillations, functional MRI (fMRI) connectivity, and subjective measures of state anxiety and arousal in a group of individuals with post-traumatic stress disorder (PTSD). METHOD: Twenty-one individuals with PTSD related to childhood abuse underwent 30 min of EEG neurofeedback training preceded and followed by a resting-state fMRI scan. RESULTS: Alpha desynchronizing neurofeedback was associated with decreased alpha amplitude during training, followed by a significant increase (‘rebound’) in resting-state alpha synchronization. This rebound was linked to increased calmness, greater salience network connectivity with the right insula, and enhanced default mode network connectivity with bilateral posterior cingulate, right middle frontal gyrus, and left medial prefrontal cortex. CONCLUSION: Our study represents a first step in elucidating the potential neurobehavioral mechanisms mediating the effects of neurofeedback treatment on regulatory systems in PTSD. Moreover, it documents for the first time a spontaneous EEG ‘rebound’ after neurofeedback, pointing to homeostatic/compensatory mechanisms operating in the brain. 

Kopřivová J, Congedo M, Raszka M, Praško J, Brunovský M, Horáček J. (2013). Prediction of treatment response and the effect of independent component neurofeedback in obsessive-compulsive disorder: a randomized, sham- controlled, double-blind study. Neuropsychobiology. 2013;67(4):210-23. doi: 10.1159/000347087. Epub 2013 Apr 27. Aims: The goal of this study was to assess the effect of independent component neurofeedback (NFB) on EEG and clinical symptoms in patients with obsessive-compulsive disorder (OCD). Subsequently, we explored predictors of treatment response and EEG correlates of clinical symptoms. Methods: In a randomized, double-blind, parallel design, 20 inpatients with OCD underwent 25 sessions of NFB or sham feedback (SFB). NFB aimed at reducing EEG activity in an independent component previously reported abnormal in this diagnosis. Resting-state EEG recorded before and after the treatment was analyzed to assess its posttreatment changes, relationships with clinical symptoms and treatment response. Results: Overall, clinical improvement in OCD patients was not accompanied by EEG change as assessed by standardized low-resolution electromagnetic tomography and normative independent component analysis. Pre- to posttreatment comparison of the trained component and frequency did not yield significant results; however, in the NFB group, the nominal values at the down trained frequency were lower after treatment. The NFB group showed significantly higher percentage reduction of compulsions compared to the SFB group (p = 0.015). Pretreatment higher amount of delta (1-6 Hz) and low alpha oscillations as well as a lower amount of high beta activity predicted a worse treatment outcome. Source localization of these delta and high beta oscillations corresponded with previous EEG resting-state findings in OCD patients compared to healthy controls. Conclusion: Independent component NFB in OCD proved useful in percentage improvement of compulsions. Based on our correlation analyses, we hypothesize that we targeted a network related to treatment resistance. 

 

Mills, G. K., & Solyom, L. (1974). Biofeedback of EEG alpha in the treatment of obsessive ruminations:An exploration. Journal of Behavior Therapy & Experimental Psychiatry, 5,37-41. The enhancement of EEG Alpha through various meditative techniques and biofeedback has been shown to correlate with alterations in mental as well as muscular activity towards a state of relaxation. We thought that such mental relaxation might be reciprocally inhibitory to ruminative activity characteristic of the obsessive neurotic. Five ruminating obsessives were given 7—20 biofeedback training sessions to learn control of EEG Alpha. Results indicate that (1) some obsessives can learn EEG control; (2) special augmented instructions seem no better than standard, minimal instructions in aiding Alpha; (3) subjective states during Alpha are reported as relaxed, daydreaming and not thinking; and (4) although difficult to generalise beyond the feedback situation, virtually no ruminations occur during Alpha regardless of the amount of Alpha produced. Further study is indicated before a treatment program can be considered.

Moore, N. C. (2000). A review of EEG biofeedback treatment of anxiety disorders. Clinical Electroencephalography, 31(1), 1-6. Alpha, theta and alpha-theta enhancements are effective treatments of the anxiety disorders (Table 1). Alpha suppression is also effective, but less so (Table 2). Perceived success in carrying out the task plays an important role in clinical improvement. Research is needed to find out how much more effective they are than placebo, and which variables are important for efficacy. Variables needing study are: duration of treatment, type and severity of anxiety, number and type of EEG waveforms used, pretreatment with other kinds of feedback, position and number of electrodes, and presence of concomitant medication.

Peeters, F., Ronner, J., Bodar, L., van Os, J. & Louisberg, R. (2013). Validation of a neurofeedback paradigm: Manipulating frontal EEG alpha-activity and its impact on mood. Int J Psychophysiol. doi: 10.1016/j.ijpsycho.2013.06.010. It is claimed that neurofeedback (NF) is an effective treatment for a variety of psychiatric disorders. NF, within an operant conditioning framework, helps individuals to regulate cortical electroencephalographic (EEG) activity while receiving feedback from a visual or acoustic signal. For example, changing asymmetry between left and right frontal brain alpha activity by NF, is claimed to be an efficacious treatment for major depressive disorder. However, the specificity of this intervention in occasioning electrophysiological changes at target locations and target wave-frequencies, and its relation to changes in mood, has not been established. During a single session of NF, it was tested if the balance between left and right frontal alpha-activity could be changed, regardless of direction, in 40 healthy females. Furthermore, we investigated whether this intervention was electrophysiologically specific and if it was associated with changes in mood. Participants were able to decrease or increase frontal alpha-asymmetry during the intervention. However, no changes in mood were observed. (Note from bibliographer: one session would rarely provide changes in behavior). Changes in EEG activity were specific in terms of location and wave-frequency.

Peniston, E. G., & Kulkosky, P. J. (1991). Alpha-theta brainwave neuro-feedback therapy for Vietnam veterans with combat- related post-traumatic stress disorder. Medical Psychotherapy, 4, 47-60. The Minnesota Personality Inventory (MMPI) was used to assess personality changes in Vietnam combat veterans with PTSD after either traditional medical treatment (TC) or alpha- theta brainwave neuro-feedback therapy (BWT). Application of brainwave training for thirty 30-minute sessions resulted in decreases in MMPI T-scores on clinical scales labeled hypochondriasis, depression, hysteria, psychopathy, deviate masculinity- femininity, paranoia, psychasthenia, schizophrenia, hypomania and social introversion-extroversion. The traditional medical control group showed decreases in T-scores only on the scale labeled schizophrenia. All 14 BWT patients initially receiving psychotropic medication reduced their dosages after treatment, but only one of thirteen TC patients reduced dosage. A thirty- month follow up study showed that all fourteen TC patients had relapsed, in contract to only three of fifteen BWT patients. These findings indicate that application of alpha-theta brainwave training is a more efficacious treatment modality in the treatment of PTSD and preventative of relapse.

Raymond, J., Varney, C., Parkinson, L. A., & Gruzelier, J.H. (2005). The effects of alpha/theta neurofeedback on personality and mood. Brain Research & Cognitive Brain Research, 23(2-3), 287-292. Alpha/theta neurofeedback has been shown to be successful both in treating addictions and in enhancing artistry in music students. How its effects are mediated are not yet clear. The present study aimed to test the hypothesis that alpha/theta neurofeedback works inter alia by normalizing extreme personality and raising feelings of wellbeing. 12 participants with high scores for Withdrawal (as measured by the PSQ) were given either alpha/theta neurofeedback or mock feedback and their personality and mood were assessed. Withdrawal scores on the PSQ-80 were not found to change in either group but significant effects were found for the Profile Of Mood States (POMS), with real feedback producing higher overall scores than mock feedback (P = 0.056). Real feedback caused participants to feel significantly more energetic (P < 0.01) than did mock feedback. Sessions of real feedback made participants feel more composed (P < 0.01), agreeable (P < 0.01), elevated (P < 0.01) and confident (P < 0.05), whilst sessions of mock feedback made participants feel more tired (P < 0.05), yet composed (P < 0.01). These findings suggest that, whilst 9 sessions of alpha/theta neurofeedback was insufficient to change personality, improvements in mood may provide a partial explanation for the efficacy of alpha/theta neurofeedback.

 

Rice, K. M., Blanchard, E. B., & Purcell, M. (1993). Biofeedback treatments of generalized anxiety disorder: Preliminary results. Biofeedback & Self-Regulation, 18, 93-105. Forty-five individuals with generalized anxiety (38 with GAD as defined by DSM-III) were randomized to 4 treatment conditions or a waiting list control. Patients received 8 sessions of either frontal EMG biofeedback, biofeedback to increase EEG alpha, biofeedback to decrease EEG alpha, or a pseudomeditation control condition. All treated subjects showed significant reductions in STAI- Trait Anxiety and psychophysiologic symptoms on the Psychosomatic Symptom Checklist. Only alpha-increase biofeedback subjects showed significant reductions in heart rate reactivity to stressors at a separate psychophysiological testing session. Decreased self-report of anxiety was maintained at 6 weeks post treatment.

Simkin, DR., Thatcher, RW. & Lubar, J. (2014). Quantitative EEGB and Neurofeedback in Children and adolescents: Anxiety disorders, depressive disorders, comorbid addiction and attention-deficit/hyperactivity disorder and brain injury. Child and Adolescent Psychiatric Clinics of North America:23(3). 427-464. This article explores the science surrounding neurofeedback. Both surface neurofeedback (using 2-4 electrodes) and newer interventions, such as real-time z-score neurofeedback (electroencephalogram [EEG] biofeedback) and low- resolution electromagnetic tomography neurofeedback, are reviewed. The limited literature on neurofeedback research in children and adolescents is discussed regarding treatment of anxiety, mood, addiction (with comorbid attention-deficit/hyperactivity disorder), and traumatic brain injury. Future potential applications, the use of quantitative EEG for determining which patients will be responsive to medications, the role of randomized controlled studies in neurofeedback research, and sensible clinical guidelines are considered.

 

Thomas, J. E., & Sattlberger, B. A. (1997). Treatment of chronic anxiety disorder with neurotherapy: A case study. Journal of Neurotherapy, 2(2), 14-19. The objective of the present case study is to report the effects of alpha- decrease biofeedback training on a patient diagnosed with Anxiety Disorder. Three Minnesota Multiphasic Personality Inventories (MMPI and MMPI-2) were used as objective measures of treatment efficacy. Following 15 sessions of slow wave inhibit/fast wave increase EEG feedback training, the patient reported a significant reduction in anxiety-related symptoms. At three-year follow-up, results of an MMPI-2 showed all clinical scales within normal range. In addition, self-reports confirmed that the patient was symptom free. After treating the patient with several other clinical modalities, only the alpha-decrease feedback training produced effective, long-term improvement of symptoms.

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