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Anxiety, PTSD and
Panic Disorders

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Gruzelier, JH., Thompson, T., Redding, E., Brandt, R. & Steffert, T. (2014). Application of alpha/theta neurofeedback and heart rate variability training to young contemporary dancers: State anxiety and creativity. Int J Psychophysiol Jul:93(1).

105-111. As one in a series on the impact of EEG-neurofeedback in the performing arts, we set out to replicate a previous dance study in which alpha/theta (A/T) neurofeedback and heart rate variability (HRV) biofeedback enhanced performance in competitive ballroom dancers compared with controls. First year contemporary dance conservatoire students were randomised to the same two psychophysiological interventions or a choreology instruction comparison group or a no-training control group. While there was demonstrable neurofeedback learning, there was no impact of the three interventions on dance performance as assessed by four experts. However, HRV training reduced anxiety and the reduction correlated with improved technique and artistry in performance; the anxiety scale items focussed on autonomic functions, especially cardiovascular activity. In line with the putative impact of hypnogogic training on creativity A/T training increased cognitive creativity with the test of unusual uses, but not insight problems. Methodological and theoretical implications are considered.

Hammond, D. C. (2005). Neurofeedback with anxiety and affective disorders. Child & Adolescent Psychiatric Clinics of North America , 14(1), 105-123.

A robust body of neurophysiologic research is reviewed on functional brain abnormalities associated with depression, anxiety, and obsessive-compulsive disorder. A review of more recent research finds that pharmacologic treatment may not be as effective as previously believed. A more recent neuroscience technology, electroencephalographic (EEG) biofeedback (neurofeedback), seems to hold promise as a methodology for retraining abnormal brain wave patterns. It has been associated with minimal side effects and is less invasive than other methods for addressing biologic brain disorders. Literature is reviewed on the use of neurofeedback with anxiety disorders, including posttraumatic stress disorder and obsessive-compulsive disorder, and with depression. Case examples are provided.

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 obsessivecompulsive 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.

 

Holmes, D. S., Burish, T. G., & Frost, R. O. (1980). Effects of instructions and biofeedback in EEG-alpha production and the effects of EEG-alpha biofeedback training for controlled arousal in a subsequent stressful situation. Journal of Research in Personality , 14(2), 212-223. No abstract found.

Huang,-Storms, L., Bodenhamer-Davis, E., Davis, R., & Dunn, J. (2006). QEEGguided 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, qEEGguided 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.

Mills, G. K., & Solyom, L. (1974). Biofeedback of EEG alpha in the treatment of obsessive ruminations: An exploration. Journal of Behaviour 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 Ss to produce alpha; (3) subjective states during alpha are reported as relaxed, daydreaming and not thinking; and (4) although difficult to generalize 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

 

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, psychopathis 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 I a more efficacious treatment modality in the treatment of PTSD and preventative of relapse.

 

Scheinost D, Stoica T, Saksa J, Papademetris X, Constable RT, Pittenger C & Hampson M. (2013). Orbitofrontal cortex neurofeedback produces lasting changes in contamination anxiety and resting-state connectivity.

Transl Psychiatry. 2013 Apr 30;3:e250. doi: 10.1038/tp.2013.24. Anxiety is a core human emotion but can become  pathologically dysregulated. We used functional magnetic resonance imaging (fMRI) neurofeedback (NF) to noninvasively alter patterns of brain connectivity, as measured by resting-state fMRI, and to reduce contamination anxiety. Activity of a region of the orbitofrontal cortex associated with contamination anxiety was measured in real time and provided to subjects with significant but subclinical anxiety as a NF signal, permitting them to learn to modulate the target brain region. NF altered network connectivity of brain regions involved in anxiety regulation: subjects exhibited reduced resting-state connectivity in limbic circuitry and increased connectivity in the dorsolateral prefrontal cortex. NF has been shown to alter brain connectivi ty in other contexts, but it has been unclear whether these changes persist; critically, we observed changes in connectivity several days after the completion of NF training, demonstrating that such training can lead to lasting modifications of brain functional architecture. Training also increased subjects' control over contamination anxiety several days after the completion of NF training. Changes in resting-state connectivity in the target orbitofrontal region correlated with these improvements in anxiety. Matched subjects undergoing a sham feedback control task showed neither a reorganization of resting-state functional connectivity nor an improvement in anxiety. These data suggest that NF can enable enhanced control over anxiety by persistently reorganizing relevant brain networks and thus support the potential of NF as a clinically useful therapy.

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.