Understanding anxiety

Anxiety is an uncomfortable, overwhelming, persistent feeling similar to fear. This feeling of worry is often difficult to control. For example, even if you know you have a strong, anxious response when you do tests or exams, it is still difficult to calm yourself down and really demonstrate you know your stuff. Anxiety can manifest as emotional symptoms (feeling unmotivated and discouraged), physical symptoms (fatigue, fluctuations in weight, changes in appetite, pain in the body, etc.), behavioural symptoms (avoiding people and events, reduced interest in sex, reduction in self-care activities), and cognitive symptoms (struggling with concentration and alertness, issues with planning and organization, forgetting things, etc.). Sometimes individuals who are anxious may also feel or be experiencing depression. See our section on depression.

Anxiety can also affect a person’s instrumental activities of daily living (IADLs) which can be simply defined as a person’s daily self care activities. Some IADLs include cooking, cleaning, communication, accessing transportation, laundry, shopping, and managing personal finances. Anxiety is usually diagnosed by a clinical psychologist or psychiatrist, but can also be diagnosed by your family physician. It is usually diagnosed after the symptoms related to Anxiety do not go away after 6 months. There are many different types of anxiety which range from a specific situation to most or all aspects of life.

Our Approach to Anxiety

We start with a Clinical Intake Interview to review background history, medical history, identify specific symptoms and their severity, review previous assessments and interventions, and identify if any other assessments are required. The next step is to complete a QEEG (Quantitative Electroencephalogram) assessment to analyze your brainwave patterns. The best way to understand brain waves is to compare them to each section of an orchestra. Every section of an orchestra needs to work together to make sure the music sounds good. Sometimes one section of the orchestra is more dominant than the other, but all sections are necessary to produce beautiful music. In the same way all brain waves are necessary to balance each other out, complement each other, and become dominant when necessary. For example, when you need to analyze and engage in higher level thinking you want your brain to be dominant in faster brain wave patterns to accomplish this task. When you are getting ready for sleep you want your brain to gradually slow down and be dominant in slower brain wave patterns.

People who usually have anxiety demonstrate an excess or dominance of fast brain wave patterns even where there is no task in front of them. Their brain is stuck in a processing or analyzing mode and they find it tough to relax. They may also have a reduction in calm and alert brain wave patterns such as alpha and sensorimotor rhythm (SMR). Once we figure out what brain wave patterns are related to your symptoms we can design a personalized program to target and improve them. During each session we monitor your brain waves in real time and when there is greater balance of brain wave patterns we reward you with video and sound. These audio and visual rewards help train and guide your brain to have improved balance and improve your symptoms.  

Sometimes clients require additional support in conjunction with neurofeedback training. Some options are psychotherapy and somatic experiencing therapy.

Research Articles on Anxiety

This section is meant to highlight research that has been done in the field. The following brief summaries are resources that we have gathered for the public. For an in-depth look at each research article we recommend using the citation to find and read the original article. We hope to add additional resources when possible!

Moradi, A., Pouladi, F., Pishva, N., Rezaei, B., Torshabi, M., & Mehrjerdi, Z. A. (2011). Treatment of anxiety disorder with neurofeedback: Case study. Procedia - Social and Behavioural Sciences, 103-107.

In this case study the authors report the effects of combining beta-increase and alpha-increase in EEG feedback training and alpha-theta biofeedback training for two patients suffering from chronic anxiety which did not respond to previous attempts to manage through psychopharmacological interventions. Both patients, in their twenties, underwent medical evaluation which showed no physical reason for presenting complaints of anxiety, ruminative thought, nervousness etc. A 90-item self-report inventory of adult psychological symptoms called the SCLR-90-R was administered to evaluate the patients complaints and assess the effectiveness of the treatment during the course of therapy at the beginning and the end of the therapy program; and again 1-year after they ended therapeutic intervention in a follow-up. Patients were also interviewed. Treatment involved attending three 50-minute sessions a week over a period of 10 weeks. Audio-visual neurofeedback programs were used to assist in reinforcing desired brainwave activity. When set thresholds were met, level of difficulty was increased. Following 30 sessions, both patients reported a significant reduction in anxiety-related symptoms; at the 1-year follow up all clinical scales were within normal range and self-reports confirmed that the patients were symptom-free. In summary, the findings from this study clearly demonstrate that neurofeedback is effective in the treatment of anxiety disorders.

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

This article engages with existing research on functional brain abnormalities associated with depression, anxiety, and obsessive-compulsive disorder. The authors describe, in detail, the neurophysiological basis for various symptoms and differentiate these factors from biological predisposition. It is argued that despite psychiatry’s strong reliance on the use of medication for the treatment of depression and anxiety; current evidence seems to suggest that pharmacologic treatment may not be as effective as was previously believed. The authors provide a brief overview of the research done to determine the efficacy of more traditional treatment models and stress the point that an increasing number of patients seem interested in less invasive treatment than medication. Neurofeedback is introduced as an alternative treatment option for modifying dysfunctional, biologic brain patterns that are associated with various psychiatric conditions and the advantages are discussed.

White, E. K., Groeneveld, K. M., Tittle, R. K., Bolhuis, N. A., Martin, R. E., Royer, T. G., & Fotuhi, M. (2017). Combined neurofeedback and heart rate variability training for individuals with symptoms of anxiety and depression: A retrospective study. NeuroRegulation, 4(1), 37–55. http://dx.doi.org/10.15540/nr.4.1.37

This report is the first of its kind to observe the impact of concurrent neurofeedback (NFB) and heart rate variability (HRV) training as a viable intervention strategy for symptoms of anxiety and depression. 183 children and adults with anxiety and/or depression symptoms underwent treatment consisting of concurrent NFB and HRV training for a total of 30 sessions within a time period of 6 to 24 weeks. Results showed that symptoms of anxiety and depression reduced in both adults and children. Both questionnaire assessment and changes in EEG, breathing rate and HRV were of clinical significance. The authors concluded that NFB and HRV training is an effective, non-pharmaceutical option for intervention to reduce symptoms of anxiety and depression. It was also concluded that NFB and HRV may improve EEG, blood pressure, resting breathing rate and HRV.

Costa, M. A., Gadea, M., Hidalgo, V., Perez, V., & Sanjuan, J. (2016). An effective neurofeedback training, with cortisol correlates, in a clinical case study. Universitas Psychologica, 15(5). The purpose of this case study was to determine the reproducibility and practicality of an economic short term neurofeedback intervention (10 sessions). The participant of this study was a 33 year old woman suffering from a set of symptoms that fulfills the diagnostic criteria of an anxiety syndrome according to the DSM-V. Over the course of 5 weeks the participant underwent treatment consisting of a well-established beta1/theta neurofeedback protocol to enhance beta1 without causing increases in theta rhythm. State anxiety and salivary cortisol levels were measured during each of the 10 sessions following a pre/post design. A significant decrease in the evaluated state of anxiety was observed during the last five sessions of treatment. Since this study is the first longitudinal study of its kind to assess neurofeedback, hormonal, cognitive and emotional variable; the observational relationship between beta1 and cortisol levels suggest that brain activity may be considered a marker of anxiety in the near future.

Ghaziri, J., Tucholka, A., Larue, V., Blanchette-Sylvestre, M., Reyburn, G., Gilbert, G., . . . Beauregard, M. (2013). Neurofeedback Training Induces Changes in White and Gray Matter. Clinical EEG and Neuroscience, 44(4), 265-272. doi:10.1177/1550059413476031

In this study, Health university students were randomly assigned to the experimental group, sham group or control group. Participants in the experimental group trained to enhance beta waves at F4 and P4. Attentional performance and MRI data were recorded one week before training and one week after training. Higher scores on auditory and visual sustained attention were present in experiment group. Gray matter volume increases were detected in cerebral structures involved in this type of attention. This study constitutes the first empirical demonstration that neurofeedback training leads to microstructural changes in white and gray matter.

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