Neurofeedback for Anxiety

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As we discuss Neurofeedback for Anxiety, I’m honored to share with you the writing and expertise of Erin Wolff LMFT, a Licensed Marriage and Family Therapist. Wolff provides neurofeedback and counseling, through her practice in Springfield, OR — helping families with trauma, addiction, anxiety, depression, ADHD and more.

I wanted to have her author this article because of her immense experience with this modality both personally and as a practitioner.

My personal passion for this topic stems from its effectiveness in my own life, and in five of my family members’.

Neurofeedback is seeing a huge increase in demand. As a result, the provision of this service is skyrocketing throughout the country and around the world. That means, you very likely have one or more practitioners in your area.

Education around this topic is vitally important, so more families and individuals can know this modality exists and get the help they need.

Neurofeedback is easy, pleasant, affordable and accessible.

Anxiety is too often something we “manage” or try to get by with, but, there’s an alternative that provides new freedom, joy and wellness.

In this article we discuss:

• What is anxiety
• What is neurofeedback
• Can neurofeedback be customized for your brain
• Neurofeedback effectiveness
• Neurofeedback for kids
• Can neurofeedback cause anxiety
• The HPA axis and slow-wave training
• Neurofeedback price
• Neurofeedback home kit
• How to find a neurofeedback practitioner in your area
• and more!

I have co-authored the following post with Erin Wolff, LMFT.

Neurofeedback for Anxiety

Symptoms in our family

The words no parent ever wants to hear: “Mom, I feel like I can’t breathe! I’m so scared. What’s happening to me?” 

When my 8-year-old called me into his bedroom night after night in full blown panic, my heart told me there was only one compassionate option – put him on medication. Being a mental health therapist myself, I knew he was unlikely to get immediate relief from panic attacks and anxiety with psychotherapy alone. Medication at 8-years old? That couldn’t be the only option. 

I remembered hearing about neurofeedback, a method for healing the brain without medication, and without talk therapy. I’d always imagined providers would be hard to find and the treatment would be expensive. And what was neurofeedback anyway?

The answer

Google led me to the office of two skilled providers. After just one session of neurofeedback, my son went days without a panic attack.

Months into therapy, the panic and anxiety dissolved almost completely, along with most of his ADHD symptoms, sensory struggles and aggressive behaviors.

As a mental health therapist, I was shocked and intrigued. I had never seen a client get so much relief so quickly. 

Pretty soon, another one of my children and myself were getting hooked up weekly, too. Within a couple of months, we were experiencing more and more wellness.

Our symptoms:

• Trauma-related nightmares – gone. 
• Repetitive negative self-talk – gone. 
• Depression – improved. 
• Anxiety – improved. 
• Speech articulation struggles – improved. 
• Bedwetting – improved. 

My conclusion? If neurofeedback could do this for my family, could it help my many clients struggling with chronic anxiety? I had to become a neurofeedback provider.

What is anxiety

Anxiety is like the body’s gas pedal being pushed too hard, too fast, for too long.

Our nervous system (brain, spinal cord and nerves) is full of sensors that detect threat. This system helps keep us safe and alive. Every time it’s triggered, we get a little push of “gas” to help us be alert, aware and proactive.

A gentle push on the gas is helpful – I can get my taxes done, have that engaged conversation with a family member or win the track meet.

Stomping on the gas pedal is designed only for survival situations when basic safety is compromised. 

Unfortunately for many of us, our nervous systems can get stuck with this “pedal to the metal”. We’re spending much of our time in a “fight, flee, freeze” survival state.

This is especially true if our developing nervous system was exposed to “toxic” levels of stress in childhood. Examples include: abuse, frequent moves, a parent with an emotional or physical illness or addiction or other basic threats to safety and stability.

Dysregulated nervous systems

With too much gas too many times, our nervous system becomes dysregulated, or out of sync. It needs help learning how to gently push on the gas, when to coast and when to idle.

Dysregulated nervous systems, those that have had repeated, chronic surges of activation or “gas,” develop symptoms and patterns of imbalance.

These include anxiety disorders of all kinds, and eventually physical and emotional imbalances of all kinds: relationship struggles, negative coping behaviors and difficulties enjoying work or free time.

Anxiety shows up in many different ways. This can depend on the specific person, their unique history and biology and cultural factors. 

Common symptoms of anxiety

Here are some of the most common symptoms of anxiety, as detailed by the American Psychological Association:

• Worry, especially about what “might happen” or upcoming events
• Difficulty controlling or managing worry
• Feeling restless, “keyed up” or “on edge”
• Feeling tired easily
• Trouble concentrating
• Feeling like your mind frequently goes “blank”
• Irritability
• Muscle tension, including tension headaches
• Trouble managing memories from the past
• Nightmares
• Panic attacks
• Racing heart
• Specific fears, like fears of the outdoors, people or germs
• Obsessive thoughts
• Excessive sweating
• Sleep troubles (falling asleep, staying asleep, restless sleep, early waking)

Anxiety and you

If you see parts of your own experience on this list, you’re not alone.

An estimated 1 in 5 adults in the U.S. has severe enough symptoms to quality for an anxiety disorder diagnosis. But more than 60% of people with an anxiety disorder never get help. 

Barriers to recovery

There are many barriers to getting better – anxiety may be protective and adaptive, especially for those who live in a toxic or unsafe home, relationship or neighborhood:

• You may worry you’ll lose your “edge” and not be able to be as productive without your anxiety.
• Your anxiety might protect you from painful memories, and harmful behaviors, like substance abuse.
• You might also be worried about being judged for getting help. Or, you might not trust counselors, mental health therapists or doctors.
• You’re likely feeling ashamed about your struggles, and the last thing most of us want to do is go and talk about all the ways we’re feeling unsure and overwhelmed. This is even more true if you’re a child or a person who’s experienced unsafe relationships, injustice or discrimination.

Thankfully, there are treatments for anxiety that don’t require much talking about the problem and are not medication-based, such as neurofeedback. 

What is neurofeedback

Neurofeedback is just like correcting posture when standing in front of a mirror. 

The brain sees the brain and makes slight adjustments to its “posture.” But in the case of the brain, it’s brainwave activity. 

Let’s break it down:

Neuro = involving the nervous system

Feedback = information from your body to your body

Neurofeedback = information from your nervous system/brain to your nervous system/brain

During a neurofeedback session, sensors are placed on different parts of the scalp. The sensors pick up on brainwave activity which is displayed as an EEG (a picture of the brainwaves).

While the mind is focused elsewhere, such as on a game or TV show, the brain is watching itself.

What’s happening during neurofeedback for anxiety

The neurofeedback software creates a “picture” or “reflection” of  brainwaves for the brain to see.

The “picture” is in the form of the image quality (brightness, size, clarity), the quality of the sound and sometimes other feedback, such as a vibration. 

Neurofeedback encourages the brain not to make huge spikes and dips in activity – aka slamming on the gas or the brake.

Because slamming on the gas or the brake uses a lot of cellular energy, the body prefers slow accelerations, coasting and idling.

In other words, if the brain finds out, through feedback, that the nervous system is slamming on the gas or the brake all the time, the brain will make adjustments to conserve gas – a.k.a. cellular energy.

After multiple sessions of “practicing” this new, more efficient way to function, the nervous system becomes more self-regulated.

More scientific terms

In more scientific terms, a dyregulated nervous system that slams on the gas too often has elevated levels of fast beta waves.

Neurofeedback reduces these beta waves, while promoting alpha waves associated with relaxation and calm.

During a NF session, when a client’s brainwave activity moves into a calmer state, the brain is rewarded with uplifting audio and video material.

This brain training is similar to rewarding positive behavior when training an animal. Our brains, like animals’, are constantly seeking rewards.

During a neurofeedback session, the brain is given many opportunities to self-correct and be rewarded. (source)

Can neurofeedback for anxiety be customized for your brain

Neurofeedback can be customized to each person’s unique brain. This customization is called the “neurofeedback protocol.”

At a patient’s first session, the provider:

•  asks questions about how the client is feeling physically and emotionally,
• collects family health history and
• asks from what symptoms the patient is hoping to get relief.

Depending on the answers, sensors are placed in specific places on the scalp. These sensors listen to the activity in the part of the brain typically associated with the specific symptoms.

Different time settings are used, depending on the sensitivity of the patient’s brain — as well as changes in frequencies for which the sensors listen. 

Site selection

An orchestra is a great analogy for neurofeedback protocols: if we’re listening to an orchestra and it just doesn’t quite sound right, it’s hard to know exactly what’s not right.

First, we have to focus on one area of the orchestra – strings, for example.

For the brain, this is the process of site selection.

Then, once we’re listening only to the strings, we may need to hear just one group of instruments, say the violins — all playing the same chord.

This is why we make changes in frequency – to hear just one chord at a time.

If we’re listening to the right area at the ideal frequency, we will feel relaxed, calm, and engaged: “Ah, yes. Now all the violins are playing harmoniously.”

Adjustments

If a patient is not feeling calm, relaxed and engaged during a session, the neurofeedback provider will make small adjustments in the frequency to get the optimal effect.

Between sessions, the client notes any changes in symptoms and reports them at each subsequent session.

These changes give the provider more information about how best to customize each of the neurofeedback sessions. 

Neurofeedback effectiveness

According to a large body of scientific research, neurofeedback is an effective treatment for: 

• Performance enhancement (aka memory, planning, efficient response time, athletic or other skilled performance)
• Attention-Deficit Hyperactivity Disorder (ADHD)
• Anxiety disorders including Post-Traumatic Stress Disorder (PTSD)
• Substance abuse disorders
• Depression
• Memory problems
• Sleep issues
• Emotional regulation
• Sustaining attention
• Autism
• Learning Disorders
• Epilepsy

Both in my personal and professional experience, neurofeedback often begins to decrease symptoms of anxiety within a few sessions.

These changes become more significant and sustained the more neurofeedback sessions you have. Most people need at least 20 sessions to maintain their improvement over time. 

Neurofeedback for kids

Because children’s brains are so adaptable and responsive to new learning, neurofeedback often works more quickly on children.

Assisting the brain with healing during childhood can dramatically change the lifelong trajectory.

Addressing childhood anxiety can help improve outcomes for relationships, academic and vocational performance and physical and emotional resiliency.

You get to watch movies…

Kids love neurofeedback because it involves “screen time” and doesn’t require their “buy in” or motivation to change. 

Yes, kids (and adults) get to watch the movie of their (or their parent’s) choice while they have neurofeedback!

Most practitioners have a huge variety of shows and movies from which to choose. These include the most popular and latest movies, but also educational material when that’s preferred.

Can neurofeedback cause anxiety

Is it possible to feel worse from neurofeedback?

The short answer is, “yes.”

However, these negative effects, such as feeling more anxious, are often temporary (a few minutes to a couple of days). Small changes to the neurofeedback settings during a session usually address these effects.

The good news is, if a patient is able to be open with their provider about how they feel during and after their first few sessions, this information, even if it is temporarily uncomfortable, can help the provider find the ideal settings for the patient. 

The HPA axis and slow-wave training

One approach your practitioner may consider is slow-wave training.

Let’s understand anxiety a little bit better to learn about it.

Two parts of the brain work together to analyze stress and respond to various situations: the prefrontal cortex (PFC) and the amygdala.

The amygdala sends signals, activating the prefrontal cortex, if a potential threat is posed.

Anxiety weakens the connection between the amygdala and the PFC, making the brain’s response less rational.

Neurofeedback decreases over-active amygdala activity and enhances the connection between these parts of the brain.

Many NF practitioners are now utilizing slow-wave training, a specific kind of neurofeedback that’s helpful for anxiety specifically.

Slow-wave training focuses on the slowest brain waves, which help to move the nervous system to a less reactive state.

One slow-wave study shows added benefits for skin conductance, blood pressure and heart rate variability, as well.

Neurofeedback price

Neurofeedback is often covered by health insurance. Some patients will first need a medical appointment, such as a mental health office visit with a therapist.

In that case, patients pay the usual copay for an office visit.

Others need no doctor’s appointment first, and still pay just a copay.

When paying out of pocket, patients could expect costs to range from $50 to $200 a visit.

Sometimes, patients can purchase a package of sessions, often sold in 20 session blocks, for a reduced per-session rate.

Either way, feel free to ask your provider any questions about fees right up front.

Neurofeedback is affordable for many patients.

Neurofeedback home kit

As with all types of medical treatment, trained medical or mental health professionals are the best approach with neurofeedback for anxiety.

However, there are biofeedback tools available for use at home that use heart rate rhythms rather than brainwaves to help people manage stress.

The Mightier device, which looks a lot like a tablet, is available for children and runs as a monthly subscription for around $35/month.

For adults, the HeartMath app or device is available for $129 and up, depending on how many features you purchase with the device. 

How to find a neurofeedback for anxiety practitioner in your area

A couple of websites provide directories that allow you to type in your zip code or state and then provide at least some of the practitioners in your area:

• http://eeginfo.com/member/directory.do
• https://www.nationalneurofeedbacknetwork.com/

If you find an office in your area but they have a waiting list (NF is becoming very popular), ask them if they know of other providers in the area (they usually do!). And then call each of these until you find an opening or only a short wait.

You may also wish to ask around:

• If you have a natural healthcare provider, such as a naturopath or functional medical doctor, ask them to help you find a neurofeedback practitioner nearby.
• Ask among friends, including on Facebook.
• Network at a natural compounding pharmacy or health food store that’s community oriented. Some of these type businesses have licensed practitioners working in them who are willing to help. Sometimes the staff in these natural venues have themselves used neurofeedback and will be able to share from personal experience.

Conclusion

No matter where you are in your anxiety wellness journey, neurofeedback is worth a try.

Don’t let the name turn you off – it’s really quite simple.

Neurofeedback is a concrete, research-based treatment. NF helps your brain and nervous system learn how to use “gas” more efficiently, without so many “pedal to the metal” and “slamming on the brake” experiences.

Give a tune-up a try!

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Are you struggling with anxiety? Have you used neurofeedback? We’d love to hear your thoughts in the Comments below.

Additional resources

https://www.neuroregulation.org/article/view/20310
https://www.bec-eeg.com/resources/infra-low-frequency-a-proposed-mechanism/
http://www.eeginfo.com/what-is-neurofeedback.jsp
https://www.medicalnewstoday.com/articles/326666#Previous-study-examined-connectivity
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458693/
https://pubmed.ncbi.nlm.nih.gov/24241476/
https://pubmed.ncbi.nlm.nih.gov/15564054/
https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder