Deficient emotion regulation and exaggerated anxiety represent a major transdiagnostic psychopathological marker. On the neural level these deficits have been closely linked to impaired, yet treatment-sensitive, prefrontal regulatory control over the amygdala. This study suggests that by gaining control over these pathways it could provide an innovative intervention to regulate exaggerated anxiety. In a randomized crossover sham-controlled design, 26 healthy subjects with high anxiety underwent real-time fMRI-guided neurofeedback training to enhance connectivity between the ventrolateral prefrontal cortex (vlPFC) and the amygdala (target pathway) during threat exposure. A follow up study was done after 3 days to track progress levels. The results showcased that training of the target pathway significantly increased amygdala-vlPFC connectivity and decreased levels of anxiety. At the group level stronger connectivity increases were significantly associated with higher anxiety reduction. Thus, the study acts to emphasize the therapeutic potential of connectivity-informed real-time neurofeedback.

This preliminary study examined the effects of 16 sessions of neurofeedback training on levels of depression, anxiety, and academic self-efficacy in college students with attention deficit hyperactivity disorder (ADHD). Participants were screened using three different measures, completed at four points throughout the investigation. Statistically significant results identified that neurofeedback was a viable option for mitigating depression and anxiety symptoms as well as increasing academic self-efficacy scores in college students with ADHD, based on their scores over time.

This study draws on previous research in the field that proposes, frontal alpha asymmetry underlies the balance between approach and withdrawal motivation associated with an individual’s affective style. The study employed thirty-two right-handed females who underwent neurofeedback training to increase frontal alpha asymmetry. This was done in an effort to evaluate discrete changes in alpha power at left and right sites, as well as in positive and negative affect, for anxiety and depression. Participants were randomly assigned to receive either the neurofeedback training, or an active control training. Results from the neurofeedback training group, showcased a significant increase in alpha asymmetry driven by higher alpha at the right site, as well as a reduction in both negative affect and anxiety symptoms, from pre-to post-training. In summary, these findings provide a strong basis for the use of the frontal alpha asymmetry neurofeedback for the reduction of negative affect and anxiety in clinical settings.

In this review the authors systematically examine the effectiveness of neurofeedback therapy for managing anxiety and stress in adults living with a chronic illness. When compared with traditional methods of treatment for anxiety – such as pharmacological modalities – neurofeedback may act to reduce or eliminate the use of these medications. Anxiety and stress have direct neurobiological consequences that act to alter certain brain-specific regions. This alludes to the usefulness of neurofeedback therapy as it targets those specific brain regions. Neurofeedback targets the internal variable such as operant brain waves in an attempt to decrease anxiety, thereby providing the patient with an appropriate level of personalized intervention based on the their own biofeedback.

This article aimed to examine the effectiveness of a 7-week neurofeedback training programme that acted to increase the range of the alpha band and improve abnormal anxiety in patients with panic disorder. A randomized controlled trial was conducted where patients were assigned to one of two groups; Neurofeedback training and a control group. The neurofeedback group received 20 sessions of personalized training whereas the control group received baseline routine care. The results showcased significantly higher changes in the neurofeedback group than the control group. This was characterized through the increased range of the alpha band in the neurofeedback group. In conclusion, an intervention involving neurofeedback significantly improved abnormal anxiety in adverse situations.

In this study, the authors used functional magnetic resonance imaging (fMRI) neurofeedback (NF) to noninvasively alter patterns of brain connectivity and to reduce contamination anxiety. Activity from a region of the orbitofrontal cortex associated with contamination anxiety was measured and provided to subjects with significant but subclinical anxiety. Subjects exhibited reduced resting state connectivity in limbic circuitry and increased connectivity in the dorsolateral prefrontal cortex. Critically significant changes were observed in connectivity several days after the completion of neurofeedback training, subjects showed increased control of contamination anxiety.Thereby demonstrating that such training can lead to lasting modifications of brain functional architecture. Matched subjects that underwent treatment in the control group showed no such reorganization nor improvement in anxiety control. This article thereby suggests that neurofeedback can enable enhanced control over anxiety and support the potential of it as a clinically useful therapy.

This study builds on the knowledge that most mental functions are associated with dynamic interactions within functional brain networks. Therefore, training individuals to alter their functional brain network may allow them with a novel means to improve cognitive performance and emotions. The authors of the study taught participants control over a key component of the emotion regulation network by using a connectivity-neurofeedback approach based on functional magnetic resonance imaging (fMRI). Participants learned to increase top-down connectivity from the dorsomedial prefrontal cortex, which is involved in cognitive control, onto the amygdala, which is involved in emotion processing. Fifteen healthy volunteers took part in 3 neurofeedback training sessions. Follow-up tests revealed that participants in the experimental group were able to control top-down connectivity significantly better after neurofeedback training and showcased significantly higher learning success than those in the control group. The results demonstrate that connectivity-based neurofeedback training of emotion regulation networks enhances emotion regulation capabilities and can potentially lead to therapeutic protocols for neuropsychiatric disorders.

Similar to most psychiatric disorders, anxiety and depression are conditions whose severity can be represented over a continuum that ranges from subclinical manifestations to full-blown biosocial disabilities. The alpha band (8-12 Hz) asymmetry in the left frontal cortex has emerged as the most prominent electroencephalographic (EEG) correlate of both anxiety and depression, followed by excessive band power in beta 1 (12-20 Hz) and beta 2 (20-3- Hz) waves in the right parietal lobe. In this study a 29-year-old woman, with no previous psychiatric history, presented with anxiety symptoms, sleep problems and mild cognitive impairments. The training protocol lasted for 20 sessions, during which the subject was trained to increase beta 1 at C4 with eyes open and eyes closed. A marked improvement in anxiety, depression, and sleep quality, as well as some improvements in executive functions were observed. From an endophenotypic viewpoint, there was an overall increase in beta 1, low alpha (8-10 Hz), and high alpha (10-12 Hz) powers and a decrease in beta 2 (a stress biomarker). These results suggest that neurofeedback can be used as an adjunct in the treatment of subclinical anxiety with minimal risk and low technology costs

Generalized anxiety disorder (GAD) is a common anxiety disorder that typically has an early age of onset, a chronic course and a high degree of comorbidity with other anxiety and mood disorders. This study compares the efficacy of two most commonly used biofeedback relaxation techniques in the treatment of GAD. 45 individuals were randomly assigned to three groups: Group I received electromyographic biofeedback relaxation training, Group II received alpha-electroencephalographic biofeedback relaxation training and Group III served as the control group. At follow-up, both treatment groups resulted in more consistent patterns of generalized relaxation changes reflected in galvanic skin resistance, state and trait anxiety as compared to the control group. Further follow-up studies showcased the prolonged persistence of effects that was initially observed in both treatment groups. The authors conclude that both biofeedback training are effective in the treatment of Generalized Anxiety Disorder.

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.

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.

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.

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.

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.

Anxiety and depression are very widespread among cancer patients. The state of anxiety covers a wide range of symptoms connected to fear, restlessness and changes in the autonomy of the patient. Neurofeedback is a behavioral technique of operant learning, in which participants learn to effect the electric activity of their brain, through a dynamic process of visual and auditory feedback. The training seeks to change the frequency of subjects’ electroencephalogram (EEG), something achieved by the majority of participants. Neurofeedback is a technique which has been successfully used in recent decades as a tool for treating a number of clinical cases. Amongst the clinical cases studied are autism, epilepsy, chronic pain, cases of major depression and also the effects of cancer upon different psychological parameters and the quality patients’ lives. Pelvic cancer and its medical treatment seem to increase anxiety and depression, which affect patients’ daily lives. In the case study, 20 sessions of Neurofeedback were applied to a patient with pelvic cancer and anxiety (state anxiety): the SCL-90 scale for the measurement of psychometric traits was applied before and after each session. Important improvements were noted to this patient on the above scales, issued during the sessions and within each session, before and after the intervention.

Neurofeedback participants exhibited lower anxiety levels than the control group at the end of the training. In addition, only neurofeedback participants achieved down-regulation of insula activation levels by cognitive reappraisal. Group differences became more pronounced over time, supporting learning as a mechanism behind this effect. Importantly, within the neurofeedback group, achieved changes in insula activation levels during training predicted long-term anxiety reduction.

Social anxiety is prevalent in adolescence. Given its role in maintaining fears, reducing social avoidance through cognitive reappraisal may help attenuate social anxiety. The researchers used fMRI-based neurofeedback (NF) to increase ‘adaptive’ patterns of negative connectivity between the dorsolateral prefrontal cortex (DLPFC) and the amygdala to change reappraisal ability, and alter social avoidance and approach behaviours in adolescents. Twenty-seven female participants aed 13-17 years with varying social anxiety levels completed a fMRI-based NF training task where they practiced cognitive reappraisal strategies, whilst receiving real-time feedback of DLPFC-amygdala connectivity. All participants completed measures of cognitive reappraisal and social approach-avoidance behaviour before and after NF training. Avoidance of happy faces was associated with greater social anxiety pre-training. Participants who were unable to acquire a more negative pattern of connectivity through NF training displayed a significantly greater avoidance of happy faces at post-training compared to pre-training. These ‘maladaptive’ participants also reported significant decreases in reappraisal ability from pre to post-training. In contrast, those who were able to acquire a more ‘adaptive’ connectivity pattern did not show these changes in social avoidance and re-appraisal. Future research could consider using strategies to improve the capacity of NF training to boost youth social-approach behaviour.

The aim of the study was to investigate the effectiveness of neurofeedback treatment on depression, anxiety, stress and psychosomatic abdominal pains in patients with clinical chronic psychosomatic abdominal pains. The research was a quasi-experimental study with pretest-posttest control group. The study population was all women with chronic psychosomatic abdominal pain, 40 patients were selected for the study; ultimately data was analyzed with 30 patients. Participants were randomly assigned to 2 groups consisting of 15 participants who were divided into an experimental group and a control group. In this intervention, the experimental group was treated with neurofeedback for 10 weeks (3 times a week for 40 minutes) and the control group received no intervention and was put on a waiting list. Experimental and control groups completed the Depression Anxiety Stress Scales-21 (DASS-21) in pre-test and post-test. Multivariate analysis of covariance was used for data analysis. The results of covariance analysis showed that neurofeedback therapy had an impact on reducing anxiety and depression (P<0.001). In other words, 53% of depression variation and 57% of anxiety variation in patients were due to neurofeedback. It was concluded that neurofeedback could significantly reduce depression and anxiety.

The efficacy of neurofeedback training was evaluated in 12 children in the autistic spectrum with matched controls, based on established training protocols for other conditions with similar symptoms. Twenty-four autistic children were divided into two groups, matched by sex, age, and disorder severity. One group received neurofeedback training and the second acted as a control group. Responses to the Autism Treatment Evaluation Checklists (ATEC) and parental assessments of problem behaviors were analyzed to evaluate the effectiveness of neurofeedback training for this condition. Neurofeedback training resulted in a 26% average reduction in total ATEC rated autism symptoms, compared to 3% for the control group. Parental assessments reported improvement in all behavioral categories: socialization, vocalization, anxiety, schoolwork, tantrums, and sleep, compared with minimal changes in the control group. Autistic spectrum children who underwent neurofeedback training showed significant improvements in autism symptoms and behaviors. The magnitude of improvement was independent of initial severity or age.

Anxiety is the most prevalent psychological disorder and it was regarded as an adaptive response versus stimulations. This study sought to determine in reducing anxiety symptoms on female in Kermanshah city. This research used a quasi-experimental methods of pretest-posttest follow-up with a control group. The sample consisted of 24 women with anxiety disorders in a counseling center in Kermanshah selected by available sampling and randomly assigned to the control and experimental groups. The experimental group received neurofeedback training for 30 sessions and 30 minutes per session. While the control group did not receive any intervention until the end of the project. The data was collected by Beck anxiety questionnaire and e-view neurofeedback system. The data was analyzed using analysis co-variance (ANCOVA). The results indicated that there were significant differences between the anxiety scores subject  of the experimental and control and follow-up group. Neurofeedback training provides useful applied practices in the treatment of anxiety disorders.

The objective of the study was to examine the effectiveness of using neurofeedback to improve patients' social phobia. A randomized controlled trial was conducted at a counseling center in west china. 30 patients reporting social phobia were recruited in this study. Participants were assigned randomly to either a neurofeedback or a non-neurofeedback group. All patients in both groups received the same traditional training except for neurofeedback. The neurofeedback group received 45 minutes of neurofeedback, twice a week for six sessions. The measure of this study was the Social Phobia Inventory (SPIN), which was administered before and after the program. Using a 2 × 2 MANOVA, the changes in mean SPIN were significantly higher in the neurofeedback group than in the non-neurofeedback group. In conclusion, a training program involving neurofeedback significantly improved social phobia. Consultants involved in social phobia patients who are interested in complementary therapies should be encouraged to obtain learning in neurofeedback technique and teach patients’ families in clinical settings.

Many studies have reported university students as a population for  mental health problems. The

most common intervention for anxiety disorders are pharmacological and/or nonpharmacological strategies such

as psychotherapies.  Besides that, there  is a growing interest  neurofeedback training for various  mental health

conditions  including  depression,  Post Traumatic  Stress Disorder  (PTSD),  stress  and  anxiety.  Therefore,  the

objective  of this  study was to determine the effectiveness  of neurofeedback  training in reducing  symptoms  of

anxiety.  A quasi-experimental  study with  a  pretest-posttest design  was  employed in  this  study. Thirty  eight

students  (M= 22.47  years, SD=  .69  years) with  moderate and  severe  anxiety  symptoms based  on the  Beck

Anxiety  Inventory  (BAI)  and  Generalized Anxiety  Disorder-7  (GAD-7)  were  randomly  assigned  to  either

neurofeedback training or waiting list. The neurofeedback group underwent a total of 20 neurofeedback training

(3 sessions per week). The post test results indicated that neurofeedback training significantly reduce symptoms

of  anxiety in  the neurofeedback  group than  those  of   the  waiting  list group  in both  BAI and  the GAD-7

instruments  with effect size ranging  from .49 to .62. The Wilcoxon signed–rank  test was  conducted to  assess the

statistical differences between the pre-scores and post-scores of BAI and GAD-7 measurements within the NFT

group. Significant differences within the NFT group was found between the pre-test and post-test scores in the

BAI  and  GAD-7  measurements. In  general,  the  current study  suggest  that  neurofeedback  was  an  effective

treatment for anxiety symptoms among university students.

Generalized Anxiety Disorder (GAD) is one of the most common anxiety disorders that has a significant negative impact on social functioning, occupational/academic performance, and daily living. The goal of the study was to investigate the effect of QEEG-based neurofeedback (NFB) therapy on anxiety, depression and emotion regulation in those with GAD. Twenty-nine college studies with GAD living in Iran were randomly divided into the NFB intervention group or control group. The intervention group underwent QEEG-based NFB therapy for 8 weeks (20 sessions, 2 per week, 45 minutes each) while control received no intervention. The results indicated that the intervention group displayed significant changes in post-test and follow-up phases compared to control. The intervention group showed reduced anxiety and depression levels and improved emotion regulation after the intervention.This showcases that QEEG-based NFB therapy can decrease anxiety and depression levels as well as increase  emotional regulation in individuals with GAD.

Anxiety is one of the most commonly diagnosed mental disorders in the United States and this study aimed to evaluate if qEEG-guided amplitude neurofeedback could be a possible treatment option to reduce anxiety symptoms. This study used a within-subjects research design in which a group of 40 adults were assessed for their anxiety symptoms on two different assessment scales before receiving neurofeedback, and again after receiving neurofeedback. The study found that neurofeedback significantly reduced the measure of anxiety symptoms on both scales. These findings suggest that qEEG-guided amplitude neurofeedback may be a viable treatment option in the reduction of anxiety symptoms.

This article discusses two meta-analyses that were conducted on the overall effectiveness of using neurofeedback to anxiety-spectrum disorders. One meta-analysis analyzed 12 studies which used a single group of participants and compared scores within each subject. The other meta-analysis analyzed 14 studies which used a between-group research design in which two groups were compared with each other. Overall, the results of the meta-analyses indicated that self-report assessments of anxiety reduced by almost one standard deviation with relatively small bias.

The researchers in this study wanted to evaluate the effectiveness of Neurofeedback therapy (NF) combined with cognitive behavioral therapy (CBT) in reducing anxiety symptoms in children and adolescents with generalized anxiety disorder (GAD). 30 children and adolescents were randomly selected and assigned to either the NF or the CBT group. The participants were evaluated using a State-Trait Anxiety Inventory self report scale pre and post intervention. The results of the study indicated that both NF and CBT were effective in reducing anxiety in both children and adolescents with no significant differences. Furthermore, they found that NF therapy yielded more improvement in state anxiety score whereas CBT yielded improvement in trait anxiety scores showing that both therapies can be used as a treatment for individuals with GAD.

The purpose of the study was to investigate the effect of Neurofeedback (NFB) alpha/theta intervention on reducing anxiety and enhancing performance in athletes. The researchers recruited 30 football players and randomly assigned them to either an experimental (alpha/theta NFB training) or the control group (that did not receive any intervention). The athletes in the experimental group recieved 12 30-minute sessions of NFB and all participants completed a Sport Anxiety Scale Questionnaire and Kick Performance Test pre- and post intervention. The results of the study showed decreased anxiety and improvements in athletic performance in the experimental group indicating that alpha/theta neurofeedback training can be effective in producing these positive outcomes. 

Childhood anxiety is a prominent issue that is occurring globally and interventions that are effective, inexpensive and easily accessible are strongly needed. This study wanted to examine the preventative effects of a neurofeedback video game called MindLight. 136 children with elevated anxiety were selected and randomly assigned to play Mindlight or a control game. All participants were assessed using a self- and parent report for anxiety pre- and post- treatment as well as at a 3 month follow up. The results of the study indicated that there was a significant reduction in child and parent reported anxiety however there were no significant differences between the magnitude of improvements between conditions.

The purpose of this study was to learn more about the effectiveness of using neurofeedback training, that focuses on alpha activity in the parietal lobe, on patients with generalized anxiety disorder (GAD). The study included 26 female participants with GAD and each participant was randomly assigned to one of two groups: the left parietal lobe (LPL) training group, or the right parietal lobe (RPL) training group. After being assigned to a group, each participant underwent ten 40-minute training sessions. An evaluation of their anxiety (using the State-Trait Anxiety Inventory, STAI) and depressive symptoms (using the Beck Depression Inventory, BDI-II) was taken after the fifth and tenth sessions. Two weeks after the fifth session, the anxiety scores from both groups decreased significantly, and continued to decrease at a reevaluation after the last training session, at the four weeks’ time point. Compared to baseline scores, both the anxiety and depression scores had decreased at the two week reevaluation, and there was no significant difference between the LPL and RPL training groups.  At the four weeks checkpoint, after the last training session, the anxiety and depression scores had decreased further, and again there were no significant differences between the two training groups. In conclusion, this study provides evidence for neurofeedback training being an effective treatment option for individuals living with GAD, when the training focuses on alpha activity over the parietal lobes.

This review provides an overview of current knowledge and understanding of EEG neurofeedback for anxiety disorders and post-traumatic stress disorders. The manifestations of anxiety disorders and post-traumatic stress disorders (PTSD) are associated with dysfunctions of neurophysiological stress axes and brain arousal circuits. Even if the pathophysiology of these disorders is complex, one of its defining signatures is behavioral and physiological over-arousal. Interestingly, arousal-related brain activity can be modulated by EEG-based neurofeedback, a non-pharmacological and non-invasive method that involves neurocognitive training through a brain–computer interface. EEG-based neurofeedback is characterized by a simultaneous learning process where both patient and computer are involved in modifying neuronal activity or connectivity, thereby improving associated symptoms of anxiety and/or over-arousal.

Dorsolateral prefrontal cortex to anterior cingulate cortex (DLPFC-ACC) functional connectivity is believed to be necessary for effective attentional control and has been found to be reduced in individuals with high trait anxiety. Therefore, this study investigated if connectivity-based real-time functional magnetic imaging neurofeedback (rt-fMRI-nf) can be used to enhance DLPFC-ACC functional connectivity individuals with trait anxiety. 32 participants with high trait anxiety were assigned to either an experimental rt-fMRI-nf or control sham feedback group. Post-training, the experimental group demonstrated reduced anxiety, increased DLPFC-ACC functional connectivity, and increased resting state functional connectivity in the posterior default mode network. Particularly, changes in DLPFC-ACC connectivity during training was associated with reduced anxiety levels. Therefore, rt-fMRI-nf targeting DLPFC-ACC can change network connectivity and is a feasible method for reducing trait anxiety.  

This retrospective study investigated the effectiveness of app-based remote neurofeedback in improving cognitive functioning and mental health. A general health questionnaire, the ADHD Rating Scale IV, the Adult ADHD Self-Report Scale, the 7-item Generalized Anxiety Disorder scale, the 9-item Patient Health Questionnaire, and cognitive tests of attention and executive functioning were administered pre and post-intervention. The greatest mental health improvement was observed for anxiety, with 69% of participants shifting from abnormal to healthy score ranges. Further, children and adults had improved ADHD scores and performance on the cognitive task demonstrating improved attention and executive functioning following training. Lastly, adults with ADHD had elevated delta/alpha and theta/alpha ratios at baseline, however, delta/alpha ratio reduced following neurofeedback. Therefore, these findings suggest that app-based remote neurofeedback can be effective in improving anxiety and ADHD and adjust EEG neural markers for individuals with symptoms of ADHD. 

Individuals with anxiety may struggle with inattention. The sensorimotor rhythm (SMR) has been reported to be closely associated with attention. Therefore, this study used trainability, frequency specificity, and brain-behaviour relationships to verify the validity of a relative SMR power protocol. EEG data were collected from 33 participants undergoing SMR up-training sessions 6 times for about 2 weeks. The feedback value of the neurofeedback group was the relative SMR power at the C3 electrode (feedback electrode), while the feedback value in the control group were pseudorandom numbers. The trainability index showed an increase in SMR power at the C3 electrode. The frequency specificity index showed that SMR activity significantly increased in the neurofeedback group. Further, increased SMR activity was associated with reduced anxiety severity. Overall, this study demonstrates that neurofeedback training using a relative SMR power protocol at C3 can reduce anxiety in healthy participants and increase SMR power. 

This paper explores neural changes and the effect of mindfulness regulation in patients with anxiety using neurofeedback. A total of 34 subjects, 17 with anxiety disorder and 17 healthy, underwent a three-stage neurofeedback protocol. Through the three stages of the experiment, electroencephalography (EEG) resting state signal and mindfulness-based EEG signal were recorded. Power spectral density was selected as the evaluation index through the regulation of neurofeedback mindfulness, and repeated analysis of variance (ANOVA) method was used for statistical analysis. The findings of this study revealed that neurofeedback has a positive effect on both types of subjects. After mindfulness adjustment, the power map exhibited an upward trend. The increase in the average power of gamma wave indicates the relief of anxiety. The enhancement of the wave power represents an improvement in the subjects’ mindfulness ability. The neurofeedback mindfulness regulation can affect the brain activity pattern of anxiety disorder patients.

The objective of this study was to determine the effectiveness of a single session of ↑sensorimotor (SMR)/↓theta neurofeedback training for mood improvements in 32 healthy men. Pre and post training, the participants completed various measures including: 1) psychometric measures of mood which measured anxiety, depression, and anger, 2) biological measures (salivary cortisol levels), and 3) neurophysiological measures (EEG frequency band power analysis). It was found that anxiety levels decreased following neurofeedback training, and increased following the sham training sessions. Further, cortisol levels decreased in both groups, though a more pronounced effect was observed in the real neurofeedback group. Lastly, the real neurofeedback group had significantly enhanced their SMR band, without changes in theta, whereas no EEG changes were observed in the sham group.

The etiology and symptomatology of social anxiety disorder (SAD) has been linked to attentional biases towards threat signals. Dysfunction of the dorsolateral prefrontal cortex (dlPFC) may contribute to attention biases in anxious individuals. The objective of this study was to determine the feasibility of near-infrared spectroscopy (NIRS) neurofeedback training-targeting the dlPFC and its effects on threat-related attention biases in individuals with SAD. 12 individuals with SAD completed 6-8 weeks of NIRS-neurofeedback training for a total of 15 sessions. It was found that neurofeedback performance significantly increased while the attention bias towards threat-related stimuli and SAD symptom severity decreased after training. Further, the individual increase in neurofeedback performance and decrease in SAD symptom severity was correlated with decreased responses to social threat signals in the cerebral attention system. 

The objective of the present study was to compare the efficacy of two commonly used biofeedback relaxation techniques in patients with generalized anxiety disorder (GAD). 45 participants with DSM-IV based GAD diagnosis were randomly assigned to electromyographic (EMG) biofeedback relaxation training, alpha-electroencephalographic (EEG) biofeedback relaxation training, or the control group. Both the EMG and EEG groups demonstrated more consistent patterns of generalized relaxation changes based on alpha-EEG activity, frontalis-EMG activity, systolic blood pressure and comprehensive anxiety test (CAT) scores compared to the control group. Further, these changes were maintained in both treatment groups at follow-up. 

In this study, 45 individuals with generalized anxiety were randomly assigned to 8 sessions of either frontal electromyographic (EMG) biofeedback, biofeedback to increase electroencephalographic (EEG) alpha, biofeedback to decrease EEG alpha, or a pseudo mediation control condition. It was found that all participants showed a significant decrease in STAI-Trait Anxiety and psychophysiologic symptoms on the Psychosomatic Symptom Checklist. However, only individuals in the alpha-increase biofeedback group demonstrated a significant reduction in heart rate reactivity at a separate psychophysiological testing session. Further, decreased self-report of anxiety was maintained 6 weeks post-treatment. 

The objective of this study was to determine if increasing alpha and theta brain wave amplitude in occipital areas impacts symptoms severity and global functioning level in patients with generalized anxiety disorder (GAD). 28 patients with a DSM-IV-TR diagnosis of GAD were randomly assigned to either the neurofeedback treatment group or the waiting list control group. Patients in both groups were assessed pre and post-test using the Generalized Anxiety Disorder Scale (GAD-7) and Global Assessment Functioning Scale (GAFSs). The neurofeedback group received fifteen 30-minute of alpha training and fifteen 30-minute theta training in occipital brain regions. It was found that increasing the alpha and theta brain brain wave amplitude in occipital areas in people with GAD increased global functioning level and reduced GAD symptoms in the treatment group. No change was observed in the waiting list group. 

The objective of this study was to determine the effects of adjunctive treatment with EEG biofeedback on the symptoms and cognitive functioning of individuals with OCD. Seventy-nine participants with OCD were randomly assigned to either the study or control group. The control group received a combination of sertraline (50 to 200 mg/d) and weekly cognitive behavioural therapy sessions by trained therapists for 8 weeks. The study group received the same regimen plus EEG biofeedback sessions 5 times a week. The Yale Brown Obsessive Compulsive Scale (YBOCS) was administered by a psychiatrist who was blind to patients’ treatment status before treatment and at the end of the 2nd, 4th, 6th and 8th week for treatment; the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was administered before and after the 8-week trial. It was found that improvement in OCD symptoms was greater in the study group than the control group by the 6th week of treatment. At the end of the trial, all 5 cognitive domains assessed by the RBANS were significantly better in the study group compared to the controls, and changes in the YBOCS were significantly correlated with changes in the RBANS score only in the study group. Overall, it was found that 8 weeks of adjunctive treatment with EEG biofeedback can significantly improve clinical symptoms and cognitive functioning in OCD patients being treated with medication and psychotherapy. 

The objective of this study was to determine the effect of independent component neurofeedback on EEG and clinical symptoms of OCD patients. 20 inpatients with OCD underwent 25 sessions of neurofeedback or sham feedback (SFB) in a randomized, double-bilnd parallel study. Neurofeedback was 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. It was found that, overall, clinical improvement in OCF patients was not accompanied by EEG changes. Further, pre- to post-treatment comparison of the trained component and frequency did not yield significant results. However, the neurofeedback group had a significantly higher percentage reduction of compulsions compared to the SFB group. Pretreatment higher amount of delta 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.

In this study, participants who were either high or low in trait anxiety used alpha neurofeedback to increase and decrease their electroencephalograic alpha activity. It was found that changes in alpha were linked to changes in anxiety, but only in participants with high anxiety. In these participants, anxiety was proportionally reduced to alpha increases and proportionally increased to alpha suppression. Further, participants with low trait anxiety were superior at both enhancement and suppression training, though their alpha changes were not related to changes in anxiety. Lastly, anxiety changes were unrelated to resting levels, changes in frontalis electromyograms or respiration rate in both groups. This study overall suggests that alpha neurofeedback training can be a beneficial tool in anxiety therapy. 

The aim of this study was to assess and present the effectiveness of EEG biofeedback as a potential therapy for patients ailed with panic attacks and other psychological symptoms as a result of the COVID-19 pandemic. In this study, a number of patients with symptoms after SARS-CoV-2 virus infection participated in QEEG-based EEG biofeedback training. The authors noticed abnormalities in brain wave frequencies and saw that EEG-biofeedback training helped to reduce symptoms of mood disorders among patients. In particular, they found that cognitive and executive functions were improved while measures of anxiety, panic, and fear were reduced. As a result, the article suggests that EEG-biofeedback can serve as an effective therapy for anxious symptoms such as panic attacks in post-COVID-19 patients. 

This study looked at the effects of electroencephalogram (EEG) biofeedback training for emotion regulation and brain homeostasis on anxiety, impulsivity, anger rumination, meta-mood, and self-regulation ability as affected by the prolonged COVID-19 pandemic situation in late adolescents. 55 late adolescents were split into experimental and control groups where the experimental group received 10 sessions of EEG biofeedback for five weeks. In all, the authors found that there were significant differences in emotion regulation between the two groups. Specifically, they saw that there were differences in anxiety about COVID-19infect, mood repair of meta-mood, and other variables. Pre and post test QEEGs showed enhanced sensory-motor rhythm as well as inhibited theta activity in the experimental group. These findings suggest that EEG biofeedback holds potential as an intervention that can improve anxiety, mood-repair, and self regulation for emotional distress during the COVID-19 pandemic. 

This study aimed to investigate the effects of neurofeedback training on reducing anxiety and improving working memory in university students. 40 university students were randomized into a control group and a neurofeedback treatment group. The neurofeedback treatment focused on the alpha frequency brain wave to target working memory and anxiety levels. Results showed that there was an increase in alpha waves by the second day of training, and by the end of the study anxiety levels were also reduced in the neurofeedback group. Working memory showed no differences between the control and neurofeedback group. More research should be done in the future to further examine how neurofeedback can be implemented in educational settings.