Overview & Efficacy: Everybody gets anxious. Treatment is called for if the amount of anxiety is out of proportion to the problem or lasts too long. Many methods for helping people reduce and control their anxiety have been shown to be effective. Behavioral techniques include relaxation training, cognitive restructuring, and biofeedback. Any form of biofeedback that helps people become aware of their physiological responses as they become anxious and that helps people learn to relax is apparently at least as effective as any other behavioral technique.

This therapy is rated as efficacious (level 4 on a scale of 1 - 5 with 5 being the best).

For more information on how efficacy is rated click here.

Why biofeedback would help this problem: There are several different underlying problems which cause abnormal levels of anxiety. Biofeedback helps each for different reasons.

a.) Breathing problems which cause anxiety: Half or more of people who habitually breathe too rapidly with shallow breaths are anxious because of the effects of their breathing on their brains' chemistry. Most of these people are not aware they have incorrect breathing patterns. These incorrect patterns are easily detected using psychophysiological assessments and are corrected using several types of biofeedback related to helping people normalize their breathing patterns. When the breathing is normalized, the anxiety goes away.

b.) When a person experiences greater levels of anxiety or the anxiety lingers far longer than it should, the body's normal responses to an emergency situation don't shut down. This can cause the body to wear out while thinking and memory patterns change. The physiological reactions to anxiety are accurately assessed using psychophysiological recording techniques so both the patient and therapist always know when any therapy is helping and how much. Biofeedback treatments show the patient the abnormal physiological response levels. Patients use this knowledge to recognize when they are becoming abnormally anxious (so they learn to identify when is actually causing the anxiety) and to control their anxiety.

Children who are successfully trained to increase SMR show decreased activity levels. Successful neurofeedback training to decrease Theta while increasing Beta results in increased attention span and increased ability to learn math.

The training almost always takes place in a therapist's office. Sensors are pasted onto the scalp over the parts of the child's brain, which are to be trained. The sensors are connected to a computer, which runs a special training program. The program usually appears in the guise of a videogame. The videogame's progress or simply continuation is dependent upon the child producing the desired proportion of brain waves. The treatment may take 30 to 50 or more sessions for effects to be apparent and lasting.

Brief summary of evidence supporting the efficacy of biofeedback for abnormal levels of anxiety:

Yucha and Gilbert (2004) report that "very few well- controlled, randomized studies have shown biofeedback to be superior to other relaxation and self-control methods for reducing anxiety. Most show biofeedback (EMG, GSR, thermal, or neurofeedback) to be roughly equivalent to progressive relaxation or meditation. Two studies showed biofeedback's efficacy in reducing anxiety without making comparisons with other relaxation techniques. Hurley and Meminger (1992) used frontal EMG biofeedback with 40 subjects trained to criterion and assessed anxiety over time using the State-Trait Anxiety Inventory (STAI). State anxiety improved more than trait anxiety. Wenck, Leu, and D'Amato (1996) trained 150 7th and 8th-graders with thermal and EMG feedback, and found significant reduction in state and trait anxiety. Roome and Romney (1985) compared progressive muscle relaxation to EMG biofeedback training with 30 children and found an advantage for biofeedback; Scandrett, Bean, Breeden, & Powell (1986) found some advantage of progressive muscle relaxation over EMG biofeedback in reducing anxiety in adult psychiatric inpatients and outpatients. Vanathy, Sharma, and Kumar (1998), applying EEG biofeedback to generalized anxiety disorder, compared increased alpha with increased theta. The two procedures were both effective in decreasing symptoms.

Rice, Blanchard, and Purcell (1994) studied reduction in generalized anxiety by comparing groups given EMG frontal feedback, EEG alpha-increase feedback, EEG alpha- decrease feedback, a pseudo-meditation condition, and a wait-list control. All treatment groups had comparable and significant decreases in the STAI as well as drops in Psychosomatic Symptom Checklist. Similar results were obtained by Sarkar, Rathee, and Neera (1999) by comparing the generalized anxiety disorder response to pharmacotherapy and to biofeedback; the two treatments had similar effects on symptom reduction. Hawkins, Doell, Lindseth, Jeffers, and Skaggs (1980), concluded from a study with 40 hospitalized schizophrenics that thermal biofeedback and relaxation instructions had equivalent effect on anxiety reduction. Fehring (1983) found that adding GSR biofeedback to a Benson-type relaxation technique reduced anxiety symptoms more than relaxation alone."

* Much of the information provided here is from Carolyn Yucha and Christopher Gilbert's 2004 book "Evidence Based Practice in Biofeedback & Neurofeedback" AAPB, Wheat Ridge, CO.

Detailed information on biofeedback augmented treatment of abnormal levels of anxiety

A. Citations to the papers noted in the "brief summary":

Fehring, R.J. (1983). Effects of biofeedback-aided relaxation on the psychological stress symptoms of college students. Nursing Research, 32(6), 362-6.

Hawkins, R.C. II, Doell, S.R., Lindseth, P., Jeffers, V., & Skaggs, S. (1980). Anxiety reduction in hospitalized schizophrenics through thermal biofeedback and relaxation training. Percep