Neurofeedback Treatment for Anxiety Disorders:

Anxiety disorder symptoms can be permanently resolved with drug-free neurobiofeedback.

There are 10 promising controlled preliminary studies that address the effectiveness of neurofeedback in treating anxiety (Hammond, 2005; Moore, 2000). Positive changes were found in 7 out of 8 anxiety studies reviewed.

In another study (Passini et al., 1977), using 10 sessions of neurofeedback, statistically significant positive improvements were recorded in both anxiety status and anxiety tendency in alcoholics with anxiety compared to controls. Improvement continued after 18 months of follow-up.

Neurofeedback Treatment in Artist Anxiety:

A randomized, placebo-controlled study (Egner & Gruzelier, 2003) conducted at London’s Royal College of Music investigated performance anxiety.

This study investigated whether alpha/theta neurofeedback was effective in improving musical performance in high-level musicians playing in stressful situations. Compared to alternative treatments (exercise, mental skills training, Alexander technique, and two neurofeedback protocols focused more on concentration), only the alpha/theta group showed improvement in live music performance under stress.

Similar randomized controlled trials have been conducted with musical performance (Egner & Gruzelier, 2003), ballroom dance performance (Raymond, Sajid, Parkinson, & Gruzelier, 2005), and singing performance (Kleber, Gruzelier, Bensch, & Birbaumer, 2008; Leach, Holmes, Hirst, & Gruzelier, 2008).

Anxiety Reduced in Medical Students with Neurofeedback:

In a randomized placebo-controlled study with medical students (Raymond, Varney, Parkinson, & Gruzelier, 2005), neurofeedback improved mood, confidence, energy levels, and self-control.

In Krause et al.'s (2024) model, neurofeedback is uniquely positioned in stress-related disorders: it is an endogenous intervention that directly targets the brain, but does so not through external medication or stimulation, but by enabling the individual to learn to regulate their own brain activity through feedback. Therefore, neurofeedback differs from classical psychotherapies, pharmacological approaches, and TMS-like brain stimulation because the source of change is the individual's own brain's capacity for learning and self-regulation.

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https://www.sciencedirect.com/science/article/abs/pii/S0166223624001504

This figure classifies interventions used in the treatment of stress-related disorders along two axes:

First axis (horizontal axis): how directly it targets the brain.
Methods on the left affect the brain in more indirect ways; methods on the right target brain activity more directly.

The second axis is the vertical axis: the source of the intervention.

The upper side shows external/exogenous interventions; that is, change is initiated mostly through an external stimulus, medication, technique, or therapeutic application. The lower side shows endogenous/internal interventions; that is, the emphasis is on the individual learning and changing their own brain and body regulation systems.

According to this model:

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EMDR and exposure therapy are externally sourced approaches that target the brain more indirectly. The individual works with the traumatic memory, fear, or stress stimulus; the brain changes in this process, but the target is not directly EEG rhythms or brain activity.

Pharmacology and brain stimulation (such as TMS, tDCS) target the brain more directly, but the source of intervention is external. Medication or electrical/magnetic stimulation is applied externally and changes brain activity in this way.

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Mindfulness and self-regulation are more internally sourced; Individuals learn to regulate their attention, breathing, body awareness, and emotional responses. However, these target the brain more indirectly.

Neurofeedback, on the other hand, is at the most distinctive point: it is an endogenously derived method that directly targets the brain. That is, no external drugs or stimulation are given to the brain; the individual sees their own brain activity through feedback and learns to make the brain work more regularly. Therefore, neurofeedback is positioned as both a directly brain-based intervention and one based on the individual's own internal learning capacity.

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The fundamental point that distinguishes neurofeedback from many other interventions is that it relies on the brain learning its own activity through feedback. Neurofeedback is a brain learning process that works on the principle of operant conditioning. The brain receives instant feedback when it approaches the desired frequency, connectivity, or regulation pattern; healthy patterns are reinforced, while dysfunctional patterns become less dominant over time. Thanks to this repetitive learning cycle, the brain learns to recognize, maintain, and reactivate more balanced and functional modes of operation when needed.

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Therefore, neurofeedback is not merely an intervention that suppresses symptoms, provides temporary relief, or offers external control. Its primary goal is to reorganize the brain's unhealthy functioning cycles and create a more lasting capacity for self-regulation. When the brain learns new and healthier patterns, the individual begins to respond to impulse, anxiety, stress, distraction, or addiction cycles not only with conscious effort but also with a more regulated nervous system.

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This learning aspect is also critically important for reducing relapses. Because relapses often stem not from a lack of knowledge about what to do or not to do, but from the brain reverting to old automatic patterns. A person may mentally know they shouldn't gamble, control their anger, or succumb to anxiety; however, if the brain continues to operate the same old impulse, reward, threat, or avoidance cycle, the behavior will repeat. With neurofeedback, as the brain repeatedly experiences the new regulatory pathway, the dominance of old patterns can decrease, and the capacity for healthy responses can be strengthened.

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Other methods may allow individuals to gain insight, talk about their feelings, develop behavioral plans, or experience temporary relief. However, a mechanism that directly retrains the brain's functional patterns through learning may not always be activated. Therefore, cognitive awareness alone, talk-based interventions, or external regulators may not be sufficient to prevent relapses in some individuals. This is where neurofeedback's clinical value emerges: rather than telling the brain what to do from the outside, it allows the brain to relearn how to function healthily. Therefore, personalized neurofeedback based on QEEG can provide a

significant advantage, especially in terms of lasting change in addiction, impulse control, stress regulation problems, and recurring symptom cycles.

Krause F, Linden DEJ, Hermans EJ. Getting stress-related disorders under control: the untapped potential of neurofeedback. Trends Neurosci. 2024 Oct;47(10):766-776. doi: 10.1016/j.tins.2024.08.007. Epub 2024 Sep 10. PMID: 39261131.