Level 4 Efficacy (Efficacious)

Clinical Efficacy of Biofeedback (AAPB Report)
General biofeedback including EMG, GSR, thermal, or EEG are equivalent to progressive relaxation or meditation effects. Anxiety is often said to be a disorder of attention and cognition (AAPB Biofeedback Efficacy, 2004). More specifically, biofeedback is most effective when applied in the same modality as the disorder (autonomic feedback for ANS disorders, EMG feedback for muscular, etc.) (Lehrer, Carr, Sargunaraj, and Woolfolk, 1994).

Self-relaxation uses conscious intent to calm oneself. For anxiety, it doesn't matter which modality is used since the central component is the cognitive-based conscious intention.

Hurley and Meminger (1992) demonstrate efficacy in reducing anxiety using frontal EMG biofeedback. State anxiety improve more than trait anxiety in fourty subjects trained to criterion and assessed anxiety over time using the State Trait Anxiety Inventory (STAI).

Wenck, Leu, and D'Amato (1996) trained 150 7th and 8th grade students with thermal and EMG feedback and also achieved a significant reduction in state and trait anxiety.

Scandrett, Bean, Breeden, & Powell (1986) found some advantage of progressive muscle relaxation over EMG biofeedback in reducing anxiety in adult psychiatric inpatients and outpatients. On the other hand, Roome and Romney (1985) compared progressive muscle relaxation to EMG biofeedback training with 30 children and found an advantage for biofeedback. Thus, combining EMG biofeedback with progressive muscle relaxation may induce even greater effects.

Vanathy, Sharma, and Kumar (1998) applied EEG biofeedback to generalized anxiety disorder and compared increased alpha with increased theta. The two procedures were both effective in decreasing symptoms.

A reduction in generalized anxiety has been demonstrated using frontal EMG biofeedback, 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 40 hospitalized schizophrenics that thermal biofeedback and relaxation instructions had equivalent effect on anxiety reduction. However, Fehring (1983) found that adding GSR biofeedback to a Benson-type relaxation technique reduced anxiety symptoms more than relaxation alone.

This is why ADNC integrates all forms of biofeedback with established relaxation and therapeutic approaches to achieve maximum benefits.

Strategies When Living with Anxiety
Simple strategies can be put in place to help people deal with feelings of anxiety.

Breathe:
Focus on your breath, not the anxiety, and breathe slowly and deeply from the abdomen.

Be aware of yourself:
Is what you're saying to yourself calming you down or making you feel more anxious? Try saying soothing things to yourself.

Do something else:
Shift your focus away from the anxiety. Try going for a walk or doing a task that takes up your attention.

Stay in the present:
Don't worry about predicting outcomes, let the future work itself out.

Lighten up on perfectionism:
Accept your limitations and don't needlessly pressure yourself.

Answer the what-ifs:
So what if you make a fool of yourself? The likely outcome is far less dire than the imagined disaster.

Anxiety Publications

Burish, T. G., & Jenkins, R. A. (1992). Effectiveness of biofeedback and relaxation training in reducing the side effects of cancer chemotherapy. Health Psychology: Official Journal of The Division of Health Psychology, American Psychological Association, 11(1), 17-23. Retrieved from Medline.

Hammond, D. C. (2005). Neurofeedback with anxiety and affective disorders. Child & Adolescent Psychiatric Clinics of North America, 14(1), 105-123.

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. Perceptual & Motor Skills, 51(2), 475-482.

Hiebert, B. A., & Fitzsimmons, G. (1981). A comparison of EMG feedback and alternative anxiety treatment programs. Biofeedback & Self Regulation, 6(4), 501-516. Retrieved from Springer Link.

Hurley, J. D. (Apr. 1980). Differential effects of hypnosis, biofeedback training, and trophotropic responses on anxiety, ego strength, and locus of control. Journal of Clinical Psychology, 36 (2), 503-507. Retrieved from Medline.

Hurley, J. D., & Meminger, S. R. (1992). A relapse-prevention program: Effects of electromyographic training on high and low levels of state and trait anxiety. Perceptual and Motor Skills, 74 (3 Pt 1), 699-705.

Khalsa, S. S., Shorter, S. M.,  Cope, S., Wyshak, G., & Sklar, E. (Aug. 2009). Yoga Ameliorates Performance Anxiety and Mood Disturbance in Young Professional Musicians. Applied Psychophysiology and Biofeedback, 34(4), 279–29. Retrieved from SpringerLink.

Kerson, C., Sherman, A., Kozlowski, G. (July 2009). Alpha Suppression and Symmetry Training for Generalized Anxiety Symptoms. Journal of Neurotherapy, 13(3), 146 – 155. Retrieved from Infomaworld Database.

Kappes, B. M. (Mar. 1983). Sequence effects of relaxation training, EMG, and temperature biofeedback on anxiety, symptom report, and self-concept. Journal of Clinical Psychology, 39(2), 203-8. Retrieved from Medline.

Lehrer, P. M., Carr, R., Sargunaraj, D., & Woolfolk, R. L. (1994). Stress management techniques: Are they all equivalent, or do they have specific effects? Biofeedback & Self Regulation, 19(4), 353-401.

Mittenberg, W., & Petersen, J. D. (Aug 1984). Validation of the Holtzman anxiety scale by vasomotor biofeedback. Journal of Personality Assessment, 48(4), 360-364. Retrieved from Medline Database.

Rice, K. M., Blanchard, E. B., & Purcell, M. (1993). Biofeedback treatments of generalized anxiety disorder: Preliminary results. Biofeedback & Self-Regulation, 18(2), 93-105.

Roome, J.R., & Romney, D.M. (1985). Reducing anxiety in gifted children by inducing relaxation. Roeper Review, 7(3), 177-179.

Sarkar, P., Rathee, S. P., & Neera, N. (1999). Comparative efficacy of pharmacotherapy and bio-feedback among cases of generalised anxiety disorder. Journal of Projective Psychology & Mental Health, 6(1), 69-77.

Schwartz, M. S., & Andrasik, F. (2003). Biofeedback: A Practitioner's Guide. 440-443.

Schachter R.. Enhancing Performance for Anxious Students. Biofeedback, 35(3), 105-109.

Smith, M. S., Doroshow, C., Womack, W. M., Tenckhoff, L., Stamm, S., & Pertik, M. (Aug. 1989). Symptomatic mitral valve prolapse in children and adolescents: catecholamines, anxiety, and biofeedback. Pediatrics 84(2), 290-295. Retrieved from Medline Database.

Vanathy, S., Sharma, P. S. V. N., & Kumar, K. B. (1998). The efficacy of alpha and theta neurofeedback training in treatment of generalized anxiety disorder. Indian Journal of Clinical Psychology, 25(2), 136- 143.

Wenck, L.S., Leu, P.W., & D'Amato, R.C. (1996). Evaluating the efficacy of a biofeedback intervention to reduce children's anxiety. Journal of Clinical Psychology, 52(4), 469-473.