Addressing Anxiety with Neurofeedback

byDan Dinsmoor, Ph.D.

The topic of anxiety is in the news. In fact, last week it was even on the cover of TIME magazine. This is a complex phenomenon. On the one hand anxiety can protect us from danger, and it can make us efficient and goal directed as we try to avoid risk. On the other hand it can also cause distress, and when it is intense and chronic, anxiety can lead to physical and cognitive challenges. At Family Compass we utilize insights coming from this line of brain research to inform many of the interventions we use to help children with high anxiety and their families. This article describes how neurofeedback, part and parcel of Family Compass interventions, is informed by the emerging brain science.

Excessive anxiety takes many forms. Some children, who come to see us have specific fears, or specific sensory sensitivities, such as fear of dogs, fear of crowds, school performance, and hyper-sensitivity to sounds or smells. In other cases, high anxiety is secondary to other challenges. For example, children with autism very often experience a high level of anxiety that can greatly interfere with learning and with engagement with the world.

The “Pavlovian Conditioning Paradigm”, though it captures just part of the complexity, helps us nevertheless to understand some of the central processes in anxiety. In this model, a stimulus that does not cause distress initially can become anxiety provoking when it is paired with a stimulus that does evoke anxiety. For example, a playground that a child initially enjoyed can become aversive to the child if it is paired with the experience of a large, threatening dog present in the playground during the child’s last visit. It often only takes one occasion of such a pairing to develop anxiety, and it can lead to prolonged avoidance of the playground.

The brain area that is central to the acquisition of this kind of anxiety response is called the Amygdala. This emotional area receives information from the sensory system (e.g. loud barking, rapid looming movement) and at the speed of light provokes strong (emotional) signals to other areas of the brain resulting in an emergency response such as increases in blood pressure and sweat responses, increase in stress hormones, decrease skin temperature, changes in breathing, and specific distress calls (such as crying). These physiological responses are often followed by a “fight” or “flight” or freezing response.

Collectively the system behind all this is called the sympathetic branch of the autonomic nervous system. To counter the effects of this high anxiety system there is a second branch of the autonomic nervous that is called the parasympathetic nervous system. This branch helps us calm down, and reverses many of the emergency, high anxiety responses. Importantly, these two branches of the autonomic nervous system tend to balance each other, ideally to a state of homeostasis. When danger (either real or imagined) lurks the sympathetic nervous system prepares us for the challenge. When the All Clear sign arrives, the parasympathetic nervous system returns us to a calmer state. For children with a chronic high anxiety, the sympathetic nervous system is persistently activated, and the parasympathetic nervous system is not able to return the child to a calmer state. This results in chronic distress that adversely affects quality of life and daily functioning, both for the child and often to the family as a whole.

When chronic high anxiety hits the brain area called Medial Prefrontal Cortex can come to the rescue. If the child who was afraid of the dog in the park can gradually be introduced to the dog, without harm and without evoking another strong fear reaction, the fear can be lessened with the help of the medial prefrontal cortex; a process called “extinction” (of fear). When less anxious another related brain area can spring into action, the Prefrontal Cortex. This brain area, when calmer head prevails, allows for a cooler, more thoughtful and less emotional assessment of the frightening situation, realizing that the fear might not be justified.

Now to how anxiety can be ameliorated by neurofeedback. Each mental state, such as when someone is fearful is associated with a specific “profile” of brain electrical activity (for the engineers among you we are talking here about profile of the various frequencies emitted from the brain). In neurofeedback sessions, sensors are placed on the child’s head to record the brain activity. Neurofeedback works by helping the child change mental state, into a more calm state, by providing the child feedback that enables to change his or her profile of brain activity to improve the self regulatory (homeostatic) capacity into a calmer state.

This intervention often results in dramatic reductions in symptoms of anxiety. When this is repeated over 15-20 treatment sessions, it often leads to reduction in chronic anxiety. In practical terms, this means that a child who is very anxious about going to school might be able to go to school. A child with autism who normally would be overwhelmed by change in routine no longer is as critically dependent on routine and predictability to feel safe and secure. A child, who is hypersensitive to sound, may begin to tolerate sounds that had previously been highly stressful. In these cases described above neurofeedback seems to work by positively affecting the circuits related to the Amygdala, reducing the emotional intensity of the child.

The second line of neurofeedback treatment to reduce anxiety involves strengthening the ability of the prefrontal cortex to bring more calm and thoughtful discourse at times of high anxiety. This is done with another device that aims at increasing the blood flow and therefore the activity level of the prefrontal cortex. It provides feedback in regard to the level of oxygenation in the prefrontal cortex and this way enables the child to increase it. Repeating this procedure over several sessions increases the ability (of the prefrontal cortex) to subordinate the emotional intensity of the Amygdala with a more thoughtful or plan-full discourse.

A third neurofeedback treatment approach is designed to better balance of the effects of the sympathetic and parasympathetic nervous systems, by using a complex concept called “heart rate variability”. In a nutshell, high level of heart rate variability characterizes health whereas a low level of variability characterizes distress. By manipulating breath rate, and heart rate, we can increase heart rate variability. It is thought that this allows the autonomic nervous system to recalibrate, and for the parasympathetic nervous system to exert its function of returning the child to calm.

In our clinic, these modes of neurofeedback treatment are often used in combination with each other. They are also used in combination with therapy to the child and with parental guidance, often provided by other therapists.