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Anxiety
Level 4 Efficacy (Efficacious)


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. This may be because anxiety is less a disorder of physiology than of attention
and cognition, and biofeedback monitors physiological changes. Lehrer, Carr, Sargunaraj,
and Woolfolk (1994) evaluated the hypothesis that biofeedback is most effective when
applied in the same modality as the disorder (autonomic feedback for ANS disorders, EMG
feedback for muscular, etc.). Self-relaxation techniques have in common the process of using
conscious intent to calm oneself, and for anxiety reduction it may matter little which
modality is used, because the central component is the cognitively-based conscious intent.

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. However, Fehring (1983) found that adding GSR biofeedback to Benson-
type relaxation technique reduced anxiety symptoms more than relaxa tion alone.

In conclusion, biofeedback of various modalities is effective for anxiety reduction; it is
not specific, but shares characteristics with other relaxation techniques.

References

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.
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.

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.
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.

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.

Scandrett, S.L., Bean, J.L., Breeden, S., & Powell, S. (1986). A comparative study of
biofeedback and progressive relaxation in anxious patients. Issues in Mental Health Nursing,
8(3), 255-271.

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.

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Anxietybf

  • 1. Anxiety Level 4 Efficacy (Efficacious) 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. This may be because anxiety is less a disorder of physiology than of attention and cognition, and biofeedback monitors physiological changes. Lehrer, Carr, Sargunaraj, and Woolfolk (1994) evaluated the hypothesis that biofeedback is most effective when applied in the same modality as the disorder (autonomic feedback for ANS disorders, EMG feedback for muscular, etc.). Self-relaxation techniques have in common the process of using conscious intent to calm oneself, and for anxiety reduction it may matter little which modality is used, because the central component is the cognitively-based conscious intent. 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. However, Fehring (1983) found that adding GSR biofeedback to Benson- type relaxation technique reduced anxiety symptoms more than relaxa tion alone. In conclusion, biofeedback of various modalities is effective for anxiety reduction; it is not specific, but shares characteristics with other relaxation techniques. References Fehring, R.J. (1983). Effects of biofeedback-aided relaxation on the psychological stress symptoms of college students. Nursing Research, 32(6), 362-6.
  • 2. 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. 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. 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. 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. Scandrett, S.L., Bean, J.L., Breeden, S., & Powell, S. (1986). A comparative study of biofeedback and progressive relaxation in anxious patients. Issues in Mental Health Nursing, 8(3), 255-271. 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.