Level 4 Efficacy

Anxiety Research

Neurofeedback has been ranked as a Level 4 ("Efficacious") treatment for anxiety!

Level 4 Efficacy Meaning

According to the Association for Applied Psychophysiology and Biofeedback (AAPB) and the International Society for Neurofeedback and Research (ISNR), neurofeedback for anxiety has achieved a Level 4: Efficacious rating. This designation means that multiple well-controlled studies have demonstrated that neurofeedback is significantly more effective than placebo treatments in reducing anxiety symptoms.

In practical terms, this means that neurofeedback is not just a promising therapy—it is a proven method for helping individuals manage and alleviate anxiety.

Supporting Research

A comprehensive review published in the Journal of Counseling & Development analyzed 26 studies on neurofeedback for anxiety. The meta-analysis concluded that neurofeedback leads to significant reductions in anxiety symptoms, reinforcing its status as an effective treatment option.

“The results indicated that neurofeedback training significantly reduced anxiety symptoms across various anxiety disorders.”
— Russo, G. M., Balkin, R. S., & Lenz, A. S. (2022)

You can read the full study here: A Meta-Analysis of Neurofeedback for Treating Anxiety-Spectrum Disorders

Feature / Benefit Neurofeedback Medication Talk Therapy (CBT)
How it Works Trains brainwave patterns using real-time feedback Alters brain chemistry with pharmaceuticals Addresses thoughts, emotions, and behaviors
Evidence-Based for Anxiety ✔ Yes (Level 4 Efficacious – multiple studies) ✔ Yes, especially for short-term symptom relief ✔ Yes, widely researched and effective
Non-Invasive ✔ Yes ✘ No – involves chemical intervention ✔ Yes
Side Effects Minimal to none Possible (e.g., drowsiness, weight changes) Minimal
Addresses Root Brain Patterns ✔ Yes – targets dysregulated brain activity ✘ No – manages symptoms rather than correcting cause ✘ No – focuses on coping, not brain regulation
Duration of Benefits Long-lasting with proper training Short-term; may require ongoing use Medium to long-term, varies by individual
Custom-Tailored ✔ Yes – based on brain maps (QEEG) ✘ Usually generalized by diagnosis ✔ Yes – therapist adjusts per session
Works Well with Other Treatments ✔ Yes – complements therapy & meds ✔ Often used with therapy ✔ Often used with meds or neurofeedback
Typical Treatment Duration 20–40 sessions (2–3 months average) Ongoing or long-term use Weekly sessions over several months

Research Supporting Neurofeedback for Anxiety Therapy

1) Hou, Y., et al. (2021). "Neurofeedback training improves anxiety trait and depressive symptom in GAD." Brain and Behavior, 11(3), e02024.

  • Summary: This 2021 randomized controlled trial by Hou et al., published in Brain and Behavior, found that 10 sessions of alpha neurofeedback significantly reduced anxiety and depressive symptoms in patients with Generalized Anxiety Disorder (GAD, p < 0.05), with sustained effects at follow-up. Increased alpha power (8–12 Hz) provided a neurophysiological basis for these improvements, supporting neurofeedback’s efficacy as a non-invasive treatment for GAD.

  • Article: Neurofeedback training improves anxiety trait and depressive symptom in GAD

2) Wang, S., et al. (2013). "EEG biofeedback improves attentional bias in high trait anxiety individuals." BMC Neuroscience, 14, 115.

  • Summary: This 2013 study by Wang et al., published in BMC Neuroscience, found that EEG biofeedback (alpha or theta/beta protocols) significantly improved attentional control and reduced anxiety symptoms (p < 0.05) in individuals with high trait anxiety, as measured by tasks like the dot-probe and anxiety scales. These findings support neurofeedback’s efficacy as a brain-based, non-invasive intervention for anxiety management.Article: EEG biofeedback improves attentional bias in high trait anxiety individuals

3) Kadosh, K. C., & Hadar, A. (2023). “QEEG Guided Neurofeedback Treatment for Anxiety Symptoms.” Frontiers in Psychiatry, 14, 1345956.

  • Summary: A 2023 study by Kadosh et al. found QEEG-guided neurofeedback significantly reduced anxiety symptoms in 20 adults after 15 sessions, supporting its personalized, non-invasive efficacy. This study supports neurofeedback by demonstrating significant reductions in anxiety symptoms (measured by STAI scores, p < 0.05) using personalized QEEG-guided protocols, which target specific EEG abnormalities (e.g., alpha asymmetry, theta excess). The tailored approach enhances efficacy, and the non-invasive nature with no reported side effects makes it a compelling treatment option for anxiety, ideal for promoting on your website.

  • Article: QEEG Guided Neurofeedback Treatment for Anxiety Symptoms

4) Paul et al., (2022). Effectiveness of Neurofeedback Therapy Adjunct to Cognitive Behavioral Therapy in Agoraphobia: A Case Study.” Annals of Neurosciences

  • Summary: This 2022 case study by Paul et al., published in Annals of Neurosciences, found that 18 sessions of neurofeedback (alpha/beta protocols) combined with cognitive behavioral therapy (CBT) significantly reduced agoraphobia symptoms, as measured by the Panic and Agoraphobia Scale and EEG changes. The study supports neurofeedback’s adjunctive efficacy, highlighting its potential as a non-invasive intervention to enhance CBT by improving prefrontal-amygdala connectivity, offering a promising approach for agoraphobia treatment.Article: Effectiveness of Neurofeedback Therapy Adjunct to Cognitive Behavioral Therapy in Agoraphobia: A Case Study

5) Chen et al. (2021). “Efficacy Evaluation of Neurofeedback-Based Anxiety Relief.” Frontiers in Neuroscience

  • Summary: This 2021 study by Chen et al. examined mindfulness-based neurofeedback in individuals with anxiety disorders. Using EEG feedback across three neurofeedback sessions, the researchers found significant increases in gamma wave activity (p < 0.05), a marker linked to mindfulness and emotional regulation. Participants with anxiety showed measurable symptom relief, supporting neurofeedback’s ability to modify anxiety-related brain patterns. The study highlights mindfulness-based neurofeedback as an effective, non-invasive intervention for anxiety, offering both neural and psychological benefits.

  • Article: Efficacy Evaluation of Neurofeedback-Based Anxiety Relief