AAPB and ISNR have established standards for Neurofeedback research [Moss & Gunkleman (2002)] that confer a status of Level 5 Efficacy for Anxiety, where evidence meets all of Level 4 criteria and investigational treatment has been shown to be statistically superior to credible placebo, pill or alternative bona fide treatment in at least two independent researcher settings. Neurofeedback provides evidence-based practices on par with health care establishment demands (Gemon, Devon & Ramsey (2000), Sacket et al, (2000). Levels of evidence include: case reports, observational studies, randomized clinical trials, fMRI scans (Andrasik & Rime (2007), and so on. “Efficacy” determination of training or treatment effect is derived from systematic evaluation in controlled clinical trial (La Vaque et al (2002).

Case A

This case involved a forty-seven year old male who complained of extreme performance anxiety with a profound sense of shame, excessive worry and a lack of focus or sense of purpose. The man reported that he had suffered a traumatic and unstable childhood and felt he was unable to experience genuine intimacy with anyone. He was plagued with bouts of anger interspersed with dread and fear, and felt unable to control his racing thoughts and a constant barrage of negative thinking. The man was reluctant to use medication for fear of addiction and had engaged in some talk therapy without much satisfaction. His speech was laconic and sparing, and he complained of anergia and low stamina. This was having a negative impact on his work performance, and a recent Performance Appraisal made note of the fact that he was performing below his abilities.

Early after the man received Neurofeedback training he reported feeling energized, and yet calmer, with a subtle sense of clear focus. His girlfriend later reported he was "a little less serious lately". The man felt his overall mood might be improving, and noted he was not as "fixated on things" as he had been. Midway through training the man reported a profound shift, stating he had realized “it is my birthright to feel proud of myself.” He was able, for the first time, to stand up before a room full of people, stay calm, maintain focus, and speak easily, without halting, and without his knees shaking. Shortly thereafter the man became engaged to be married. He reported less anger overall, as if “a hard part of me has melted”. He reported being more in touch with his feelings of vulnerability, stating that this was making it possible for him to let go of anger more easily. By discharge, he reported significant progress in positive and forward moving thinking, and in being able to exercise appropriate assertiveness on a consistent basis.

Case B

This case involved a fifty-two year old female who struggled with a composite of
symptoms. She complained of generalized anxiety with depression and some obsessive and compulsive tendencies. She also suffered frequent migraine headaches and struggled with executive functioning deficits, including an inability to organize herself, chronic tardiness and procrastination, and some errors of logic with impaired hazard recognition.

Initially, after the woman received Neurofeedback training she reported no changes. However, after several sessions she reported feeling calmer overall, and noted her spouse had congratulated her on her neatly organized desk. As training progressed the woman reported that her full-blown migraines appeared to be in recession, and that these had been reduced to dull, low level headaches that were occurring once a week at most. Midway through training the woman reported she was worrying and obsessing less about issues, and that her spouse had agreed she was “more composed and focused” and able to better attend to details. The woman later reported that she was able to be much more punctual. She was no longer experiencing even the duller headaches, and she felt more confident about her ability to make good decisions/avert trouble. By discharge she reported her mood as consistently "good". She said she was able to cope and to contain her worries, and felt more optimistic then ever. The woman also noted she was able to form effective strategies for completing tasks that previously had piled up.