Comparing the effectiveness of neurofeedback therapy with mindfulness-based stress reduction in reducing anxiety symptoms in patients with social anxiety

Master's Thesis in Clinical Psychology

Abstract:

Objective:

Social anxiety is a very debilitating disorder that can disrupt many aspects of a person's life. In this research, the researcher is looking for treatment using neurofeedback methods and presence of mind as new treatments in the field of psychology. Method: The design of this research is quasi-experimental with pre-test and post-test with two groups. 10 people received neurofeedback and presence of mind treatment. The statistical method in this research is the use of covariance analysis and dependent t-test. Findings: The findings show that neurofeedback and presence of mind had a significant effect on social anxiety and reduced it. Since Leiboutiz's questionnaire was used in this research, which has two components of anxiety and avoidance, statistical analysis shows that neurofeedback treatment and stress reduction based on the presence of mind have no significant difference in reducing anxiety symptoms. But in the neurofeedback group, the reduction of avoidance was more than in the presence of mind group.

Key words:

Neurofeedback - reduction of stress based on presence of mind - social anxiety.

Introduction

Social anxiety[1] is a very debilitating disorder that can disrupt many aspects of a person's life (Hollander[2], Simon [3], 2008). The main feature of social phobia is an overt and persistent fear of social situations that may cause embarrassment. Exposure to social or performance situations almost always immediately results in an anxiety reaction. Although teenagers and adults with this disorder realize that their fears are excessive or irrational, this may not be true for children. In social or functional situations that are frightening (in the eyes of the individual) people with social anxiety disorder have concerns about embarrassment and fear that others will perceive them as anxious, incompetent, confused, or confused. They may be afraid of speaking in public because they worry that others will notice their trembling hands or voice, or they may feel intense anxiety when speaking to others because of the fear of revealing their poor communication skills. And it is also possible that they avoid others while eating and drinking in public because of the fear of being humiliated for observing hand tremors. People with social anxiety disorder almost always feel symptoms of anxiety (palpitations, tremors, sweating, gastrointestinal discomfort, diarrhea, muscle tension, and flushing) in social situations (American Psychiatric Association [4], 2000). Anticipatory anxiety is a clear predictor of social anxiety and causes disruption in social relationships (Maani, 2010). In this research, the effectiveness of neurofeedback and presence of mind is investigated. Given the knowledge that now exists about the brain and the activities of observing the brain in action, therapists in various therapeutic settings are increasingly working on brain-focused therapies. Neurofeedback is based on electroencephalograph self-regulation (Ayres [5], 2000) (Rang and Eng [6], Hessell [7], 2013) and as a tool, it changes brain waves and improves the individual's performance (Grizlier [8], Thompson, Redding, Brandi, Steffert, 2013). In neurofeedback, to reduce anxiety, alpha, beta and theta neurofeedback should be taught and people should be taught that by affecting these waves, it reduces anxiety. The length of the sessions is different for different disorders, in the case of social anxiety, the number of sessions is 12 sessions and they work on certain brain waves. In fact, neurofeedback is used to suppress waves that exceed the range and strengthen waves that are lower than the range. In fact, these changes are related to neurological and psychological disorders. Neurofeedback makes the human brain learn ways to relax.

The effectiveness of neurofeedback is related to specific areas of the brain based on the type of disorder (Serriot[9] et al., 2002) (Stephen Beale, Brewer, Keyser, Van Woo[10], 2013).The preliminary results in animal studies based on the effect of neural feedback on the change of brain waves and cortical activity and the effect of these changes on improving the performance of cats have been presented by Sterman Viorika Worth (Vashughi Fard, Zarei, Ali Nazari and Kamali, 2018). The first treatment case was a 21-year-old man with a disorder in the central nervous system, who improved attention and auditory memory by using neurofeedback (Brikva, Timoferl, Musolo [11], 2003). In neurofeedback therapy, electroencephalography is used as a prelude to the treatment, in this way that the pattern of brain waves in the disorder is determined first, then the degree of deviation of the waves from the normal pattern is determined, which is done quantitatively through electroencephalography. Quantitative electroencephalography is obtained from 19 cranial locations that are specified based on the 20-10 system, and actually 19 electrodes are placed on the skull. Neurofeedback is designed to change the spectrum of brain waves (Koben[12] and Padalski[13], 2002). Neurofeedback is a type of rehabilitation approach, and its goal is the stable normalization of behavior without constant dependence on drugs or behavioral therapy. Neurofeedback accepts the basis of neurological disorders. Neurofeedback seeks to teach patients to normalize their brain wave responses to stimuli (Moradi et al., 2011). Neurofeedback is a means by which participants can have control over brain waves (Kerimi, Haqshanas, Rostami, 2011). Neurofeedback is used to treat clinical problems such as: epilepsy, anxiety, depression, hyperactivity with inattention, learning disorders, and substance abuse disorders (Brikva, Timoferl, and Musolo, 2003). Neurofeedback as a complex treatment method, while it is a safe and non-invasive method that causes growth and changes in brain cells. In this method, in order to have a neurofeedback treatment protocol, an electroencephalography is taken from each person separately (Vawoqi et al., 2013).

Presence of mind means paying attention in a specific way, focused on the goal, in the present time and without judgment. In the presence of one's mind, one learns to be aware of one's mental state at every moment and to focus one's attention on different modes of one's mind (Amidi and Mohammadkhani, 2017). The presence of the mind means the experience of pure reality without explanation (Aghabaghri, Khani, Omrani, Farahmand, 2011). Mindfulness was first used at the University of Massachusetts by John Kabat-Zinn, and in his stress reduction clinic, he taught participants mental relaxation exercises along with presence of mind, which became Mindfulness Based Stress Reduction. In recent decades, methods of presence of mind such as presence of mind based on stress reduction and presence of mind based on cognitive-behavioral and presence of mind based on dialectical behavioral method have been used as treatment methods in medicine, mental health and mental health settings. At present, the most common method of mindfulness training is based on stress reduction (MBSR) [14], which was previously known as the stress reduction and relaxation program. This method was designed in the structure of behavioral medicine and for a wide range of people suffering from disorders related to stress and chronic pain. The mentioned method is implemented in the form of an 8 to 10 week program. The sessions are in groups and each session lasts for 2 hours. Participants are trained to focus on their activities and become moment-to-moment self-awareness, and to observe non-judgmentally as emotions, feelings or cognitions are processed. When participants become aware that the mind has wandered into thoughts, memories, or daydreams, they return their attention to the present when possible, regardless of their content or nature. Therefore, participants learn to pay attention to their thoughts and feelings, but not to cling to their content. One of the consequences of the present exercises of the mind is that people learn that most of the feelings, thoughts and emotions with fluctuations pass quickly and pass like the waves of the sea. Mindfulness is a method of directing attention that has its roots in Eastern meditative traditions and has been increasingly discussed and used. Kabat Zain (2003) points out that the presence of mind includes the position of compassion, interest, friendship, and kindness (Amidi and Mohammadkhani, 2017). Historically, presence of mind is the main technique used in Buddhist meditation, which is rooted in the said ritual. The presence of the mind causes a change in the functional and clinical course of the client's mind and improves performance and relationship (Yousfi and Sohrabi, 2018). It has been proven for centuries that the presence of the mind can lead to reducing pain and suffering and increasing well-being (Chamerkohi and Mohammad Amini, 2013).