A Clinical Trial Comparing the Efficacy of Two EEG-Based Neurofeedback Protocols for Generalized Anxiety Disorder: Sensory Motor Rhythm and Alpha-Theta

Background: Electroencephalographic (EEG) neurofeedback training provides an effective alternative treatment for generalized anxiety disorder (GAD) through various protocols. Objectives: The purpose of this study was to compare the alpha-theta (AT) increase protocol with the sensorimotor rhythm (SMR) protocol in individuals with GAD. Methods: A randomized two-arm trial assessed two single-electrode EEG neurofeedback protocols based on operant conditioning. Forty university students receiving treatment for GAD at Taleghani Hospital, Tehran, were randomly assigned to 15 sessions of either AT training at Pz or sensory motor rhythm training at Cz (three sessions per week for five weeks). Assessments at pretest, posttest, and two-month follow-up included the State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS), and Beck Anxiety Inventory (BAI). Data were analyzed using repeated measures and mixed ANOVA in SPSS 26. Results: Analysis indicated that both protocols led to a significant reduction in anxiety symptoms. A significant time × group interaction was observed for state anxiety (P = 0.01), with the SMR group demonstrating a slightly greater immediate reduction at the post-test. Both protocols effectively reduced trait anxiety over time, with no significant differences between groups. Conclusions: These results suggest that EEG neurofeedback can be an effective non-pharmacological intervention for anxiety reduction, with potential for long-term benefits. Personalized neurofeedback protocols may enhance treatment outcomes by targeting specific brain regions involved in emotional regulation. However, given the sample characteristics and study design, caution is warranted when generalizing these findings to broader and more diverse populations, underscoring the need for future research to confirm their applicability.