Clinical and Psychological Efficiency Predictors of Adaptive Biofeedback in Mindfulness Formation in Anxiety Treatment

Anxiety disorders are a widespread mental pathology, yet standard pharmacotherapy often fails to provide sustained remission. Adaptive biofeedback and mindfulness training are effective psychological correction methods, although the clinical and psychological profile of patients who are most responsive to these interventions remains understudied. This research aimed to predict the effectiveness of biofeedback training in cultivating mindfulness in patients with anxiety disorders. This prospective randomized controlled trial included 180 patients (coded F40 and F41 under ICD-10) divided into three groups: isolated biofeedback training (n = 76), combined therapy (biofeedback training plus pharmacotherapy, n = 58), and medication monotherapy (n = 46). The assessment tools included the Hamilton Anxiety Rating Scale, the Five Facet Mindfulness Questionnaire, the Toronto Alexithymia Scale, and functional diagnostics (EEG alpha-rhythm asymmetry and power). The statistical analysis employed analyses of variance (ANOVA). The predominating somatic component in the isolated biofeedback group was associated with a sustained increase in alpha rhythm at follow-up. In patients with predominantly psychic anxiety, the achieved increase was not maintained. Alexithymia emerged as a significant predictor. In the acute phase, the biofeedback training promoted the verbal component of mindfulness (the Describe subscale). At follow-up, it provided a higher overall level of mindfulness and stable anxiety reduction compared to isolated pharmacotherapy (p ≤ 0.05). The patients with low alexithymia demonstrated no significant differences between treatment modalities. Thus, the level of alexithymia and the structure of anxiety symptoms proved to be informative clinical and psychological predictors for tailoring biofeedback training. In this study, the patients with high or moderate alexithymia and somatic anxiety proved to be especially susceptible to the method.