By Steven T. Padgitt, Ph.D.

A woman was referred by her physician to the Brain Wave Treatment Center for the treatment of Panic Disorder. During the intake interview she reported that she had experienced a long standing history of anxiety problems, which had not been effectively treated with medication. She further noted that she felt resistant to taking medication. She stated that she had seen mental health professionals for her anxiety problems, but that anxiety persisted despite her attempts to remedy the problem through talk therapy.

Upon questioning, it became clear that her history included Panic Attacks, with some Agoraphobic episodes. She reported visiting the emergency room of her local hospital the prior week with Panic Attack symptoms, where the provisional diagnosis was made. Her symptoms had sudden onset and she reported feeling impending doom, shortness of breath, lightheadedness, and stated that during the episode she thought she was going crazy. In addition, she stated that she found herself sweating profusely while trembling and feeling like she was losing complete control of herself. During further questioning, she was unable to isolate any situational trigger that would serve as a catalyst to her panic attacks.

Following an assessment of her symptoms, the psychophysiological nature of Panic Attacks was explained. After the assessment and educational processes, relevant information about Respiration and EEG Biofeedback modalities was introduced. She was told that Respiration Biofeedback involves the use of two strain gauge respiration sensors that would be fitted around her torso and on the outside of her clothing - one to measure chest expansion and one to measure abdominal expansion. She was told that these sensors would be used to help her learn to differentiate diaphragmatic from thoracic breathing. In addition, the concepts of electrical activity occurring in the brain and brain waves were introduced and she was told that following Respiration Biofeedback, she would have the opportunity to engage in and learn EEG self regulation. The various ranges and names of EEG activity were described. Lastly, the idea of reduced psychophysiological arousal and its relationship to the experience of relaxation was explained.

During the last 20 minutes of the first session, Respiration Biofeedback was conducted. Her baseline recordings demonstrated - via the computer screen - a predominantly thoracic breathing orientation. With instruction, she had little difficulty in differentiating diaphragmatic and thoracic respiration. By the end of the first session she had established and demonstrated, the ability transfer her predominant breathing efforts to diaphragmatic muscles. She was instructed to practice this newly acquired breathing pattern on a daily basis and ultimately to make this new response her normal pattern of breathing.

During the second session, her respiration was again monitored. She had made and demonstrated continued advances in diaphragmatic respiration. As this assessment was completed, and respiration monitoring continued, her attention was turned to EEG Biofeedback. She was told that Neurofeedback involves the surface placement of several sensors (electrodes): one reference sensor on the back of her neck (at C-7), one reference sensor on her ear lobe, and an active sensor placement on the surface of her scalp - from which her EEG activity would be recorded. She was instructed to relax with her eyes closed while she continued to breath diaphragmatically, and listen to the computer tones which represented her having surpassed the Alpha and Theta brain wave amplitude thresholds set during the training session. She was told that the computer tones she would hear were instantaneous verifications of her having produced the kind of brain wave activity that induces a relaxed state, and that her memorizing the sensation of her increase in Alpha and Theta activity would help her gain control of her anxiety related symptoms.

By the fifth EEG Biofeedback session, she reported that she was no longer having panic attacks, and that her general level of anxiety had diminished noticeably. She added that while she could feel herself begin to become anxious at times, she was able to willfully head off her anxiety and panic symptoms by focusing on diaphragmatic respiration and engaging in the EEG self regulation she had learned.

This skill building Biofeedback approach has been used with numerous patients and consistently yields positive results within a brief treatment strategy. Self regulation as a treatment goal places permanency of symptom relief within the control of the patient.