Neurofeedback Rehabilitation Reduces Anxiety in Methamphetamine Abusers

  • Roghieh Nooripour Department of Counseling, Faculty of Education and Psychology, Alzahra University, Iran
  • Sverker Sikström Professor in Cognitive Psychology, Chair of the Cognitive Division, Department of Psychology, Lund university,
  • Nikzad Ghanbari Ph.D. Student of Clinical Psychology (Prevention and Treatment of Addiction) Faculty of Education and Psychology, Shahid Beheshti University (SBU), Tehran, Iran
  • Simin Hosseinian Simin Hoseinian Professor, Department of Counseling, Alzahra University, Tehran, Iran
  • Peyman Hassani-Abharian Peyman Hassani-Abharian MD- Ph.D. in Cognitive Neuroscience. Assistant professor in Institute for Cognitive Science Studies, Brain and Cognition Clinic, Tehran, Iran
  • Hossein Ilanloo PhD of Counseling, Kharazmi University, Tehran, Iran
Keywords: Anxiety, Methamphetamine Abuse, Neurofeedback, Rehabilitation


Addictive disorders are characterized by cognitive, behavioral, and neurological impairments caused by dysregulations of brain structure that can extend well beyond early withdrawal in the months and years of recovery. The present study aimed to examine the efficacy of neurofeedback rehabilitation on anxiety in methamphetamine abusers. The sample consisted of 14 male methamphetamine drug addicts who were randomly assigned to an experimental group (n = 7) and a control group (n = 7). Participants were assessed for Axis I disorders (SCID) and the Beck Anxiety Inventory (BAI). Mixed repeated ANOVA, independent t-tests, and chi-square were used for data analysis. The experimental group received 18 sessions of neurofeedback rehabilitation and standard psychological interventions treatment as usual, while the control group received only standard interventions. Results showed that neurofeedback significantly reduced anxiety in methamphetamine abusers at posttreatment and during a one-month follow-up. Along with other psychological interventions, neurofeedback rehabilitation is recommended for methamphetamine abusers.


Albini, M., Morano, A., Fattouch, J., Fanella, M., Avorio, F., Basili, L. M., Irelli, E. C., Manfredi, M., Giallonardo, A. T., & Di Bonaventura, C. (2020). Anxiety as the only manifestation of focal non-convulsive status epilepticus: Case report and review of the literature. Neurocase, 26(2), 98–102.

Aliño Costa, M., Gadea, M., Hidalgo, V., Pérez, V., & Sanjuán, J. (2017). An effective neurofeedback training, with cortisol correlates, in a clinical case of anxiety. Universitas Psychologica, 15(5).

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Askovic, M., Watters, A. J., Coello, M., Aroche, J., Harris, A. W. F., & Kropotov, J. (2020). Evaluation of neurofeedback for posttraumatic stress disorder related to refugee experiences using self-report and cognitive ERP measures. Clinical EEG and Neuroscience, 51(2), 79–86.

Avirame, K., Nuss, L., & Todder, D. (2016). Safety and feasibility of neurofeedback training (NFB) during sleep in uncooperative child with autism: Case report. NeuroRegulation, 3(3), 135–139.

Bink, M., van Nieuwenhuizen, C., Popma, A., Bongers, I. L., & van Boxtel, G. J. M. (2015). Behavioral effects of neurofeedback in adolescents with ADHD: A randomized controlled trial. European Child & Adolescent Psychiatry, 24(9), 1035–1048.

Brewer, J. A., Worhunsky, P. D., Carroll, K. M., Rounsaville, B. J., & Potenza, M. N. (2008). Pretreatment brain activation during Stroop task is associated with outcomes in cocaine-dependent patients. Biological Psychiatry, 64(11), 998–1004.

Chen, T.-C., & Lin, I.-M. (2020). The learning effects and curves during high beta down-training neurofeedback for patients with major depressive disorder. Journal of Affective Disorders, 266, 235–242.

Davelaar, E. J. (2018). Mechanisms of neurofeedback: A computation-theoretic approach. Neuroscience, 378, 175–188.

Doostian, Y., Bahmani, B., Farhoudian, A., Azkhosh, M., & Khanjani, M. S. (2019). Vocational rehabilitation for individuals with substance-related disorders. Iranian Rehabilitation Journal, 17(2), 105–112.

Egner, T., Zech, T. F., & Gruzelier, J. H. (2004). The effects of neurofeedback training on the spectral topography of the electroencephalogram. Clinical Neurophysiology, 115(11), 2452–2460.

Elkington, K. S., Bauermeister, J. A., & Zimmerman, M. A. (2010). Psychological distress, substance use, and HIV/STI risk behaviors among youth. Journal of Youth and Adolescence, 39(5), 514–527.

Fitzpatrick, R. E., Rubenis, A. J., Lubman, D. I., & Verdejo-Garcia, A. (2020). Cognitive deficits in methamphetamine addiction: Independent contributions of dependence and intelligence. Drug and Alcohol Dependence, 209, 107891.

Goldstein, R. Z., & Volkow, N. D. (2011). Dysfunction of the prefrontal cortex in addiction: Neuroimaging findings and clinical implications. Nature Reviews Neuroscience, 12(11), 652–669.

Gray, S. N. (2017). An overview of the use of neurofeedback biofeedback for the treatment of symptoms of traumatic brain injury in military and civilian populations. Medical Acupuncture, 29(4), 215–219.

Gregory, J. C., Romero, D., & Jones, M. S. (2020). Predictors of neurofeedback outcomes following qEEG individualized protocols for anxiety. NeuroRegulation, 7(1), 18–25.

Gruzelier, J. H. (2014). Differential effects on mood of 12–15 (SMR) and 15–18 (beta1) Hz neurofeedback. International Journal of Psychophysiology, 93(1), 112–115.

Gruzelier, J. H., Foks, M., Steffert, T., Chen, M. J.-L., & Ros, T. (2014). Beneficial outcome from EEG-neurofeedback on creative music performance, attention and well-being in school children. Biological Psychology, 95, 86–95.

Hammond, D. C. (2005). Neurofeedback with anxiety and affective disorders. Child and Adolescent Psychiatric Clinics of North America, 14(1), 105–123.

Hanslmayr, S., Sauseng, P., Doppelmayr, M., Schabus, M., & Klimesch, W. (2005). Increasing individual upper alpha power by neurofeedback improves cognitive performance in human subjects. Applied Psychophysiology and Biofeedback, 30(1), 1–10.

Harris, S., Hundley, G., & Lambie, G. (2021). The effects of neurofeedback on depression, anxiety, and academic self-efficacy. Journal of College Student Psychotherapy, 35(1), 15–29.

Hou, Y., Zhang, S., Li, N., Huang, Z., Wang, L., & Wang, Y. (2021). Neurofeedback training improves anxiety trait and depressive symptom in GAD. Brain and Behavior, 11(3), e02024.

Imperatori, C., Valenti, E. M., Della Marca, G., Amoroso, N., Massullo, C., Carbone, G. A., Maestoso, G., Quintiliani, M. I., Contardi, A., & Farina, B. (2017). Coping food craving with neurofeedback. Evaluation of the usefulness of alpha/theta training in a non-clinical sample. International Journal of Psychophysiology, 112, 89–97.

Janes, A. C., Pizzagalli, D. A., Richardt, S., Frederick, B. deB., Chuzi, S., Pachas, G., Culhane, M. A., Holmes, A. J., Fava, M., Evins, A. E., & Kaufman, M. J. (2010). Brain reactivity to smoking cues prior to smoking cessation predicts ability to maintain tobacco abstinence. Biological Psychiatry, 67(8), 722–729.

Karageorghis, C. I., Bigliassi, M., Guérin, S. M. R., & Delevoye-Turrell, Y. (2018). Brain mechanisms that underlie music interventions in the exercise domain. In S. Marcora & M. Sarkar (Eds.), Progress in Brain Research (vol. 240, pp. 109–125). Elsevier.

Kelley, M. J. (1997). “Native Americans, neurofeedback, and substance abuse theory”. Three year outcome of alpha/theta neurofeedback training in the treatment of problem drinking among Dine’ (Navajo) people. Journal of Neurotherapy, 2(3), 24–60.

Khajehpour, H., Mohagheghian, F., Ekhtiari, H., Makkiabadi, B., Jafari, A. H., Eqlimi, E., & Harirchian, M. H. (2019). Computer-aided classifying and characterizing of methamphetamine use disorder using resting-state EEG. Cognitive Neurodynamics, 13(6), 519–530.

Khesht-Masjedi, M. F., Omar, Z., & Kafi Masoleh, S. M. (2015). Psychometrics properties of the Persian version of Beck Anxiety Inventory in North of Iranian adolescents. International Journal of Educational and Psychological Researches, 1(2), 145–153.

Konova, A. B., Moeller, S. J., & Goldstein, R. Z. (2013). Common and distinct neural targets of treatment: Changing brain function in substance addiction. Neuroscience & Biobehavioral Reviews, 37(10 Part 2), 2806–2817.

Kosmyna, N., & Maes, P. (2019). AttentivU: An EEG-based closed-loop biofeedback system for real-time monitoring and improvement of engagement for personalized learning. Sensors, 19(23), 5200.

Liu, W., Chen, X.-J., Wen, Y.-T., Winkler, M. H., Paul, P., He, Y. L., Wang, L., Chen, H.-X., & Li, Y.-H. (2020). Memory retrieval-extinction combined with virtual reality reducing drug craving for methamphetamine: Study protocol for a randomized controlled trial. Frontiers in Psychiatry, 11, 322.

Luctkar-Flude, M., Groll, D., & Tyerman, J. (2017). Using neurofeedback to manage long-term symptoms in cancer survivors: Results of a survey of neurofeedback providers. European Journal of Integrative Medicine, 12, 172–176.

Mallorquí-Bagué, N., Lozano-Madrid, M., Testa, G., Vintró-Alcaraz, C., Sánchez, I., Riesco, N., Perales, J. C., Navas, J F., Martínez-Zalacaín, I., Megías, A., Granero, R., Veciana de las Heras, M., Chami, R., Jiménez-Murcia, S., Fernández-Formoso, J. A., Treasure, J., & Fernández-Aranda, F. (2020). Clinical and Neurophysiological Correlates of Emotion and Food Craving Regulation in Patients with Anorexia Nervosa. Journal of Clinical Medicine, 9(4), 960.

Moeller, S. J., & Goldstein, R. Z. (2014). Impaired self-awareness in human addiction: Deficient attribution of personal relevance. Trends in Cognitive Sciences, 18(12), 635–641.

Niv, S. (2013). Clinical efficacy and potential mechanisms of neurofeedback. Personality and Individual Differences, 54(6), 676–686.

Nooripour, R., Hosseinian, S., Afrouz, G. A., & Bakhshani, N.-M. (2018). Effectiveness of neurofeedback on executive functions and tendency toward high-risk behaviors in adolescents with attention deficit hyperactivity disorder. International Journal of High Risk Behaviors and Addiction, 7(4), e82012.

Osman, A., Kopper, B. A., Barrios, F. X., Osman, J. R., & Wade, T. (1997). The Beck Anxiety Inventory: Reexamination of factor structure and psychometric properties. Journal of Clinical Psychology, 53(1), 7–14.<7::AID-JCLP2>3.0.CO;2-S

Raymond, J., Varney, C., Parkinson, L. A., & Gruzelier, J. H. (2005). The effects of alpha/theta neurofeedback on personality and mood. Cognitive Brain Research, 23(2–3), 287–292.

Reichert, J. L., Kober, S. E., Neuper, C., & Wood, G. (2015). Resting-state sensorimotor rhythm (SMR) power predicts the ability to up-regulate SMR in an EEG-instrumental conditioning paradigm. Clinical Neurophysiology, 126(11), 2068–2077.

Reid, A., Nihon, S., Thompson, L., & Thompson, M. (2013). The effects of heart rate variability training on sensorimotor rhythm: A pilot study. Journal of Neurotherapy, 17(1), 43–48.

Richter, F., García, A. M., Rodriguez Arriagada, N., Yoris, A., Birba, A., Huepe, D., Zimmer, H., Ibáñez, A., & Sedeño, L. (2020). Behavioral and neurophysiological signatures of interoceptive enhancements following vagus nerve stimulation. Human Brain Mapping, 42(5) 1227–1242.

Roche, K., Moss, S., Baxendale, E., & Stephens, S. (2020). Are psychological distress, substance misuse, and sexual sensation seeking associated with autoerotic asphyxiation-related distress? The Canadian Journal of Human Sexuality, 29(2), 221–227.

Rostami, R., & Dehghani-Arani, F. (2015). Neurofeedback training as a new method in treatment of crystal methamphetamine dependent patients: A preliminary study. Applied Psychophysiology and Biofeedback, 40(3), 151–161.

Schönenberg, M., Wiedemann, E., Schneidt, A., Scheeff, J., Logemann, A., Keune, P. M., & Hautzinger, M. (2017). Neurofeedback, sham neurofeedback, and cognitive-behavioural group therapy in adults with attention-deficit hyperactivity disorder: A triple-blind, randomised, controlled trial. The Lancet Psychiatry, 4(9), 673–684.

Scott, W. C., Kaiser, D., Othmer, S., & Sideroff, S. I. (2005). Effects of an EEG biofeedback protocol on a mixed substance abusing population. The American Journal of Drug and Alcohol Abuse, 31(3), 455–469.

Sharifi, V., Assadi, S. M., Mohammadi, M. R., Amini, H., Kaviani, H., Semnani, Y., Shabani, A., Shahrivar, Z., Davari-Ashtiani, R., Shooshtari, M. H., Seddigh, A., & Jalali, M. (2009). A Persian translation of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: Psychometric properties. Comprehensive Psychiatry, 50(1), 86–91.

Simkin, D. R., Thatcher, R. W., & Lubar, J. (2014). Quantitative EEG and neurofeedback in children and adolescents: Anxiety disorders, depressive disorders, comorbid addition and attention-deficit/hyperactivity disorder, and brain injury. Child and Adolescent Psychiatric Clinics of North America, 23(3), 427–464.

Ticci, C., Luongo, T., Valvo, G., Ferrari, A. R., Brovedani, P., Masi, G., Pellacani, S., & Sicca, F. (2019). Clinical and electroencephalographic correlates of psychiatric features in children with frontal lobe epilepsy. Epilepsy & Behavior, 92, 283–289.

Vaschillo, E. G., Vaschillo, B., & Lehrer, P. M. (2006). Characteristics of resonance in heart rate variability stimulated by biofeedback. Applied Psychophysiology and Biofeedback, 31(2), 129–142.

Vernon, D., Egner, T., Cooper, N., Compton, T., Neilands, C., Sheri, A., & Gruzelier, J. (2003). The effect of training distinct neurofeedback protocols on aspects of cognitive performance. International Journal of Psychophysiology, 47(1), 75–85.

Research Papers