Tag: Neurofeedback

Mental Health and Cardiac Conditions: Understanding the Mind–Heart Connection

Posted on by TriWellness in Blog

Why Mental Health and Cardiac Conditions Are Closely Linked

When we think about heart disease, we often focus on cholesterol, blood pressure, and diet. However, research increasingly shows that mental health and cardiac conditions are strongly interconnected.

The brain and heart communicate through the autonomic nervous system, hormonal pathways, and immune responses. When mental health is compromised, it directly affects cardiovascular functioning.

The Science Behind Mental Health and Cardiac Conditions

The connection between mental health and cardiac conditions is rooted in the body’s stress-response systems. When an individual experiences chronic psychological stress, anxiety, or depression, the brain activates the hypothalamic–pituitary–adrenal (HPA) axis and the sympathetic nervous system.

This activation leads to a cascade of physiological changes, including:

  • Increased release of stress hormones such as cortisol and adrenaline
  • Elevated heart rate and blood pressure
  • Chronic low-grade inflammation
  • Endothelial dysfunction (impaired blood vessel function)

While these responses are adaptive in short-term situations, persistent activation can become harmful. Over time, these changes contribute to atherosclerosis, reduced heart rate variability, and increased cardiovascular risk.

Research shows that chronic stress and emotional distress play a significant role in the development and progression of cardiovascular disease, highlighting the importance of addressing mental health and cardiac conditions together (Cohen et al., 2015; Steptoe & Kivimäki, 2012). Additionally, dysregulation of the autonomic nervous system has been identified as a key mechanism linking psychological factors with adverse cardiac outcomes (Thayer et al., 2010).

How Mental Health Conditions Affect Heart Health

The relationship between mental health and cardiac conditions is supported by a growing body of large-scale and longitudinal research. Mental health disorders are not only associated with cardiovascular disease—they can actively contribute to its development and progression.

Chronic Stress and Heart Disease

Chronic psychological stress activates the body’s stress-response system, increasing cortisol, blood pressure, and inflammation. Over time, this can damage blood vessels and contribute to atherosclerosis. Research shows that stress-related biological changes—including autonomic dysregulation—are key mechanisms linking mental health and cardiac conditions (Steptoe & Kivimäki, 2012). 

Anxiety and Cardiac Conditions

Anxiety disorders are associated with repeated activation of the sympathetic nervous system, leading to increased heart rate and cardiovascular strain. Large cohort studies have shown that individuals with anxiety are at significantly higher risk of developing coronary heart disease and other cardiac events (Roest et al., 2010). 

Depression and Cardiovascular Risk

Depression is one of the most well-established risk factors linking mental health and cardiac conditions. A large study of over 500,000 adults found that individuals reporting poor mental health had higher rates of heart attacks, strokes, and cardiovascular risk factors (Kwapong et al., 2023). 

Additional research shows that depression increases inflammation, disrupts autonomic regulation, and is associated with worse outcomes and higher mortality in people with existing heart disease (Lichtman et al., 2014). 

Trauma, PTSD, and the Heart

Trauma and PTSD contribute to chronic nervous system dysregulation, keeping the body in a prolonged state of hyperarousal. This ongoing physiological stress increases cardiovascular risk over time. Recent large-scale analyses confirm that individuals with mental health disorders—including PTSD, depression, and anxiety—have a significantly higher likelihood of developing future cardiovascular disease (All of Us Research Program study, 2025). 

How Cardiac Conditions Impact Mental Health

The relationship between mental health and cardiac conditions is bidirectional—cardiac disease can significantly affect emotional well-being.

Many individuals with cardiovascular disease experience anxiety, depression, and reduced quality of life. Research shows that 20–30% of patients with coronary heart disease have major depression, with even higher rates of milder symptoms (Lichtman et al., 2014). Anxiety is also common, especially after cardiac events or procedures (Tully et al., 2013).

These symptoms are not just emotional—they impact physical outcomes. Depression is associated with a 2–2.5 times higher risk of mortality in cardiac patients and can interfere with recovery by reducing adherence to treatment and participation in rehabilitation (Whooley et al., 2008; Lichtman et al., 2014).

Emotional distress can also worsen inflammation and autonomic dysregulation, contributing to poorer cardiac outcomes. Addressing mental health and cardiac conditions together is essential for improving recovery and long-term health.

Behavioral Links Between Mental Health and Cardiac Conditions

The relationship between mental health and cardiac conditions is strongly influenced by behavior. Depression, anxiety, and chronic stress can negatively affect daily habits that are essential for heart health.

Individuals experiencing psychological distress are more likely to develop:

  • Difficulty adhering to medical treatment, including medications and cardiac rehabilitation programsiovascular disease.
  • Poor sleep patterns, including insomnia or fragmented sleep, which are associated with increased cardiovascular risk and hypertension
  • Reduced physical activity, often due to low motivation or fatigue, contributing to obesity and decreased cardiovascular fitness
  • Changes in eating behaviors, such as emotional eating or loss of appetite, which can negatively affect metabolic and heart health
  • Smoking or substance use, frequently used as coping strategies, which significantly increase the risk of cardiovascular disease

Research shows that depression is associated with lower medication adherence and reduced engagement in health-promoting behaviors (Whooley et al., 2008), while sleep disturbances independently increase the risk of hypertension and cardiac events (Cappuccio et al., 2011). These combined factors can significantly worsen outcomes in individuals with heart disease (Lichtman et al., 2014).

Addressing these behavioral patterns highlights the importance of treating mental health and cardiac conditions together for improved long-term health.

Integrative Treatments for Mental Health and Cardiac Conditions

Supporting both mental health and cardiac conditions requires an approach that addresses the nervous system, emotional well-being, and lifestyle factors together.

At TriWellness, we focus on evidence-informed, integrative treatments that help regulate stress and improve both mental and physical health outcomes.

Neurofeedback supports brain regulation and may reduce symptoms of anxiety, stress, and PTSD by improving self-regulation of neural activity. A systematic review found neurofeedback to be associated with significant symptom improvement in trauma-related conditions, though variability in protocols suggests it is best used as an adjunctive treatment (Steingrimsson et al., 2020).

HRV biofeedback strengthens the body’s ability to regulate stress and improve autonomic balance, which is critical for heart health. Meta-analytic evidence shows improvements in emotional regulation and physiological functioning (Lehrer et al., 2020), and recent randomized trials demonstrate measurable improvements in cardiac response to stress in patients with coronary artery disease (Shah et al., 2025).

Psychotherapy, particularly cognitive behavioral therapy (CBT), is well-supported in cardiac populations and has been shown to significantly reduce depressive symptoms. A meta-analysis of randomized controlled trials found meaningful improvements in depression among patients with coronary heart disease, which is important given its impact on cardiac outcomes (Nuraeni et al., 2023).

Yoga and mind–body practices help regulate the stress response through breathwork, movement, and mindfulness. Large meta-analyses of randomized controlled trials show yoga can significantly reduce blood pressure, cholesterol, and other cardiovascular risk factors while also improving mental health (Virk et al., 2023).

Animal-assisted therapy can promote relaxation, reduce stress, and improve emotional well-being. Systematic reviews indicate positive effects on anxiety, depression, and overall quality of life, although research specific to cardiovascular outcomes is still developing (Pandey et al., 2024).

Lifestyle support and social connection are foundational in addressing mental health and cardiac conditions. Strong social relationships are associated with a 50% increased likelihood of survival (Holt-Lunstad et al., 2010), while physical activity and healthy sleep are linked to reduced risk of both depression and cardiovascular disease (Pearce et al., 2022; Kwok et al., 2018).

Take the Next Step

If you’re experiencing stress, anxiety, or low mood alongside a cardiac condition, you don’t have to manage it alone. A personalized, integrative approach can support both your emotional well-being and heart health.

Schedule a consultation to explore the right treatment plan for you.

A Whole-Person Approach to Mental Health and Cardiac Conditions

The divide between mental and physical health is outdated. Treating mental health and cardiac conditions together leads to better long-term outcomes.

By addressing the nervous system, emotional well-being, and lifestyle factors, individuals can improve both heart health and overall quality of life.

References

All of Us Research Program Investigators. (2025). Mental health disorders and incident cardiovascular disease risk. American Journal of Cardiology.

Cappuccio, F. P., Cooper, D., D’Elia, L., Strazzullo, P., & Miller, M. A. (2011). Sleep duration predicts cardiovascular outcomes: A systematic review and meta-analysis of prospective studies. European Heart Journal, 32(12), 1484–1492. https://doi.org/10.1093/eurheartj/ehr007

Cohen, S., Janicki-Deverts, D., & Miller, G. E. (2015). Psychological stress and disease. JAMA, 298(14), 1685–1687. https://doi.org/10.1001/jama.298.14.1685

Edmondson, D., & Cohen, B. E. (2013). Posttraumatic stress disorder and cardiovascular disease. Progress in Cardiovascular Diseases, 55(6), 548–556. https://doi.org/10.1016/j.pcad.2013.03.004

Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7(7), e1000316. https://doi.org/10.1371/journal.pmed.1000316

Kwapong, Y.A. MD, MPH, Boakye, E. MD, MPH, Khan, S.S. MD, MSc, Honigberg, M.C. MD, MPP, Martin, S.S. , MD, MHS, Hays, A.G. MD, Mamas A. Mamas, BM Bch, MA, DPhil, FRCP, Blaha, M.J. MD, MPH, and Sharma, G. MD  (2023). Association of poor mental health with cardiovascular disease risk in young adults. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.122.028332

Kwok, C. S., Kontopantelis, E., Kuligowski, G., Gray, M., Muhyaldeen, A., Gale, C. P., Peat, G. M., Cleator, J., Chew-Graham, C., Loke, Y. K., & Mamas, M. A. (2018). Self-reported sleep duration and quality and cardiovascular disease and mortality: A dose-response meta-analysis. Journal of the American Heart Association, 7(15), e008552. https://doi.org/10.1161/JAHA.118.008552

Lehrer, P., & Gevirtz, R. (2014). Heart rate variability biofeedback: How and why does it work? Frontiers in Psychology, 5, 756. https://doi.org/10.3389/fpsyg.2014.00756

Lehrer, P. M., Kaur, K., Sharma, A., Shah, K., Huseby, R., Bhavsar, J., & Zhang, Y. (2020). Heart rate variability biofeedback improves emotional and physical health and performance: A systematic review and meta-analysis. Applied Psychophysiology and Biofeedback, 45(3), 109–129. https://doi.org/10.1007/s10484-020-09466-z

Lichtman, J. H., Froelicher, E. S., Blumenthal, J. A., Carney, R. M., Doering, L. V., Frasure-Smith, N., Freedland, K. E., Jaffe, A. S., Leifheit-Limson, E. C., Sheps, D. S., Vaccarino, V., & Wulsin, L. (2014). Depression as a risk factor for poor prognosis among patients with acute coronary syndrome. Circulation, 129(12), 1350–1369. https://doi.org/10.1161/CIR.0000000000000019

Nuraeni, A., Suryani, S., Trisyani, Y., & Sofiatin, Y. (2023). Efficacy of cognitive behavior therapy in reducing depression among patients with coronary heart disease: An updated systematic review and meta-analysis of randomized controlled trials. Healthcare, 11(7), 943. https://doi.org/10.3390/healthcare11070943

Pandey, R. P., Himanshu, Gunjan, Mukherjee, R., & Chang, C.-M. (2024). The role of animal-assisted therapy in enhancing patients’ well-being: Systematic study of qualitative and quantitative evidence. JMIRx Med, 5, e51787. https://doi.org/10.2196/51787

Pearce, M., Garcia, L., Abbas, A., Strain, T., Schuch, F. B., Golubic, R., Kelly, P., Khan, S., Utukuri, M., Laird, Y., Mok, A., Smith, A. D., Brage, S., & Woodcock, J. (2022). Association between physical activity and risk of depression: A systematic review and meta-analysis. JAMA Psychiatry, 79(6), 550–559. https://doi.org/10.1001/jamapsychiatry.2022.0609

Roest, A. M., Martens, E. J., de Jonge, P., & Denollet, J. (2010). Anxiety and risk of incident coronary heart disease. Journal of the American College of Cardiology, 56(1), 38–46. https://doi.org/10.1016/j.jacc.2010.03.034

Shah AJ, Raggi P, She H, et al. Heart Rate Variability Biofeedback and Mental Stress Myocardial Flow Reserve: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(10):e2538416. doi:10.1001/jamanetworkopen.2025.38416

Steingrimsson, S., Bilonic, G., Ekelund, A. C., Larson, T., Stadig, I., Svensson, M., Vukovic, I. S., Wartenberg, C., Wrede, O., & Bernhardsson, S. (2020). Electroencephalography-based neurofeedback as treatment for post-traumatic stress disorder: A systematic review and meta-analysis. European psychiatry : the journal of the Association of European Psychiatrists, 63(1), e7. https://doi.org/10.1192/j.eurpsy.2019.7

Streeter, C. C., Gerbarg, P. L., Saper, R. B., Ciraulo, D. A., & Brown, R. P. (2012). Effects of yoga on the autonomic nervous system gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Medical Hypotheses, 78(5), 571–579. https://doi.org/10.1016/j.mehy.2012.01.021

Thayer, J. F., Yamamoto, S. S., & Brosschot, J. F. (2010). The relationship of autonomic imbalance, heart rate variability, and cardiovascular disease risk. International Journal of Cardiology, 141(2), 122–131. https://doi.org/10.1016/j.ijcard.2009.09.543

Whooley, M. A., de Jonge, P., Vittinghoff, E., Otte, C., Moos, R., Carney, R. M., Ali, S., Dowray, S., Na, B., & Feldman, M. D. (2008). Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. JAMA, 300(20), 2379–2388. https://doi.org/10.1001/jama.2008.711

Aarti S. Felder, MA, LCPC, BCN, CIT, AAT-I, QEEG-DC

Aarti is an expert in mental health in chronic illness who also specializes in neurofeedback, biofeedback, and Animal Assisted Therapy.

Learn more about Aarti S. Felder, MA, LCpC, BCN, CIT, AAT-I, QEEG-DC

Your journey to wellness begins here

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Better Sleep, Anxiety Relief, and Mental Health with Neurofeedback

Posted on by TriWellness in Neurofeedback, Uncategorized

An analysis of the use of Remote Neurofeedback and its enhancement

In a world filled with constant stressors, achieving optimal mental health and wellbeing has never been more critical. Remote neurofeedback emerges as a cutting-edge solution, leveraging advanced technology to address concerns such as sleep disturbances, anxiety, and overall mental health. Let’s delve into the transformative potential of remote neurofeedback, backed by scientific research, to help you unlock a more balanced and rejuvenated life.

Sleep, Anxiety, and Mental Health: The Trifecta of Wellbeing

Quality sleep is the cornerstone of mental health and overall wellbeing. Research consistently demonstrates the intricate link between sleep, anxiety, and mental health. Studies (Walker, 2017; Walker & van der Helm, 2009) highlight the bidirectional relationship – disrupted sleep contributes to heightened anxiety, while elevated anxiety impedes restful sleep. This vicious cycle underscores the need for comprehensive interventions that target both domains simultaneously.

Remote Neurofeedback: A Technological Breakthrough

Remote neurofeedback is a non-invasive, state-of-the-art technology designed to optimize brain function and regulate neural patterns from the comfort of your home. Neurofeedback harnesses the brain’s neuroplasticity, enabling it to reorganize and adapt for improved functioning. This innovative approach has garnered attention for its effectiveness in addressing sleep disorders, anxiety, and promoting overall mental health (Thibault et al., 2017).

Scientific Backing

Numerous studies have illuminated the positive impact of neurofeedback on sleep and anxiety. A randomized controlled trial conducted by Arns et al. (2014) demonstrated significant improvements in sleep quality and anxiety levels in participants who underwent neurofeedback training. Similarly, a meta-analysis by Wang and Hsieh (2013) aggregated data from multiple studies, concluding that neurofeedback interventions were associated with substantial reductions in anxiety symptoms.

Remote Neurofeedback and Sleep Enhancement

Remote neurofeedback adapts to the demands of modern life, offering a convenient and accessible solution to sleep-related issues. By targeting specific neural patterns associated with sleep disturbances, neurofeedback helps regulate circadian rhythms and promote deep, restorative sleep. This approach is particularly beneficial for individuals grappling with insomnia, night-time awakenings, or irregular sleep patterns (Sterman, 2000).

Anxiety Relief Through Neurofeedback:

Neurofeedback’s effectiveness in alleviating anxiety has been extensively researched. By training the brain to modulate neural activity associated with anxiety, individuals experience a reduction in symptoms and an overall sense of calmness. Neurofeedback promotes a balanced interplay between the brain’s arousal and relaxation mechanisms, facilitating resilience against stressors (Hammond, 2005).

General Mental Health Wellbeing

Beyond sleep and anxiety, remote neurofeedback contributes to general mental health and wellbeing. Regular neurofeedback sessions have been associated with improved cognitive function, enhanced mood, and increased overall psychological resilience (Gapen et al., 2018). This holistic approach positions remote neurofeedback as a comprehensive solution for those seeking to optimize their mental health.

Remote neurofeedback stands at the forefront of mental health innovation, offering a scientifically-backed solution to enhance sleep, alleviate anxiety, and promote overall wellbeing. The convergence of advanced technology and rigorous research underscores the transformative potential of neurofeedback in empowering individuals to take charge of their mental health from the comfort of their own homes. Embrace the future of mental wellness with remote neurofeedback and unlock a more balanced, rejuvenated, and fulfilling life.

Remote Neurofeedback by TriWellness

References

Arns, M., de Ridder, S., Strehl, U., Breteler, M., & Coenen, A. (2014). Efficacy of neurofeedback treatment in ADHD: The effects on inattention, impulsivity and hyperactivity: A meta-analysis. Clinical EEG and Neuroscience, 40(3), 180-189.

Gapen, Mark, van der Kolk, Bessel A, Hamlin, Ed., Hirshberg, Laurence, Suvak, Michael, Spinazzola, Joseph (2016). A Pilot Study of Neurofeedback for Chronic PTSD. Applied Psychophysiology and Biofeedback, 41 (3), 251-261.

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

Sterman, M. B. (2000). Basic concepts and clinical findings in the treatment of seizure disorders with EEG operant conditioning. Clinical Electroencephalography, 31(1), 45-55.

Thibault, R. T., Lifshitz, M., & Raz, A. (2017). Neurofeedback or neuroplacebo? Brain, 140(4), 462-264 doi: 10.1093/brain/awx033

Walker, M. P. (2018). Why We Sleep: Unlocking the Power of Sleep and Dreams. Simon & Schuster.

Walker, M. P., & van der Helm, E. (2009). Overnight therapy? The role of sleep in emotional brain processing. Psychological Bulletin, 135(5), 731-748.

Wang & Hsieh (2013). Neurofeedback training improves attention and working memory performance. Clinical Neurophysiology, 124(12), 2406-2420.

Aarti S. Felder, MA, LCPC, BCN, CIT

Aarti is Board Certified in Neurofeedback and has been practicing neurofeedback for nine years. Her specialities in neurofeedback include, sleep, pain management, mental health, neurological and cognitive improvement.

Aarti S. Felder, MA, LCPC, BCN, CIT

The NeuroPhysiological Response to Trauma

Posted on by TriWellness in Blog

Trauma, a deeply disturbing or distressing experience, can rattle the foundations of our reality, leaving profound imprints on both our psyche and body. It extends beyond the boundaries of our minds and permeates the very fabric of our being, echoing within our nervous system. This article aims to provide a comprehensive exploration of the physiological repercussions of trauma, catering to a broad audience that includes the general public, trauma survivors, and researchers.
The human nervous system, the body’s intricate communication network, bridges our external and internal environments. This dynamic system includes the central nervous system (comprising the brain and spinal cord) and the peripheral nervous system (consisting of sensory and motor neurons). When we experience trauma, this system is fundamentally disrupted.
Typically, when we encounter a threat, our body triggers an automatic “fight, flight, or freeze” response, orchestrated primarily by the amygdala. Our bodies flood with stress hormones like adrenaline and cortisol, our heart rate increases, and we find ourselves in a heightened state of alertness. This is our built-in survival mechanism, preparing us to confront danger or evade it.
However, trauma can distort this acute stress response, transforming it into a chronic condition with lasting effects on brain structure and function. Key regions such as the amygdala, hippocampus, and prefrontal cortex – involved in memory processing, emotional regulation, and executive functioning – undergo significant changes.
Post-trauma, the amygdala, our emotional alert system, may become hyperactive, escalating anxiety and fear responses. The hippocampus, which facilitates memory and learning, might shrink, leading to memory consolidation issues and an inability to differentiate between past and present experiences. The prefrontal cortex, which manages planning, decision-making, and impulse control, may function less efficiently, impairing these cognitive processes.
The continuous activation of the stress response can disrupt the neuroendocrine system, especially the Hypothalamic-Pituitary-Adrenal (HPA) axis. This disruption can lead to a hormonal imbalance, with possible physical health implications, such as cardiovascular disease, gastrointestinal issues, and chronic pain.
For trauma survivors, it’s vital to remember that these physiological alterations have profound societal implications, affecting relationships, self-perception, and societal interactions. Yet, these effects also create a window of opportunity.
Various therapies such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Neurofeedback, Biofeedback, and Eye Movement Desensitization and Reprocessing (EMDR) are designed to address the neurobiological effects of trauma. They provide strategies to process traumatic memories, manage emotions, and rewire the neural pathways associated with the traumatic response, offering potential paths to healing.

Pari Shah

Pari is our newest multilingual clinician who specializes in adult psychotherapy.

Pari Shah, LCSW, C-PD

Sleep and neurofeedback

Posted on by TriWellness in Blog 
Come Sleep! O Sleep, the certain knot of peace, 
The baiting-place of wit, the balm of woe, 
The poor man's wealth, the prisoner's release, 
Th' indifferent judge between the high and low. 
With shield of proof shield me from out the prease 
Of those fierce darts despair at me doth throw: 
O make in me those civil wars to cease; 
I will good tribute pay, if thou do so. 
Take thou of me smooth pillows, sweetest bed, 
A chamber deaf to noise and blind to light, 
A rosy garland and a weary head: 
And if these things, as being thine by right, 
Move not thy heavy grace, thou shalt in me, 
Livelier than elsewhere, Stella's image see.
-Sir Philip Sidney

The importance of sleep

Sleep is an important function of all living creatures, everyone in the animal kingdom has some variation of a sleep wake cycle. However why is sleep so important in humans? Research has shown that sleep has many functions.

Sleep helps us to consolidate what we have learned into memory through acquisition (information introduced to our brain), consolidation (the process of memorizing the information in the brain), and recall (information being brought up in any mental state). Those who have impaired sleep, can have impacts on memory and learning (Healthy Sleep, 2007).

Another example of the importance of sleep is its impact on mood. Having a good night sleep can lead to feeling energized, motivated, and content. In the reverse, impaired sleep or insomnia can lead to irritability, increased stress, or even the development of a mood disorder (Get Sleep, 2008).

Sleep also has an impact on body restoration. Certain hormones are released during sleep that is responsible for tissue repair and muscle growth. Another restorative factor sleep can assist in cognitive functioning, which may impact in learning and memory. Recent research has also found the importance of sleep on Neuroplasticity.

We previously believed in the idea that if we don’t use certain neurons through practice our brain loses the capacity to use it in the future (use or lose it principle). We now know that it isn’t true, as our brain has what is called Neuroplasticity, which the brain’s ability to form new neurological connections. We do this in everyday life, from learning something new (even if it is small), to sleep, to psychotherapy. We are making new neurological connections without realizing it! Proper sleep helps strengthen and these newer neurlogical connections.

Conditions that effect sleep

Knowing that sleep is very important and its impact that it can have on our brain, mind, and body, what happens when certain conditions impair sleep?

Mental Health CONDITIONS

There are several mental health conditions that can impact sleep. Anxiety, for example, can severely impact sleep. During the first part of the pandemic, many people were experiencing fear, uncertainty, stress, and many other emotions that naturally turned into anxiety. When one is feeling anxious their mind can race, especially while laying in bed trying to fall asleep. As a result of the anxiety, many individuals struggled to get enough sleep which could also further impact their mood.

Another symptom of anxiety that impacts sleep is hyperarousal, the state of being excessively alert. Therefore, when one is trying to sleep while also experiencing hyperarousal, they may be quick to awaken from even the smallest of stimuli (hearing a small thud from the apartment above, for example) and ready to react. 

Certain types of anxiety can also lead to nightmares. Post-Traumatic Stress Disorder and other anxiety and stress disorders can cause night terrors and nightmares that can impact a person’s relationship to sleep. Due to the fear of having night terrors or nightmares, one can also experience anticipatory anxiety.

Depression is another mental health condition that can impact sleep. Depression can impair sleep as well as sleep can impact depression. Due to this relationship, it can be difficult to know which condition caused which symptom. Depression is characterized by experiencing sleep-related symptoms of insomnia, hypersomnia, as well as having abnormal levels of Serotonin, a neurotransmitter that is important for regulation of sleep as well as other bodily functions. 

Medical conditions

There are also several medical conditions that impact sleep. In fact, there are several sleep disorders that can be treated with medication or devices, such as Sleep Apnea, a disorder that is related to breathing disruptions, and Narcolepsy, a sleep disorder related to regulation of the sleep-wake cycle. These are just a few types of sleep disorders, however there are many more conditions that fall under the umbrella of sleep disorders. There are also several chronic medical conditions that impact sleep.

Inflammatory chronic conditions such as, Arthritis, Fibromyalgia, and Inflammatory Bowel Diseases, can impair one’s sleep leading to the symptom of fatigue. Sleep disturbances can be a result of pain impacting one’s sleep, as pain is common in areas of inflammation. When someone is experiencing pain it can lead to mood dysregulation resulting in sleep disturbance conjointly with the the physical discomfort. Furthermore, research has shown that sleep disturbance can result in higher levels of C-Reactive Protein (CRP), a marker of inflammation, suggesting that sleep impairment and inflammation are directly correlated. 

Much like the aforementioned inflammatory conditions as well as cancer can impact one’s immunity. Our immune system is very important in our ability to fight off infections, and for those with a compromised immune system, contraction of infections can be regular occurrence or fear of contraction. Research has also found that sleep impacts immunity; when one has impaired sleep their immune system has difficulty fighting off infections. This also can further compound an already compromised immune system, leading to increased infections and overall feeling of being unwell, increased inflammation, and the cyclical nature of impaired sleep. (Simpson & Dinges, 2007).

Sleep Hygiene

Sleep hygiene is defined by the healthy habits one practices on a regular basis to promote restful sleep. The Sleep Foundation lists some great steps to improve sleep hygiene that is summarized below.

Setting a consistent sleep schedule

  • Go to bed and wake up at the same time everyday, regardless of weekend day
  • If you want to change your bedtime/wake up routine, make changes gradually
  • Try not to take as many naps; if you do take naps, have short 10-20 minute naps in the early afternoon

Have a bed time routine

  • Having a consistent bedtime routine can prep your mind for bedtime
  • Take 30 minutes to wind down before going to bed by doing something relaxing and not stimulating
  • Refrain form using electronics 30-60 minutes before bed, as the screens can be overstimulating to your brain
  • If you haven’t fallen asleep within 20 minutes of lying in your bed, get out of bed, do something relaxing, and then try again

Have healthy daily habits

  • Try and get some sunlight exposure to promote healthy circadian rhythm
  • Build a exercise/movement routine that is right for your ability
  • Limit smoking and alcohol consumption
  • Skipping on caffeinated beverages in the afternoon and evening
  • Try to eat and drink 2 hours before bed (be mindful of heaving/spicy meals); if you need to eat or drink something before bed try to make it small to not wake you up in the middle of the night
  • Regulate activity in bed to only sleep and sex

Having a restful and Relaxing environment

  • Having a bed, pillow, and sheets that matches your comfort needs
  • Have a cool and dark sleeping environment
  • Have devices that block or drown out noise (i.e. ear plugs, noise cancelling machines, etc.) to not wake you in the middle of the night

Neurofeedback as a treatment strategy for sleep impairment

Now we know why sleep is important, what can affect sleep, and how we can improve sleep with proper sleep hygiene. But what if sleep hygiene isn’t enough to get a good night’s rest and there are more underlying issues that impact sleep. Therapy can be very helpful if the underlying symptom of sleep impairment originates from a mental health condition. However if there is a neurological reason for sleep challenges (either from mental health or medical conditions) a treatment strategy must address the neurological source of the disturbance. 

Neurofeedback is a form of biofeedback that encourages healthy neurological connections through the use of training one’s brain to effectively operate in specific conditions. Therefore, in regards to sleep, Neurofeedback training promotes healthy brain activity during the sleep state by regulating one’s brainwaves. 

In some cases, sleep and brain activity can be effected by the situation. In one study looking at college students with sleep onset insomnia, they found that poor sleepers had difficulty regulating their alpha brainwave. This suggested the use of neuro-regulating therapies to promote neuroflexibility (Buckelew et. al., 2013).

In another study that focused on the Central Nervous System, researchers studied the effects of electromyography tele-biofeedback versus tele-neurofeedback in subjects with insomnia. They found that not only does neurofeedback improved the amount of sleep in subjects, but also the efficacy of remote neurofeedback (Cortoos, 2010).

As previously mentioned, chronic health conditions can impact sleep, such as fibromyalgia, a condition where a patient experiences pain throughout their body and experience several other symptoms (including sleep disturbance and fatigue). In a study that researched the efficacy of neurofeedback in patients with fibromyalgia, researchers found that neurofeedback protocols that focused on alpha brainwave and sensorimotor rhythm regulation in an 8-week program produced significant results. Patients experienced sleep improvement and pain severity reduction (Wu, Fang, et al., 2021).

Neurofeedback is an evidence-based treatment strategy that does not utilize pharmaceutical intervention to treat sleep problems. In some cases, neurofeedback conjoint with behavioral modifications can drastically improve, if not alleviate, symptoms of fatigue due to sleep impairment.

Resources

Anxiety and Sleep, Suni, E., Sleep Foundation (March 2022).

Buckelew et. al, Neuroflexibility and Sleep Onset Insomnia Among College Students: Implications for Neurotherapy, Journal of Neurotherapy (2013). doi: https://doi.org/10.1080/10874208.2013.784681

Cortoos, A., De Valck, E., Arns, M. et al. An Exploratory Study on the Effects of Tele-neurofeedback and Tele-biofeedback on Objective and Subjective Sleep in Patients with Primary Insomnia. Appl Psychophysiol Biofeedback 35, 125–134 (2010). https://doi.org/10.1007/s10484-009-9116-z

Get Sleep– Harvard Medical School

Gorgoni et. al., Is Sleep Essential for Neural Plasticity in Humans, and How Does It Affect Motor and Cognitive Recovery?. Hindawi, 2013. doi: 10.1155/2013/103949

Healthy Sleep– Harvard Medical School

Sleep Disorders, Rehman, A., Sleep Foundation (December 2020)

Sleep and Inflammation, Simpson & Dinges, Wiley (December 2007)

Yu-Lin Wu, Su-Chen Fang, Shih-Ching Chen, Chen-Jei Tai, Pei-Shan Tsai, Effects of Neurofeedback on Fibromyalgia: A Randomized Controlled Trial. Pain Management Nursing, Volume 22, Issue 6 (2021).

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This month’s blog post was written by Aarti S. Felder, MA, LCPC, BCN, our Chronic Illness Specialist and Board Certified in Neurofeedback Therapist.

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Chronic pain and mental health

Posted on by TriWellness in Blog

It has been said that time heals all wounds. I don’t agree. The wounds remain. Time – the mind, protecting its sanity – covers them with some scar tissue and the pain lessens, but it is never gone. 

Rose Kennedy

Pain is something that everyone experiences. It is a signal that there is something wrong in the body. According to the CDC, 20.4% of adults had chronic pain and 7.4% of adults had chronic pain that frequency limited life or work activities. This data also found that chronic pain increased as people got older. And while we are still recording data, we have preliminary reports about long-term effects of Covid-19, we find that different types of pain is one of those effects.  This study found that chronic pain was highest in women at 21.7%, and that women are less likely to be believed about pain by their doctors. This is something that is also seen in physician’s responses to people of color, as they are often acting on unconscious bias about how minoritized individuals feel less pain or feel pain differently than white people. 

What is Pain?

There are many ways to define pain, and how you define it impacts how you approach it. Do we consider physical pain? What about emotional pain? Social pain? Psychological pain? Here are some common types of pain:

  • Acute pain
  • Chronic pain
  • Neuropathic pain
  • Psychogenic pain

Acute pain is a sudden pain that has a limited duration, usually a few minutes to three months, sometimes up to six months. Chronic pain is more long-term pain that can be constant or intermittent, even after healing is complete. Neuropathic pain is pain caused by nerve damage and is often described as shooting or burning pain. Nociceptive pain is pain caused by tissue damage. Psychogenic pain is pain that might have started physically, but is prolonged by fear, stress, depression, anxiety, or is caused by a psychological condition. Often psychogenic pain is a type of pain that doesn’t match the symptoms a person is experiencing, and is diagnosed after everything else has been ruled out.

How is Pain Processed

The gate-control theory of pain was developed to look at three systems involved in the perception of pain. These systems are the peripheral nerves that first receive pain signals, the spinal cord which receives the signal and sends it to different areas of the brain. In the brain there are different areas that can be impacted by pain such as the limbic system developing a memory of pain, and some emotional areas. This process can be inhibited at different points in the pathway, and through other pathways that responds to deep touch and inhibits the release of pain signals. While this is an abstract look at how pain is processed by the body, it is important to look at how pain affects everyday life. 

How pain impacts life

Pain can have a profound impact on a person’s life; from limiting the things a person can do, to decreasing the quality of sleep, to leading to mental health issues, pain can bring about a lot of changes. Chronic pain specifically can impact physical, psychological, and social functioning. Often pain management is primarily handled through pharmaceuticals, but we are now seeing how that overmedication is leading to increased substance abuse. Studies have shown that people with chronic pain are four times more likely to have depression and anxiety than those without pain. 

Common chronic pain conditions

There are many different things that can cause chronic pain, but some of the most common are: 

  • Arthritis/joint pain
  • Back pain
  • Cancer pain
  • Headaches/migraines
  • Muscle pain
  • Nerve damage

This pain can lead to what is known as the “terrible triad.” The terrible triad happens when pain interferes with the normal activity of life leading to depression and irritability, which can lead to insomnia. This state of being in pain, being depressed and being sleepless create a triad of suffering.  

Another thing that is often not considered is how pain affects younger people. In a study from 2016, it was conservatively estimated that 20-35% of children and adolescents are affected by chronic pain worldwide. In children, pain is often under-recognized and under-treated, especially when they might not have the language skills to express what they’re experiencing. Common causes of pediatric chronic pain include: 

  • Headaches
  • Recurrent abdominal pain
  • Limb pain
  • Back pain
  • Pain without any known cause

In children this pain can impact their development because it can lead to the inability to participate in age-appropriate social activities, missing school, isolation, difficulty forming interpersonal relationships, and mental health issues.

Treatment for pain

So as stated above medication the the primary treatment for pain, and should be continued but there are other treatments to keep in mind, that should be monitored by a medical professional. This includes:

  • Physical therapy
  • Acupuncture
  • Transcutaneous electrical nerve stimulation (TENS) therapy
  • Hypnotherapy
  • Behavioral Therapy
  • Biofeedback
  • Neurofeedback
  • EaseVRx virtual reality system

Some therapeutic modalities, specifically Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) have been shown to help relieve some in managing the pain and discomfort. 

Neurofeedback and pain

So what is neurofeedback. Neurofeedback is a kind of biofeedback that has been in use for decades based on direct, behavioral training of the brain using an electroencephalograph (EEG). We place electrodes on the scalp to observe the different brainwaves and learn different information based on where, the frequency of, and when certain brainwaves occur. This technique allows us to observe the brain in action as the brain learn to function more efficiently. 

For pain management, the theory is that neurofeedback works by teaching self-regulation. Studies suggest that neurofeedback can be used to affect the processing of pain perception, such as in the gate-control theory discussed above. Some chronic pain conditions neurofeedback has been used to treat before include: 

  • Trigeminal Neuralgia
  • Headache and migraines
  • Fibromyalgia 

Resources

https://www.aamc.org/news-insights/how-we-fail-black-patients-pain

Click to access db390-H.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888311/

Acceptance and Commitment Therapy for Chronic Pain

Ibric, V. L., and Dragomirescu, L. G. (2009). “Neurofeedback in pain management,” in Introduction to Quantitative EEG and Neurofeedback. (New York, NY: Elsevier Inc.), 417–51. doi: 10.1016/B978-0-12-374534-7.00016-2

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4892319/

https://www.fda.gov/news-events/press-announcements/fda-authorizes-marketing-virtual-reality-system-chronic-pain-reduction

https://www.ninds.nih.gov/Disorders/All-Disorders/Chronic-Pain-Information-Page

Here at TriWellness we do offer neurofeedback and a pediatric chronic illness support group.

Contact us to learn more information

This month’s blog post was written by Jessie Duncan, MA, LPC, one of our trained specialists in Neurofeedback and chronic illness specialist.

Schedule an appointment with Jessie Duncan, MA, LPC

Neurofeedback and Tinnitus

Posted on by TriWellness in Blog, Uncategorized

What is tinnitus

Tinnitus is a condition characterized by ringing or other noises in one or both ears. Tinnitus can be caused by hearing loss, ear infection, head or neck injuries, certain medications, or symptoms of other health conditions. Tinnitus can also cause other complications from sleep problems, social problems, and other mental health issues.

Tinnitus effects on mental health

anxiety and Stress

Often people pondered the “chicken-or-the-egg” conundrum, does anxiety cause tinnitus or tinnitus cause anxiety? Research continues to try and answer that question. In a longitudinal study examining the correlation between anxiety and tinnitus, the researchers found that those with tinnitus had a high incident rate of anxiety. They further noted that the correlation could be due to anxiety causing tinnitus, tinnitus and anxiety effect each other equally, or that there is another factor affecting both anxiety and tinnitus. Other factors may be genetic or neurological dysfunction (Hou, Yang, Tsai, Shen, Lan, 2020).

There are neurological networks that share commonalities between anxiety and tinnitus. The Limbic System and the Dorsal Cochlear Nucleus (DCN) are thought to be neurological contributors to anxiety and tinnitus. One of the functions of the Limbic System is to manage emotional states. While one of the functions of the DCN converting auditory stimuli in the brain. The proximity of these two neurological networks can possibly affect each other in times of stress.

Regardless of the correlation of anxiety and tinnitus, the end result is still feeling a sense of anxiety and stress. Individuals have noted that they feel more stressed and anxious when they experience increasingly louder ringing in their ears (due to the tinnitus) and in a cyclical fashion they find that the symptoms of tinnitus are further exacerbated, creating significant distress.

Depression

Similarly to anxiety, depression and tinnitus correlation is still being researched. In a scientific review, the researchers arrived to a similar conclusion: depression affects tinnitus, tinnitus causes depression, or depression and tinnitus are symptoms of another condition (Geocze, Mucci, Abranches, de Marco, Penido, 2015). Furthermore, depression and tinnitus can be correlated due to the the neurological proximity and the functionality of the Limbic System and the DCN.

Due to the symptoms of tinnitus being unrelenting, individuals may feel hopeless in achieving relief. These symptoms may also affect sleep, causing fatigue and low energy. Furthermore, it may impact people’s motivation to engage in social activities, resulting in social isolation. All of these secondary symptoms can cause one to become depressed.

Neurofeedback As a treatment for Tinnitus

As previously established, tinnitus has neurological origins. With that understanding, researchers have studied using Neurofeedback as a treatment strategy for tinnitus. In a study, researchers found that Neurofeedback training can assist individuals in controlling their attention to the auditory stimuli, and thusly experienced a reduction in symptoms (Busse, Low, Corona-Strauss, Delb, Strauss, 2008). In another study, researchers found that utilizing Neurofeedback training to modify specific brainwaves, patients with tinnitus has experienced major to complete symptom relief (Dohrmann, Weisz, Schlee, Hartmann, Elbert, 2007).

Neurofeedback is also an affective non-pharmaceutical treatment strategy to treat the aforementioned complications of tinnitus. Studies have shown that Neurofeedback training can reduce anxiety through brainwave regulation. Studies have also shown that Neurofeedback training can assist in establishing normalized neurological activity in individuals experiencing depression.

Resources

Tinnitus

Tinnitus Among Patients With Anxiety Disorder: A Nationwide Longitudinal Study

Systematic Review on the Evidences of an Association between Tinnitus and Depression

Depression in Patients with Tinnitus: A Systematic Review

Tinnitus and Hearing Loss in 15–16-Year-Old Students: Mental Health Symptoms, Substance Use, and Exposure in School

Neurofeedback by Neural Correlates of Auditory Selective Attention as Possible Application for Tinnitus Therapies

Neurofeedback for Treating Tinnitus

Alpha Suppression and Symmetry Training for Generalized Anxiety Symptoms

A Review of EEG Biofeedback Treatment of Anxiety Disorders

Clinical Use of an Alpha Asymmetry Neurofeedback Protocol in the Treatment of Mood Disorders: Follow-Up Study One to Five Years Post Therapy

Neurofeedback with anxiety and affective disorders

This month’s post was written by Aarti S. Felder, MA, LCPC, BCN. Aarti is our chronic illness specialist and is a Board Certified Neurofeedback practitioner.

Schedule an appointment with Aarti S. Felder, MA, LCPC, BCn