Effects of a single session of SMR neurofeedback training on anxiety and cortisol levels

Neurophysiol Clin. 2020 Jul;50(3):167-173. doi: 10.1016/j.neucli.2020.03.001. Epub 2020 Apr 9.


Objectives: According to some studies, a putatively calming effect of EEG neurofeedback training could be useful as a therapeutic tool in psychiatric practice. With the aim of elucidating this possibility, we tested the efficacy of a single session of ↑sensorimotor (SMR)/↓theta neurofeedback training for mood improvement in 32 healthy men, taking into account trainability, independence and interpretability of the results.

Methods: A pre-post design, with the following dependent variables, was applied: (i) psychometric measures of mood with regards to anxiety, depression, and anger (Profile of Mood State, POMS, and State Trait Anxiety Inventory, STAI); (ii) biological measures (salivary levels of cortisol); (iii) neurophysiological measures (EEG frequency band power analysis). In accordance with general recommendations for research in neurofeedback, a control group receiving sham neurofeedback was included.

Results: Anxiety levels decreased after the real neurofeedback and increased after the sham neurofeedback (P<0.01, size effect 0.9 for comparison between groups). Cortisol decreased after the experiment in both groups, though with significantly more pronounced effects in the desired direction after the real neurofeedback (P<0.04; size effect 0.7). The group receiving real neurofeedback significantly enhanced their SMR band (P<0.004; size effect 0.88), without changes in the theta band. The group receiving sham neurofeedback did not show any EEG changes.

Conclusions: The improvement observed in anxiety was greater in the experimental group than in the sham group, confirmed by both subjective (psychometric) measures and objective (biological) measures. This was demonstrated to be associated with the real neurofeedback, though a nonspecific (placebo) effect likely also contributed.

Keywords: Anxiety; Cortisol; Neurofeedback; SMR rhythm; Sham procedure.

MeSH terms

  • Adolescent
  • Adult
  • Affect
  • Anxiety / prevention & control
  • Anxiety / psychology*
  • Beta Rhythm*
  • Brain / physiology*
  • Humans
  • Hydrocortisone / analysis*
  • Male
  • Neurofeedback / methods*
  • Psychometrics
  • Theta Rhythm*
  • Young Adult


  • Hydrocortisone