Anxiety & Mild Depression - Mid Twenty Year Old Male

While this case is based on a real client, certain identifying details have been changed to protect privacy and ensure HIPAA compliance.

Synopsis

The client presents with a longstanding history of executive dysfunction, attention deficits, and mood dysregulation with roots in early developmental and relational trauma. Adverse childhood experiences, intergenerational family mental health history, and a prior substance use history have contributed to difficulties with daily routines, self-care, and cognitive organization.

The client at the time was beginning his steps to recovery, which marked a meaningful turning point reflected in growing insight, motivation, and recent academic progress.

His treatment comprised of both neurostimulation and neurofeedback, executive skills coaching, and evidence-based modalities including Family Systems, CBT, and Trauma-Informed Therapy to target attention regulation, mood stability, and identity reconstruction.

Initial Presentation

The client's initial brain mapping revealed the following.

Alpha - The initial mapping shows excess alpha concentrated in the frontal and occipital lobes. Within the literature, excess occipital and parietal alpha is most commonly associated with cortical idling, withdrawal, and disengagement. This commonly expresses as withdrawn, depressive, or a lack of motivation.

Beta - The excess beta in the frontal-medial and occipital-parietal regions is associated with anxiety, hyperarousal, and rumination.

This map is consistent with a mixed depression/anxiety profile. Posterior alpha excess suggesting withdrawal/disengagement, frontal beta elevation suggesting hyperarousal, and relative power patterns suggesting the beta is dominating the spectral composition.

After Treatment

This data was collected after roughly 10 sessions.

Immediately we can see more regulation across the entire frequency domain. Particularly, we can see the most improvements to frontal alpha, and centralized beta activity.

The reduction in frontal beta is the most clinically meaningful shift that his hyperarousal/anxiety signature has clearly calmed down. The posterior alpha is still present but looks less intense, suggesting his cortical disengagement is improving but still a work in progress.

Overall this map tells us his brain is responding and reorganizing, which lines up well with what you'd hope to see after 10 sessions.

Wrapping up

This client noted major improvements in both reducing obsessive thinking and ruminations. Additionally, he had found his depression was starting to lift, although it wasn't completely gone. We were only able to work together briefly, but a presentation like this often shows just how powerful a focused intervention can be.

Methodology

qEEG analysis was conducted using an eyes open and eyes closed recording. The information above was quantified into a report which targeted the above-mentioned areas.

tACS stimulation with positive anodes placed at F3 and F4, negative cathodes placed at P3 and P4. The protocol was a biphasic 13-15hz SMR protocol, with strong magnetic coils placed above sites Fz, Cz, C3, and C4 running a 13-15hz pEMF frequency in-tandem. This was done for 10 session for 20 minutes using Neurofield's software and hardware.

Neurofeedback was also done alongside this, for 20 minutes a beta & alpha downtraining protocol was run targetting frontal attentional, default mode, and salience networks. This was done using SWLORETA-based Neurofeedback through a 19-channel EEG, the software used was Neuroguide.

REFERENCES

Begić, D., Mahnik-Miloš, M., & Grubišin, J. (2009). EEG characteristics in depression, schizophrenia, obsessive-compulsive and posttraumatic stress disorder. Psychiatria Danubina, 21(2), 246–250.

Herrmann, C. S., Rach, S., Neuling, T., & Strüber, D. (2013). Transcranial alternating current stimulation: A review of the underlying mechanisms and modulation of cognitive processes. Frontiers in Human Neuroscience, 7, Article 279. https://doi.org/10.3389/fnhum.2013.00279