The Effectiveness of Neurofeedback Therapy on Social Anxiety and Rumination in People with Social Anxiety

Psychological pressures caused by modern life and rapid social changes that are formed under the influence of the rapid growth of industrial life have major effects on human mental health and can lead to disorders such as social anxiety (2). This disorder is defined as an obvious fear or anxiety about one or more social situations in which the person is exposed to attention and criticism by others. People with this disorder are extremely afraid of doing inappropriate behavior or showing signs of anxiety in social relationships and try to refuse to be in public places (3).
The issue of anxiety is so broad that it even involves the main organs of the body, for example, it is known that the brain is the central regulator of emotions, physical symptoms, thoughts and behaviors that explain many psychological problems. . Research studies showed that social anxiety disorder is related to dysfunction and brain waves (12). On the other hand, by examining the relationship between the underlying mechanisms of the thalamocortical brain and psychological states, it has been shown that by making optimal changes in the rhythm and frequency of brain waves, using neurotherapeutic methods, optimal changes can be made in a person's neuro-psychological states. (13). One of the methods of neurotherapy is neurofeedback. People can be aware of the cortical activities of the brain through neurofeedback. Basically, neurofeedback is a kind of biofeedback that tries to teach the patient some kind of self-regulation by recording the electrical waves of the brain and giving feedback to the person. So that in a conditioning process, a person learns to voluntarily change his brain waves using the feedback he receives from the device (14).
Now, considering the prevalence of social anxiety and considering the importance of the role of brain-nerve waves and psychological factors in the emergence and continuation of social anxiety and the fact that there was no research on the effectiveness of neurofeedback treatment as a neurotherapeutic method on social anxiety, and considering the importance Choosing the right treatment for these people, the researcher is trying to answer the question of whether neurofeedback treatment has an effect on the level of social anxiety and mental rumination of people suffering from social anxiety.

In order to conduct this semi-experimental and applied research, which was conducted in the field and with a pre-test-post-test-follow-up plan, among the people suffering from social anxiety referring to counseling centers under the supervision of the welfare organization in Shahin Shahr city in 1400 (150 people) ) a number of 30 people were selected as a sample in a targeted manner and diagnosed based on the cut-off point of Jarbak's social anxiety questionnaire (1996) and were divided into experimental (neurofeedback) and control groups (21). Next, the experimental group received neurofeedback treatment for 25 sessions (three sessions per week) under the supervision of the researcher. During neurofeedback, the subjects were seated on a comfortable chair in a quiet room, and electrodes were attached to the scalp using special glue according to the international 10-20 system (28) and the electrical changes from the brain surface were continuously recorded. was taking place The neurofeedback device is a tool equipped with a computer system that was used for neural feedback training. The data measurement tool included Jarbak's social anxiety questionnaire (1996) and Hoeksma and Maro's rumination response scale (1991). Finally, descriptive statistics (tables and graphs) and Shapiro-Wilk tests, analysis of variance with repeated measures, and Bonferroni's post hoc test were used to analyze the data using spss software version 24.

Due to the inequality of covariances, the modified Greenhouse-Geisser test was used to report the within-subject effects of social anxiety and its dimensions and mental rumination, and the results of the Wilks's lambda test for the effects of time and the time*group interaction were significant (<0.01). P). Also, the results for the average scores of social anxiety at the time of the results showed a significant difference (F=41.15 and P=0.001) between the different stages (time) of measurement (pre-test, post-test and follow-up) as well as the interaction of the measurement time with the group as (F=13.86 and P=0.001) is significant, in fact, the results show that the average scores of social anxiety and its dimensions in the test and control groups were significantly different from each other at different times of measurement (Table 1).
The results of the inter-subject effects also showed that the mean social anxiety scores of the experimental and control groups were significantly different from each other (F = 18.77 and P = 0.001). The obtained eta coefficient is equal to 0.472, which indicates that more than 47% of the changes in the average scores of the experimental group were related to the provision of neurofeedback treatment. Finally, the results of the Bonferroni test in the test and control groups in the 3 times of pre-test, post-test and follow-up in Table 3 show that there is a significant difference between the average social anxiety scores of the research groups in the post-test phase compared to the pre-test (P<0.01) and the follow-up phase. There was a significant difference to the pre-test (P<0.01), but no significant difference was observed in the average scores of social anxiety in the post-test stage compared to the follow-up stage (P<0.01).

The aim of the present study was to determine the effectiveness of neurofeedback treatment on social anxiety and mental rumination of people suffering from social anxiety in Shahinshahr. The findings showed that neurofeedback treatment was effective on social anxiety and mental rumination of people suffering from social anxiety. In explaining this finding, it can be said that neurofeedback has the ability to improve the activity of the middle and lower frontal areas and can regulate their activity. In addition, regulating the activity of the middle frontal gyrus reduces anxiety (34). In fact, anxiety is considered as an aspect of reducing self-regulation of the brain, and when the EEG is obtained from the patient, the state of anxiety is clearly evident; In addition, when the brain starts to self-regulate, its activities and functions improve (35). In fact, when the client is placed in the neurofeedback process, there is a good opportunity to learn to condition his brain wave pattern and increase the optimal level (32). Of course, the main reason for the effectiveness of neurofeedback can be attributed to the increased activity of the anterior cingulate cortex, which is responsible for modulating cognitive and emotional processes in the brain (33). With a quick look at the different dimensions of social anxiety, it is clear that these dimensions are somewhat consistent with what neurofeedback treatment is looking for. In fact, social anxiety includes the fear of speaking in public, which leads to a person's avoidance of starting or continuing conversations in groups, classes, public, or parties by reducing the effectiveness of verbal communication (36).