Downloaded from https://journals.lww.com/jbisrir by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3wX04VDhDA65SwmSPQPoSm7qSgD9jRwjwlDEwNGtqQgg= on 06/19/2018 Effectiveness of neurofeedback therapy for anxiety and stress in adults living with a chronic illness: a systematic review protocol Farriss Blaskovits 1  Jane Tyerman 1  Marian Luctkar-Flude 2,3 1 Trent/Fleming School of Nursing, Trent University, Peterborough, Canada, 2 School of Nursing, Queen’s University, Kingston, Canada, and 3 Queen’s Collaboration for Health Care Quality: a Joanna Briggs Institute Center of Excellence, Kingston, Canada Review question/objective: The objective of this review is to systematically examine the effectiveness of neurofeedback therapy for managing anxiety and stress in adults living with a chronic illness. The specific objectives are to identify which neurofeedback systems and/or protocols demonstrate effectiveness and determine the level of supporting evidence. The review question is as follows: What is the effectiveness of neurofeedback therapy for managing anxiety and stress in an adult population aged 18 years of age or older living with a chronic illness? Keywords Anxiety; EEG biofeedback; mood disorder; neurofeedback; neurotherapy; stress JBI Database System Rev Implement Rep 2017; 15(7):1765–1769. Background C hronic illness is a substantial global burden, with the World Health Organization (WHO) reporting that 38 million of 56 million deaths world- wide in 2012 were due to non-communicable, or chronic, illness. 1 Furthermore, chronic illness in the Canadian population is estimated to increase by 4.7% from 2010 to 2030. 2 Chronic illness has numerous definitions, but commonalities include a lengthy time course, progressive severity and decreased overall function- ing causing impaired quality of life. 1,3 The WHO focuses on medically based chronic illnesses; 4 how- ever, mental illness, drug abuse and chronic pain can be included given their long persistence and drain on sufferers. 2,5,6 Anxiety, stress and distress associated with chronic medical conditions have been well documented. 7,8 Anxiety is the subjective psychological experience of environmental stressors which is marked by con- tinued excessive worry, sleep abnormalities, difficulty concentrating, emotional lability, fatigue and rest- lessness. 9,10 Stress/distress is the psychological and hormonal response to environmental pressures. 10,11 Although separate definitions of anxiety and stress/ distress are presented, these terms are often used interchangeably due to their inherent connection with each other. Chronic anxiety and stress can increase catechol- amine release, decrease growth hormones, and aberrantly activate immune and inflammatory cascades. 12 As such, stress and anxiety can directly influence illness progression and can lead to irritable bowel syndrome exacerbations and increased cardiovascular risk. 7 Increased frequency of general anxiety disorder has also been found in people with asthma, cancer and chronic pain. 7 This comorbidity of anxiety with chronic illness can cause increased morbidity, mortality and decreased quality of life. 13 Traditional treatment for anxiety includes psycho- logical treatments such as cognitive therapy, cogni- tive behavioral therapy, exposure therapy and self- help groups, as well as pharmacological modalities such as benzodiazepines and antidepressants. 14 Neurofeedback may reduce or eliminate the use of these medications. Anxiety and stress also have direct neurobiolog- ical consequences. Stress hormones have been linked to neuronal remodeling, excitotoxic damage and neuroanatomical changes to the hippocampus and basolateral amygdala. 15 Alpha electroencephalogra- phy (EEG) recordings have revealed right frontal lateralization in anxious aroused patients as Correspondence: Jane Tyerman, janetyerman@trentu.ca There is no conflict of interest in this project. DOI: 10.11124/JBISRIR-2016-003118 JBI Database of Systematic Reviews and Implementation Reports ß 2017 THE JOANNA BRIGGS INSTITUTE 1765 SYSTEMATIC REVIEW PROTOCOL ©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.