The Impact of a Neurofeedback Training Intervention on College Students' Levels of Anxiety, Stress

272 Pages·2017·3.26 MB·English

by  Caitlyn Bennett

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Electronic Theses and Dissertations
2018
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Caitlyn Bennett
University of Central Florida
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THE IMPACT OF A NEUROFEEDBACK TRAINING INTERVENTION ON
COLLEGE STUDENTS’ LEVELS OF ANXIETY, STRESS, DEPRESSION, AND CORTISOL

by

CAITLYN MCKINZIE BENNETT
B.S., University of Central Florida, 2011
M.A., University of Central Florida, 2014

A dissertation submitted in partial fulfillment of the requirements
for the degree of Doctor of Education
in the College of Education and Human Performance
at the University of Central Florida
Orlando, Florida

Spring Term
2018

Major Professors: Glenn W. Lambie and Gulnora Hundley
© 2018 Caitlyn McKinzie Bennett

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ABSTRACT
Anxiety, depression, and stress are three of the most common experiences that impact
college student functioning and academic achievement. At least one in six college students
struggle with anxiety, increasing risk for developing depressive symptoms or disorders that
further impact wellness. However, as mental health concerns increase across campuses,
universities are not equipped to meet the demand of mental health support for college students.
Neurofeedback (NF) training presents as an innovative intervention to treat anxiety, depression,
and stress as it is designed to regulate brain processes in an effort to increase more effective
brain functioning.
A quasi-experimental, nonequivalent control group design was utilized to determine
differences between treatment group and waitlist control group participants’ anxiety, stress, and
depression scores at four time points as measured by the: (a) Beck Anxiety Inventory [BAI]
(Beck, Epstein, Brown, & Steer, 1988); (b) Beck Depression Inventory, Second Edition [BDI-II]
(Beck, Steer, & Brown, 1996); (c) Perceived Stress Scale [PSS] (Cohen, Kamarck, &
Mermelstein, 1983); and (d) Social Anxiety Thought questionnaire [SAT] (Hartman, 1984).
Furthermore, cortisol testing was used through assessment of saliva samples using Salimetrics
Enzyme-Linked Immunosorbent Assay (ELISA).
Key findings for the current investigation include: (a) a marginally significant (p = .051)
difference between treatment group and control group participants’ PSS (partial ƞ2 = .093), BDI-
II (partial ƞ2 = .089), and SAT (partial ƞ2 = .052) scores over time; (b) no significance difference
among participant demographics between treatment group and control group assessment scores
over time; (c) no significance between treatment group and control group assessment scores and
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salivary cortisol levels over time; and (d) a negative relationship between the control group
participants’ salivary cortisol levels at pre-test on the BAI, PSS, and SAT. Finally, results are
compared to previous studies. Limitations and implications as well as areas for future research
are explored.
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Dedicated to my loving husband, Michael. You have been the best partner in this journey. Thank
you for giving me purpose, strength, and motivation.

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ACKNOWLEDGMENTS
This dissertation journey was successfully completed due to the unwavering support,
patience, and words of encouragement from those who mean the most to me. I have to begin by
thanking and recognizing my parents. You have been pillars of strength for me throughout my
entire life and throughout my educational journey. You have always encouraged me, believed in
me, and loved me through all of the obstacles that I have stumbled upon, and I am a better wife,
daughter, sister, friend, and scholar because I have you as my parents. Dad, your hardworking
and kind nature has been instilled in me and has been a value that I try to integrate in all that I
do. Mom, your warmth and passion for creativity has been something that I attempt to emulate in
my personal and professional life. To my sisters, Cara and Crystal: I am who I am because of
your love and friendship. I have always looked up to both of you and will continue to do so
throughout my life. Cara: you are always kind and loving, which provides me with hope and
peace. Crystal, your fire and infectious personality provide me with strength and passion. To my
husband who has played an instrumental role in my doctoral journey. Michael, I cannot find the
words to articulate what you have meant to my success in this process. You have been patient,
kind, and an invaluable source of support. I hope that as we continue life together, I can give you
even a fraction of the support and love that you have provided to me during this (educational)
season of my life.
My doctoral and dissertation journey was also made better by those who were marching
forward with me. To my cohort, the Stupendous Seven: you have helped me to maintain my
passion, sanity, and sense of humor. We have experienced every vulnerable and engulfing
emotion imaginable and I am eternally grateful that we were able to share this challenging and
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fulfilling season together. I am thankful for the University of Central Florida and the possibilities
and experiences that were provided to me there. It is hard to believe that a sudden interest in
serving as an undergraduate research assistant at the Marriage and Family Research Institute
would have sparked desire for a lifelong journey of education and research; this fire would not
have been sparked without a fearless leader (Dr. Daire). The Counselor Education program at
UCF has played an instrumental role in my development as a counselor and now as a counselor
educator and I am forever grateful.
Finally, I want to thank my amazing and patient committee members. Dr. Bai, I am
appreciative of your time, guidance, and questions that allowed me to embark upon the puzzling
path that is statistics. You have further developed my desire to immerse myself in the world of
statistics in order to be a better researcher and scholar. Dr. Taylor, I am thankful for your fiery
spark and truthful words. Your perspectives, inquiries, and belief in my abilities allowed me to
feel even more grounded in the dissertation process. My co-chairs have also been an instrumental
source of support and motivation. Dr. Hundley, I would not have even been able to immerse
myself in the world of Neurofeedback training had it not been your passion and interest in my
abilities. From the beginning of my research endeavors, you have been available, supportive, and
always encouraged me continue moving forward. Dr. Lambie, you have expressed an
unwavering amount of faith and belief in my abilities from the very beginning, even when I
could not see them myself. Although, at times, your faith in me felt blind, I never felt
unsupported or uncertain of your guidance. You always brought me back to reality, pointed out
my strengths, and encouraged me to think outside of the box. I am a better researcher, scholar,
and educator because you have believed in and supported me.

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TABLE OF CONTENTS
LIST OF FIGURES ..................................................................................................................... xiii
LIST OF TABLES ....................................................................................................................... xiv
LIST OF IMPORTANT ACRONYMS OR ABBREVIATIONS ................................................ xv
CHAPTER ONE: INTRODUCTION ............................................................................................. 1
Statement of the Problem ........................................................................................................... 2
Significance of the Study ........................................................................................................... 3
Theoretical Foundations ............................................................................................................. 4
Stress ..................................................................................................................................... 4
Anxiety .................................................................................................................................. 6
Depression ............................................................................................................................. 7
Cortisol .................................................................................................................................. 8
Neurofeedback Training ........................................................................................................ 8
NeurOptimal. .................................................................................................................. 12
College Students .................................................................................................................. 13
Methods .................................................................................................................................... 13
Research Design .................................................................................................................. 14
Research Questions ............................................................................................................. 14
Exploratory Research Question 1. .................................................................................. 15
Exploratory Research Question 2. .................................................................................. 15
Population and Sampling..................................................................................................... 15
Neurofeedback Training Intervention ................................................................................. 16
Data Collection Procedures ................................................................................................. 17
Recruitment. ................................................................................................................... 17
Study funding. ................................................................................................................ 18
Incentives ........................................................................................................................ 18
Screening. ....................................................................................................................... 19
Data Collection Instruments ................................................................................................ 19
Data Analysis ........................................................................................................................... 21
Primary Research Question ................................................................................................. 22
Exploratory Research Question 1 ........................................................................................ 22
Exploratory Research Question 2 ........................................................................................ 23
Secondary Research Question ............................................................................................. 23
Exploratory Research Question 3 ........................................................................................ 23
Ethical Considerations ............................................................................................................. 23
Potential Limitations of the Study ........................................................................................... 24
Chapter One Summary ............................................................................................................. 25
CHAPTER TWO: REVIEW OF THE LITERATURE ................................................................ 27
Stress ........................................................................................................................................ 27
Stress Theories and Emotional Implications ....................................................................... 28
Impacts of Stress: Physical, Cognitive, and Emotional Consequences ............................... 31
The brain and body ......................................................................................................... 31
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Stress and anxiety ........................................................................................................... 33
Stress and depression ...................................................................................................... 34
Stress and College Students ................................................................................................ 34
Anxiety ..................................................................................................................................... 37
Prevalence of Anxiety and Anxiety Disorders .................................................................... 37
Theories and Treatment of Anxiety..................................................................................... 38
Presentation of Anxiety and Anxiety Disorders .................................................................. 40
Anxiety and the brain ..................................................................................................... 41
Anxiety and College Students ............................................................................................. 42
Depression ................................................................................................................................ 45
Prevalence of Depression and Depressive Disorders .......................................................... 45
Theories and Treatment of Depression ............................................................................... 46
Presentation of Depression and Depressive Disorders ........................................................ 46
Depression and the brain ................................................................................................ 47
Depression and College Students ........................................................................................ 48
Cortisol ..................................................................................................................................... 51
Cortisol and College Students ............................................................................................. 52
Neurofeedback Training........................................................................................................... 53
History and Development of Neurofeedback Training ....................................................... 53
Neurofeedback Training Systems and Methods .................................................................. 54
Alpha-theta training ........................................................................................................ 55
Slow cortical potential training ...................................................................................... 55
Roshi ............................................................................................................................... 56
Low energy neurofeedback systems (LENS) ................................................................. 56
Low resolution electromagnetic tomography (LORETA) ............................................. 56
Live Z-score neurofeedback training .............................................................................. 57
Functional magnetic resonance imaging (fMRI) neurofeedback ................................... 57
Hemoencephalography ................................................................................................... 58
NeurOptimal neurofeedback .......................................................................................... 58
Neurofeedback Training with Various Populations ............................................................ 59
NF Training and Anxiety .................................................................................................... 60
NF Training and Depression ............................................................................................... 70
NF Training with NeurOptimal ........................................................................................... 72
Chapter Two Summary ............................................................................................................ 73
CHAPTER THREE: METHODS ................................................................................................. 75
Research Design ....................................................................................................................... 75
Threats to Validity ................................................................................................................... 76
Statistical Conclusion Validity ............................................................................................ 76
Construct Validity ............................................................................................................... 78
Experimenter expectancies ............................................................................................. 78
Inadequate explication .................................................................................................... 79
Internal Validity .................................................................................................................. 79
Treatment fidelity ........................................................................................................... 80
History ............................................................................................................................ 80
Maturation ...................................................................................................................... 81
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