Unlocking the Brain

By Dara Chadwick

November 2025

A pounding heartbeat. Rapid breaths. Feelings of dread or losing control. This is how anxiety, panic and worry may feel to your clients. Through understanding how the nervous system responds to these emotions, you can design and deploy neuroscience-informed interventions that help clients meet and manage these feelings effectively.

Anxiety, panic and worry begin in the autonomic nervous system. Neural pathways govern this system, constantly releasing chemicals and signals designed to keep the body in a balanced state. The sympathetic nervous system scans for threats, triggering the “fight, flight or freeze” response, while the parasympathetic system drives the calmer “rest and digest” response.

Any threat a person experiences can produce a nervous system reaction, says Eric Beeson, PhD, LPC, NCC, chair of the Department of Counseling at Marshall University in West Virginia. “There’s an initial wave that’s automatic and activates many systems throughout our brain and body to promote quick action for survival,” he says.

But while the nervous system’s mechanisms are universal, threat perception is highly individual. “The nervous system is a collection of circuits that are constantly moving backward and forward in an attempt to understand the stimuli in front of us,” says Chad Luke, PhD, LPC-MHSP, NCC, professor of counselor education at St. Bonaventure University in New York. “We’re born into a sociocultural context that we didn’t choose, with a genetic inheritance we didn’t choose, with early caregivers and living environments we didn’t choose, having experiences we didn’t cause,” he says. “These things combine to create patterns of how we think, feel, act, relate and experience the world.”

Anxiety, panic and worry typically result when the sympathetic nervous system is overactivated — a response that can occur at any time, according to Eraina Schauss, PhD, LPC-MHSP, ACS, associate professor and founding director of the BRAIN Center at the University of Memphis. “Much of the work that needs to be done is deactivating that sympathetic response and activating the rest-and-digest parasympathetic response,” she says.

Anxiety often has a physiological basis, while worry can be more cognitive, says Thomas Field, PhD, LMHC, LPC, associate professor and head of the Department of Counseling & Adult and Higher Education at Oregon State University and co-editor of Neuroscience-Informed Counseling, Second Edition. “Often, we need to re-regulate the physiological system when working with anxiety,” he says. “That’s why we have traditionally long used interventions like parasympathetic deep breathing and progressive muscle relaxation to reduce tension within the body.”

Neuroscience-Informed Treatment

Some counselors associate neuroscience-informed treatment with technology-heavy interventions such as biofeedback and neurofeedback, which use electronic devices to gather real-time feedback on physiological processes and brain activity. Neuroscience-informed treatment also includes newer techniques such as brainspotting and eye movement desensitization and reprocessing. But not all counselors who consider themselves neuroscience-informed use these techniques.

Using neuroscience to understand the multidirectional functioning of the brain and body can help counselors be more effective, Field says. Some use neuroscience to better understand a client’s challenges, and some share neuroscience information — known as psychoeducation — to educate and empower their clients.

According to Luke, neuroscience-informed counseling helps clients understand themselves and why they react the way they do. “Integrating neuroscience is learning about your nervous system and how it works,” he says. “It’s also about making peace with the nervous system you have rather than trying to demand that it be different.”

Schauss helps her pediatric patients and their family members develop coping strategies and skills using neuroscience-informed approaches such as mindfulness-based stress reduction and interpersonal and social rhythm therapy (IPSRT).

“IPSRT is based on the diathesis-stress model,” she says. “The idea is that everyone has a predetermined stress response. It might be panic attacks or intrusive thoughts. If you’re able to regulate your physical and social rhythms, you’re less likely to have the stress that causes the onset of whatever condition you’re predisposed to. I make sure all the counselors I train take these courses, and we do a lot of psychoeducation with patients. I also train my students on acceptance and commitment therapy, which is a beautiful blend of mindfulness work with the cognitive piece.”

Data-Driven Approaches

Ted Chapin, PhD, LMFT, a licensed clinical psychologist and neurotherapist with the Neurotherapy Institute of Central Illinois, is trained in neuroanatomy and board-certified in neurofeedback by the Biofeedback Certification International Alliance. He uses both biofeedback and neurofeedback with his clients, many of whom experience anxiety, worry and panic that prevents them from progressing with cognitive interventions during counseling.

“Clients who have severe anxiety, stress and panic disorder are at a much more elevated persistent state,” Chapin says. “They often come in very anxious, hypervigilant and mistrustful and have a hard time focusing and listening. Biofeedback and neurofeedback can help calm a client’s dysregulation.”

During neurofeedback — a top-down type of biofeedback, according to Chapin — practitioners use an electroencephalogram (EEG) to record brainwaves and provide feedback to the client. By responding to this feedback, clients learn to change their brain activity over time.

Classic biofeedback techniques are a bottom-up approach that focuses on measures such as peripheral skin temperature and heart rate variability. Clients receive detailed information to help train their breathing and responses toward a desired state. “The brain doesn’t sit alone,” Chapin says. “It’s connected to the heart, lungs, muscles, organs and peripheral nervous system. With this training, clients can re-establish their parasympathetic response. Then, they can connect, socially engage, focus and practice skills.”

Incorporating biofeedback and neurofeedback into your counseling practice requires specialized training and certification. But Chapin encourages counselors without this training to begin to observe and assess a client’s neurophysiological manifestations. “Watching a client’s breathing rate through shoulder or chest movements and noticing a client’s hand temperature and appearance can help you assess levels of relaxation or anxiety,” he says. “Most counselors are trained to do relaxation training and deep breathing to help calm anxious behavior.”

When clients experience significant neurophysiological dysregulation that interferes with counseling sessions, referral for neurofeedback training may help, Chapin says.

Counselors can also use tools such as pulse oximeters to help clients understand their resting heart rate and how it changes when they’re anxious, according to Field. Building awareness of the physical changes experienced with anxiety, panic or worry can help clients learn to self-regulate.

How Neuroscience Can Help

There’s no one-size-fits-all approach to neuroscience-informed counseling. Integrating neuroscience into treatment for anxiety, panic and worry also doesn’t mean clients won’t continue to experience symptoms — but it can help clients learn to regulate their responses.

“Counselors who want to use neuroscience in their practice with anxiety can start by focusing on helping their client develop interoceptive awareness of their anxiety,” Field says, referring to the ability to notice and understand internal bodily sensations, such as a racing heart or tight chest. “Just helping a client acknowledge anxiety and sit with it is a very important first step in being able to regulate it. If you can help a client understand where these feelings are coming from and what to do with them when they occur, it helps lessen the secondary response of feeling overwhelmed or powerless. That’s the piece that can be adjusted in psychotherapy.”

Normalizing these feelings can also help. Field and his colleagues recently conducted a study with four Spanish-speaking clients, most of whom had significant physiological anxiety in the wake of sociopolitical events. The goal was to help reduce their anxiety over 20 sessions.

“We used an intervention called neuroscience-informed cognitive behavior therapy,” Field says. “Part of our protocol was helping them understand where anxiety comes from, what it is about, and to understand it from a normative position. In other words, it made sense that they felt anxious because they felt under threat. When we feel under threat, we have different physiological, cognitive and behavioral experiences, and we define those as anxiety.”

Framing anxiety this way helped each person reduce their sense of shame at having an anxious response. “Understanding where anxiety is coming from helps the person engage with it,” Field says. “Naming anxiety symptoms as a healthy part of a response system to threat allows the person to distance from, and interact with, those symptoms.”

The three participants who completed the study (one dropped out) experienced a significant reduction in anxiety, according to Field. They could recognize physiological symptoms of anxiety and use coping tools to accept the experience. “By working with their anxiety symptoms instead of pushing against them, each felt a sense of mastery,” he says. “This led to a reduction in anxiety because they saw it as normative.”

Most counseling models based in neuroscience have some commonalities, according to Luke. “It’s attention, intention and action,” he says. “You narrow your focus onto a phenomenon within your body and set an intention that you’re going to do this thing on purpose for a set amount of time with the belief that it could help. Then, you take meaningful action.”

Beeson cautions counselors to be mindful of the “seductive allure of neuroscience.” Framing an approach in neurobiological terms can affect clinical decision-making, as well as client self-efficacy and the types of treatments they believe in, he says. “Dig a little beyond the headlines you might read,” he says. “The number-one predictor of therapeutic outcomes is not the type of therapy you do; it’s the quality of the therapeutic relationship that’s formed.”

Deepening Knowledge

Not all counseling education programs include neuroscience training beyond courses in addiction or trauma. Without knowledge of nervous system anatomy and physiology, counselors might find it challenging to evaluate the usefulness of applied models that use neuroscience.

Books and free online trainings can help ground counselors in neuroscience and neuroscience-based techniques. It’s also important to get guidance from an experienced practitioner.

“This has been the decade of the brain,” Schauss says. “We’re beginning to understand how the brain works and how to optimize different areas of the brain. I think continuing education in neuroscience-informed practice is going to be critical as we advance as a profession. It’s always important for counselors using any new model or methodology to have good support and the supervision of somebody who is practicing in that methodology.”

Schauss also says that CACREP-accredited programs require training in diagnostic assessment and interventions. “A good understanding of the brain and the [Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision™] helps you apply what you know when planning treatment,” she says.

Beeson defines being neuroscience-informed as understanding the neuroscience behind what you already do — and allowing what you learn about neuroscience to inform how you practice. “Neuroscience gives us a new lens through which to look at human experiences,” he says. “I work with emotions differently because of neuroscience research I’ve read about emotions.”

To successfully integrate neuroscience-informed treatment of anxiety, panic and worry, Luke says it’s important to establish your own sense of safety before using specific interventions. “Your client’s nervous system will draw more support from you feeling safe and present than they will from any other intervention that you do,” he says.