At a Glance
Patient | SM, 37-year-old woman |
|---|---|
Condition | Generalized Anxiety Disorder (GAD), with Schizoid Personality Traits |
Duration of struggle | Since the age of 7-8 years |
Treatment | EASE tDCS headband + Cognitive-Emotional Training (CET), twice daily |
Sessions to remission | 20 sessions |
Hamilton Depression Rating Scale (HAM-D) | Scores improved from 19 (Moderate Anxiety) to 5 (Minimal Symptoms), representing a 73.7% reduction in anxiety symptoms. |
Hamilton Anxiety Rating Scale (HAM-A) | Scores improved from 11 (Mild Depression) to 5 (Minimal Symptoms), representing a 54.5% reduction in depressive symptoms. |
The Clinical Picture
Diagnoses: Generalized Anxiety Disorder (GAD) with Schizoid Personality Traits
Presenting symptoms at assessment (March 2026):
Core Key Symptoms:
Chronic anxiety and overthinking since early school school years
Pervasive low mood
Pervasive fear of being "not good enough"; fear of reprimand by authority
Approval-dependence- worth tied to achievement and performance
Guilt internalization on perceived underperformance
Persistent restlessness
Reduced socialization with limited capacity for deep connection due to fear of evaluation
Structure-dependence to manage anxiety
History of Presenting Illness
SM reported that her difficulties began during her early school years, around 1st or 2nd grade. Even as a young student, she worried excessively about her performance, felt a strong need to achieve good results, and frequently sought approval from parents and teachers. Although she consistently performed well academically, success rarely brought lasting reassurance. Instead, she would quickly become concerned about the next challenge or expectation.
As she grew older, these patterns became deeply ingrained. She developed a tendency to judge her self-worth through achievement, productivity, and external validation. She described feeling significant pressure to prove herself and often experienced guilt or self-criticism whenever she felt she had not performed well enough.
Over time, these difficulties extended beyond academics into her professional and personal life. She frequently worried about making mistakes, disappointing others, or being viewed as inadequate. She reported a persistent fear of being reprimanded by authority figures despite consistently performing well in her role. Much of her mental energy became devoted to performance-related concerns, leaving little room for relaxation or enjoyment. Reportedly, this also affected her capacity for deep social connection, so her relational needs get channeled into achievement and approval-seeking driving anxiety while being unable to build social attachment.
These longstanding patterns of overthinking, anxiety, and self-pressure had persisted for decades and continued to affect her emotional wellbeing despite her outward success.
Given the chronic nature of these difficulties and their impact on her quality of life, a home-based EASE protocol was recommended. The aim was to target brain networks involved in emotional regulation, attention, self-critical thinking, and anxiety, while helping her develop more balanced and adaptive thinking patterns.
Treatment Protocol
SM underwent a home-based treatment protocol consisting of twice-daily sessions that combined two complementary interventions:
tDCS (Transcranial Direct Current Stimulation)
EASE is a portable, non-invasive headband that delivers a gentle electrical current to targeted brain regions involved in emotional regulation. Each session lasted 20 minutes and targeted the left dorsolateral prefrontal cortex (DLPFC), an area commonly associated with anxiety regulation, cognitive control, and mood.
Cognitive-Emotional Training (CET)
Cognitive-Emotional Training was completed simultaneously with tDCS. These exercises were designed to strengthen attention, emotional regulation, and more balanced thinking patterns.
Combining CET with tDCS aims to activate relevant brain circuits while they are being stimulated, helping the brain learn and maintain healthier emotional patterns over time.
Outcome Measures
SM experienced substantial reductions in both anxiety and depressive symptoms over the course of treatment. Anxiety scores decreased by 73.7%, while depressive symptoms decreased by 54.5%, with both measures reaching the minimal symptom range.
Scale | Baseline | Post-Treatment | Change |
|---|---|---|---|
Hamilton Depression Rating Scale (HAM-D) | 27 — Severe | 1 — Subclinical | ↓ 96.3% |
Hamilton Anxiety Rating Scale (HAM-A) | 19 — Moderate to Severe | 2 — Subclinical | ↓ 89.5% |
Importantly, the improvement extended beyond questionnaire scores. Changes were reflected in her daily thinking patterns, emotional wellbeing, and ability to manage stress more effectively.
Functional outcomes:
Post-tDCS Review — Key Pointers:
Significant improvement in overall anxiety symptoms
Reduced overthinking, rumination and performance-related distress
Improved tolerance of uncertainty, with reduced tendency toward excessive worry
Notable reduction in self-criticism and internalized guilt
Greater emotional stability and resilience under stress
Increased confidence in managing workplace responsibilities and authority interactions
Enhanced ability to disengage from performance-related preoccupations
Patient Story
For most of her life, SM felt driven to prove herself.
From as early as 1st or 2nd grade, she worried about her performance and felt a strong need to meet expectations. Good grades and achievements brought only temporary relief before new worries emerged. She often felt that she needed to work harder, achieve more, and continually demonstrate her competence to those around her.
As she progressed through school and later built a successful career as a software engineer, these patterns remained. Although she consistently performed well, she struggled to feel secure in her accomplishments. Instead, she found herself overthinking decisions, worrying about mistakes, and fearing that she might disappoint others or fall short of expectations.
Over time, this constant mental pressure became exhausting. Much of her attention remained focused on performance, productivity, and seeking reassurance from others. While she continued to function well professionally, the anxiety beneath the surface rarely switched off.
After beginning the EASE treatment programme, she noticed a gradual but meaningful shift. The constant cycle of overthinking became less intense, and she felt less driven by fear of failure or negative evaluation. Situations that previously triggered significant anxiety became easier to manage, and she found it easier to step back from self-critical thoughts.
Following 20 sessions, she reported significant improvement in her overall anxiety and emotional wellbeing. While some perfectionistic tendencies remained, she felt calmer, more balanced, and less controlled by the constant need to prove herself. After a really long time, she felt able to approach daily life with greater confidence, flexibility, and peace of mind.
Key Takeaway: Despite a decades-long history of overthinking, self-criticism, and anxiety dating back to her early school years, SM experienced substantial improvement following 20 sessions of EASE tDCS combined with Cognitive-Emotional Training. Treatment was associated with significant reductions in anxiety and depressive symptoms, alongside meaningful improvements in emotional wellbeing, confidence, stress management, and day-to-day functioning.
