Anxiety is not a mistake, but a highly efficient warning system. Three key nodes are crucial: the amygdala (danger detector), the hippocampus (context/memory), and the prefrontal cortex (regulation and evaluation). In healthy states, prefrontal areas dampen an overactive amygdala; in anxiety disorders, this very brake is often weakened – threat is recognized more quickly, persists longer, and is triggered even in non-threatening contexts. This explains why rumination, avoidance, and physical warning signs (rapid heartbeat, shallow breathing) reinforce each other.
A second component is the learning dynamics of fear and its extinction: What was once stored as dangerous is only slowly "overwritten" later. Even after successful exposure, the fear can quickly resurface in a new context—one reason why relapses in anxiety disorders are common.
Finally, anxiety disorders are often characterized by reduced heart rate variability (HRV) – a marker for insufficient parasympathetic (calming) activity. This isn't just a paper finding; it explains why the body remains "high" during anxiety and has difficulty downregulating.
How bilateral stimulation helps – the evidence behind the principle
Bilateral stimulation (BLS)—alternating left/right stimuli via eye movements, tones, or touch—is a core element of bilateral interventions. Two models of action are best supported:
Working memory load: When you keep a stressful image active while simultaneously performing a secondary task (e.g., rhythmic eye movements or alternating tones), your working memory "splits." The memory remains accessible but becomes less vivid and emotionally intense—resulting in a reduced anxiety response. This has been repeatedly demonstrated in experimental studies.
Orienting Response & De-Arousal: Alternating stimuli repeatedly elicit a mild orienting response—attention opens, the organism checks "Is it safe?"—which is accompanied by physiological calming (de-arousal). Meta-analyses demonstrate that the bilateral component (e.g., eye movements or left-right play) contributes a significant effect in addition to exposure.
Translational research has also shown that bilateral, alternating stimulation can facilitate fear extinction and attenuate the dreaded “return of fear” – a finding that addresses precisely where many anxiety treatments fail.
Why the handpan is an ideal instrument: sound, rhythm and self-efficacy
Music reduces anxiety—not only subjectively, but also physiologically measurable. Reviews and meta-analyses consistently show that musical interventions reduce preoperative and general anxiety, lower stress hormones like cortisol, and improve autonomic markers like HRV. This applies to passive listening, but is often even more pronounced for active music-making.
Handpan sounds, in particular, are rich in overtones and develop long, soft decay phases—precisely the acoustic properties that correlate with parasympathetic activation, calm breathing, and increased HRV. Reviews of music and the autonomic nervous system confirm these mechanisms.
In Pan Balance, bilateral stimulation is added: You play yourself – using a simple left-right pattern. This simultaneously creates (a) bilateral tactile/motor stimuli, (b) bilateral auditory stimuli (the sound "wanders"), and (c) a focused attention shift to breath, rhythm, and body. This multi-channel setting combines the mechanisms described above: working memory load, orienting response with de-arousal, facilitation of extinction learning – plus music-induced autonomic calming. Initial experimental studies specifically on bilaterally alternating auditory stimuli demonstrate precisely such effects on fear learning and fear extinction.
The factor of self-efficacy should not be underestimated: Instead of being "bombarded," one actively shapes the process. Active music-making has repeatedly been linked in music therapy with stronger, more lasting effects on anxiety and mood (e.g., drumming programs in psychiatry).
What does the clinical evidence say about anxiety disorders?
Although bilateral stimulation was originally developed in trauma therapy contexts, recent meta-analyses show that bilateral procedures can significantly reduce anxiety, panic, phobias, and somatic anxiety symptoms. Systematic reviews conclude that BLS-based protocols are effective across the anxiety spectrum—particularly when exposure and cognitive techniques have already been exhausted or when a body-based, sound-based approach is sought.
Current state-of-the-science reviews classify bilateral stimulation as an evidence-based component within psychotherapy; while the mechanism of its effectiveness (working memory vs. orienting response, among others) remains controversial, there is robust data available for its clinical efficacy in anxiety-related settings.
Borders, security, integration
"Pan Balance" is not a substitute for therapy for severe or acute anxiety disorders (e.g., with suicidal thoughts, heavy substance use, or significant impairment of daily life). However, it is suitable as a stabilizing, body- and sound-based supplement: for anxiety prevention in everyday life, as a bridge between therapy sessions, or as a gentle introduction when cognitive techniques seem too cerebral. For persistent symptoms, consultation with treating professionals is recommended; the evidence for music- and BLS-based interventions supports a meaningful combination of both.
Conclusion
Anxiety arises from a learning- and body-based interplay of threat detection, context, and inadequate top-down regulation. Bilateral stimulation targets precisely these circuits: It relieves working memory, triggers orientation and calming responses, and supports extinction learning. Combined with the calming, parasympathetic-friendly properties of handpan sounds, this results in a low-threshold, active self-practice with good theoretical plausibility and growing evidence—particularly as a complement to proven anxiety therapies.
Further studies & reviews (selection)
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LeDoux J. (2016). Overview of the neurobiology of fear and amygdala circuits.
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Giustino T. & Maren S. (2015). The Role of the Medial Prefrontal Cortex in the Conditioning and Extinction of Fear
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van den Hout M. & Engelhard I. (2012). Working memory model of eye movements/BLS.
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Lee C. & Cuijpers P. (2013). Meta-analysis on the additive effect of bilateral stimuli in exposure procedures.
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Wurtz R. et al. (2016). Bilaterally alternating auditory stimuli and fear/extinction.
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Cochrane Review Bradt J. et al. (2013). Music interventions and anxiety.
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Kühlmann A. et al. (2018). Meta-analysis on music and perioperative anxiety/stress.
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Thoma M. et al. (2013). Music and Stress
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Reviews on HRV and music (e.g. Mojtabavi S. et al., McCrary J. et al.).
