EMOTIACT: Regulation of Performance Anxiety and Consolidation of Emotional Control in High Stakes Matches Through Integrated Brain Based Training

Performance anxiety represents a critical yet often underestimated determinant of failure in elite sport, particularly during high-stakes competitive moments. Contemporary neuroscience conceptualizes this phenomenon as a neurophysiological imbalance involving hyperactivation of the anterior cingulate cortex (Brodmann areas 24–32), dysregulation of the Salience Network, reduced vagally mediated heart rate variability (HRV), and impaired heart–brain coherence. The present study introduces and validates EMOTIACT, a randomized, longitudinal, controlled clinical protocol designed to recalibrate these mechanisms through an integrated multimodal intervention. Forty professional athletes were randomly assigned to an experimental group receiving the full EMOTIACT protocol (EEG neurofeedback, transcutaneous vagal nerve stimulation, HRV biofeedback, binaural auditory stimulation, and cerebral photobiomodulation) or to a control group receiving structured relaxation without active neurophysiological modulation. The intervention was delivered over six weeks (18 sessions), with assessments at baseline, mid-intervention, and post-intervention. Results demonstrated significant improvements in the experimental group compared with controls across all primary outcomes: reduced physiological stress (GP-8), increased vagal tone (RMSSD), decreased LF/HF ratio, reduced high-beta activation in BA24–32, enhanced HRV coherence, improved self-rated emotional control, and higher behavioral reliability in high-pressure matches. These findings support the hypothesis that performance anxiety reflects a modifiable neurophysiological state rather than a fixed psychological vulnerability. EMOTIACT provides a reproducible and scalable framework for integrating emotional regulation training into elite sport preparation. By restoring cortical–autonomic integration, the protocol enhances decisional clarity, emotional stability, and competitive reliability under pressure.