Everything You Need To Know About Neurofeedback

Neurofeedback refers to a non-invasive therapy technique that helps patients learn to control their own brainwaves to treat mental health conditions. It does this by providing real-time readings of brainwaves, giving the patient the opportunity to monitor how certain techniques cause change.

Neurofeedback: What is it?

To understand the foundations of neurofeedback, we need to briefly discuss its parent field, biofeedback.

Biofeedback is a technique that purports to train people to improve their physical health by consciously controlling physical functions that usually occur unconsciously. For example, practitioners learn to regulate their own heart rates, blood pressure, body temperature, and gastrointestinal activity.

Neurofeedback is a form of biofeedback that trains people to control their brainwaves to treat a range of mental health conditions. It is also used to help people who have suffered brain injuries or cognitive deficiencies.

Neurofeedback Theory

Neurofeedback is grounded in basic biofeedback theory, that physical functions cause certain illnesses and disorders. It operates on the assumption that people are able to learn to regulate these functions.

How Does Neurofeedback Suggest the Mind Works?

Neurofeedback suggests that brainwaves at varying frequencies are associated with different mind states. Four basic types of brainwave are associated with these varying states:

  • Fast, low amplitude beta waves cause alertness and arousal, leading to engaged cognitive activity.
  • Slower alpha waves, with a higher altitude than beta waves, lead to non-arousal, mental coordination, and encourage learning and mind-body integration.
  • Theta waves, even slower and with a higher amplitude than alpha waves, create a heightened awareness of internal signals and encourage memory, learning, and creativity.
  • Finally, delta waves are the slowest brainwaves with the highest amplitude and cause dreamless sleep, which helps with regeneration and healing.

Neurofeedback suggests that these waves work in a cyclical fashion. For example, alpha waves lead to non-arousal but are also generated by calming, meditative activity. In other words, they can be activated by an individual’s active determination.

How Does Neurofeedback Cause Change?

Neurofeedback attempts to cause change by allowing the individual to monitor their own brainwaves. They do this using EEG (electroencephalogram) devices which process brain signals and interpret their frequencies. Using a computer program that provides graphics, music, and other stimuli, to direct one’s brainwaves towards desirable states. Feedback from the EEG machine shows whether one’s brainwave patterns are improving, and subsequent activity can be better directed to regulate these patterns more effectively.

What Happens in a Neurofeedback Session?

When one enters a neurofeedback session, the therapist directs them to sit down and attaches sensors to their scalp. The computer EEG program then starts processing brain signals and providing live interpretation. Some practitioners use qEEG (quantitative EEG) or brain mapping to track brain function and map out problem areas. However, this is not necessary for neurofeedback therapy, and its cost can be restrictive.

Techniques Used in Neurofeedback

The main technique used in neurofeedback has the computer program playing music and videos. When the brainwaves are going in a desirable direction, the music and video continue playing. As soon as the brainwaves start going in the other direction, towards anxiety, for example, the music and video stop, and the individual has to try getting the brainwaves back to the desired state. The more often the individual does so, at higher and higher levels of difficulty, the better he or she becomes at it.

Some neurofeedback therapy, especially when used for children with attention disorders, functions like a video game, with children having to direct their brainwaves to make characters move in certain directions, or to achieve certain results on the screen.

Does Neurofeedback Work?

The question of whether neurofeedback works has no simple answer. Practitioners of neurofeedback claim they have helped many people overcome a range of disorders. There are also many people who report that they have been helped by neurofeedback. However, most of this evidence is anecdotal. Research reports conducted on the efficacy of neurofeedback therapy are mixed. Many of the studies finding positive results were led by proponents of the therapy.

Even those studies that found positive results do not claim to be conclusive. But whereas on that side of the spectrum studies prove inconclusive, on the other side of the spectrum are studies which show no effect at all.

For example, a 2012 study found that most of the results of neurofeedback can be accounted for by the placebo factor. A 2016 study concluded that “evidence from well-controlled trials… fails to support neurofeedback as an effective treatment for ADHD.” A 2017 study that gave one group neurofeedback and a control group “sham” neurofeedback found that the neurofeedback group did not benefit any more than the sham neurofeedback group. Finally, in a 2017 paper in American Psychologist, researchers concluded that placebo factors likely accounted for positive findings and that neurofeedback “entails a degree of deception.”

Proponents of neurofeedback contest the findings in these papers, questioning methodology as well as the difficulty to measure the effects of neurofeedback. They claim that the anecdotal evidence they have encountered speaks for itself, and point to the studies which did show positive results. Many practitioners tout its effectiveness when used in tandem with a holistic therapeutic program. Studies published in 2014 found strong evidence for its effectiveness in treating ADHD.

What Kinds of Concerns is Neurofeedback Best For?

While the validity of neurofeedback will continue to be questioned, proponents of the therapy recommend it for a range of conditions. It is used to treat children, adolescents and adults who suffer from seizures, people with attention disorders including ADD and ADHD, autism, sufferers of brain injuries, mental illnesses such as anxiety, depression, and PTSD, along with insomnia and memory loss.

Many practitioners recommend it not as a cure, but as part of a therapy regimen that includes other types of mental and physical wellness therapies.

How Are Neurofeedback Specialists Trained?

Neurofeedback specialists are taught to use software and hardware that uses EEG data to maps the brain. They are taught to identify those areas of the brain that are deficient or in need of therapy. This is called ZScore training and has been in use since the 1990s.

Practitioners are taught to use the software to teach patients to learn to direct their brainwaves appropriately. There is no specific license required to perform neurofeedback. However, the Biofeedback Certification International Alliance (BCIA) provides certification to practitioners, and individuals are recommended to seek out BCIA certified therapists.

Concerns/Limitations of Neurofeedback

The main concern regarding neurofeedback is the lack of evidence supporting its efficacy. The studies that show negative results will deter many from using it as a primary form of treatment.

There is also no clear evidence that the four types of brainwaves actually cause the associated mental states. Correlation is no proof of causation, so while the brainwaves are associated with these states, this fact might be incidental.

Another limitation of neurofeedback is that most of the conditions it is used to treat can be treated by other methods, that have more evidence behind them. For this reason, it may be advisable to only turn to neurofeedback if other treatments have not worked. Many parents of children with attention deficit disorders turn to neurofeedback because treatments such as medication either do not work or have unbearable side effects.

Finally, a major deterrent to seeking neurofeedback therapy is the lack of accessibility. There are not all that many neurofeedback therapists, and the cost is particularly high. Those who might prefer neurofeedback to other forms of treatment might find the cost restrictive, especially since there is no guarantee that the treatment will help. Health insurance providers are also reluctant to pay for neurofeedback treatment.

Important Practitioners in Neurofeedback

German psychiatrist Hans Berger is credited as the forerunner of neurofeedback. He studied EEGs back in the ‘20s and ‘30s. It was only in the ‘60s that Joe Kamiya popularized neurofeedback with an article in Psychology Today.

In 1969, the Association for Applied Psychophysiology and Biofeedback was formed by proponents of biofeedback and neurofeedback. Presidents of the organization included Joe Kamiya, as well as Barbara Brown who had helped popularize the treatment.

Currently serving as president of the organization is Patrick R. Steffen, a Ph.D. Associate Professor at Brigham Young University.

Another important practitioner is Dr. Diane Roberts Stoler, who leads seminars training therapists in neurofeedback.

How to Find a Therapist

Biofeedback and neurofeedback services are not regulated by state or national oversight. Anyone can, therefore, provide neurofeedback therapy, regardless of their training or lack thereof. It is therefore important to be particularly thorough in your search for a neurofeedback specialist. Ideally, they should be a licensed mental health practitioner (LMHP) who also has BCIA certification.

What Should I be Looking for in an LMHP?

You should look for an LMHP with a background in psychology, psychiatry, or both. They will have to have completed at least a Masters degree in order to obtain licensing. An LMHP does not have to have years of experience to be trustworthy. However, if they do not have experience, make sure to check any testimonials from the clients they have seen or from their mentors and teachers.

It is always ideal that an LMHP is transparent about the process and helps you understand what s/he is doing to treat you.

The website for the Association for Applied Psychophysiology and Biofeedback has a directory of practitioners available. However, their presence in the directory is at their own discretion – it is still necessary to do research on any name that comes up.

Questions to Ask a Potential Therapist

Always ask a potential therapist to detail their training and experience. Ask for evidence of their licensing as an LMHP and their BCIA certification. Ask what conditions they regularly treat, and if they have experience with your particular condition.

Furthermore, ask them if they provide neurofeedback therapy alone or offer it as part of a more holistic treatment program. There is no problem with seeking only neurofeedback therapy, but it is important to know their opinion on how to achieve the best treatment outcomes.

Finally, try to gauge whether you feel you can relate to the therapist. In all kinds of therapy, a positive relationship with the therapist is an important factor in success. If you feel you cannot trust or simply dislike the therapist, chances are that treatment outcomes will be less than perfect.

Final Thoughts on Neurofeedback

Neurofeedback as a science and therapy has been developing since the 1920s. There are many proponents of it as an effective treatment for a range of ailments, including mental illness, brain injuries, and attention disorders.

However, the lack of conclusive evidence in spite of its long history is discouraging. Studies that show its efficacy are lacking either in sound methodology or in proving at all definitive. On the other hand, studies comparing neurofeedback to “sham” neurofeedback have indicated no difference in results.

Because neurofeedback can be very costly, it is perhaps more prudent to seek out treatment that has more conclusive evidence in its efficacy. For most of the conditions that neurofeedback aims to treat, there are more accepted alternatives. If you have had no luck with the alternatives, or find side effects of medication are not worth the cure, neurofeedback provides at the least a non-invasive treatment that has no known risks.

author avatar
Angel Rivera
I am a Bilingual (Spanish) Psychiatrist with a mixture of strong clinical skills including Emergency Psychiatry, Consultation Liaison, Forensic Psychiatry, Telepsychiatry and Geriatric Psychiatry training in treatment of the elderly. I have training in EMR records thus very comfortable in working with computers. I served the difficult to treat patients in challenging environments in outpatient and inpatient settings
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