Neurofeedback Research: How Effective is Neurofeedback?
Neurofeedback isn’t anything new and has in fact been in use since the 1960’s and steadily has increased since the advent of the personal computer in the late 1980’s. Today, there are tens of thousands of studies and over 3,000 peer reviewed studies that demonstrate the effectiveness of neurofeedback in treating a variety of clinical conditions and psychiatric disorders that affect mental health.
In the late 1950s and early 1960s, two researchers, Dr. Joseph Kamiya at the University of Chicago and Dr. Barry Sterman at UCLA, began studying the effects of simple reinforcement on brain wave activity, which was published in APA’s Psychology Today in 1968.
In the 1970’s, neurofeedback research studies began with children, adolescents, and adults to treat Attention Deficit Hyperactivity Disorder (ADHD) with Dr. Joel Lubar, who continued his research for decades. Many families would go out to his center to help their children improve their attention and reduce hyperactivity.
Some of the earliest neurofeedback studies were with Vietnam war veterans with dual diagnoses (post-traumatic stress disorder (PTSD), anxiety, depression) and substance abuse.
The main reason why people seek out neurofeedback therapy is to reduce clinical symptoms and improve brain activity, albeit some use it for peak performance training or to just optimize brain functioning, such as athletes and musicians.
Neurofeedback not only can reduce a variety of symptoms and issues, it can actually change brain functions. Through the reinforcement of brainwave activity, neurofeedback creates new electrical activity in the brain or in other words, changes how neurotransmitters function. Moreover, it can actually affect brain structures, as research from Ghaziri et. al (2013) found that neurofeedback induces changes in the white and gray matter of the brain.
Neurofeedback Basics: So How Does Neurofeedback Work?
Based on operant conditioning, EEG neurofeedback involves giving visual and auditory reinforcement to the brain, so it learns to self regulate. Computer technology not only gives this pleasing real time reinforcement to the brain so it can learn to find a healthy rhythm, it measures brain wave activity too.
There are different types of neurofeedback including:
- EEG neurofeedback
- Slow Cortical Potential Neurofeedback (SCP-NF)
- Low-Energy Neurofeedback System (LENS)
- Hemoencephalographic (HEG) Neurofeedback
- Live Z-score Neurofeedback
- Low-Resolution Electromagnetic Tomography (LORE-TA)
- Functional Magnetic Resonance Imaging (fMRI)
Each of these types of neurofeedback are FDA approved and are shown to be effective, with some types more beneficial for specific issues. The success of neurofeedback is largely determined by the experience of the practitioner and the client’s ability to follow the treatment plan and recommended number of sessions.
Using a board certified neurofeedback practitioner ensures that the provider you are using has met certain qualifications. You can learn more about board certified practitioners such as Dr. Roseann, from the Biofeedback Certification International Alliance (BCIA) at www.bcia.org.
Most equipment requires the placement of sensors on the head, which is often referred to as a 10-20 sensor placement. This system ensures that all neurofeedback practitioners know the placement for sensors in a consistent, uniform manner.
Types of Brain Waves
Brain waves are different patterns of electrical activity that are recognized by their amplitudes and frequencies, which are associated with certain brain states. Frequency indicates how fast the waves oscillate, which is measured by the number of waves per second (Hz), while amplitude represents the power of these waves measured by microvolt (μV).
Delta Waves (.2hz –4hz) are associated with deep and dreamless sleep. When in the delta state, anti-aging hormones increase, including melatonin and DHEA are released and human growth hormone (HGH) due to pituitary gland stimulation. Delta waves are also associated with memory and are sensitive to brain injury, seizures and toxicity.
Theta Waves (4hz – 8hz) is our subconscious awake state and is associated with dreaming, daydreaming, creativity, light sleep, light meditative state, learning, intuition, improved physical healing, and reduction of anxiety and stress. Children have a lot of Theta waves because they have open and creative minds.
Alpha Waves (8hz – 12hz) put us in a state of physical and mental relaxation. Alpha states significantly increase “feel good” neurotransmitters, such as norepinephrine and dopamine and the peptide hormone beta-endorphin. Too little or too many Alpha waves are often associated with mood and pain.
Beta Waves (12hz – 27hz) is what we need for an alert, focused brain state. Normal beta helps us with concentration, alertness, reasoning, logic and critical thinking and is what powers up the brain to do all tasks that require focus and concentration.
Gamma Waves (27 Hz and up) are required for higher consciousness. Strong Gamma levels correspond with intelligence, compassion, self-control and regulation, happiness, mind/body connection, sensory awareness, the formation of ideas, language, memory processing and various types of learning. Those with regulated nervous systems or who meditate regularly, often have higher levels of Gamma waves.
How Effective is Neurofeedback?
There are many clinical applications of neurofeedback, including the treatment of attention-deficit hyperactivity disorder (ADHD), anxiety, OCD, PTSD, depression, epilepsy, sleep problems/insomnia, pain, addiction, schizophrenia, learning disabilities, (such as dyslexia and dyscalculia), autistic spectrum disorders (ASD) and many other issues. It has also been used for the improvement of musical and athletic performance.
No matter the clinical issue, neurofeedback serves to calm the nervous system and get it into a regulated parasympathetic state. Neurofeedback takes the brain out of fight, flight or freeze so a person can pay attention, think, and take action. It regulates neurotransmitters in the brain when brainwaves are balanced.
Studies have shown that neurofeedback can reduce symptoms associated with many mental health conditions. Despite several meta analysis studies, the biggest complaint of neurofeedback research is that many are small or pilot studies and not randomized controlled trials.
Neurofeedback is an evidence-based approach for some of the biggest clinical issues affecting children and teens today. It is safe and effective and should be the standard of care in mental health.
Neurofeedback Research for ADHD and Executive Functioning
There is a large body of research supporting the efficacy of neurofeedback in reducing symptoms associated with Attention-Deficit Hyperactivity Disorder (ADHD), including meta analyses (Arns, Conners & Kraemer, 2013; Arns, de Ridder, Strehl, Breteler & Coenen, 2009;
Micoulaud-Franch et. al, 2014).
Neurofeedback can be more than 90% effective in reducing the core features that affect children with ADHD, as measured by neuropsychological tests (Xiong, Shi & Xu, 2005).The American Academy of Pediatrics gave neurofeedback a Level 1 effectiveness rating in the treatment of ADHD, which is the same effectiveness as medication.
In a meta analysis of the research, after neurofeedback, there was a high level of symptom reduction for inattention and impulsivity and a medium level of symptom reduction for hyperactivity (Arns, de Ridder, Strehl, Breteler & Coenen, 2009), which is impressive considering the amount of children, teens, and their families impacted by ADHD.
Neurofeedback Research for Anxiety
With anxiety at an all-time high and the number one clinical issue in the United States, we need to look at more effective treatment options.
Training brain waves with eeg biofeedback to combat the effects of stress and anxiety on the central nervous system that can result in significant symptom reductions (Hammond, 2005). As Hammond notes, neurofeedback involves minimal risk of side effects or adverse reactions and it is less invasive than antidepressant medication or transcranial magnetic stimulation and should be considered as a treatment option for anxiety disorders, OCD and depression.
Clinical studies from Chen et. al (2021) found that neurofeedback mindfulness regulation can positively affect the brain activity pattern of anxiety disorder patients.
There are many studies that show anxiety reduction in those with specific clinical issues such as social anxiety, phobias, body-focused repetitive behaviors, and post-traumatic stress disorder. With neurofeedback for those with anxiety, it not only addresses specific areas of the brain with brainwave dysregulation, it calms hyper brain communication and the autonomic stress response.
Neurofeedback Research for Depression, Mood Disorder and Behavior
Neurofeedback has been used to support mood, behavior, and emotional regulation since the 1970’s. It can have significant effects on major depressive disorder (Cheon, 2016).
Research from Yuan et. al (2014) that focused on neurofeedback training in the brain’s emotional center, the amygdala, found that it enhanced connectivity with temporal cortical regions, including the hippocampus. These results demonstrate lasting brain changes induced by amygdala neurofeedback training and suggest the importance of reinforcement learning in rehabilitating emotion regulation in supporting depression.
Lee (2019) found that neurofeedback can even be beneficial for treatment resistant depression. Noting that, “the results suggest that neurofeedback treatment may be effective as an augmentation treatment, not only for depressive symptoms, but also for functional recovery.”
Neurofeedback Research for OCD
Obsessive Compulsive Disorder (OCD) can be a highly treatment resistant condition with 42% of those with OCD not responding to psychotherapy or pharmacological treatment (Krebs et. al, 2015).
That is why in our BrainBehaviorReset™ Program, when we work with children and teens with OCD and their families to calm the brain with science-backed methods, such as neurofeedback, and teach individuals how to dismantle the behavioral components of obsessions and compulsions with ERP Therapy and parent coaching.
Studies show that neurofeedback reduces obsessions and compulsions without medication (Barzegary, L., Yaghubi, H., Rostami, R., 2011 and Kopřivová et. al, 2013). Hampson et. al (2012) found that neurofeedback calmed the overactive orbitofrontal cortex to calm compulsions and hyperactive behaviors.
In a meta analysis of neurofeedback research (Ferreira, S., Pêgo, J. M., & Morgado, P., 2019) despite heterogeneity groupings, “The overall effect size within the treatment group varied between medium to large” indicating that neurofeedback research for OCD can be a powerful component in treating OCD.”
Important for long-term symptom resolution, studies show that gains in OCD symptom reduction from neurofeedback were maintained post-treatment (Sürmeli & Ertem, 2011).
Neurofeedback Research for PANS/PANDAS
With all the physical, psychiatric and behavioral complexities of PANS and PANDAS, a more strategic approach needs to be taken to treatment and that is what Dr. Roseann does in her BrainBehaviorReset™ Program. When we look to psychoimmunology or the study of the impact of stress on the immune system, regulating the nervous system or calming the brain is an essential component in getting the immune system to work properly. Moreover, it supports the gut-brain axis and gets the nervous system into a regulated parasympathetic state.
Psychoimmunology has helped us to understand that behavioral and psychological events can influence the immune system and really that our mind impacts our health. When the body experiences stress, your immune system kicks into action and cells are mobilized into the bloodstream, potentially preparing the body for injury or infection during a “fight or flight” response and thereby using all of its available resources, leaving it unavailable to properly address infections or injury.
We know that the simple but powerful practice of mindfulness based stress reduction activities can improve physical health for those with chronic physical illness (Bohlmeijer et. al, 2010). Neurofeedback has been shown to support immune system functioning with a variety of physical ailments including fibromyalgia (Wu, 2021), cancer (Hetkamp et. al, 2019), complex regional pain (Jensen et. al, 2007), depression in those with multiple sclerosis and fatigue (Choobforoushzadeh et. al, 2015), neuropathy (Prinsloo, 2018), stroke (Mottaz et. al, 2018), and other physical issues,
Neurofeedback can not only be used to calm the autonomic nervous system, but can also be used to directly target associated PANS/PANDAS clinical symptoms including attention and executive functioning, memory and word retrieval, anxiety and separation anxiety, obsessions and compulsions, food restrictions, sensory processing, tics, mood, anger and rage, as well as emotional and behavioral regulation.
Neurofeedback Research Citations:
Arns, M., Conners, C. K., Kraemer, H.C. (2013). A decade of EEG theta/beta ratio research in ADHD: a meta-analysis. Journal of Attention Disorders, 17(5), 374-383. doi: 10.1177/1087054712460087
Arns, M., de Ridder, S., Strehl, U., Breteler, M., & Coenen, A. (2009). Efficacy of neurofeedback treatment in ADHD: The effects on inattention, impulsivity and hyperactivity: A meta-analysis. Clinical EEG and Neuroscience, 40(3), 180-189. doi:10.1177/1550059409040003
Barzegary, L., Yaghubi, H., Rostami, R., (2011). The effect of QEEG- guided neurofeedback treatment in decreasing of OCD symptoms. Procedia – Social and Behavioral Sciences, Volume 30. https://www.sciencedirect.com/science/article/pii/S1877042811023469
Blaskovits, F., Tyerman, J., & Luctkar-Flude, M. (2017). Effectiveness of neurofeedback therapy for anxiety and stress in adults living with a chronic illness: a systematic review protocol. JBI database of systematic reviews and implementation reports, 15(7), 1765–1769. https://doi.org/10.11124/JBISRIR-2016-003118
Bohlmeijer, E., Prenger, R., Taal, E., & Cuijpers, P. (2010). The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: a meta-analysis. Journal of psychosomatic research, 68(6), 539–544. https://doi.org/10.1016/j.jpsychores.2009.10.005
Choobforoushzadeh, A., Neshat-Doost, H. T., Molavi, H., & Abedi, M. R. (2015). Effect of neurofeedback training on depression and fatigue in patients with multiple sclerosis. Applied psychophysiology and biofeedback, 40(1), 1–8. https://doi.org/10.1007/s10484-014-9267-4
Cueli, M., Rodríguez, C., Cabaleiro, P., García, T., & González-Castro, P. (2019). Differential Efficacy of Neurofeedback in Children with ADHD Presentations. Journal of clinical medicine, 8(2), 204. https://doi.org/10.3390/jcm8020204
Cheon, E. J., Koo, B. H., & Choi, J. H. (2016). The Efficacy of Neurofeedback in Patients with Major Depressive Disorder: An Open Labeled Prospective Study. Applied psychophysiology and biofeedback, 41(1), 103–110. https://doi.org/10.1007/s10484-015-9315-8
Ferreira, S., Pêgo, J. M., & Morgado, P. (2019). The efficacy of biofeedback approaches for obsessive-compulsive and related disorders: A systematic review and meta-analysis. Psychiatry research, 272, 237–245. https://doi.org/10.1016/j.psychres.2018.12.096
Hampson, M., Stoica, T., Saksa, J., Scheinost, D., Qiu, M., Bhawnani, J., Pittenger, C., Papademetris, X., & Constable, T. (2012). Real-time fMRI biofeedback targeting the orbitofrontal cortex for contamination anxiety. Journal of visualized experiments : JoVE, (59), 3535. https://doi.org/10.3791/3535
Hetkamp, M., Bender, J., Rheindorf, N., Kowalski, A., Lindner, M., Knispel, S., Beckmann, M., Tagay, S., & Teufel, M. (2019). A Systematic Review of the Effect of Neurofeedback in Cancer Patients. Integrative cancer therapies, 18, 1534735419832361. https://doi.org/10.1177/1534735419832361
Gustafson C. (2016). David Haase,md: Healing the Gut and Brain Through Electrophysiology. Integrative medicine (Encinitas, Calif.), 15(5), 26–29.
Ghaziri, J., Tucholka, A., Larue, V., Blanchette-Sylvestre, M., Reyburn, G., Gilbert, G., Lévesque, J., & Beauregard, M. (2013). Neurofeedback training induces changes in white and gray matter. Clinical EEG and neuroscience, 44(4), 265–272. https://doi.org/10.1177/1550059413476031
Jensen, M. P., Grierson, C., Tracy-Smith, V., Bacigalupi, S. C., & Othmer, S. (2007). Neurofeedback treatment for pain associated with complex regional pain syndrome type I. Journal of Neurotherapy, 11(1), 45–53. https://doi.org/10.1300/J184v11n01_04
Kopřivová, J., Congedo, M., Raszka, M., Praško, J., Brunovský, M., & Horáček, J. (2013). Prediction of treatment response and the effect of independent component neurofeedback in obsessive-compulsive disorder: a randomized, sham-controlled, double-blind study. Neuropsychobiology, 67(4), 210–223. https://doi.org/10.1159/000347087
Lee, Y. J., Lee, G. W., Seo, W. S., Koo, B. H., Kim, H. G., & Cheon, E. J. (2019). Neurofeedback Treatment on Depressive Symptoms and Functional Recovery in Treatment-Resistant Patients with Major Depressive Disorder: an Open-Label Pilot Study. Journal of Korean medical science, 34(42), e287. https://doi.org/10.3346/jkms.2019.34.e287
Marzbani, H., Marateb, H. R., & Mansourian, M. (2016). Neurofeedback: A Comprehensive Review on System Design, Methodology and Clinical Applications. Basic and clinical neuroscience, 7(2), 143–158. https://doi.org/10.15412/J.BCN.03070208
Micoulaud-Franchi, J-A., Geoffroy, P. A., Fond, G., Lopez, R., Bioulac, S., Philip, P. (2014). EEG neurofeedback treatments in children with ADHD: An update meta-analysis of randomized controlled trials. Frontiers in Human Neuroscience, 8(906), 1-7. doi:10.3389/fnhum.2014.00906 https://www.ncbi.nlm.nih.gov/pubmed/25431555
Micoulaud-Franchi, J. A., McGonigal, A., Lopez, R., Daudet, C., Kotwas, I., & Bartolomei, F. (2015). Electroencephalographic neurofeedback: Level of evidence in mental and brain disorders and suggestions for good clinical practice. Neurophysiologie clinique = Clinical neurophysiology, 45(6), 423–433. https://doi.org/10.1016/j.neucli.2015.10.077
Mottaz, A., Corbet, T., Doganci, N., Magnin, C., Nicolo, P., Schnider, A., & Guggisberg, A. G. (2018). Modulating functional connectivity after stroke with neurofeedback: Effect on motor deficits in a controlled cross-over study. NeuroImage. Clinical, 20, 336–346. https://doi.org/10.1016/j.nicl.2018.07.029
Prinsloo, S., Novy, D., Driver, L., Lyle, R., Ramondetta, L., Eng, C., Lopez, G., Li, Y., & Cohen, L. (2018). The Long-Term Impact of Neurofeedback on Symptom Burden and Interference in Patients With Chronic Chemotherapy-Induced Neuropathy: Analysis of a Randomized Controlled Trial. Journal of pain and symptom management, 55(5), 1276–1285. https://doi.org/10.1016/j.jpainsymman.2018.01.010
Shrestha, M., Lautenschleger, J., & Soares, N. (2020). Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: a review. Translational pediatrics, 9(Suppl 1), S114–S124. https://doi.org/10.21037/tp.2019.10.01
Sürmeli, T., & Ertem, A. (2011). Obsessive compulsive disorder and the efficacy of qEEG-guided neurofeedback treatment: a case series. Clinical EEG and neuroscience, 42(3), 195–201. https://doi.org/10.1177/155005941104200310
Wu, Y. L., Fang, S. C., Chen, S. C., Tai, C. J., & Tsai, P. S. (2021). Effects of Neurofeedback on Fibromyalgia: A Randomized Controlled Trial. Pain management nursing : official journal of the American Society of Pain Management Nurses, 22(6), 755–763. https://doi.org/10.1016/j.pmn.2021.01.004
Xiong, Z., Shi, S., & Xu, H. (2005). A controlled study of the effectiveness of EEG biofeedback training on-children with attention deficit hyperactivity disorder. Journal of Huazhong University of Science and Technology. Medical sciences, 25(3), 368–370. https://doi.org/10.1007/BF02828171
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Disclaimer: This article is not intended to give health advice and it is recommended to consult with a physician before beginning any new wellness regime. *The effectiveness of diagnosis and treatment vary by patient and condition. Dr. Roseann Capanna-Hodge, LLC does not guarantee certain results.
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