Overview

Neurofeedback, often called EEG (electroencephalogram) feedback or EEG biofeedback,1 is an operant conditioning procedure and therapeutic technique rooted in applied neuroscience and clinical psychology. This applied psychophysiology concept is based on the principle that individuals can learn to change and regulate their brainwaves when given information about specific neural activities. The process typically involves monitoring brainwave patterns using sensors placed on the scalp and providing real-time feedback to the individual, often through visual or auditory signals.

The origins of EEG (neurofeedback) date back to the late 1950s and early 1960s when researchers began exploring the brain's ability to self-regulate using feedback. Early pioneers in the field, such as Dr. Barry Sterman, laid the groundwork by demonstrating that cats could modify their brainwave activity when rewarded for producing specific patterns. This early work laid the foundation for subsequent clinical applications, notably in treating epilepsy. Over the decades, as technology advanced and our understanding of the brain improved, neurofeedback's applications expanded, offering therapeutic interventions for various psychological and neurological disorders including brain injury, sleep disorders, anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD).2

Today, neurofeedback stands at the intersection of technology and cognitive therapy. Its evolution, fueled by advancements in neuroscience, imaging, and computer technologies, has enabled it to be utilized in diverse settings, including clinics, hospitals, and educational environments. As research continues and the breadth of its applications grows, neurofeedback may offer a more holistic and individualized approach to mental health and cognitive performance enhancement.

 

How it works

In its simplest form, neurofeedback is a feedback loop that allows individuals to self-regulate their brainwave activity. Feedback-driven learning offers a noninvasive technique that uses the brain's inherent plasticity and ability to change and reorganize itself. 

During a typical neurofeedback session, sensors (electrodes) are attached to the individual's scalp to measure electrical activity or brainwaves. These brainwaves are then relayed to a computer, which processes the information and provides real-time feedback, often in a visual format.

For instance, a patient might watch a movie or play a game in which their brain activity directly affects the visuals and sounds. When desired brainwave patterns are detected, the movie might play seamlessly, or the game might score points. Conversely, if brain activity deviates from the intended pattern, the movie may pause, or the game might become more challenging. Over time and repeated sessions, the brain typically uses that real-time feedback to learn to produce healthy patterns independently, adjusting its waves to the desired state without external prompts.

This self-regulation from neurofeedback training is made possible because the brain often seeks patterns and tries to make sense of information. Neurofeedback leverages this innate ability. It's worth noting that the process doesn't typically add anything to the brain. Instead, neurofeedback treatment gives the brain information about its performance, enabling self-correction and optimization.

As with many therapeutic modalities, neurofeedback effectiveness may vary depending on the individual and the treated condition. According to “Neurofeedback: A Comprehensive Review on System Design, Methodology and Clinical Applications”, it can take several months to notice improvements.This process typically requires multiple sessions, with the brain gradually learning from the consistent feedback it receives. Over time, neurofeedback can promote more stable and efficient neurological functioning, leading to symptomatic relief in various physical and mental health conditions.

What to expect

The process typically begins with a comprehensive assessment, often called a brain map or quantitative electroencephalogram (qEEG). This initial step gives the therapist and client a baseline view of brain activity, highlighting areas of dysregulation or abnormal patterns. The assessment is a noninvasive procedure where a cap fitted with electrodes is placed on the head to measure electrical patterns. This data is typically then compared with a normative database, helping practitioners pinpoint areas of concern.

Once the assessment is complete, the actual neurofeedback training sessions can begin. During these sessions, patients are usually comfortably seated with sensors attached to their scalp. These sensors monitor brainwave activity, feeding the information to a computer. As the patient’s brain responds, they receive feedback, usually through a video or audio medium. For example, they might watch a scene where the brightness intensifies when their brain functions within the desired range. If their brainwaves shift out of this range, the scene might dim or pause, encouraging their brain to return to its optimal state. Each session can last between 30 and 60 minutes.

Over the course of treatment, which may include 20 to 40 sessions depending on the individual's needs, many people report feeling more relaxed and alert. Patients may not notice immediate shifts after initial sessions, but as sessions progress, changes in behavior, mood, or cognitive performance often become more evident. As with the process of learning a new instrument or language, the brain often needs time and consistent feedback to adjust its patterns effectively.

There's usually no downtime or side effects post-session, allowing individuals to resume daily activities. However, as with any therapeutic intervention, individual experiences can vary. Therefore, it's typically best to maintain open communication with the practitioner to optimize the process and address any concerns.

Who it benefits

Because neurofeedback focuses on understanding and modulating brain activity, it has many applications. Over the years, its benefits have extended beyond specific medical conditions, making it a versatile tool in neurotherapeutic interventions.

Some of the primary beneficiaries of neurofeedback therapy have been individuals diagnosed with attention-deficit/hyperactivity disorder (ADHD), including children with ADHD. The therapy typically targets irregular brainwave patterns often found in ADHD patients and trains slow cortical potentials (SCPs). By training the brain to maintain a steadier and more focused state, neurofeedback may lead many individuals to experience a reduction in hyperactivity, impulsivity, and inattention. The non-pharmacological nature of this intervention makes it an attractive alternative or complementary treatment for those hesitant about long-term medication use.

Beyond ADHD, neurofeedback has shown promise in assisting individuals with various mood disorders, particularly anxiety and depression. By addressing the dysregulated brainwave patterns often associated with these disorders, neurofeedback often leads to improved mood stability, better emotional regulation, and an enhanced sense of well-being after sessions. Similarly, those with post-traumatic stress disorder (PTSD) and other trauma-related conditions have found relief in neurofeedback's ability to stabilize brain activity, diminishing the intensity and frequency of flashbacks, nightmares, or intrusive thoughts.

Neurofeedback isn't limited to treating diagnosable conditions. Many individuals, from peak-performing athletes to high-functioning executives, have turned to neurofeedback to enhance their cognitive performance. The treatment's ability to promote optimal brain functioning can lead to sharper focus, quicker decision-making, and heightened creativity. Anyone looking to fine-tune their brain's performance—whether to address a specific condition or to achieve a competitive edge—might find neurofeedback a valuable tool for achieving their goals. 

However, neurofeedback isn't a cure-all for all neurological ailments, and individual results may vary depending on the person and the condition in question. Therefore, it’s typically best to consult with a qualified practitioner regarding any concerns and remain open to feedback throughout the process. With an understanding of what to expect and an awareness of the potential benefits, you may experience a more positive and successful treatment journey.

For those experiencing trauma, support is available. Please see our Get Help Now page for more resources.

Goals for therapy

Neurofeedback therapy aims to train the brain to function more efficiently by harnessing its ability to change and adapt. While the specific goals for therapy can vary based on the individual's unique needs, some overarching objectives underlie most neurofeedback interventions:

  • Symptom reduction: The primary objective for many people undergoing neurofeedback is to reduce or even eliminate bothersome symptoms. For instance, patients with ADHD might seek decreased impulsivity, distractibility, and hyperactivity. Similarly, an individual with panic disorder3 or anxiety might aim for fewer panic attacks4 or a generally calmer state of being. Neurofeedback may improve overall well-being by directly modulating brainwave patterns associated with these symptoms.
  • Enhancement of cognitive performance: Beyond managing symptoms, neurofeedback is often used to sharpen cognitive abilities. This may include improving focus and concentration, boosting memory retention, and enhancing problem-solving skills. As a result, neurofeedback is not only about bringing the brain back to a normal state but also about elevating its performance to optimal levels.
  • Emotional regulation: For many, emotional dysregulation, such as sudden outbursts, prolonged periods of sadness, or intense anxiety, can be a significant challenge. A key objective of neurofeedback is often to teach the brain patterns of stability and resilience, allowing for better control over one's emotional responses. Over time, this can lead to more stable moods, better interpersonal relationships, and a higher quality of life.
  • Self-awareness and mindfulness: Another common benefit of neurofeedback is heightened self-awareness. As individuals gain insight into their brain's workings, they often become more attuned to their thoughts, emotions, and reactions. This enhanced self-awareness can be a foundation for mindfulness, helping individuals stay present, grounded, and more in control of their responses to external stimuli.

The goals of neurofeedback therapy can be both therapeutic and transformative. Whether someone is looking to manage specific symptoms, elevate their cognitive abilities, or gain a deeper understanding of themselves, neurofeedback can be a valuable intervention to achieve these objectives.

Research

Neurofeedback has garnered increasing interest in recent years due to its potential applications for various cognitive and neurological conditions. Recent research has shed light on a few promising aspects of this approach.

A 2021 study used randomized controlled trials to investigate the efficacy of neurofeedback as a treatment modality for children on the autistic spectrum. The research targeted the children's high theta/beta ratio, often associated with attentional challenges. Over several sessions, the therapeutic regimen focused on decreasing this ratio by inhibiting theta activity while promoting beta activity. Post-treatment assessments revealed substantial improvements in cognitive function across multiple tasks. Furthermore, the intervention yielded auxiliary benefits, with enhancements in social, attention, and thought domains, which underscores the holistic potential of neurofeedback in addressing the multifaceted challenges associated with autism.

In a broader context, growing evidence and double-blind studies suggest that neurofeedback can modulate disorder-specific electrophysiological activity. Particularly in conditions like ADHD, research on neurofeedback has found reductions in symptom severity even after a week of training. Other research found that improvements were sustained, with patients demonstrating symptom alleviation six months and even two years post-intervention. While neurofeedback's potential looks promising, the lack of standardized protocols and varying methodologies across studies suggest a pressing need for more structured and unified research approaches.

The journey of understanding and refining neurofeedback is ongoing, and the research underscores its potential as an effective therapeutic tool for a spectrum of cognitive and neurological challenges. The coming years may hold more insights and advancements, potentially revolutionizing how we approach and treat various conditions. 

Finding therapy

As therapeutic interventions continue to evolve, neurofeedback may be a promising noninvasive technique for a variety of disorders and neurological challenges. However, finding the right therapist or institution that provides this specialized service can often be challenging, especially for those unfamiliar with treatment.

Traditional therapeutic settings, such as hospitals or clinics, often have specialists trained in neurofeedback. It’s recommended that patients seek practitioners with certification or training from recognized institutions. The International Society for Neuroregulation & Research (ISNR) and the International QEEG Certification Board are two recognized bodies that certify neurofeedback practitioners. Patients may also find qualified practitioners through the Biofeedback Certification International Alliance (BCIA).

Additionally, online therapy has revolutionized the way that people obtain therapeutic care. Websites like BetterHelp offer online therapy options, which, in some cases, might include services related to neurofeedback. Online therapy provides the advantage of allowing people to obtain specialized services from the comfort of home, removing geographical constraints. This may be helpful for those who live in areas that don’t have many licensed therapists. 

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