What Is Neurofeedback And Does It Work?

Neurofeedback generally refers to the use of electrodes placed on certain brain regions to stimulate them, potentially allowing for the self-regulation of various brain functions. This therapeutic method used in neurofeedback sessions can treat certain mental health disorders, such as anxiety, depression, ADHD, OCD, substance use disorder, developmental delays, and insomnia. It can also improve focus by altering brain wave patterns.

However, it may not be an appropriate treatment for everyone, and it can be crucial to find a medical professional who is experienced in providing this type of treatment. Neurofeedback is often paired with therapy for the best results, and you may also choose to try therapy on its own to improve your mental health. 

What is neurofeedback therapy?

In vertebrates, the nervous system is generally made up of two parts - the central nervous system or CNS (the brain and spinal cord) and the peripheral nervous system or PNS, which is subdivided into three separate systems. One of these is the Autonomic Nervous System (ANS). The ANS usually controls functions like digestion, heartbeat, and circulation. Neurofeedback therapy is a therapeutic tool in clinical neurophysiology that primarily focuses on healing the central nervous system, as many of the conditions it treats are related to the brain and mental health.

According to a review done by Basic And Clinical Neuroscience, neurofeedback is a form of biofeedback that can teach its subjects self-regulation of brain functions. It usually does this by measuring brainwave activity for abnormalities or irregularities and then providing helpful brain signals in return. By providing these brain signals, patients learn how this therapy can restore normal brain patterns, which often gives the client more cognitive control.

Different brain waves are associated with how patients learn  

Since cognitive control can affect emotions, thoughts, and actions, these services can help clients with their mental health conditions, control their emotions, reduce anxiety, muscle tension, and act more appropriately in social situations. Many clients wonder "what is neurofeedback", but depending on the issue the client is experiencing, these services may target EEG signals to specific brain regions, such as the motor cortex or cerebral cortex, depending on their brain function. Some conditions may require targeting specific neural substrates of cognitive control, while other conditions may need EEG biofeedback to focus on other types of brainwave activity for treatment.

Recording electrical activity in a patient's brainwaves 

There are 5 levels of brainwave, and while all 5 are working at some level while in a conscious state, there is one that dominates depending what state of consciousness you are currently experiencing. Clinical neuroscience offering neurofeedback services can adjust these waves:

• Gamma Waves: The highest frequency waves, used for cognitive functioning and high processing activities.
• Beta Waves: Commonly observed while awake, these brainwaves are stimulating and involved in conscious thought and logical thinking.
• Alpha Waves: A link between the conscious and subconscious mind, these brainwaves are calming and promote deep relaxation. 
• Theta Waves: This deeper brainwave is involved in daydreaming and sleep, and these slower brain waves are also connected to deep emotions. 
• Delta Waves: The slowest brainwaves, seen dominant during deep sleep. When dominant in a person's waking hours, these slowest brain waves can indicate impaired functioning.

For example, a child with ADHD symptoms may demonstrate an increase in the theta waves, a slower brain wave activity, and a lower power of beta brainwaves, the faster brainwaves. The focus of these neurofeedback work sessions would be to guide the child’s brain to shift greater activity onto the faster brainwaves, and decrease the power of the theta brainwaves, as an excess of theta waves are associated with learning disorders. 

The birth of biofeedback work

For most of the 20th century, accepted brain science believed that a person could consciously control only the central nervous system. In contrast, the ANS was observed to function automatically and beyond possible conscious control or awareness. Only the central nervous system was thought to be responsive to EEG operant conditioning, which, essentially, is the use of stimulants, such as punishment and reinforcement through electrical impulses, to change or modify behavior. The famous experiments conducted on dogs by Ivan Pavlov in the 1800s are probably one of the best examples of operant conditioning.

There was initially strong resistance to experimentation with instrumental control of ANS responses. However, numerous studies eventually showed that humans and animals could control certain ANS responses through instrumental training and real-time feedback. In practical terms, this means that, through instruments that provide information on the brainwave activity of a system in the body, a person can self-regulate these systems of how the brain responds. Patients can learn how to control their own biofeedback and create the desired improvements they desire. This could be called the birth of biofeedback as we know it today. Biofeedback therapy is usually done with the purpose of improving health and performance, and, according to the Association of Applied Psychophysiology and Biofeedback, these changes are usually lasting. Continued use of an instrument can eventually become unnecessary.

Specialist and researcher Siegfried Othmer, Ph.D., says, "Our intellectual abilities and emotional resources can be considerably enhanced with neurofeedback training."

Traditional or EEG Neurofeedback has been in use since the 1970s. Electrodes that record brain regions are typically placed on the person's scalp and then stimulated with various treatment protocols.

There are normally seven types of EEG therapies that can work well for the treatment of various disorders such as anxiety, schizophrenia, and depression. Traditionally, two brain sensors, two ear sensors, and the ground are used. The treatment can be tailored to the individual in training surface brain activity, except in the case of LORE-TA and fMRI neurofeedback. These types of psychotherapy sessions usually allow for whole and deep brain stimulation to specific brainwaves.

EEG can be versatile in its application but often requires great expertise to administer.

1. Frequency/Power

This is generally the most frequently-used neurofeedback, also called “surface neurofeedback.” Two to four electrodes are typically used to change the amplitude or speed of specific brain waves in particular areas of the brain. It can treat attention deficit hyperactivity disorder (ADHD) and anxiety disorders.

2. Slow Cortical Potential

This type of EEG neurofeedback generally results in cortical activation, which can change the amount of slow cortical potentials in brainwave activity. This can be used to treat epilepsy and other seizure disorders, attention deficit disorder (ADD), ADHD, and migraines.

3. Low-Energy Neurofeedback System For Patients' Brainwaves

This usually delivers a weak electromagnetic signal to change a patient’s person's brain waves while they are motionless with their eyes closed. It can be used for treatment when doctors diagnose ADHD, traumatic brain injury insomnia, restless leg syndrome, fibromyalgia, anxiety, or depression.

4. Hemoencephalographic (HEG)

This usually gives feedback on cerebral blood flow and can be used for treating migraines.

5. Live Z-Score

This can be used to treat insomnia and post traumatic stress disorder, among other conditions.

6. Low-Resolution Electromagnetic Tomography (LORE-TA)

This is a technique that usually involves the use of 19 electrodes. This generally allows for simultaneous neuro-training in multiple areas of the brain, as opposed to single areas with the more common two-sensor neurofeedback. It can be used to treat drug addiction, depression, and obsessive-compulsive disorder.

7. Functional Magnetic Resonance Imaging (fMRI)

This is a relatively new type of treatment that "controls brain activity based on the brainwave activity feedback from deep subcortical areas of the brain." It can improve voluntary control of activity in the targeted brain region. fMRI neurofeedback can be used for treating ADHD, ADD, autism spectrum, depression, anxiety, Parkinson's disease, behavior disorders, and even phobias.

These treatments are generally offered in several 30-60 minute sessions. How many sessions are necessary depends on the patient, as well as the condition being treated. During treatment, the patient may either listen to music or watch a screen with video game style graphics, and receive visual and auditory cues from the computer program to reinforce positive brainwave changes. For example, it may stimulate parts of the brain to stimulate and reward faster brain waves for optimal functioning. 

Traditional EEG Neurofeedback is a highly specialized therapeutic modality that typically requires great expertise and continuous training. Practitioners are usually qualified doctors or psychiatrists with education in basic and clinical neuroscience. You may want to look for a professional with certification from the Biofeedback Certification International Alliance, for example, indicating the practitioner has met educational and training standards to provide neurofeedback services. 

Learning how to use software with pre-packed treatment protocols, on the other hand, doesn't usually require rigorous training. In most cases, it is simply a matter of learning the software and how to work with the interface. Neurofeedback treatment protocols used in software register patterns of electrical activity, known as brainwaves, and provide feedback on the patient's brainwaves. Treatment mainly focuses on such as alpha, theta, gamma, and beta brain waves or a combination of them such as alpha/theta. Frequency relates to the speed in which the waves oscillate, as measured by the number of waves per second, whereas amplitude refers to the power of these measured waves. 

Who should avoid neurofeedback therapy?

Persons living with epilepsy should only consult with therapists who are also qualified doctors or psychiatrists. This therapy has demonstrated efficacy in the treatment of epileptic seizures, but it should be administered with great care and skill. It can be important to note that the fact that a patient has epilepsy should never be concealed from a medical practitioner before embarking on any form of therapy. Neurofeedback systems with preloaded protocols should be avoided as there is evidence that they can induce seizures in those with seizure disorder.

It is also contraindicated for persons living with severe psychiatric disorders. Symptoms should first be stabilized before treatment is started, and then only under the supervision of a qualified mental health practitioner.

A comprehensive review indicating more research might be needed

A comprehensive review on neurofeedback's system design, methodology and clinical applications for the treatment of various disorders, including autistic spectrum disorder and attention deficit hyperactivity disorder, noted its possible usefulness as a complementary or alternative treatment of brain dysfunctions. However, it also suggests that more research is needed to determine its efficacy.

What are the side effects of neurofeedback?

This therapy has been associated with adverse side effects, such as increased anxiety and agitation, mania, nausea, fatigue, hypersomnia, panic attacks, seizures, mood swings, and increased depression, to name but a few. These were generally due to operator incompetence or mistakes, which further underscores the need to insist that only qualified practitioners perform these services. Doctors should also be vigilant in watching for side effects.

Can children use neurofeedback safely?

Neurofeedback therapy has been successfully employed to help children and adolescents with the following:

• ADD, ADHD, OCD, and autism spectrum disorders
• Developmental, speech, and learning disabilities
• Chronic pain and physical disabilities
• Sleep disorders
• Self-control
• Post-traumatic stress disorders, anxiety disorders, and brain injuries
• Emotional regulation

Benefits from neurofeedback include that it has shown improvement in cortical function and can teach self-regulation and healthier patterns. It can also help with sustained attention span. Again, therapists should be chosen with care. Neurofeedback treatment should also be administered cautiously for children with severe behavioral problems. It may not be an appropriate treatment option for all children.

Other therapy options

Neurofeedback therapy can have immense value, and human neuroscience is finding that there may be promising prospects for even more applications. However, there is generally no silver bullet that can fix everything. Often, neurofeedback therapy is paired with counseling or talk therapy to target both the brain and the mind.

Talk therapy has long been used to address and treat a wide variety of mental health concerns. Recently, therapy has become more available because it can be possible to attend sessions with a licensed mental health professional online. Online therapy can be an excellent option for those with busy schedules and those who cannot easily travel to a therapist’s office.

As this study explains, online therapy can be as effective as traditional face-to-face therapy. If you are experiencing any kind of mental health challenges or feel you’d benefit from working with a therapist, please don’t hesitate to reach out for the help you deserve.