Neurofeedback is a brain-based treatment that uses a sophisticated brain-computer interface (BCI) to “strengthen” or retrain the brain. Neurofeedback harnesses neuroplasticity and the brain’s natural and life-long ability to learn by training brainwaves, the tiny electrical signals produced by the brain.
Neurofeedback started in the late 1950’s in The USA, involving studies of consciousness and epilepsy. By the late 1960’s NASA was using neurofeedback in astronaut training, initially to reduce the likelihood of their astronauts having seizures and hallucinations when exposed to spacecraft fuel, and later for “Peak Performance” training to improve focus and attention. NASA are still using neurofeedback in their space training programmes today as also do The U.S. Military to train their Special Forces. Neurofeedback has being successfully used to treat attention deficit disorders since the 1980’s and its application has progressed to include treatment for a wide range of brain-based disorders.
The applications of neurofeedback are broad and people most commonly present to clinics with problems such as: ADHD and Learning Disorders; Anxiety and Panic Disorders; Depression; Epilepsy; Insomnia and Sleep Disorders; Migraines and Chronic Headaches; Traumatic Brain Injury and Stroke. Increasingly, following the lead from NASA and The U.S. Military, and more recently from Olympic Teams and other professional sports, ordinary people are using neurofeedback for “Peak Performance” to enhance focus and mental clarity, to improve decision-making and to strengthen their resilience under pressure.
What happens in a neurofeedback training session?
Neurofeedback is suitable for people of almost all ages and training typically occurs in a clinic setting. Patients sit comfortably whilst small sensors are gently attached to their head. These sensors are connected to a sophisticated brain-computer interface (BCI) which monitors brainwave activity in real-time. The clinician will have designed and programmed a specific training protocol, based upon the patient’s needs and often guided by a qEEG Brain Scan. The training protocol might be to train a patient to reduce slow brainwave activity in the front of their brain (as in many cases of ADHD) or to reduce fast brainwave activity in the middle of their brain (as in many cases of anxiety).
Once training starts patients are encouraged to pay attention to what they can see or hear. In the “old days” of neurofeedback patients would be instructed to “listen for beeps” or to watch moving graphs or simple animations on a computer screen. These days, thanks to the advances in technology, patients can train watching a movie or playing a video game that appears to quickly fade in and out, or start and stop.
Of course, it’s not as simple as it looks, and there are some very clever things going on behind the scenes: In summary, the patient’s brainwaves are monitored and analysed in real-time and, depending upon the training protocol, they are given instantaneous feedback (in the form of video and/or audio reward) about their performance. So for example, in a case of ADHD where there is too much slow brainwave activity at the front of the brain, whenever the computer detects that the patient’s slow brainwave activity reduces, they are instantly “rewarded” and the video or game runs brighter or smoother. Conversely, whenever the computer detects that the patient’s slow brainwave activity increases, they are instantly “punished” and the video or game goes dark or stops. In essence their brain is being taught to work more normally. Perhaps not surprisingly, the patient’s brain doesn’t learn straight away, but with repeated training the brain is “strengthened” and re-trained and things start to improve.
How will I know if I will benefit from neurofeedback?
The best way to find out if you would benefit from neurofeedback is to contact a clinic and speak with a practitioner directly. They are likely to be able to tell you from a brief history whether it is worth making an initial appointment for an assessment.
As you would expect your initial consultation will comprise a detailed history and examination, and sometimes also include additional special tests such as neuro-cognitive assessments. Many people will have previously seen a lot of other doctors and specialists and you are likely to be asked to bring along the results of any past tests and examinations. Many clinics offering neurofeedback will also offer a QEEG (a special test that assesses brain function) and are likely to recommend this additional examination as well. Finally, in many cases, you will asked to return for a follow-up appointment once your practitioner has reviewed your case. During this Report of Findings he or she will explain the results of any tests that may have been conducted and whether you are likely to be a good candidate for neurofeedback. They will outline their recommendations for care and give you plenty of opportunity to ask any questions you may have.
What conditions respond best to neurofeedback and what’s the supporting data ?
Neurofeedback appears to work with many conditions that are linked to abnormal brain activity. Some of these include: ADHD and Learning Disorders, Anxiety and Panic Disorders, Depression, Epilepsy, Insomnia and Sleep Disorders, Migraines and Chronic Headaches, Traumatic Brain Injury and Stroke. Neurofeedback is also used for “Peak Performance Training” to enhance focus and mental clarity, to improve decision-making and to strengthen resilience under pressure.
The scientific evidence supporting neurofeedback is strong. There are over 1000 studies published on neurofeedback including over 200 peer-reviewed articles in leading medical journals. Research has accelerated over the past 10 years and studies have shown that neurofeedback can help improve creativity, “executive function” (such as attention, processing speed and working memory), intelligence, sleep, task performance and general well-being. It is worth pointing out that in many cases these improvements are seen in both “healthy” and “unhealthy” populations. There is also convincing research demonstrating that neurofeedback can help specific conditions such as anxiety, ADHD, depression, epilepsy, migraines, PTSD, traumatic brain injury and stroke.
For example, a meta-analysis(1) of randomised-controlled trials published in 2014 showed that neurofeedback significantly improved attention in children with ADHD. Other research(2,3) has supported this evidence with clear and significant gains seen in children’s attention and executive functioning. Interestingly, this same research showed that those children that were taking medication for ADHD and also received neurofeedback training did not need to increase their medication. This was in stark contrast to those children in the control groups. Another important finding from research(4) is that when compared directly to medication, only those children with ADHD that receive neurofeedback training show significant improvements in academic performance in school.
How much will I improve ? And how quickly does neurofeedback work ?
Neurofeedback is not a “miracle cure” and as you would expect, results can vary. This is because some problems are harder to resolve than others, some people have had their problems for longer than others, people’s lives and lifestyles are different, and of course everybody’s brain is different and learns at a different rate. Nevertheless, most people will report significant improvements and this is supported by the literature.
Every case is different, however it is common for people to need about 40 training sessions to gain a significant improvement, and in most cases people train between 2 to 4 times per week. Some people need less than this and some people need more, and your practitioner will often be able to give you an approximate idea based upon your specific case. Many patients are given specific lifestyle and self-help advice and it is important to follow this in order to get the best results from training. The good news is that the evidence suggests that once the brain has learnt to work better it seems to stay that way, and that the results of training appear to be permanent – As they say “you never forget how to ride a bicycle.” There are exceptions of course, and in complex cases such as stroke or traumatic brain injury, neurofeedback may become an integral part of a patient’s long-term rehabilitation.
How much does neurofeedback cost ?
Cost varies, with approximately $2500-$3500 being fairly common for a course of neurofeedback. This may include an initial consultation, a qEEG brain scan, and about 20 sessions of training. Practitioners typically re-assess after a given number of sessions to determine if more neurofeedback would be helpful. Private health insurance and Medicare will sometimes cover some of the cost.
Who is qualified to provide neurofeedback ?
Currently, the field of neurofeedback is unregulated. This means that there is nothing stopping anyone from purchasing equipment and “plugging” themselves, or someone else, in and having a go. Common sense would suggest that this is not a good idea. It would seem reasonable that as a starting point you should consult a registered healthcare professional (see: https://www.ahpra.gov.au/), preferably with a background in neurology, and seek clarification about their level of experience and training.
Despite its long history, neurofeedback is still regarded as an emerging field and in many cases neurofeedback practitioners have to simply complete years of self-directed study. Increasingly however, practitioners are seeking certification.
Research and Safety
Neurofeedback has its foundation in basic and applied neuroscience as well as evidence-based clinical practice. There are over 1000 studies published in relation to neurofeedback and the literature that exists is substantial. No one has published any significant studies suggesting that neurofeedback does not work and in over 30 years of clinical applications there are no known situations where a long-term adverse effect has been reported.
- Front Hum Neurosci. 2014 Nov 13;8:906. doi: 10.3389/fnhum.2014.00906. eCollection 2014.EEG neurofeedback treatments in children with ADHD: an updated meta-analysis of randomized controlled trials. Micoulaud-Franchi JA, Geoffroy PA, Fond G, Lopez R, Bioulac S, Philip P.
- J Dev Behav Pediatr. 2014 Jan;35(1):18-27. doi: 10.1097/DBP.0000000000000009. Neurofeedback and cognitive attention training for children with attention-deficit hyperactivity disorder in schools. Steiner NJ, Frenetic EC, Rene KM, Brennan RT, Perrin EC.
- Pediatrics. 2014 Mar;133(3):488-92.doi:10.1542/peds/2013-2059.Epub 2014 Feb 17. In-school neurofeedback training for ADHD: sustained improvements from a randomised control trial. Steiner NJ, Frenetic EC, Rene KM, Brennan RT, Perrin EC.
- Biol Psychol. 2014 Jan;95:116-25. doi: 10.1016/j.biopsycho.2013.09.009. Epub 2013 Sep 18. Reprint of “Neurofeedback and standard pharmacological intervention in ADHD:” a randomized controlled trial with six-month follow-up”. Meisel V, Servera M, Garcia-Banda G, Cardo E, Moreno I.