Neurofeedback Therapy: Modulating Your Brain for Improved Health

You wake up after a night of tossing and turning in your bed, with sleep coming only in the early morning hours. As you rush around your house, you feel anxious about making it to work on time and preparing for a presentation you have in the afternoon. Despite your efforts to focus, your mind feels foggy, making it difficult to concentrate. You find yourself fidgeting at your desk, fueled by the coffee you consumed to compensate for the lack of sleep. It sounds like a familiar nightmare, doesn’t it?

What if you could guide your brain’s activity in a similar way to how you train your body through exercise? Neurofeedback aims to achieve that. It is a type of non-invasive biofeedback technique designed to modulate your brain activity to self-regulate through real-time feedback.

The technique has been studied for various mental health conditions and is often marketed as a cure for them all. However, we all know the saying: if it's too good to be true, it probably is. So, I did some research.

This article dives into research behind neurofeedback therapy, its potential benefits and limitations, types of neurofeedback, and general considerations. While I have an MSci and have completed several modules on neuroscience, I am not an expert in the field. So, I asked our in-house researcher Paula Vaidelauskaitė, BSc, who has a degree in Clinical and Cognitive Neuroscience, for some additional insights.

Understanding neurofeedback: how does it work?

Neurofeedback is a noninvasive technique for monitoring, training, and potentially improving brain function. It involves brain wave recognition and measurement design, data gathering and processing, real-time feedback, a personalized neurofeedback protocol, and, in many cases, support from a neurofeedback coach or a licensed medical professional.

When brain activity aligns with desirable brain wave patterns, users receive positive feedback, which varies depending on the device used and the training protocol.

Measuring brain wave activity using electroencephalogram (EEG) technology is the essence of neurofeedback. Here is a summary table of what state each of the brain waves is associated with. However, this is a summarized version from one review paper. Different brain waves may be associated with multiple cognitive and physiological states, and the precise frequencies will vary based on sources and are unique to each individual.

What happens during a neurofeedback session?

The specifics of what occurs during a neurofeedback therapy session can vary depending on the practices of the professional overseeing the treatment or the type of device used if you choose at-home neurofeedback. However, after conducting some research and trying one of the at-home devices myself, I can provide a general overview of the experience.

• Initial assessment. Personalization is key to neurofeedback therapy. Thus, you will start by discussing your issues and goals with a practitioner and are likely to take some sort of assessment test, which will again be followed up with a discussion to fine-tune everything. However, only some of the at-home devices offer such neurofeedback services.
• Setup. If you are doing in-clinic neurofeedback therapy, a doctor or a nurse will attach electrodes to your scalp. If you are opting for an at-home device, you will need to follow the provided guidance to set up the neurofeedback equipment.
• Training session. Again, the precise nature of the session will vary, but you will need to focus on some sort of visual or audio feedback.
• Feedback. Visual or auditory feedback guides the brain toward specific activity patterns, adapting over time.

The main idea is that consistent training, accompanied by real-time feedback, may help you gradually learn to modulate your brain wave activity. In simple terms, it is like a combination of a video game and meditation. The better you are at staying calm and focused, the higher your scores. Based on your performance, you receive cues, such as the screen dimming or brightening or variations in sound, that help you understand if you are doing well or not.

Types of neurofeedback therapy

There are several types of neurofeedback technologies, each having its own specificity and the potential to deliver different benefits. I will break down the current ones below.

Frequency/power neurofeedback

Frequency/power neurofeedback is one of the most commonly used due to its relative simplicity. Two or four electrodes are placed on the head to measure and alter the amplitude or speed of specific brain waves in those locations. The device works by simultaneously measuring, processing, and feeding back the data to the user.

Slow cortical potential neurofeedback (SCP-NF)

SCP-NF is aimed at training individuals to self-regulate their slow cortical potentials (SCPs), which are gradual shifts in the brain’s electrical activity that last from seconds to minutes and determine whether the brain is ready to process new information or is relaxed and focused. The idea is that with consistent training, a person can learn to shift between the states voluntarily.

Low-energy neurofeedback system (LENS)

LENS type of neurofeedback works by delivering very low-intensity electromagnetic signals to change brain waves while the trainee remains still with their eyes closed. The goal is to disrupt maladaptive brain waves and promote a more desired state. This type of neurofeedback does not require active participation.

Hemoencephalographic (HEG) neurofeedback

HEG measures the oxygenation changes in the brain regions, such as the prefrontal cortex (PFC) using near-infrared light. The PFC is responsible for planning, decision-making, emotional control, and attention. The data is processed and fed back to the user via visual or auditory cues to alter brain activity.

Live z-score (LZT) neurofeedback

LZT neurofeedback compares an individual's EEG to a normative database and feeds back continuous video and sound cues to help the trainee adjust brain waves and minimize abnormalities.

Low-resolution electromagnetic tomography (LORE-TA)

LORE-TA uses 19 electrodes that measure brain waves in real-time and then estimate the origin of the EEG signals using a mathematical model to generate 3D maps of brain activity. Initially, this neurofeedback model was marketed as superior. However, actual evidence to substantiate the claims is lacking.

Functional magnetic resonance imaging (fMRI) neurofeedback

fMRI measures brain activity by measuring changes in blood flow. The data is then analyzed and processed in real time and presented as a graph of images for the person using it to analyze. The idea is that over time, you get visual feedback on how different mental strategies influence your brain activity, enabling the user to learn to self-regulate. fMRI neurofeedback is one of the newer strategies and is mostly used as a complementary tool.

Below is a summary table presenting the types of neurofeedback.

What conditions is neurofeedback researched for?

Neurofeedback therapy has been suggested to help with numerous symptoms of mental health conditions and psychiatric disorders. However, it is important to note that most of the studies focus on clinical neurofeedback and not on at-home devices that are getting popular. Neurofeedback is not a replacement for medical treatment or medications and should not be used for diagnostic purposes.

Below, I will overview the existing research for using neurofeedback for attention deficit hyperactivity disorder (ADHD), anxiety, depression, insomnia, migraines, and some others.

ADHD

Early studies suggested that individuals with ADHD tend to have higher theta and lower beta brain wave activity. Neurofeedback is believed to have the potential to help regulate these brain activity patterns. However, neurofeedback is not yet approved as an ADHD treatment in clinical settings.

A meta-analysis of ten studies on children with ADHD, which included follow-ups of 2 to 12 months, found that neurofeedback training significantly reduced inattention, hyperactivity, and impulsivity. The effects were consistent at follow-up.

In essence, neurofeedback has the potential to help with focus and attention in individuals with ADHD and has been investigated in clinical settings. However, there is no generalized protocol, and each case requires an individual approach.

Anxiety

Feeling stressed or anxious was shown to be associated with changes in alpha, theta, and gamma brain wave activity.

A quasi-experimental study on 28 patients with generalized anxiety disorder (GAD) found that increasing the amplitude of alpha and beta waves can reduce the symptoms of generalized anxiety. While another review suggested that alpha-theta brain wave enhancement may be more effective.

The same study also found that mindfulness neurofeedback sessions reduced anxiety in all subjects. However, even the authors admit that more objective and larger sample studies are needed to confirm the use of neurofeedback therapy for anxiety.

A randomized controlled study on 26 healthy subjects with high anxiety found that fMRI-guided neurofeedback training decreased the levels of anxiety. The results were maintained at the 3-day follow-up.

The evidence for neurofeedback helping anxiety is pretty scarce and inconsistent, with many studies done on healthy subjects with some anxiety and some on individuals with clinical anxiety, making it hard to compare.

Furthermore, research on neurofeedback and anxiety is limited, thus, more robust, long-term investigations are needed. However, neurofeedback sessions are generally calming and meditation-like, which on their own could also contribute to a calmer state of mind and better emotional control, and thus less anxiety.

Insomnia

A research study on 17 individuals with primary insomnia found that remote neurofeedback significantly improved the total time spent asleep, overall sleep quality, and decreased sleep latency. However, the results are not enough to draw conclusions as the sessions were done remotely and relied on self-reports.

A meta-analysis of 12 studies found that EEG-based neurofeedback, mostly surface and z-score neurofeedback, helped improve subjective sleep in people with insomnia in the majority of the included studies. However, it is hard to draw conclusions due to differing protocols and the potential placebo effect.

While some studies have found neurofeedback to improve sleep in individuals with insomnia, others have not, making it hard to draw conclusions. Furthermore, many studies conduct experiments only in a lab environment or rely solely on self-reports. However, meditation-like neurofeedback may be helpful for some as a calming practice and thus indirectly contribute to better sleep.

Migraines

A migraine is a severe and persistent headache that can be debilitating and interfere with daily activities. Currently, the only available treatment is medications, but neurofeedback therapy is proposed as an alternative.

In one study on 37 individuals suffering from migraines, the participants used EEG and HEG-type neurofeedback three times weekly for 6 months. The results showed that in 70% of individuals, headache frequency decreased by at least 50% when medication was combined with neurofeedback. The improvement was sustained at 14.5-month follow-up.

A study of 71 participants with frequent headaches found that qEEG-guided neurofeedback stopped migraine episodes for 54% of participants and reduced the frequency of episodes by at least 50% in 39% of participants. However, the results were based on the patients’ reports, making the improvements subjective.

The overall evidence for using neurofeedback to relieve migraines is quite promising, however, larger-scale studies are needed to confirm these potential benefits.

Other conditions

Neurofeedback also has some research to suggest it can be useful for substance use disorder (SUD) and general mind wandering.

Neurofeedback has been studied as a complementary therapy for SUDs. A literature review looked at 16 studies that used fMRI neurofeedback on individuals with SUDs (alcohol, tobacco, or drugs).

The overall results suggest that neurofeedback training was associated with brain function changes, especially in addiction-related brain regions, and some craving reductions compared to control groups. However, the evidence is mixed, and there is a lack of placebo-controlled studies.

Nonetheless, the study results vary too greatly to draw a unified conclusion. Furthermore, substance use recovery is significantly influenced by factors like the environment and support received, making it difficult to attribute better outcomes to a single cause.

Mind wandering is not a medical condition, however, it can make it hard to focus and be present or cause anxiety if you fall into a negative spiral. A small study on 16 volunteers used EEG to measure brainwave activity during a breath-counting task.

The participants pressed a button every time their mind wandered, and the final analysis revealed that theta and delta brainwave activity increased while alpha and beta activity decreased during mind wandering.

While this study has flaws and more research is needed to confirm the association, it reveals a potential use of neurofeedback. Most sessions involve feedback that requires full attention, potentially helping the brain learn to focus instead of mind wandering.

Are there downsides? Addressing concerns and side effects

Although most sources focus on the potential benefits of neurofeedback, there are some drawbacks as well.

• Side effects. Most studies have not reported side effects; however, none have really examined them, especially long-term. Brain functions are very intricate and complex; thus, anything that interferes with it may help but may also make it worse, so it is essential to work with a professional and monitor how you feel.
• It's not a quick fix. Neurofeedback requires a long-term commitment and proper training. You have to perform neurofeedback at least several times a week, lasting 10–30 minutes for several weeks.
• Cost. Neurofeedback sessions or at-home devices tend to be expensive.
• Placebo effect. Several of the perceived benefits in the studies may be due to a placebo effect or due to the meditative nature of the neurofeedback itself.
• Results vary. Both the training protocols and the results of neurofeedback are highly individual, so despite what the research says, you may have a different experience.

Is neurofeedback right for you?

Neurofeedback is a non-invasive technique that may help with attention and focus, anxiety, migraines, sleep, and overall well-being. However, the results are highly individual, and the research is inconclusive. The key point is that despite promising benefits, neurofeedback, especially done at home, is not an approved treatment for any medical condition. It may be used as an addition, but it is important to consult with your doctor beforehand.

I asked Paula Vaidelauskaitė, who has a degree in Clinical and Cognitive Neuroscience, for an opinion about clinical versus at-home neurofeedback devices. Here’s what she has to say. “Consumer-grade devices typically employ fewer EEG channels, which are often integrated into wearable headbands with dry electrodes. This design is convenient but limits the brain area that can be investigated. These devices are tailored for general wellness, including relaxation, focus improvement, and stress management.

Clinical-grade systems use multiple EEG channels with wet electrodes for better signal acquisition. These systems can capture detailed activity across multiple brain regions, making them suitable for comprehensive analysis. Also, clinical-grade devices are employed by trained professionals to diagnose and manage symptoms of neurological and psychological conditions, such as ADHD or anxiety disorders, and are often part of a broader therapeutic plan.”

In short, if your goal is general wellness, a consumer-grade at-home device may suffice. “However, if you seek to address symptoms of a specific health condition, consult a healthcare professional for guidance,” Paula emphasizes.

Bottom line

Neurofeedback is a type of biofeedback that may help you learn to modulate your brain activity. It has been studied for various conditions, such as ADHD, anxiety, insomnia, migraines, and other mental health conditions. While the evidence for improving focus and relaxation is pretty solid, other benefits still lack consensus among studies.

It is important to remember that neurofeedback is an evolving field with new devices and technologies emerging. However, as studies differ in design, it is hard to compare and summarize them. Furthermore, each case is individual and requires a personalized approach, so what worked for the participants of a study may not work for you.

If you want to try neurofeedback, I highly suggest talking to your doctor first, especially if you have any diagnosed health conditions, to determine the best approach for your goals, health status, and lifestyle. Neurofeedback therapy is not considered a cure for acute mental health issues and may only be useful as a cherry on top of positive lifestyle changes to improve your well-being.