the evidence basis

Neurofeedback has been practiced for well over four decades, although the technology and methods have come a long way in that time!  Hundreds of thousands of individuals and families have benefited greatly from this powerful, effective, and established intervention.  LORETA neurofeedback is the most recent, technologically advanced modality of neurofeedback and thus does not have as much research behind it yet; however, the existing evidence has shown it to produce even greater outcomes in less time than more traditional modalities.

Contrary to some recent claims that neurofeedback is insufficiently supported by research, below is a comprehensive bibliography on the existing literature that provides solid evidence of the effectiveness and power of neurofeedback for a variety of ailments and targets.

Most studies have found neurofeedback to produce significant outcomes with medium to very large effect sizes, depending on the specific modality, measurement tools, and targeted symptoms.

what does the research show?

Waitlist-controlled studies have shown neurofeedback to be highly superior to no treatment (i.e., passage of time), and studies comparing neurofeedback against other efficacious interventions or medications have found it to have comparable to superior effects, with minimal to no adverse side effects (for an example, see van der Kolk et al., 2016 and Bell et al., 2018 under PTSD).

Furthermore, neurofeedback trains the brain to produce healthier activity on its own (rather than doing it for the brain); thus, research has also observed these benefits to be long-lasting for both symptoms and neurophysiology (for an example, see Steiner et al., 2014a under ADHD).

Structural neuroimaging studies have even found changes in both the gray and white matter volume within brain regions trained by neurofeedback (for an example, see Ghaziri et al., 2013 under ADHD).

is it just a placebo effect?

The most common argument against neurofeedback is the lack of quality, placebo-controlled studies and some studies that have not found a significant different betweeen the sham and true neurofeedback conditions.  While placebo studies have been deemed the gold standard in the field of research, what many don’t realize is that many non-pharmaceutical interventions, such as psychotherapy, acupuncture, and chiropractic care, cannot be adequately controlled for placebo.  Likewise, it is much more challenging to implement a true placebo condition for neurofeedback (i.e., sham neurofeedback) than for medication (i.e., a simple sugar pill).  There is some evidence that sham neurofeedback might not actually be a true placebo condition due to a variety of factors.  Sham neurofeedback is also considered unethical for many clinical populations due to some evidence that it might impair a person’s ability to successfully benefit from true neurofeedback following the sham experience.  This has all limited the ability to do such research in this field.

Of the existing placebo-controlled studies, some trials have failed to show a statistically significant difference (similar to many placebo trials for medications and other interventions), but many studies have shown neurofeedback to be superior (for an example, see Micoulaud-Franchi et al., 2014 under ADHD).  An important consideration here is that the studies which have not found a “statistically significant” difference between neurofeedback and placebo might not have had a large enough sample size to achieve statistical significance.

Furthermore, the lack of difference has not been due to neurofeedback having no effect, but rather the placebo having a large effect – particularly on subjective reports.  Subjective reports (such as symptom questionnaires) are more susceptible to placebo than objective data (such as neuroimaging and computerized neurocognitive testing).  Placebo-controlled studies that have included objective measures have found more differential effects showing neurofeedback to be superior.  It is hard to argue that a person could change several specific metrics in their brain (sometimes over 200 metrics being trained simultaneously) simply via belief – especially if they don’t even consciously know exactly which metrics are being trained.  Moreover, a larger difference comes into play when examining how long the benefits last, as true physical changes in the brain tend to have more lasting effects than belief alone.

how do I know who to trust?

Internet searches do not always provide accurate, trustworthy information.  Internet posts are highly prone to bias (from both sides of the fence) and might contain ulterior motives.  Unfortunately, the more legitimate, quality research studies are often locked within expensive databases and thus unavailable to the general public.  Furthermore, lack of adequate funding has limited the ability for this field to conduct many large, high-quality studies, which impacts how the intervention is viewed in the overall field of research.  Whereas pharmaceutical trials tend to receive large amounts of funding, most neurotherapy studies have been very limited on budget.

When understanding statistical analysis, sample size also has a big impact on whether an intervention is considered “statistically significant” or not (which is often uses to determine whether it is effective or not).  As a result, studies with large sample sizes require only a small effect (e.g., minor improvements in symptoms) to achieve statistical significance, while studies with smaller samples require a much larger effect (e.g., major improvements in symptoms).  Interestingly, due to the large effect sizes often observed in the field of neurotherapy, some studies have achieved this statistical significance despite small samples.  However, this is why it is important to read the details of research articles and take effect sizes into account.

The real fallout from inaccurate, erroneous, or misconstrued coverage of neurofeedback is the lack of options provided to millions of Americans who suffer from the numerous conditions which neurofeedback can address.  Unfortunately, many aren’t yet aware that research-based, effective neuroregulation techniques are available to reduce their suffering.  Equally important is the responsibility of our media sources to provide fair and balanced reporting so that we don’t limit choice and block access to legitimate, life-changing interventions.

What to look for in a provider

Furthermore, it is important for the public to be accurately informed and discerning when selecting their care.  When comparing options, be sure to ask what type of neurofeedback a provider is offering and verify its legitimacy, as there are some methods and technologies being offered under the title “neurofeedback” that are not true neurofeedback nor supported by research.

Look for providers who are licensed clinicians, are adequately trained, and are experienced in the particular ailment you are seeking help with.  Don’t be afraid to ask them about their training and experience!  They should also be certified in neurofeedback by the Biofeedback Certification International Alliance (BCIA) and thus contain the credentials “BCN”.  If they are going to be messing with your brain, you want to be sure they know what they are doing!

Dr. Bell, for example, contains all these credentials and more.  She was extensively trained in the field of neurotherapy through her doctoral program, as well as trained and mentored by several experts within the fields of neurofeedback, neurostimulation, biofeedback, and brain assessment, including Michael and Lynda Thompson, Robert Thatcher, Nick Dogris, Tiff Thompson, Cynthia Kerson, Jay Gunkelman, and Donald Moss, among others.  She is also an approved mentor for BCIA, the organization in charge of certification for neurofeedback.  She also has over 15 years of experience in the fields of health and mental health.

read it for yourself!

Click on an item below to see a list of references for that item:

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Arnold, L. E., Lofthouse, N., Hersch, S., Pan, X., Hurt, E., Bates, B., … Grantier, C. (2013). EEG neurofeedback for ADHD: Double-blind sham-controlled randomized pilot feasibility trial. Journal of Attention Disorders, 17(5), 410–419. https://doi.org/10.1177/1087054712446173

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