“Neurofeedback” is a form of biofeedback training that aims to help people learn how to consciously control certain aspects of their brain activity. This promising new technology has been proposed to be a potential treatment for a wide variety of different conditions, from depression, ADHD, chronic pain, headaches, and even some symptoms of PTSD and schizophrenia. Does it work? Read on to learn more.
What is Neurofeedback?
“Biofeedback training” is a growing trend in healthcare, where people are hooked up to devices for measuring different aspects of bodily functions in order to see how these processes are taking place in real-time. People can then be trained to learn to control the way these processes are carried out [1, 2].
“Neurofeedback” is a specific form of biofeedback training, which is based on the idea that people can consciously alter the way their brains function by using training programs to help them to visualize and learn to change the patterns of electrical activity taking place in their brain [3].
Purported Benefits of Neurofeedback Therapy
While a considerable amount of early research has been done on neurofeedback, it is still a relatively new technology, and not much is known about the exact mechanisms underlying each different form of neurofeedback training.
There is also another major limitation that is worth noting about much of the existing research: because neurofeedback requires a person to be hooked up to complex devices and extensively trained, it is often difficult, impractical, or even impossible to have proper “control” groups to compare the effects to. This means that it’s possible that many of the reported findings so far are simply due to the “placebo” effect [4].
Therefore, due both to a general lack of adequate research so far, as well as methodological limitations when it comes to ruling out possible “placebo” effects, all of the purported uses described below are currently considered to have “insufficient evidence” to come to any firm conclusions about the efficacy of neurofeedback training. None of the uses below have been FDA-approved, and much more research will be needed before any of the proposed uses below could become officially approved and accepted as valid medical approaches to treating the various conditions and other biological functions discussed below.
With that in mind, let’s review what some of the preliminary research so far has to say about the potential effects of neurofeedback training!
Insufficient Evidence For
1) Cognitive Function
Some researchers have proposed that neurofeedback may help to enhance neuroplasticity (the capacity of the brain to change and adapt). This, in turn, could possibly help to slow or reverse the natural declines in cognitive function that occur over aging [5].
For example, one early study reported that neurofeedback training improved cognitive processing speed and executive function in elderly subjects [6].
Other studies have reported that certain specific types of neurofeedback training, such as decreasing sensorimotor rhythm (SMR) beta rhythms, may help improve reaction time [7].
According to another preliminary study, subjects who were able to learn to boost their alpha brain wave activity via neurofeedback were reported to perform better at a visual-spatial reasoning task (mental object rotation) [8, 9].
While these early results are promising, little is known about how long-lasting these changes might be, or how significant any changes in overall cognitive functioning might be. Therefore, considerably more research work will still be needed to verify and extend these preliminary findings further.
2) Attention and Working Memory
Problems with working memory are often associated with issues with attention and short-term memory.
According to some preliminary findings, healthy individuals have reported to improve their working memory and extend their attention spans by increasing certain types of brain wave activity (in this case, alpha-, theta-, and SMR waves) [10, 11, 12, 13, 14].
Another study in 32 human subjects reported that EEG-based neurofeedback improved attention and working memory in older patients, while younger subjects improved their concentration and attention (executive functioning). This led some researchers to suggest that neurofeedback may be an effective way to prevent age-related cognitive impairment – although more research will be needed to find out for sure [15, 16].
In one other study, fMRI-based neurofeedback training (a type of MRI that can be used to monitor brain responses in real-time) was used to help 18 healthy adults learn to control their blood oxygen level-dependent signals, and was reported to lead to improved working memory abilities [17].
3) Learning & Memory
Some early evidence suggests that EEG-based neurofeedback training may have potential to enhance the acquisition and organizations of new memories (both short- and long-term memory) [18].
According to one preliminary study in 50 healthy adults, using an EEG-based neurofeedback program to boost alpha wave strength was reportedly associated with increases in the accuracy of multiple types of memory (episodic, working, short-term). The stronger the boost in alpha waves, the more memory enhancement each subject showed [19, 20].
In another study, EEG-based neurofeedback training (targeting SMR and upper alpha waves) was reported to improve verbal memory, short-term visual memory, and working memory in 70% of the subjects (including 17 stroke patients and 40 healthy control subjects). This neurofeedback training was reported to be more effective than traditional cognitive training, and the study’s authors proposed that neurofeedback could potentially benefit patients suffering from brain damage (such as the stroke patients in their study) [21].
Finally, another study in 27 healthy human subjects reported that EEG-based neurofeedback improved memory consolidation during sleep [22].
4) Skills Training
In a few preliminary studies, EEG-based neurofeedback was used to promote brain waves associated with attention and relaxation, which was reported to improve the performance of professional musicians when performing in stressful conditions. A follow-up study used alpha/theta EEG neurofeedback training to try to enhance the creativity and technical skill of novice musicians. According to this study, SMR neurofeedback may have noticeably enhanced their technical skills [23, 24].
Neurofeedback training has also been reported to improve musical performance in 33 school children, who displayed greater creativity and reported higher well-being after being trained to increase their alpha and theta wave activity. This preliminary finding may suggest that neurofeedback could be helpful as a learning tool in the classroom [25].
Another preliminary study reported that EEG neurofeedback also helped actors learn faster, as well as improved their creativity, the quality of their performance, and boosted their confidence [26].
There is also some preliminary evidence that athletic performance could also potentially be enhanced by neurofeedback training. For example, two early studies using EEG-based neurofeedback training reported that golfing accuracy was improved in 6 subjects, and that dance performance was improved in 24 professional dancers. Another study also reported improved reaction time and visual-spatial abilities in 41 healthy subjects – skills that are likely quite relevant for athletic performance [27, 28, 29].
Finally, neurofeedback training (of alpha-, theta, and SMR waves) was reported to improve surgical technique in 28 medical surgery trainees [30].
However, these studies all generally have small sample sizes, and many of them used different neurofeedback training protocols – so a lot more research will still be needed to find out exactly what training programs are effective, and why.
5) Anxiety
According to a few early studies, patients who received neurofeedback training to enhance their alpha wave activity reported reductions in anxiety and other negative emotions [31, 32, 33].
In one study, neurofeedback training aimed at boosting alpha and theta brain waves was reported to enhance mood and boost confidence in a group of medical students [34].
Similarly, a few preliminary studies reported that alpha and theta brain wave neurofeedback training lowered performance anxiety and stress in musicians, dancers, and singers [23, 28].
6) Depression
According to a handful of preliminary studies, neurofeedback targeting alpha brain waves in the frontal cortex has shown some early promise in potentially treating depression by boosting mood and reducing anxiety [35, 36, 37].
In one interesting study, EEG-based neurofeedback training reduced depression symptoms – even when this training was “disguised” by having participants use their own brain activity to control music (rather than being shown their own brain waves per se) [38].
Hemodynamic (HEG) neurofeedback – i.e. training to control blood flow in specific brain regions – has also been studied as a potential treatment for depression. Some researchers speculate that this may work by enhancing responses to positive memories in the limbic system, a key brain network involved in the processing and regulation of emotions [39, 40, 41].
Similarly, a controlled study in 10 depression patients reported that using neurofeedback to reduce the brain’s responses to negative information was also effective in improving depression symptoms [42].
7) Sleep Quality
According to one early study in 38 healthy human participants, using neurofeedback training to increase a type of brain wave called the sensorimotor rhythm (SMR) has been reported to help people fall asleep faster and improve sleep quality [22].
Neurofeedback has also been reported to improve sleep quality in 29 adult insomniacs. In one study, 18 sessions of remote neurofeedback (administered over the internet) was reported to decrease both the time needed to fall asleep as well as increase total sleep time [43].
Similarly, according to a few studies, a total of 64 insomnia patients reported experiencing improvements in sleep quality – but only if the appropriate feedback therapy was used. A follow-up study also reported that these benefits lasted for up to 9 months. Patients who were tense and anxious only reported benefits from theta feedback, while more “relaxed” patients only reported benefitting from SMR feedback [44, 45].
8) ADHD
Some early studies have looked at the potential for neurofeedback training to improve or better-manage the common symptoms of ADHD.
For example, one study in 20 children with ADHD who had received fMRI neurofeedback treatment reported increased activation in the anterior cingulate cortex, a part of the brain involved in selective attention [46].
In another study of 38 children with ADHD, 30 sessions of neurofeedback training (SCP) was reported to improve cognitive function and attention. Additionally, these effects were still seen up to 6 months after the initial treatment. This finding was confirmed by another follow-up study in 23 children with ADHD [47, 48].
According to the authors of one other study, neurofeedback training may be similar in effectiveness as certain common ADHD medications. In this study, 20 sessions of neurofeedback training were reported to produce improvements in attention and concentration equal to methylphenidate (commonly known as Ritalin) [49].
A follow-up study tested the effects of EEG neurofeedback combined with a 1-year program of Ritalin (average dose of 25 mg/3x a day), parent counseling, and academic support. All children received the program and 51 children also received neurofeedback. Although all of the children reported improved symptoms, the neurofeedback group reported not needing to continue taking Ritalin to maintain the initial benefits from the program (100 children with ADHD, aged 6-19) [50].
9) Learning Disabilities
According to one study in 16 learning-disabled children, 2 months of EEG neurofeedback (targeting alpha and theta waves) led to improved behavior and cognitive abilities (such as memory, attention, and attitude), as reported by their parents [51].
Another study in 19 children with dyslexia who received 20 sessions of EEG neurofeedback training reported improvements in spelling but not reading ability (19 children) [52].
Finally, another study involving 30-35 sessions of EEG neurofeedback training reported helping 12 dyslexic children improve their reading speed and comprehension abilities by at least two whole grade levels [53].
Some studies have also looked at the potential of neurofeedback for children with developmental disabilities.
For example, a study of 23 children with mental retardation reported that 22 of these children showed clinical improvements in behavior after undergoing neurofeedback training [54].
Similarly, a pilot study of 7 children with Down’s Syndrome reported that EEG neurofeedback training improved their symptoms. However, this study did not use a control group for comparison, so further research is necessary to confirm this finding [55].
10) Autism Spectrum Disorder
One large-scale review of data from 150 patients with Asperger’s Syndrome concluded that EEG neurofeedback may have some potential in improving symptoms of Asperger’s. According to the study’s authors, neurofeedback also enhanced the patients’ attention and improved their levels of academic achievement [56].
Similarly, according to several preliminary studies, neurofeedback training has been reported to improve social behavior, communication skills, and executive control [57, 58].
11) Recovery from Head Injuries
Head injury and brain trauma often lead to unique cognitive impairments that can be difficult to treat with usual medical techniques. Intriguingly, some researchers have proposed that neurofeedback may potentially help patients recover cognitive function after a head injury [59, 60].
For example, in one study of 27 patients with a variety of head-injury symptoms, customized neurofeedback training was reported to improve head injury symptoms – and these benefits even reportedly grew stronger with additional neurofeedback training sessions. Similarly, another study reported that beta EEG neurofeedback helped 12 head injury patients improve their attention [61, 59].
According to one open trial of neurofeedback training in 26 head injury patients, neurofeedback reportedly helped achieved symptom improvements of at least 50% in the majority of treated patients (88%), and may have even played a role in enabling these patients to return to work [60].
Similarly, 25 sessions of EEG neurofeedback training were reported to improve symptoms of depression, fatigue, and cognitive functioning in 6 head injury patients. The patients in this study also reported improved overall social and occupational functioning [62].
12) Addiction
Chronic alcoholism can drastically alter alpha, theta, and beta brain waves. Thus, some researchers have proposed that re-training (“normalizing”) these brain waves may potentially help treat addiction [63].
According to a few early studies in a total of 121 alcoholics, neurofeedback training was reported to help many alcoholics maintain sobriety for up to 12-21 months after addiction treatment [64, 65].
In another study, alcoholics who received 30 sessions of neurofeedback training reported improvements in their depression symptoms [66].
In a study of 10 cocaine addicts, EEG neurofeedback combined with motivational interviewing reduced depression, stress, as well as total cocaine and marijuana use [67].
Similarly, a few preliminary studies have reported that EEG neurofeedback training improved mental health symptoms (such as aggression and psychosis), as well as reduced the desire to use drugs in opioid addicts. In a follow-up study, neurofeedback was reported to improve physical symptoms, depression, and even reduced the patients’ desire to seek out and consume drugs. However, in both of these studies, neurofeedback was used along with medication such as methadone or buprenorphine – so it’s unknown to what extent the neurofeedback training per se was responsible for these specific findings [68, 69].
13) PTSD
One early review paper examined 5 individual pilot studies on the effects of neurofeedback training on the symptoms of PTSD. The authors of this review concluded that neurofeedback is a likely potential treatment for PTSD (3 of 5 studies reported positive results in these patients) [70].
According to one randomized control trial (RCT) study in 52 PTSD patients and a smaller pilot study with 3 military veterans, EEG neurofeedback and fMRI neurofeedback training were each reported to improve PTSD symptoms [71, 72].
14) Headaches and Migraines
Some early evidence suggests that neurofeedback training may be helpful for alleviating migraines and headaches.
For example, the authors of one review paper concluded that neurofeedback treatment may reduce the frequency of headaches by up to 50%. However, children with tension headaches needed “reminder” training every 6-12 months to maintain these benefits [73].
A study of 4 different biofeedback treatments (including alpha neurofeedback) in a total of 75 patients reported that each of the different neurofeedback treatments had some effect on reducing the number of migraine headaches (but unfortunately not their intensity or duration) [74, 75].
According to one exploratory study in 30 children, 10 of the 30 children reported reduced frequencies of migraines after 10 sessions of slow cortical potentials neurofeedback training [76].
Finally, in one other study, combining EEG and hemoencephalography neurofeedback with hand-warming biofeedback (40 sessions on average) was reported to reduce the frequency of headaches in 26 out of 37 migraine patients, and these changes were maintained for up to 14 months after initial treatment [77].
15) Chronic Pain
Chronic pain is often difficult to treat, and current treatments have several major drawbacks, such as the potential for patients to become addicted to painkiller medications.
However, some researchers have suggested that neurofeedback training may be a powerful and more effective alternative treatment for pain disorders. However, not many controlled studies have been performed so far [73, 78].
According to one early study, 10 patients with chronic pain reported experiencing immediate relief from pain intensity following EEG neurofeedback. In some of these patients, this reduction in pain lasted for up to 3 months after initial treatment [79].
Similarly, another preliminary study has reported fMRI neurofeedback helped chronic pain patients reduce their pain symptoms (36 healthy controls and 12 patients with chronic pain) [80].
16) Fibromyalgia
Preliminary evidence from one study in 30 patients with fibromyalgia has reported that neurofeedback may lead to significant improvements in mood, mental clarity, and sleep [81].
One other early study in 36 fibromyalgia patients reported that 20 sessions of EEG neurofeedback training were equally effective at controlling pain as 10 mg / day of the medication escitalopram (Lexapro) [82].
17) Eating Behavior and Weight Loss
According to the authors of one review, neurofeedback may be a promising treatment for eating disorders, obesity, and food cravings [83].
One pilot study in 6 otherwise-healthy overweight or obese males reported that hemoencephalography neurofeedback helped increase self-control with food, and may have even reduced the patients’ total body weight [84].
Similarly, another preliminary study has reported that neurofeedback helped 8 overweight or obese males choose lower-calorie foods. However, it also increased some of these patients’ secret snacking tendencies, so the results are mixed and inconclusive [85].
18) Parkinson’s Disease
One study in 16 Parkinson’s patients reported that neurofeedback improved balance (both standing and moving) after just 8 sessions of training [86].
In one other preliminary study, 30 Parkinson’s disease patients were reported to show improved movement speed and other motor functions after 2 sessions of fMRI neurofeedback combined with motor training [87]. However, the combination of the two treatments means that we can’t yet know for sure if the neurofeedback training itself was directly responsible for these improvements.
19) May Affect Epilepsy
According to clinical data, up to 1/3 of epileptic patients don’t respond successfully to conventional seizure therapies. This has motivated some researchers to look at neurofeedback training as a potential alternative treatment [88].
According to one study, sensorimotor rhythm (SMR) and slow cortical potentials (SCP) neurofeedback training were reported to reduce the frequency of seizures in 70% of the tested patients [88].
Similarly, another study reported that 25 epilepsy patients became seizure-free after being treated with neurofeedback, with 76% of the patients no longer needing anti-seizure medication [89].
Another study reported that 5 out of 8 epilepsy patients reduced the frequency of their seizures by using EEG-based neurofeedback [90].
However, the authors of a large-scale review of data from neurofeedback studies in epilepsy patients concluded that the current evidence is still somewhat weak, and that much additional research will need to be conducted to firmly establish the medical effectiveness of neurofeedback training in these cases [91].
20) Cerebral Palsy
Children born with cerebral palsy have abnormalities in overall brain activity that can be detected with EEG almost immediately after birth. Some researchers have proposed that by correcting these abnormalities with neurofeedback training, children with cerebral palsy may be able to improve their speech, physical coordination, and emotion-regulation abilities [92, 93].
However, because cerebral palsy patients often have very unique sets of impairments in brain function, coming up with effective training programs for each patient can be quite tricky and time-consuming, thus somewhat limiting the potential of this treatment [94].
Additionally, one study reported that alpha neurofeedback did not have any significant effect on cerebral palsy syndromes [95].
21) Schizophrenia
According to a single preliminary study, neurofeedback was reported to improve symptoms in 47 out of 48 tested patients with schizophrenia who did not respond to conventional antipsychotic medication. This finding may suggest that neurofeedback techniques could be a potential treatment for severe psychological disorders that are often difficult to manage effectively – but much more research will still be needed [96].
22) OCD
According to one early study, 33 out of 36 patients treated with neurofeedback reported significant improvements in their OCD symptoms. 19 of these patients even reported that these improvements lasted for up to 26 months after initial treatment [97].
In one other study, two patients given neurofeedback training saw improvements in common behaviors of OCD (e.g. obsessive washing, grooming, and checking). One patient also saw improvements in depression and anxiety and even become more extroverted [98].
However, the sample size of this study is extremely small, and much more research will be needed to find out for sure if neurofeedback might be an effective approach to alleviating OCD symptoms and behaviors.
23) Tourette’s Syndrome
A handful of preliminary studies have reported that using neurofeedback training to reduce theta brain waves and enhance activity in the sensorimotor cortex may give patients with Tourette’s syndrome better control over their movements. This could potentially help reduce or even completely eliminate their motor “tics” (sudden and uncontrolled movements) [99, 100].
Nonetheless, much more follow-up research will be needed to confirm these early results further.
24) Tinnitus
Tinnitus has been associated with particular brain wave patterns in the temporal lobe. According to two studies (with 21 and 15 tinnitus patients, respectively), neurofeedback was reported to show some early potential for reducing the severity of tinnitus symptoms [101, 102].
Takeaway
Neurofeedback training has produced some intriguing early results in small clinical trials. The most notable potential benefits observed in such trials include improved cognitive function, working memory, and ability to learn. Thus, some researchers are currently investigating whether it could benefit people with learning disabilities, autism, OCD, ADHD, and Tourette’s, among others.
Some research has also found potential benefits of neurofeedback for various types of pain and movement disorders, as well as eating disorders, sleep disorders, and tinnitus. However, the evidence for all of neurofeedback’s potential benefits is considered insufficient to recommend it as a therapy. More research will be required.
