ⓘ Neurofeedback, also called neurotherapy or neurobiofeedback, is a type of biofeedback that uses real-time displays of brain activity - most commonly electroence ..


ⓘ Neurofeedback

Neurofeedback, also called neurotherapy or neurobiofeedback, is a type of biofeedback that uses real-time displays of brain activity - most commonly electroencephalography - in an attempt to teach self-regulation of brain function. Typically, sensors are placed on the scalp to measure electrical activity, with measurements displayed using video displays or sound. Neurotherapy is currently not widely accepted in the mainstream medical community, with its validity been questioned in terms of conclusive scientific evidence". Nevertheless, it is known as a complementary and alternative treatment of many brain dysfunctions. However, current research does not support conclusive results about its efficacy.


1. Definition

Neurofeedback is a type of biofeedback that measures brain waves to produce a signal that can be used as feedback to teach self-regulation of brain function. Neurofeedback is commonly provided using video or sound, with positive feedback for desired brain activity and negative feedback for brain activity that is undesirable. Related technologies include hemoencephalography biofeedback HEG and functional magnetic resonance imaging fMRI biofeedback.


2.1. Uses ADHD

Clinical guidelines on neurofeedback as a treatment for ADHD are mixed. However, the American Academy of Pediatrics does not list neurofeedback or biofeedback as a recommended treatment in their clinical practice guidelines for the diagnosis, evaluation, and treatment of ADHD in children and adolescents, instead mentioning EEG biofeedback as an area for future research. The NICE guideline for ADHD leaves the efficacy of biofeedback an open question p. 412. In page 202 states "Biofeedback has been employed as a non-invasive treatment for children with ADHD since the 1970s but is probably not used as a significant intervention in UK clinical practice". However this is unsurprising since in the UK, NICE evaluates whether treatments should be recommended on the basis of the cost of a quality-adjusted life year. SIGN guideline no 112 in page 24 mentions "Neurofeedback is presently considered to be an experimental intervention in children and young people with ADHD/HKD. There are no standardised interventions". Institute for Clinical Systems Improvement guideline on Diagnosis and Management of Attention Deficit Hyperactivity Disorder in Primary Care for School-Age Children and Adolescents in page 41 mentions neurofeedback lacks enough research evidence for efficacy in ADHD.

Overall research into neurofeedback is considered to have been limited and of low quality, although others have disagreed.

It has been argued there is some indication on the effectiveness of biofeedback for ADHD but that it is not conclusive: several studies have yielded positive results, however the best designed ones have either shown absent or reduced effects. Other experts have proposed that standard neurofeedback protocols for ADHD, such as theta/beta, SMR and slow cortical potentials neurofeedback are well investigated and have demonstrated specificity. No serious adverse side effects from neurofeedback have been reported.

QEEG has been used to develop EEG models of ADHD. According to this model, persons with ADHD often have too many slow theta brain waves associated with relaxation and not enough fast beta wave activity associated with mental focus. Neurofeedback therapies for ADHD generally attempt to increase the production of betawaves and decrease the number of slower brain waves. This can be accomplished by allowing the patient to view their levels of brain waves on a screen and attempt to alter them, or by integrating brain waves into a video game.


2.2. Uses Non-medical

The applications of neurofeedback to enhance performance extend to the arts in fields such as music, dance, and acting. A study with conservatoire musicians found that alpha-theta training benefitted the three music domains of musicality, communication, and technique. Historically, alpha-theta training, a form of neurofeedback, was created to assist creativity by inducing hypnagogia, a" borderline waking state associated with creative insights”, through facilitation of neural connectivity. Alpha-theta training has also been shown to improve novice singing in children. Alpha-theta neurofeedback, in conjunction with heart rate variability training, a form of biofeedback, has also produced benefits in dance by enhancing performance in competitive ballroom dancing and increasing cognitive creativity in contemporary dancers. Additionally, neurofeedback has also been shown to instil a superior flow state in actors, possibly due to greater immersion while performing.

However, randomized control trials have found that neurofeedback training using either sensorimotor rhythm or theta/beta ratio training did not enhance performance on attention-related tasks or creative tasks. It has been suggested that claims made by proponents of alpha wave neurofeedback training techniques have yet to be validated by randomized, double-blind, controlled studies, a view which even some supporters of alpha neurofeedback training have also expressed.


2.3. Uses Sports

Training of accuracy in top-level sports, especially in target-based sports e.g. Golf


3. History and application

In 1924, the German psychiatrist Hans Berger connected a couple of electrodes small round discs of metal to a patients scalp and detected a small current by using a ballistic galvanometer. During the years 1929–1938 he published 14 reports about his studies of EEGs, and much of our modern knowledge of the subject, especially in the middle frequencies, is due to his research. Berger analyzed EEGs qualitatively, but in 1932 G. Dietsch applied Fourier analysis to seven records of EEG and became the first researcher of what later is called QEEG quantitative EEG.

Later, Joe Kamiya popularized neurofeedback in the 1960s when an article about the alpha brain wave experiments he had been conducting was published in Psychology Today in 1968. Kamiyas experiment had two parts. In the first part, a subject was asked to keep his eyes closed and when a tone sounded to say whether he thought he was in alpha. He was then told whether he was correct or wrong. Initially the subject would get about fifty percent correct, but some subjects would eventually develop the ability to better distinguish between states. In the second part of the study, subjects were asked to go into alpha when a bell rang once and not go into the state when the bell rang twice. Once again some subjects were able to enter the state on command. Alpha states were connected with relaxation, and alpha training had the possibility to alleviate stress and stress-related conditions.

Despite these claims, the universal correlation of high alpha density to a subjective experience of calm cannot be assumed. Alpha states do not seem to have the universal stress-alleviating power indicated by early observations. At one point, Martin Orne and others challenged the claim that alpha biofeedback actually involved the training of an individual to voluntarily regulate brainwave activity. James Hardt and Joe Kamiya, then at UC San Franciscos Langley Porter Neuropsychiatric Institute published a paper that supported biofeedback.

In the late sixties and early seventies, Barbara Brown, one of the most effective popularizers of Biofeedback, wrote several books on biofeedback, making the public much more aware of the technology. The books included New Mind New Body, with a foreword from Hugh Downs, and Stress and the Art of Biofeedback. Brown took a creative approach to neurofeedback, linking brainwave self-regulation to a switching relay which turned on an electric train.

The work of Barry Sterman, Joel F. Lubar and others has been relevant on the study of beta training, involving the role of sensorimotor rhythmic EEG activity. This training has been used in the treatment of epilepsy, attention deficit disorder and hyperactive disorder. The sensorimotor rhythm SMR is rhythmic activity between 12 and 16 hertz that can be recorded from an area near the sensorimotor cortex. SMR is found in waking states and is very similar if not identical to the sleep spindles that are recorded in the second stage of sleep.

For example, Sterman has shown that both monkeys and cats who had undergone SMR training had elevated thresholds for the convulsant chemical monomethylhydrazine. These studies indicate that SMR may be associated with an inhibitory process in the motor system.

Within the last 5–10 years, neurofeedback has taken a new approach in taking a look at deep states. Alpha-theta training has been tried with patients with alcoholism, other addictions as well as anxiety. This low frequency training differs greatly from the high frequency beta and SMR training that has been practiced for over thirty years and is reminiscent of the original alpha training of Elmer Green and Joe Kamiya. Beta and SMR training can be considered a more directly physiological approach, strengthening sensorimotor inhibition in the cortex and inhibiting alpha patterns, which slow metabolism. Alpha-theta training, however, derives from the psychotherapeutic model and involves accessing of painful or repressed memories through the alpha-theta state. The alpha-theta state is a term that comes from the representation on the EEG.

A recent development in the field is a conceptual approach called the Coordinated Allocation of Resource Model CAR of brain functioning which states that specific cognitive abilities are a function of specific electrophysiological variables which can overlap across different cognitive tasks. The activation database guided EEG biofeedback approach initially involves evaluating the subject on a number of academically relevant cognitive tasks and compares the subjects values on the QEEG measures to a normative database, in particular on the variables that are related to success at that task.


3.1. History and application Organizations

The Association for Applied Psychophysiology and Biofeedback AAPB is a non-profit scientific and professional society for biofeedback and neurofeedback. The International Society for Neurofeedback and Research ISNR is a non-profit scientific and professional society for neurofeedback. The Biofeedback Federation of Europe BFE sponsors international education, training, and research activities in biofeedback and neurofeedback.


3.2. History and application Certification

The Biofeedback Certification International Alliance formerly the Biofeedback Certification Institute of America is a non-profit organization that is a member of the Institute for Credentialing Excellence ICE. BCIA certifies individuals who meet education and training standards in biofeedback and neurofeedback and progressively recertifies those who satisfy continuing education requirements. BCIA offers biofeedback certification, neurofeedback also called EEG biofeedback certification, and pelvic muscle dysfunction biofeedback certification. BCIA certification has been endorsed by the Mayo Clinic, the Association for Applied Psychophysiology and Biofeedback AAPB, the International Society for Neurofeedback and Research ISNR, and the Washington State Legislature.

The BCIA didactic education requirement includes a 36-hour course from a regionally accredited academic institution or a BCIA-approved training program that covers the complete Neurofeedback Blueprint of Knowledge and study of human anatomy and physiology. The Neurofeedback Blueprint of Knowledge areas include: I. Orientation to Neurofeedback, II. Basic Neurophysiology and Neuroanatomy, III. Instrumentation and Electronics, IV. Research, V. Psychopharmalogical Considerations, VI. Treatment Planning, and VII. Professional Conduct.

Applicants may demonstrate their knowledge of human anatomy and physiology by completing a course in biological psychology, human anatomy, human biology, human physiology, or neuroscience provided by a regionally accredited academic institution or a BCIA-approved training program or by successfully completing an Anatomy and Physiology exam covering the organization of the human body and its systems.

Applicants must also document practical skills training that includes 25 contact hours supervised by a BCIA-approved mentor designed to teach them how to apply clinical biofeedback skills through self-regulation training, 100 patient/client sessions, and case conference presentations. Distance learning allows applicants to complete didactic course work over the internet. Distance mentoring trains candidates from their residence or office. They must recertify every 4 years, complete 55 hours of continuing education 30 hours for Senior Fellows during each review period or complete the written exam, and attest that their license/credential or their supervisors license/credential has not been suspended, investigated, or revoked.


4. Criticism on the medical application

In 2015, a scientific article was published that suggested the benefits of clinical EEG neurofeedback to result from placebo effects. Today, the effectiveness of the medical treatment of psychiatric disorders using EEG neurofeedback remains controversial.

Although over 3.000 scientific articles have been published on EEG neurofeedback since 1968, EEG neurofeedback has failed to gain acceptance among the medical mainstream. The United States Food and Drug Administration FDA allows neurofeedback for relaxation training, but has not approved neurofeedback for any other purpose.


5. Neuroplasticity

In 2010, a study provided some evidence of neuroplastic changes occurring after brainwave training. Half an hour of voluntary control of brain rhythms led in this study to a lasting shift in cortical excitability and intracortical function. The authors observed that the cortical response to transcranial magnetic stimulation TMS was significantly enhanced after neurofeedback, persisted for at least 20 minutes, and was correlated with an EEG time-course indicative of activity-dependent plasticity.

  • Decoded Neurofeedback DecNef is the process of inducing knowledge in a subject by increasing neural activation in predetermined regions in the brain
  • individuals who meet education and training standards in biofeedback and neurofeedback and progressively recertifies those who satisfy continuing education
  • Neurofeedback NFB also called neurotherapy, neurobiofeedback or EEG biofeedback EEGBF is a therapy technique that presents the user with real - time
  • medicine. Many members are practitioners or researchers of biofeedback and neurofeedback Their interests include the non - medication treatment of developmental
  • analogous to the human mu rhythm. Neurofeedback training can be used to gain control over the SMR activity. Neurofeedback practitioners believe that this
  • Neuromodulation, Neurofeedback and Applied Neuroscience was a scientific journal for the study and application of neuromodulation and neurofeedback On December
  • Audacity audio editor Audio visual entrainment Comparison of neurofeedback software Neurofeedback Virtual Light Sound Machine Psychologist simulates visual
  • Bedford, Ohio and is a past president of the International Society for Neurofeedback Research ISNR He also has served the Association for Applied Psychophysiology
  • Certification Institution of America BCIA and the International Society for Neurofeedback and Research ISNR approved the following definition of biofeedback
  • for his work in mythology, and for being a pioneer in the field of neurofeedback Larsen is a graduate of Columbia University, B.A., M.A. and Union
  • Hemoencephalography HEG is a relatively new neurofeedback technique within the field of neurotherapy. Neurofeedback a specific form of biofeedback, is based
  • Barbara Brown scientist researcher and popularizer of biofeedback and neurofeedback Barbara Brown figure skater Barbara Elaine Ruth Brown 1929 - 2019
  • neurofeedback The International Society for Neurofeedback and Research ISNR is a non - profit scientific and professional society for neurofeedback