Neurofeedback therapy – Scientifically valid or not?

Fancy having a real-time insight into your brain activity? It is possible with Neurofeedback – a method straight from science fiction film, with which you are capable of changing your brainwaves activity by remaining relaxed and focused.

Writer: Maria Kossowska
Editor: Eva-Katharina Lymberopoulos
Artist: Iona Jenkins

It has been reported that Neurofeedback is a non-invasive, high-tech, and drug-free method for training bioelectrical activity of brainwaves. Sounds like science fiction? Definitely! Yet, it has been widely used for the past 50 years – but how does it work and is it effective? To acquire a signal from the brain, Neurofeedback measures the electrical fields generated by the activity of neurons. The bioelectrical signal of brainwaves is detected by electrodes fastened to the head with conductive adhesive to make a contact against the scalp. Bioelectrical signal is converted into digital data, whilst specialised software, such as BioTrace+, processes it to enable the execution of Neurofeedback therapy.  

Neurofeedback therapy is a learning process based on real-time feedback. During a therapy session, the naturally-occurring frequencies of brainwaves are presented to the patient in real-time through visual and auditory modality – that is the feedback paradigm. Meanwhile, a therapist sets a threshold to control the feedback. Given that, any excess brainwave frequency is trained down. Correspondingly, insufficient brainwave frequency is trained up to increase brain activity. Therefore, the goal is to return the distribution of brainwaves frequencies back to ‘normal’ or typical for the person’s age. The patient is able to train their brainwaves, when achieving a state of relaxation, whilst remaining focused. Each time the patient reaches a normalised frequency of trained brainwave, they are rewarded with a visual and/or auditory stimulus – that is the learning paradigm. However, Neurofeedback is rather controversial, and there is no general consensus about its effectiveness. 

Whether suffering from epilepsy, ADHD, alcoholism or post-traumatic stress disorder in childhood or adulthood, researchers suggest that Neurofeedback therapy is effective in changing neurological functions. Nevertheless, Neurofeedback has not been immune from criticism. A psychologist and scientific sceptic, Barry Beyerstein, wrote that, “alpha wave production can produce a meditative state”, in no more correlation than, “opening an umbrella can make it rain”. Across literature, Neurofeedback therapy does not show consistent and successful outcomes for disorders such as anxiety or dyslexia. However, a Neurofeedback therapy clinician, Dr Tony Steffert, points out that much of the academic research that fails to demonstrate beneficial effects, comes from groups that lack the experience of working with Neurofeedback on a daily basis. The following interview reveals why he believes Neurofeedback therapy is as much an art as it is a science. 

M: Why there is a controversy on the efficiency of Neurofeedback therapy?

T: Neurofeedback is a really complicated topic and people are really complicated; you cannot just read a few papers and copy the methodology, but many researchers seem to think you can. There are many complexities that you don’t see from a paper, so when you spent months doing a study that does not get a good result, what are the chances of you doing a replication study to find out where you went wrong. It’s quicker and easier to conclude that Neurofeedback doesn’t work and move onto a different topic. I have read some papers on the efficiency of Neurofeedback therapy from some really good research groups. It is a wonderful paper, yet the authors make a really odd decision at one point that no clinician would ever do with a real patient. Thus, the authors conclude Neurofeedback doesn’t work. Well, of course this study is not going to have positive outcomes, if you set the threshold 400 times higher than the participants brainwave ever gets. The researchers should come and talk to some Neurofeedback clinicians who are doing Neurofeedback therapy on a daily basis, I’m sure they would all be very happy to help.

M: In one of your workshops you’ve said that Neurofeedback is a form of art, what do you mean by that?

T: Well, for me it is an art and a science. There is obviously a lot of science involved. But for example, setting the training thresholds is where I feel Neurofeedback training as a form of art for the clinician. It is true, you could mathematically calculate means and standard deviations etc., work it out statistically where you should put a threshold to achieve some criteria to train the brainwave in a desired direction. However, because the brain and the EEG are so dynamic, by the time you have done that, all the values would have changed again. In one study we tried this, we did a full brain map assessment, and analysed the EEGs and spent ages calculating means and percentages of time etc., then fixed the training threshold for 15 sessions. It didn’t work at all, and in my opinion, this is because there is so much variability in people from day to day and minute to minute: how well they slept, what they eat, their mood or even the weather. For example, when setting the threshold there is a risk you make the training too difficult, which would demotivate the patient. But if you make it too easy the patient might be happy because he is doing nothing, yet they would not learn either. There isn’t any rational, mathematical or algorithmic way that you could get the threshold right every time. I am not saying that a clinician is the only way, or they will always get the threshold right, but at least a human can consider the patients current mental state.  The art is in all those subtle decisions an experienced therapist makes without even realising it!

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