![Neurofeedback Process Diagram](https://upload.wikimedia.org/wikipedia/commons/0/0f/Neurofeedback_Process_Diagram.png)
Neurofeedback (NFB), also called neurotherapy, is a type of
biofeedback
Biofeedback is the process of gaining greater awareness of many physiology, physiological functions of one's own body by using Electronics, electronic or other instruments, and with a goal of being able to Manipulation (psychology), manipulate t ...
that presents real-time feedback from brain activity in order to
reinforce
In behavioral psychology, reinforcement is a consequence applied that will strengthen an organism's future behavior whenever that behavior is preceded by a specific antecedent stimulus. This strengthening effect may be measured as a higher freq ...
healthy brain function through
operant conditioning
Operant conditioning, also called instrumental conditioning, is a learning process where behaviors are modified through the association of stimuli with reinforcement or punishment. In it, operants—behaviors that affect one's environment—are c ...
. Typically, electrical activity from the brain is collected via sensors placed on the scalp using
electroencephalography
Electroencephalography (EEG) is a method to record an electrogram of the spontaneous electrical activity of the brain. The biosignals detected by EEG have been shown to represent the postsynaptic potentials of pyramidal neurons in the neocortex ...
(EEG), with feedback presented using
video displays or sound. The effectiveness of neurofeedback is disputed. While studies and reviews have often found neurofeedback treatment to be beneficial for the patient, it has yet to be shown these effects are directly caused by the neurofeedback technique applied. Placebo-controlled trials have often found the control group to show the same level of improvement as the group receiving actual neurofeedback treatment, which suggests these improvements may be caused by secondary effects instead.
Despite this controversy and never having gaining prominence in the medical mainstream, it has been practiced for over four decades. NFB is relatively non-invasive and is administered as a long-term treatment option, typically taking a month to complete. A 30-minute to 60-minute neurofeedback session is typical.
Several neurofeedback protocols exist, with potential additional benefit from use of
quantitative electroencephalography
Quantitative electroencephalography (qEEG or QEEG) is a field concerned with the numerical analysis of electroencephalography (EEG) data and associated behavioral correlates.
Details
Techniques used in digital signal analysis are extended to t ...
(QEEG) or
functional magnetic resonance imaging
Functional magnetic resonance imaging or functional MRI (fMRI) measures brain activity by detecting changes associated with blood flow. This technique relies on the fact that cerebral blood flow and neuronal activation are coupled. When an area o ...
(fMRI) to localize and personalize treatment.
Related technologies include
functional near-infrared spectroscopy-mediated (fNIRS) neurofeedback,
hemoencephalography biofeedback (HEG) and fMRI biofeedback.
History
In 1924, the German psychiatrist
Hans Berger
Hans Berger (21 May 1873 – 1 June 1941) was a German psychiatrist. He is best known as the inventor of electroencephalography (EEG) in 1924, which is a method used for recording the electrical activity of the brain, commonly described in terms ...
connected a couple of electrodes (small round discs of metal) to a patient's scalp and detected a small current by using a ballistic
galvanometer
A galvanometer is an electromechanical measuring instrument for electric current. Early galvanometers were uncalibrated, but improved versions, called ammeters, were calibrated and could measure the flow of current more precisely.
A galvanom ...
. 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
In mathematics, Fourier analysis () is the study of the way general functions may be represented or approximated by sums of simpler trigonometric functions. Fourier analysis grew from the study of Fourier series, and is named after Josep ...
to seven records of EEG and became the first researcher of what later is called QEEG (quantitative EEG).
The first study to demonstrate neurofeedback was reported by Joe Kamiya in 1962.
Kamiya's 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
Alpha (uppercase , lowercase ; grc, ἄλφα, ''álpha'', or ell, άλφα, álfa) is the first letter of the Greek alphabet. In the system of Greek numerals, it has a value of one. Alpha is derived from the Phoenician letter aleph , whic ...
. 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.
Many could then produce alpha and non-alpha states at will. In the second part of the study, a tone was sounded whenever alpha was present, and subjects were asked to increase the percentage time the tone was on. Most participants were able to increase their percent time spent in alpha within about four training sessions.
Maintaining the alpha state was found to be associated with relaxation, a sense of "letting go", and pleasant affect.
High alpha amplitude had been seen in advanced meditators,
combined with an emerging counter-cultural interest in altered states of consciousness, led to significant public interest in alpha training as an alternative to psychedelic drugs. Several optimistic studies replicated Kamiya's findings and suggested alpha training could be useful for treating stress and anxiety.
However, other studies found that alpha was not reliably associated with calm and pleasant mental states, while eyes-closed alpha never increased above the resting baseline. Hardt and Kamiya (1976) argued that the replication failures were an artifact of an incorrect method of measuring alpha,
and future studies continued to demonstrate learning of alpha based on feedback.
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
Hugh Malcolm Downs (February 14, 1921July 1, 2020) was an American radio and television broadcaster, announcer and programmer; television host; news anchor; TV producer; author; game show host; talk show sidekick; and music composer. A regular t ...
, 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.
In the 2000s, neurofeedback took 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
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
.
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 subject's values on the QEEG measures to a normative database, in particular on the variables that are related to success at that task.
Organizations
The Society of Applied Neuroscience(SAN) is an EU-based nonprofit membership organization for the advancement of neuroscientific knowledge and development of innovative applications for optimizing brain functioning (such as neurofeedback with EEG, fMRI, NIRS)
The International Society for Neurofeedback & Research(ISNR) is a membership organization aimed at supporting scientific research in applied neurosciences, promoting education in the field of neurofeedback.
The Foundation for Neurofeedback and Neuromodulation Researchis a non-profit organization that, through donations, provides grants for student research. The FNNR also issues awards for professionals and publishes books related to neurofeedback.
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.
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
The Institute for Credentialing Excellence (ICE) is one of the two main U.S. organizations that accredit personnel certifications or certificates. In November 2009 the ICE formally changed its name from the National Organization for Competency Ass ...
(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. Applicants must also pass a written exam, complete 25 hours of mentoring, 10 case reviews, perform 100 hours of client sessions, and conduct 10 hours of personal NF. The Neurofeedback Blueprint of Knowledge areas include: I. Orientation to Neurofeedback, II. Basic Neurophysiology and Neuroanatomy, III. Instrumentation and Electronics, IV. Research, V. Psychopharmacological 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 coursework over the internet. Distance mentoring trains candidates from their residence or office. They must recertify every four 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 supervisor's license/credential) has not been suspended, investigated, or revoked.
Neuroplasticity
In 2010, a study provided some evidence of
neuroplastic
Neuroplasticity, also known as neural plasticity, or brain plasticity, is the ability of Neural circuit, neural networks in the brain to change through growth and reorganization. It is when the brain is rewired to function in some way that diffe ...
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
Transcranial magnetic stimulation (TMS) is a noninvasive form of brain stimulation in which a changing magnetic field is used to induce an electric current at a specific area of the brain through electromagnetic induction. An electric pulse gener ...
(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 Activity-dependent plasticity is a form of functional and structural neuroplasticity that arises from the use of cognitive functions and personal experience; hence, it is the biological basis for learning and the formation of new memories. Activity- ...
Criticism of neurofeedback as a medical treatment
There is significant controversy about the effectiveness of treating psychiatric disorders using EEG neurofeedback. While studies and meta-analyses often note apparent positive effects, it is yet to be shown conclusively that this effect is directly related to the neurofeedback, and not caused by secondary or placebo effects
Additionally, meta-analyses and reviews tend to emphasize that different neurofeedback protocols should be considered entirely different treatment methods, further increasing the difficulty of drawing conclusions about neurofeedback in general.
A double-blinded, sham-controlled study of neurofeedback as a treatment for insomnia found that neurofeedback did not beat placebo.
Reviews into the effectiveness of neurofeedback for ADHD have found neurofeedback to have durable effects following treatment, although double-blind placebo-controlled studies show the control group will experience very similar improvements to the treatment group, suggesting improvements were not caused by a specific treatment method, but by secondary effects not directly related to neurofeedback.
Results are inconclusive about whether neurofeedback is an effective treatment for depression,
post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on ...
(PTSD), or developmental trauma.
Similarly, systematic reviews about its effectiveness as a treatment for traumatic brain injuries or strokes have not been able to produce conclusive results.
More conclusive evidence exists for its effectiveness as a treatment for epilepsy and seizure disorders. Patients who had been unable to control their condition with medication were the focus of numerous studies, and meta-analysis has yielded generally promising results.
No neurofeedback device has yet been approved by FDA for treatment of ADHD. In 2019, the FDA permitted marketing of the first medical device (external Trigeminal Nerve Stimulation or eTNS) for treatment of ADHD.
eTNS is a nerve stimulation and not a neurofeedback device.
Non-medical applications
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
Musicality (''music -al -ity'') is "sensitivity to, knowledge of, or talent for music" or "the quality or state of being musical", and is used to refer to specific if vaguely defined qualities in pieces and/or genres of music, such as melodiousnes ...
, communication, and technique. Historically, alpha-theta training, a form of neurofeedback, was created to assist creativity by inducing
hypnagogia
Hypnagogia is the experience of the transitional state from wakefulness to sleep: the ''hypnagogic'' state of consciousness, during the onset of sleep. Its opposite state is described as the transitional state from sleep into wakefulness. Mental ...
, 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
Biofeedback is the process of gaining greater awareness of many physiology, physiological functions of one's own body by using Electronics, electronic or other instruments, and with a goal of being able to Manipulation (psychology), manipulate t ...
, 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
''Flow State'' is the debut studio album by Australian singer-songwriter Tash Sultana, released on 31 August 2018, through their own record label, Lonely Lands Records (distributed by Sony Music Australia in Australia, and Mom + Pop elsewher ...
in actors, possibly due to greater immersion while performing.
Neurofeedback has been used to improve athletic psychomotor and self-regulation ability. Sensorimotor rhythm neurofeedback training of accuracy has been used in top-level sports, especially in target-based sports (e.g. golf).
Neurofeedback training of shooting accuracy in elite football has been employed by the German company neuro11 at
Liverpool FC
Liverpool Football Club is a professional football club based in Liverpool, England. The club competes in the Premier League, the top tier of English football. Founded in 1892, the club joined the Football League the following year and has p ...
since the summer of 2021.
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.
See also
*
Brainwave synchronization
Brainwave entrainment, also referred to as brainwave synchronization or neural entrainment, refers to the observation that brainwaves (large-scale electrical oscillations in the brain) will naturally synchronize to the rhythm of periodic externa ...
*
Decoded neurofeedback
*
Comparison of neurofeedback software
Within the field of neurotechnology, Neurofeedback (NFB), also called neurotherapy, neurobiofeedback or EEG biofeedback (EEGBF) is a therapy technique which presents the user with real-time information about activity within their brain, as measured ...
*
Mind machine
A mind machine (aka ''brain machine'' or ''light and sound machine'') uses pulsing rhythmic sound, flashing light, or a combination of these to alter the frequency of the user's brainwaves. Mind machines can induce deep states of relaxation, conc ...
References
Further reading
*
*
External links
BBC article about neurofeedback improving the performance of musicians*
{{Authority control
Devices to alter consciousness
Medical tests
Electroencephalography
Evoked potentials
Neurotechnology
Behaviorism
Attention deficit hyperactivity disorder management
Alternative medical systems
Naturopathy
Neuropsychology