by Tedi Asher
figures by Brad Wierbowski
What if, instead of taking a pill or talking with your therapist, you could train your brain to be healthier through a video game? Brain training is becoming increasingly feasible using a technique called neurofeedback, which allows individuals to change the way their brains function by responding to personalized feedback about how their own brains work naturally. This is one approach being used to treat those struggling with neurological or psychiatric disorders, such as children diagnosed with attention deficit hyperactivity disorder (ADHD), who have difficulty focusing their attention. We now know that a focused brain acts differently than an unfocused brain. Researchers and clinicians are currently investigating whether we can use neurofeedback training to help children induce a “focused” brain state.
How does neurofeedback work?
An important premise of neurofeedback training is that our brains have the ability to change the way they function. Research over the last several decades indicates that our brains are, in fact, malleable. The question, then, is how to influence brain function to stimulate this change.
The trick to getting our brains to act in desirable ways is to leverage the behavior-changing power of operant conditioning. During an operant conditioning procedure, an individual modifies its behavior based on learned consequences. For example, if a dog receives a treat each time he sits on command, then he will eventually learn that sitting leads to treats (which he wants very much), and the likelihood increases that he will sit on command in the future.
Humans learn in very similar ways. And, as it turns out, we can use operant conditioning to teach ourselves to promote healthier brain functioning. In neurofeedback training, this is accomplished by pairing information about one’s brain activity with desirable or undesirable outcomes, often in a virtual context, such as a video game. When we generate desirable brain activity, we are rewarded, say by gaining points in the brain-training game; when we generate unwanted activity, we may lose points. Repeated exposure to such gains and losses can bring about long-lasting changes in brain activity.
How can we detect brain activity?
There are two widely used, non-invasive techniques that detect different aspects of brain functioning: electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) (Figure 1).
EEG is a common method by which we can detect brain activity in the cortex, which is the outermost layer of the brain. Activated neurons possess an electrical charge. When groups of neurons are activated at the same time in the same place in the cortex, as occurs during various behavioral or cognitive tasks, the cumulative electrical energy can be detected by electrodes placed on the scalp during an EEG test. These electrical signals are referred to as brain oscillations, or waves. The multiple different kinds of brain waves each represent a different aspect of brain function.
By contrast, fMRI detects patterns in blood flow to cortical areas as well as those lying beneath the cortex. Areas that receive more blood flow are considered to be more active. Because different brain regions have different functions, we can make inferences about how the brain works by observing which areas receive blood flow during various tasks.
Either of these approaches can be used to deliver information about brain function to an individual undergoing neurofeedback training. fMRI relates which parts of our brains are active, while EEG reveals the nature of the observed activity.
How can neurofeedback be used to treat disease?
Many different psychiatric disorders are characterized by specific patterns of brain activity, leading researchers and clinicians to investigate whether EEG and fMRI-based neurofeedback training can be used to treat such disorders by altering pathological aspects of brain function. To examine how this might work, let’s return to how neurofeedback training might be used to help children with ADHD increase their focus.
Children diagnosed with ADHD tend to have an excess of low frequency (theta) brain waves and fewer high frequency (beta) waves in certain regions of the cortex, as detected by EEG (Figure 2). Therefore, neurofeedback training for children with ADHD attempts to minimize the occurrence of lower frequency theta waves and enhance the occurrence of higher frequency beta waves. This is done by rewarding the children each time they demonstrate beta waves during neurofeedback training. Through the process of operant conditioning, the children intuitively learn to promote beta waves and suppress theta waves (Figure 2).
Interestingly, studies have shown that neurofeedback training as a therapy for ADHD may be even more effective than the standard medication (Methylphenidate/Ritalin) used to treat this disorder. This was shown in 2002 by Vincent Monastra and colleagues at the FPI Attention Disorders Clinic in New York, who studied 100 children diagnosed with ADHD (Figure 3). All of the kids were prescribed Ritalin, while approximately half of them also participated in neurofeedback training. The children who participated in neurofeedback training in addition to taking Ritalin showed greater improvements in focus and a significant decrease in hyperactive/impulsive behavior. Furthermore, only those children who underwent neurofeedback training showed promising changes in patterns of brain activity associated with increased focus. Even more striking was that these behavioral and neurological improvements persisted even after medication was stopped. This was not true of those children who took Ritalin but did not participate in the neurofeedback treatment, suggesting that brain training has the potential to induce long-term changes in how one’s brain works.
Why aren’t neurofeedback treatments more mainstream?
As promising as many of the studies pertaining to the neurofeedback therapy are, they bear some considerable caveats. One example is the fact that many clinical trials testing the efficacy of neurofeedback training do not randomize the subjects into treatment groups, since it is considered more ethical to let patients choose which treatment group they prefer. As a result, it is possible that the treatment groups may not be composed of comparable subject populations at the outset of the experiment, which in turn may skew the results of the study.
In truth, there is much that is yet to be learned about the potential of neurofeedback to be used for therapeutic purposes. In addition to increasing the number of truly randomized controlled clinical trials, it seems that the trickiest part of establishing neurofeedback as an effective therapeutic approach to treating psychiatric disorders is to know exactly what our biological measurements are telling us. What exactly do patterns in EEG and fMRI readouts mean about how our brains work? More basic research into the meaning of neurofeedback signals is needed to fully answer this question.
For now, the gold standard for treating psychiatric conditions remains medication and various forms of therapy. Nevertheless, studies such as that performed by Monastra and colleagues suggest that there may be a bright future for neurofeedback training in the treatment of certain psychiatric disorders. Such studies have inspired commercial efforts to develop portable and affordable neurofeedback devices that can be used in the comfort of one’s own home. Chances are good that very soon you will be able to ask your doctor about this alternative treatment!
Tedi Asher received her PhD from the Biological and Biomedical Sciences Program at Harvard Medical School in 2016 where she studied neurobiology.
For more information:
For information about nerofeedback in depression: http://commonhealth.legacy.wbur.org/2011/07/neurofeedback-depression
A research study about neurofeedback: http://pediatrics.aappublications.org/content/133/3/483.long
Basic information about neurofeedback: https://www.psychologytoday.com/blog/the-resilient-brain/201410/what-is-neurofeedback
Cover image modified from Mr. Pipo EEG © Nevit Dilmen [CC BY-SA 3.0], via Wikimedia Commons
Mostly people think that playing video games is perhaps the best brain training, but such games are mostly paid. You cannot increase the efficiency in your brain training by meditating. However I think brain training could be totally free because substitution in your diet and a way to reduce your stress, some physical exercise and simple brain exercise that could be reading or brain teasers can be found profoundly helpful for mental health. Taking care of these routines could prevent you from later psychiatric treatments.
This does not seem like a well thought-out comment. Clearly there is absolutely no understanding of the article or of this therapy.
According to a survey there are roundabout 450 million people from are all over the world that are having mental disorders. And sadly it is predicted to be more in 2020. That’s why the future of psychiatric treatments seems very bright, fortunately and unfortunately.
Wow, it’s funny how right your comment was, three years before the pandemic.
Our group has shown that surface neurofeedback training combined with brief, daily LED-based, near infrared light stimulation of the cortex can significantly alter memory and motor performance. Adding this to regular exercise and diet change offers a low cost and actionable way to impedenandbreverse age related cognitive and physical decline. Clinical trials are being conducted now involving home based use of neurotraining and Photobiomodulation technology.
The article said:” Interestingly, studies have shown that neurofeedback training as a therapy for ADHD may be even more effective than the standard medication (Methylphenidate/Ritalin) used to treat this disorder. This was shown in 2002 by Vincent Monastra & colleagues.
The ADHD Assessment software suite was designed by a team of clinicians, as led by Dr. Vince Monastra and Dr. Joel Lubar, with the goal to create a fast and simple assessment method for ADHD in adults and children as young as 5 years old. The design and methodology of this software suite is based heavily on the hallmark published study by Monastra, Lubar et al. 1999.
https://www.bfe.org/buy/adhd-assessment-suite-p-294.html
The software consists of age-appropriate assessment scripts, during which the client performs a reading, listening, drawing and/or working-memory task. Statistics are monitored throughout the assessment from a single EEG-Z sensor and the results are arranged in an excel report. The excel report includes notes and norm values for easy comparison and interpretation. A second EEG sensor is also used during the recording, however it is co-opted as an electrooculogram (EOG) sensor. (This second sensor is useful but not necessary for assessment)
What about OCD ?
WHAT ABOUT ASPERGER ?
REGARDS
ENRICO
I THINK YOU ARE OUT OF LUCK
It is indeed used to treat OCD and Autism as well.
lovely post. Interesting to read. Its good that we have non-invasive techniques that detect different aspects of brain activity and functioning: electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) . The science is an area, that there are so many people in-working,testing,researching,trying, summarizing etc. Still a big amount of people with mental health problems. I do hope and wish every year i better in terms of studies and researches carried out with the medication to treat different problems that people suffer in today’s world. I want to thank every single who are involved and helping out! Your work is much appreciated ! We badly need you.
Better knowledge of brain functioning, the pathologies that affect it, and the development of more precise new technologies can shorten the gap between cutting-edge scientific knowledge and day-to-day clinical practice. Congratulations!
I hope one day children will be tested for ‘at risk’ psyche features at a young age so that help for them will be routinely available. Not just for the advantaged, but for all children in our nation. Maybe this will be an answer to much of the suicide/ violence/ underachievement we see. We tend instead to wait so long until real problems arise. This should be part of everybody’s routine work up.
Does neurofeedback works for Autism?
Yes. At least it did with mine. About 6 months back I did some Youtube videos about me living with my various Psychological issues – ADHD, OCD, Depression, Autism (Asperger’s). One of those videos I go over how NFB impacted each of those issues. Beldan4 – Youtube just look for the one that says Neurofeedback Therapy
Anyway, in short. Before NFB I was about as close to non-functional as you could get living on my own and losing weight because I couldn’t be bothered to go to the store sometimes. Last June I graduated from Eastern Washington University with a 3.7 B.S. in psychology. I would love to go on and get a PhD in clinical psych, with a focus on NFB (QEEG) related tools to assist in treatments. The trouble is, such programs are very hard to find, and those that I have found are simply terminal master’s programs. I wish I could find a school (and the funding) to go to a school that is open minded enough to let me pursue a clinical psych program that was more interdisciplinary. I hate having to decide between spending 5+ years studying things I don’t agree with to qualify professionally to help people vs studying things I am really interested in only to be stuck doing teaching and research.
Hi Daniel,
My son (age 6) just began NF and would love to ask you a few questions about your journey with NF. If you can contact me so we can connect, that would be awesome 🙂
Thanks for sharing your story!
Hi Daniel,
Can you share with me, how NFB training helped you, and if it persisted? Sounds like it did.. I would appreciate your thoughts and experience. you can email me at brycefbarnes@gmail.com. thanks. Bryce
I certainly may have my facts wrong and I’ve heard the field of psychology is often against what they might find threatening but….. If you read this atricle from Psychology today and it’s may cited references it would lead you to the conclusion that biofeedback is nothing more than Placebo Foo. https://www.psychologytoday.com/us/blog/brain-myths/201302/read-paying-100s-neurofeedback-therapy
I would love to hear some feedback about the skeptical article in Psychology Today referenced above.
Scam, placebo or do it help?
Thanks!
Read my comments below
Psychology Today is not a peer-reviewed journal, and nothing in there should be taken seriously unless further research by proper sources is done.
Hi
I have tried neurofeedback training 2years ago for 12 sessions. They told me I have high wave of beta up to around 30 meaning that I had quite an fast moving active wave to prevents information coming through. That meant it was also hard to keep information. At the end of the training, I felt my memory had improved but not for long and not much else improved either. So I would say for me it didn’t work and I wasted a lot of money. I have been advised to go on a ten day meditation course instead.
Hana my understanding is a minimum of 20 sessions is recommended. Anything less than that the improvements don’t last.
Hana, I am exploring NFB training myself. I have found a doctor i trust very much who explained that the process should take 30-40 sessions.. Not suggesting I know whether this would help you or not.. but 12 sessions over 2 years, is so spread out.. and perhaps might be completely ineffective. Most treatments for severe conditions require 30 sessions over 12-15 weeks.. very focused, bi-weekly. Perhaps you might try again? The alternatives is not great… drugs can be very damaging themselves.
My son is mid-way thru a 30-40 treatment NF program for ADHD. He is doing 4-6 sessions a week because our schedule allows it and the doc recommends that frequency of sessions to optimize outcomes. At half way thru we are seeing amazing results in our son. Everything positive, no negatives. Won’t know the difference for his exec function until school is back in and by then he’ll be finished his NF. I’m really optimistic.
I would LOVE to hear about your results . My daughter has started just recently.
Please share what you did and results.
Please share how this worked out for your child.
Does Neurofeedback help those who are special needs, or low IQ to increase their IQs?
My reading suggest that it can by increasing and decreasing various brain waves so they work better. I’ve talked to one psychologist who has treated children with cerebral palsy, read about others, and read about some treating autistic children. Experience and the type of neurofeedback software matter, LORETA being one that is one of the best is my impression. Success rates reported on the internet are only 80 – 90%, but the number of visits can vary from the typical recommended of 30 – 40 therapies to a 100 or more for very complex issues, e.g., severe schizophrenia. There are reports on the internet of individual situations or small studies of people increasing their IQs by 10 to 20 points, but clearly every person’s situation is different.
“Experience and the type of neurofeedback software matter, LORETA being one that is one of the best is my impression..”
Hi Charlie, I am researching and would like to get more information from you stated above. Would you please email me your email address to tim at timothytang dot com. Thanks.
Hi I have done about 60 sessions of Neurofeedback ( twice a week). I saw the first change in my behaviour after around the 20th session. I have had severe anger outbursts and difficulty with self regulation, due to untreated childhood trauma and depression after my two children were born 6,5 and 4,5 year ago.
In the last six years, I have tried group therapy for 3 years and individual psychotherapy for last 2 years. I am still having personal psychotherapy once a month. While all these therapies have helped me I a positive I would not be where I am today without NFB, this technology was able to change my automatic reactions and gave resilience to deal with stressful situations, make decisions, establish relationship boundaries. I knew all that in theory but just could not bring myself to make these changes without NFB.
Has anyone used an at home neurofeedback device? Did it work? What is the cost?
Would like to stay informed on this topic.
It’s so cool that we can teach ourselves to have a healthier brain function with something like a videogame. How long does it usually take for your brain to change its activity? Either way, this sounds like a really good way to help with a lot of disorders.
I am considering neuro-feedback for my 19 year old son. He was diagnosed with ADHD, dyslexia and dysgraphia at age 7. He has been on a stimulant medicine for 13 years, until recently when he experienced significant increase in heart rate. Therefore, we are searching for alternative therapies so that he can continue as a freshman at the University of Chicago. Any thoughts you can provide on the situation would be very much appreciated.
I’m a retired psychotherapist and ADHD coach. I cannot offer you a solution for your son’s difficulties, but here’s a bit of encouragement: In only a few years (up to mid-20’s), your son’s brain will be fully developed, and that’s a turning point. Things may become easier. It helps to learn some good management strategies to help things along. Also, Dr. Vince Monastra, mentioned above, has had good results in using neurofeedback in diagnosing and treating ADHD. I had some contact with him some years ago, and he’s an extremely nice guy, and very knowledgeable. I don’t know what he is doing now, but his work is excellent. So yes – neurofeedback, if you can find a competent practitioner, might be worth a try. Don’t give up – if your son seems a bit behind the curve right now, he’ll catch up in later years, especially if he’s intelligent enough to get into the Univ. of Chicago (and people with ADHD are among the smartest people I’ve ever encountered). Hang in there; nurture your sense of humor – it’ll be o.k.
How to take care of Mental Health during Covid-19.
https://www.hupcfl.com/
During this tough times Covid-19, Every individual has to focus on diet and little bit of exercises to come out of depression and Anxiety.
https://www.hupcfl.com/
Love this article!! I blindly believe in the effectiveness of games about the brain for a million reasons. I found some of the best ones via my brain games’ website. They have some great tried and tested recommendations regarding brain health for people of all ages.
Thank you for this great article! I am wondering, if you have any advice on which professional neurofeedback system is the most advanced currently?
The content was well explained and described. This article is a “must read” article. Great work, thank you for sharing this.
Wow! this article is very great. I could conclude that this blog is indeed informative and it is very much helpful to our readers. Worth to read and share.
My daughter wants to try NF after multiple hospitalizations, psychotropic medications, and stress that no amount of medication seems to work for her. I am having a hard time finding the right answer for her because NF could be expensive if government health programs don’t cover them. Is this treatment only for rich people?
I think neurotech wearables for brain training will become just as popular in the coming decade for improving mental health as fitness wearables have become in the last decade for improving physical health. I’ve found that neurofeedback training works better than anything else I’ve tried for reducing my stress and anxiety.