Frequently asked
Questions
A Meta-analysis of 15 studies with 1194 subjects (5 studies in Germany, 5 in the USA, 2 in Switzerland, 1 in Canada, 1 in China, 1 in Russia) has proven NFB to meet the highest level of efficacy (level 5) as a treatment for ADHD. The results of the analysis and findings have been published: Martijn Arns et al (2009) Journal on Integrative Neuroscience, Vol. 7, No 3 (2008) 421-439, Imperial College Press
Level 5 efficacy means that the investigational treatment has been shown to be statistically superior to credible sham therapies, pills, or alternative bona fide treatments in at least two independent research settings. Means and effect sizes are reported wherever possible.
In the NIMH MTA study Jensen et al (2007) showed that early advantages of medication treatment compared with community care and behavior therapy were no longer present at a 3 year follow-up.
The long-term effects of neurofeedback can be considered as a major advantage of this treatment compared with pharmacological treatment (Gani 2008).
Neurofeedback training for Seizure Disorders
There is a professional literature to demonstrate that NFB is efficacious treatment (level 4) for seizure disorders. The following reviews can be researched:
Dr Tan`s review 2009
Dr Sterman`s review 2000
Meta-analysis of EEG biofeedback in treating epilepsy. Clinical EEG Neuroscience. 2009 Jul; 40(3): 173-9. Tan G, Thornby J, Thornby J, Hammond DC, Strehl U, Canady B, Arnemann K, Kaiser DA, Michael E.DeBakey. About one third of patients with epilepsy do not benefit from medicine. Neurofeedback is a viable alternative for these patients.
The therapist decides on appropriate placement of electrodes on the scalp. Brain wave activity is recorded and displayed on a computer screen. (Electrical signals coming from the scalp are transformed into brain waves). Reward and inhibit thresholds are set by the therapist. When the trainee`s brain responds, graphics appear and tones are heard which serve as reinforcement. These rewards are reflected on a computer game. The trainee does not need to understand the process at all in order for it to be effective.
To normalize the EEG (electro-encaphalogram) in cases where it differs from established data for norm groups.
To modify the EEG towards states that are associated with improved functioning.
To improve mental flexibility
To help a client manage symptoms and optimise their performance in areas they have indicated as being important in their lives. The person's entire physiological and psychological state is taken into consideration and procedures that can result in shifts to the appropriate mental state for the tasks at hand are carried out in a logical sequence. Those shifts then become automatic.
A 2009 meta-analysis of neurofeedback involving 1,194 ADHD subjects concluded that neurofeedback meets the highest level of evidence-based support for the treatment of ADHD with a large effect size for inattention and impulsivity and a medium effective size for hyperactivity,
Building on the neuroscience research foundation provided by Maurice Sterman and Joel Lubar, NFB's evidence-base continues to grow with over 50 peer-reviewed journal articles published to date documenting its effectiveness in treating ADHD's core symptoms. In 2009, Arns and colleagues published the most complete meta-analysis to date of NFB's effectiveness in treating the core symptoms of ADHD. This analysis had 1,194 ADHD subjects from 10 controlled studies combined with an additional five prospective pre/post design trials. Their analysis concluded that neurofeedback treatment for ADHD can be considered Efficacious and Specific (Level 5) with a large effect size for inattention and impulsivity and a medium effective size for hyperactivity, the highest rating possible based on the criteria jointly accepted by the International Society of Neurofeedback and Research (ISNR) and the Association for Applied Psychophysiology and Biofeedback (AAPB) that were modeled on those established by the American Psychological Association (APA). Besides SMR training (increase SMR/decrease theta), this meta-analysis included studies using two other NFB protocols; theta/beta (decrease theta/increase beta) and operant conditioning of slow cortical potentials (SCP). As noted by Arns et al, both SCP and SMR neurofeedback have been successful in treating epilepsy likely due to both methods teaching patients how to better regulate cortical excitability while controlled studies comparing SCP and theta/beta NFB show similar effects on the core symptoms of ADHD.
Furthermore in October 2012, PracticeWise, the company that maintains the American Academy of Pediatrics ranking of research support for child and adolescent psychosocial treatments, awarded biofeedback/neurofeedback the highest level of evidence-based support for the treatment of ADHD. Similar to those of ISNR and AAPB, PracticeWise's rigorous ranking system is modeled on APA's 5-level system for grading the strength of the evidence in support of mental health treatments for different diagnoses. PracticeWise has applied its ranking methodology to over 600 randomized controlled trials (RCTs) of psychosocial treatments. All of the biofeedback and neurofeedback RCTs reviewed by PracticeWise in arriving at NFB's highest ranking were coded by three independent raters on variables related to the quality and relevance of the research including the number of RCTs and the resulting effect size of the biofeedback/neurofeedback treatments as compared to the experimental control 18 group conditions. While the bulk of the RCTs reviewed by PracticeWise evaluated the efficacy of EEG neurofeedback, several EMG biofeedback studies for ADHD from the 1980s were also included.
To Summarise:
Recent meta-analyses have shown a high level of agreement in the findings of open clinical trials and randomized controlled ones providing support for the position that a balanced approach to assessing a treatment's evidence-base should take into account both forms of evidence.
The ADHD treatment guidelines developed by the American Academy of Child and Adolescent Psychiatry takes such a balanced approach by rating ADHD treatments based on the preponderance of the evidence as to whether the benefits of the recommended approach clearly exceed the harms of that approach
Using this professional academy's preponderance of the evidence evaluative standard, neurofeedback for the treatment of children and adolescents with ADHD clearly warrants the highest level of recommendation
Neurofeedback is a specialty field within biofeedback, which devotes itself to training control over electro-chemical processes in the human brain (LaVaque, 2003; Evans & Abarbanel, 1999). Neurofeedback uses a feedback electroencephalogram (EEG) to show the trainee current electrical patterns in his or her cortex. Many neurological and medical disorders are accompanied by abnormal patterns of cortical activity. Neurofeedback assessment uses a baseline EEG, and sometimes a multi-site quantitative EEG (QEEG), to identify abnormal patterns (LaVaque, 2003). Clinical training with feedback EEG then enables the individual to modify those patterns, normalizing or optimizing brain activity. Neurofeedback practice is growing rapidly, with the widest acceptance for applications to attention deficit hyperactivity disorder (ADHD), learning disabilities, seizures, depression, acquired brain injuries, substance abuse, and anxiety (Clinical EEG, 2000).
Both biofeedback and neurofeedback are holistic therapies, based on the recognition that changes in the mind and emotions affect the body, and changes in the body also influence the mind and emotions. Biofeedback and neurofeedback emphasize training individuals to self-regulate, gain awareness, increase control over their bodies, brains, and nervous systems, and improve flexibility in physiologic responding. The positive effects of feedback training enhance health, learning and performance. There are biofeedback protocols to address many of the disorders, including anxiety, depression, and chronic pain.
(Kessler, et al, 2001; Burke, 2003; Bassman & Uellendahl, 2003).
The diversity of applications of biofeedback therapies reflects the commonality of underlying factors in many behavioral and psychophysiologic disorders such as emotional and cognitive stressors, the stress response, and failure to maintain healthy homeostasis. That biofeedback therapies are effective with a variety of symptoms is no mystery. Theoretically, any physiological process that responds to stress will respond to stress reduction. Biofeedback therapies incorporate a solid core of behavioral, cognitive, and physiological self-regulation techniques that are used by the patient to alleviate the underlying causes of the disorder. Biofeedback therapies have broad applications because they give the patient skills that facilitate the natural tendency of the body to return to healthy homeostasis as well as skills for enhanced well-being and prevention of disease.