Neurofeedback, also known as EEG biofeedback, is a painless, non-invasive and non-pharmaceutical procedure. It helps improve emotional, cognitive and behavioural functioning by training patients to increase or inhibit certain brainwaves, to promote optimal brain regulation.
Unlike medications, neurofeedback has no adverse side effects. It provides an all natural and long-term solution as it treats the underlying functional problem rather than simply masking the symptoms.
Neurofeedback has been found effective in treating problems of brain dysregulation such as ADHD, autism spectrum, sleep disorders, seizures and migraines, brain injuries and learning deficits. It has also been used for overall performance enhancement in individuals of all ages.
Neurofeedback has been practiced clinically for over five decades with supporting scientific research dating back to the 1960s.
How does neurofeedback work?
Neurofeedback is based on the principles of operant conditioning wherein individuals are rewarded for activating or suppressing certain brain waves to produce the desired pattern of brain activity.
In each neurofeedback session, electrodes are placed on the scalp to measure the client's brain activity. This real-time feedback allows the individual to voluntarily recondition their brain by influencing the signals on the screens.
In practice, a client typically watches an age appropriate video while the brain wave patterns are recorded in real-time. When the client produces a different and unsought pattern of brain activity, the video is inhibited which signals the client to recondition and optimise their brain activity.
Through repeated practice, the brain becomes tuned into producing the desired brainwave activity that is indicative of a normal brain function. These changes are associated with positive outcomes in physical, emotional and cognitive states.
Standard neurofeedback training involves 30-40 sessions. However, each individual is different which requires a qualified training practitioner to outline an individualised plan to suit the client's specific needs and ensure lasting results. Consistency and commitment to the training program is vital to yield enduring benefits. It is recommended for an individual to attend 2 sessions per week for optimal results.
Benefits of Neurofeedback
FEELING SYMPTOMS OF UNDER-AROUSAL?
Individuals who present themselves with symptoms of underarousal will benefit from neurofeedback training by becoming highly motivated, displaying active thinking, having increased wakefulness, mental clarity and a strong focus.
FEELING SYMPTOMS OF OVER-AROUSAL?
Individuals who present themselves with symptoms of overarousal will benefit from neurofeedback training by having a calmer mind-body state, greater mental alertness, reduced anxiousness and impulsivity.
OTHER KEY BENEFITS
- peak performance
- improved sleep patterns
- interpersonal effectiveness
- increased cognitive and emotional intelligence
- enhanced overall well-being
Courtesy of International Society for Neurofeedback and Research (ISNR)
Research supporting neurofeedback
ADHD & NEUROFEEDBACK
Neurofeedback is considered as one of the primary treatments for ADHD (attention deficit and hyperactivity disorder) and mood disorders. It has been widely used in the U.S. and is starting to gain its recognition as an alternative treatment in Australia. Neurofeedback has been acknowledged as the ‘best practice’ intervention for ADHD by the American Paediatric Association.
Van Doren and colleagues (2018) conducted a meta-analysis and found that the clinical benefits of Neurofeedback on ADHD symptoms were sustained over a 6 to 12-month follow-up period (in which no additional treatments were performed). An intensive course on Neurofeedback was found to have greater and lasting improvements in hyperactivity, impulsivity and inattention compared to non-active treatments such as cognitive training however similar follow-up treatment effects were found compared to active treatments such as medications. These findings offer significant implications on the use of neurofeedback treatment as a beneficial non-pharmacological frontline treatment for ADHD.
A study by Nooner and colleagues (2017) showed that the positive neurocognitive and behavioural changes in ADHD participants was well evident merely within the first 12 clinic-delivered neurofeedback sessions.The treatment effectiveness of neurofeedback within just a short period of time holds promising implications in its efficacy as a long-term and frontline treatment for reducing ADHD symptoms.
In 2014, Steiner and colleagues compared the efficacy of neurofeedback training (NFT), cognitive training (CT) and a control in reducing ADHD symptoms in second and fourth grade children. Baseline and post-intervention measures using parent reports, teacher reports, psychological assessments and classroom observations were gathered. Results suggest that ADHD participants receiving standard NFT (40 sessions) showed significant improvements in measures of attention, executive function, motor and verbal task behaviour relative to its matched CT and control group. Moreover, ADHD medication dosage significantly increased for participants receiving CT or control yet did not change for those in the NFT group. These outcomes support the efficacy of NFT as a treatment intervention for children with attention-deficit hyperactivity disorder (ADHD).
AUTISM & NEUROFEEDBACK
Datko, Pineda and Muller (2018) investigated the effects of neurofeedback training on brain function and behaviour in children (aged 8-17), with high-functioning Autism Spectrum Disorders (ASD) and a matched comparison of typically developing children. Children diagnosed with Autism have been characterised as having deficits in socio-communicative abilities. However, this recent study found that following neurofeedback training, ASD participants showed increase activation in the mirror neuron system during imitation and observation tasks. The human mirror neuron system is a vital component in aspects of human social cognition such as ability to comprehend action, understanding intentions and learning through imitation. Thus, the benefits of improved brain activation in the mirror neuron system following neurofeedback therapy can promote behavioural improvements for children with ASD.
Another study by Friedrich and colleagues (2015) showed that Neurofeedback training (NFT) improves the behaviour, cognition and emotion regulation of children with ASD. Following 16 sessions of a game-based NFT with focus on social interactions, ASD participants were able to regulate their mu-rythm - a vital component in motor, affective and cognitive imagery. Such changes resulted to significant improvements in brain activity, emotional responsiveness and behaviour in everyday life.
BRAIN INJURY & NEUROFEEDBACK
In 2017, Wang, Mantini and Gillebert conducted a systematic review on the effectiveness of real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback therapy in the rehabilitation of motor and cognitive impairments following incidence of a stroke. rt-FMRI neurofeedback works through the principle of operant conditioning by training the brain to regulate its neural activity. Based on these studies, it was found that rt-FMRI neurofeedback training led to learned modulation of brain signals, with associated neural and behavioural changes.
Following stroke, individuals often display abnormalities in brain activity and deficits in brain function. However, there are supporting evidences which show that neurofeedback may stand as an effective technique for stroke rehabilitation. Kober et. al (2017) investigated the effects of upper alpha based neurofeedback training on the brain activity and cognitive functions of stroke survivors. Compared to healthy controls, stroke survivors who received up to ten sessions of neurofeedback training displayed improvements in memory function a result of cortical reorganisation. Through repeated neurofeedback training, stroke survivors learned to regulate and normalise their brain activity. This study provides further evidence that neurofeedback may be used as an alternative cognitive rehabilitation tool as it directly affects the electrical activity of the brain and thus, their cognitive functions as well.
MOOD DISORDERS & NEUROFEEDBACK
Frontal alpha symmetry has been found to underlie the balance between approach and defensive dispositions amongst individuals. Mennella, Patron and Palomba (2017) examined the effects of frontal alpha symmetry neurofeedback (NF) training in reducing negative affect, depression and anxiety. It was found that compared to an active control group, participants receiving the seven sessions of NF training over the 2-week period showed an increase in alpha symmetry and this corresponded to a significant decrease in negative affect, anxiety and withdrawal tendencies. This study provides support for the effectiveness of NF training in conditions characterised by trait-like increase in negative affect such as generalized anxiety disorder and depression.
PEAK PERFORMANCE & NEUROFEEDBACK
Theta activity within the frontal brain region is shown to be directly associated with the top-down control of sustained attention. Thus, optimal activity in this brain area is vital when performing an attention-demanding task. With this, Kao, Huang and Hung (2014) investigated the effects of neurofeedback training (aimed at reducing frontal mid-line theta activity) in enhancing the performance of expert golfers. In this study, participants received a single session of the said neurofeedback training. The results showed that neurofeedback training (with the target of reducing the frontal mid-line theta amplitude), enhanced the putting performance stability and score of the participants. This study provides support for the use of neurofeedback training as a mechanism for performance enhancement.
Datko, M., Pineda, J. A., & Muller, R. (2018). Positive effects of neurofeedback on austism symptoms correlate with brain activation during imitation and observation. European Journal of Neuroscience, 47, 579-591. doi: 10.1111/ejn.13551
Friedrich, E., Sivanathan, A., Lim, T., …., Pillen, S., & Pineda, J. (2015). An effective neurofeedback intervention to improve social interactions in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(1), 4084-4100
Kao, S., Huang, C., & Hung, T. (2014). Neurofeedback training reduces frontal theta and improves putting performance in expert golfers. Journal of Applied Sport Psychology, 26, 271-286
Kober, S., Schweiger, D., Reichert, J., Neuper, C. and Wood, G. (2017). Upper Alpha Based Neurofeedback Training in Chronic Stroke Brain Plasticity Processes and Cognitive Effects. Applied Psychophysiology and Biofeedback, 42(1), 69-83
Mennella, Patron & Palomba (2017). Frontal alpha symmetry neurofeedback for the reduction of negative affect and anxiety, Behaviour Research and Therapy, 92, 32,40
Nooner, K., Leaberry, K., Keith, J.& Ogle, R. (2017) Clinic Outcome Assessment of a Brief Course Neurofeedback for Childhood ADHD Symptoms. Journal of Behavioural Health Services and Research, 44(3), 507-514
Steiner, N. J., Frenette, E. C., Rene, K. M., Brennan, R. T., & Perrin, E. C. (2014). Neurofeedback and cognitive attention training for children with attention-deficit hyperactivity disorder in schools. Journal of Developmental and Behavioral Pediatrics : JDBP, 35(1), 18-27.
Van Doren, J., Arns, M., Heinrich, H., Vollebregt, M. A., Strehl, U., & Loo, S. K. (2018). Sustained effects of neurofeedback in ADHD: A systematic review and meta-analysis. European Child & Adolescent Psychiatry. doi:https://doi.org/10.1007/s00787-018-1121-4
Wang, T., Mantini, D., and Gillebert, C. (2017). The potential of real-time fMRI neurofeedback for stroke rehabilitation: A systematic review, Cortex, doi:https://doi.org/ 10.1016/j.cortex.2017.09.006
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