Neurofeedback is a form of biofeedback to help a person monitor their brain waves; specifically, electroencephalogram (EEG) waves. Biofeedback involves the use of technology or other techniques (e.g. pulse monitoring) to help a person monitor their physiological conditions, such as heartrate. Being able to monitor conditions like heartrate and blood pressure has been shown to improve physical training (Perry, Shaw, & Zaichkowsky, 2011) For example, an athlete will be more effective at keeping a low heartrate during training using a heartrate monitor. Similar findings have occurred with the use of neurofeedback and mental training (Nan, et al., 2012). Neurofeedback is typically used to address clinical issues, but it has also been found to be effective when paired with other medical treatments. For example, neurofeedback has shown promise as a form of treatment for patients with epilepsy (Monderer, Harrison, & Haut, 2002).
What are EEG waves and why are they important?
A brain communicates using electrical impulses, which are categorized by frequencies. EEG waves are measured through hertz, or cycles per second. To understand frequency, think of waves at the beach. The height of the wave is an example of amplitude. The number of waves coming back-to-back is known as the frequency. EEG waves are categorized by their frequency:
- Delta: 0-4 hz (Deep Sleep)
- Theta: 4-7 hz (Attention)
- Alpha: 8-12 hz (Relaxed)
- Sensory Motor Rhythm: 13-15 hz (Alert but calm)
- Beta: 15-30 hz (Higher levels of energy and activeness)
- Gamma: 30+ hz (Awareness)
Neurofeedback is interested in EEG waves because many of these waves are correlated with different thought patterns, feelings, and behaviors (Hamlin, 2018). Often these waves are either firing too low, too high, or in an unstable manner, which is associated with different mental and physical conditions. Neurofeedback is used to help a person identify their EEG patterns in different brain regions. With this awareness comes the ability to affect these waves using different skills, such as deep breathing.
How does it work?
A person starts with describing their concerns and possibly filling out checklists to help identify whether the person’s EEG waves are most likely under-aroused, over-aroused, or unstable. The clinician then attaches leads to the person’s head using a washable gel. The leads act as headphones reading the person’s EEG waves. NO ELECTRICITY OR CHEMICALS ARE PUT INTO THE BRAIN OR TAKEN OUT OF THE BRAIN! The person then focuses on a screen with a game or video, completes a task, closes eyes and relaxes, or meditates with eyes open based on needs. Once the person’s EEG waves are firing in an enjoyable pattern, the behavior is then reinforced through pleasant beeps.
Neurofeedback utilizes theories on human behavior known as Operant Conditioning (Skinner, 1971) and Classical Conditioning (Spence, 1956).
Operant conditioning involves rewarding something that is desired. When someone gives a treat to a dog after it sits, the dog learns that a reward follows the sitting, which increases the frequency of sitting. Neurofeedback uses pleasant beeps as the reward for the brain. When the EEG waves fire at the desired frequencies, then the machine beeps triggering a pleasant sensation for the brain. The beep acts as the treat for the brain so the brain learns to fire the EEG waves at the desired frequency more often.
After enough sessions, a person can utilize classical conditioning to feel the effects without being in a training session. A student getting hungry after hearing a lunch bell is a good example of classical conditioning. A person can learn to pair a stimulus (lunch bell) with a physiological response (hunger). After enough sessions, the brain will pair the beeps with the desired EEG frequencies. If a person starts feeling, thinking, or behaving in an undesirable manner, then they can imagine the beeps, which will cause the brain to fire EEG waves at the desired frequencies. The brain pairs the stimulus (beeping) with the desired physiological response (EEG frequency).
How many sessions does it take?
Many clinicians have differing opinions on the amount of sessions required. Some clinicians believe one session has an effect while other believe it takes 20+ sessions. After researching neurofeedback packages, the most common amount of sessions offered was between 15 and 20 sessions, with one session per week. Personal experience using neurofeedback was consistent with the average number of sessions recommended.
Why have I not heard of this?
Neurofeedback continues to face harsh criticism, and Dr. Mark Gapen offered a good reason why. Many people feel that the thousands of studies validating the use of neurofeedback are useless because of the problem associated with randomized control trials and double-blind studies. Think about a study testing the effectiveness of a pill meant to treat a specific disease. The ideal study for many is known as the randomized control trial. For the pill study to be this type of study, one group of people with the disease must receive the pill, while another group of people receive a fake pill that does nothing, known as a placebo. Then the researcher can see if the pill makes a difference. However, many feel that researchers are prone to believing a treatment works, so the best solution is known as the double-blind method. For the current study, the participants cannot know what pill they are getting, which is known as single-blind. When the researcher also does not know which group received which pill until the data is analyzed, it is known as a double-blind study.
Unfortunately, neurofeedback studies struggle to be double-blind. It is possible to have a participant not know whether they are receiving neurofeedback treatment or a fake protocol (i.e. single-blind). However, most neurofeedback clinicians would know whether the participant is receiving the treatment or a placebo protocol. Therefore, double-blind studies with neurofeedback are nearly impossible to conduct. For now, critics have a go-to reason to deny neurofeedback despite thousands of studies validating it as a treatment for physical and mental conditions. Still, something as effective as neurofeedback will not be kept down for long.
Gapen, M., van der Kolk, B. A., Hamlin, E., Hirshberg, L., Suvak, M., & Spinazzola, J. (2016). A pilot study of neurofeedback for chronic PTSD. Applied psychophysiology and biofeedback, 41(3), 251-261.
Hamlin, E. (2018). Neurofeedback in a Clinical Practice. Lecture Hadley, MA.
Monderer, R. S., Harrison, D. M., & Haut, S. R. (2002). Neurofeedback and epilepsy. Epilepsy & Behavior, 3(3), 214-218.
Nan, W., Rodrigues, J. P., Ma, J., Qu, X., Wan, F., Mak, P. I., … & Rosa, A. (2012). Individual alpha neurofeedback training effect on short term memory. International journal of psychophysiology, 86(1), 83-87.
Perry, F. D., Shaw, L., & Zaichkowsky, L. (2011). Biofeedback and Neurofeedback in Sports. Biofeedback, 39(3), 95-100.
Skinner, B. F. (1971). Operant conditioning. The encyclopedia of education, 7, 29-33.
Spence, K. W. (1956). Behavior theory and conditioning, 35. New Haven: Yale University Press.