Neurofeedback has shown to be an effective drug-free approach to many brain-based disorders. Neurofeedback helps the client regulate their own brainwaves into more optimal patterns via operant conditioning (a type of learning), leading to amelioration of symptoms.
Is Neurofeedback an Efficacious Treatment for ADHD? A Randomised Controlled Clinical Trial
Published in the Journal of Child Psychology and Psychiatry
Background: For children with attention-deficit/hyperactivity disorder (ADHD), a reduction of inattention, impulsivity, and hyperactivity by neurofeedback (NF) has been reported in several studies. But so far, unspecific training effects have not been adequately controlled for, and/or studies do not provide sufficient statistical power. To overcome these methodological shortcomings we evaluated the clinical efficacy of neurofeedback in children with ADHD in a multisite randomized controlled study using a computerized attention skills training as a control condition.
This study follows results from 102 children between the ages of 8-12 years old. The results are definitive, and the authors conclude that neurofeedback provides a “clinically superior result for ADHD symptoms.”
Authors: Holger Gevensleben Birgit Holl Björn Albrecht Claudia Vogel Dieter Schlamp Oliver Kratz Petra Studer Aribert Rothenberger Gunther H. Moll Hartmut Heinrich
Efficacy of Neurofeedback Treatment in ADHD: The Effects on Inattention, Impulsivity and Hyperactivity
Arns M, de Ridder S, Strehl U, Breteler M and Coenen A, Journal of Clinical EEG & Neuroscience
Since the first reports of neurofeedback treatment in Attention Deficit Hyperactivity Disorder (ADHD) in 1976, many studies have investigated the effects of neurofeedback on different symptoms of ADHD such as inattention, impulsivity and hyperactivity. This technique is also used by many practitioners, but the question as to the evidence-based level of this treatment is still unclear. In this study selected research on neurofeedback treatment for ADHD was collected and a meta-analysis was performed. Both prospective controlled studies and studies employing a pre- and post-design found large effect sizes (ES) for neurofeedback on impulsivity and inattention and a medium ES for hyperactivity. Randomized studies demonstrated a lower ES for hyperactivity suggesting that hyperactivity is probably most sensitive to nonspecific treatment factors. Due to the inclusion of some very recent and sound methodological studies in this meta-analysis, potential confounding factors such as small studies, lack of randomization in previous studies and a lack of adequate control groups have been addressed, and the clinical effects of neurofeedback in the treatment of ADHD can be regarded as clinically meaningful. Three randomized studies have employed a semi-active control group which can be regarded as a credible sham control providing an equal level of cognitive training and client-therapist interaction. Therefore, in line with the AAPB and ISNR guidelines for rating clinical efficacy, we conclude that neurofeedback treatment for ADHD can be considered “Efficacious and Specific” (Level 5) with a large ES for inattention and impulsivity and a medium ES for hyperactivity.
Authors: Arns M, de Ridder S, Strehl U, Breteler M and Coenen A
View full article: https://www.ncbi.nlm.nih.gov/pubmed/19715181
In-School Neurofeedback Training for ADHD: Sustained Improvements From a Randomized Control Trial
Published in Pediatrics Journal
To evaluate sustained improvements 6 months after a 40-session, in-school computer attention training intervention using neurofeedback or cognitive training (CT) administered to 7- to 11-year-olds with attention-deficit/hyperactivity disorder (ADHD). Neurofeedback participants made more prompt and greater improvements in ADHD symptoms, which were sustained at the 6-month follow-up, than did CT participants or those in the control group. This finding suggests that neurofeedback is a promising attention training treatment for children with ADHD.
Authors: Naomi J. Steiner, Elizabeth C. Frenette, Kirsten M. Rene, Robert T. Brennan and Ellen C. Perrin
View full article: https://pediatrics.aappublications.org/content/133/3/483.long
EEG Biofeedback in the Treatment of Attention Deficit Hyperactivity Disorder
Friel PN, Alternative Medicine Review, Volume 12, #2, June 2007, pp146-151
Electroencephalogram (EEG) biofeedback, also known as neurofeedback, is a promising alternative treatment for patients with attention-deficit/hyperactivity disorder (AD/HD). EEG biofeedback therapy rewards scalp EEG frequencies that are associated with relaxed attention and suppresses frequencies associated with under- or over-arousal.
Nada Pop-Jordanova, Tatjana Zorcec, Aneta Demerdzieva, Zoran Gucev Pop-Jordanova et al. Nonlinear Biomedical Physics 2010
Autistic spectrum disorders are a group of neurological and developmental disorders associated with social, communication, sensory, behavioral, and cognitive impairments, as well as restricted, repetitive patterns of behavior, activities, or interests. The aim of this study was a) to analyze qEEG findings of autistic patients and to compare the results with the database, and b) to introduce the calculation of spectrum weighted frequency (brain rate) as an indicator of general mental arousal in these patients. Results: Results for Q-EEG shows generally increased delta-theta activity in the frontal region of the brain. Changes in the qEEG pattern appeared to be in a non-linear correlation with maturational processes. Brain rate measured in CZ shows slow brain activity (5. 86) which is significantly lower than normal and corresponds to low general mental arousal. Recent research has shown that autistic disorders have as their basis disturbances of neural connectivity. Neurofeedback seems capable of remediating such disturbances when these data are considered as part of treatment planning. Conclusions: Prognosis of this pervasive disorder depends on the intellectual abilities: the better intellectual functioning, the possibilities for life adaptation are higher qEEG shows generally increased delta-theta activity in the frontal region of the brain which is related to poor cognitive abilities. Brain rate measured in CZ shows slow brain activity related to under arousal. Pharmacotherapy combined with behavior therapy, social support, and especially neurofeedback technique promises slight improvements.
View full article: https://nonlinearbiomedphys.biomedcentral.com/articles/10.1186/1753-4631-4-4
Anxiety And Depression
In evaluating the studies in the overall broad area of the neurofeedback treatment of anxiety disorders, EEG biofeedback (neurofeedback) qualifies for the evidence-based designation of being an efficacious treatment. EEG biofeedback is an exciting, cutting-edge technology that offers an additional treatment alternative for modifying dysfunctional, biologic brain patterns that are associated with various psychiatric conditions
Real-Time Functional Connectivity-Informed Neurofeedback of Amygdala-Frontal Pathways Reduces Anxiety
Zhiying Zhao et al. Real-Time Functional Connectivity-Informed Neurofeedback of Amygdala-Frontal Pathways Reduces Anxiety, Psychotherapy and Psychosomatics (2019)
Background: Deficient emotion regulation and exaggerated anxiety represent a major transdiagnostic psychopathological marker. On the neural level these deficits have been closely linked to impaired, yet treatment-sensitive, prefrontal regulatory control over the amygdala. Gaining direct control over these pathways could therefore provide an innovative and promising intervention to regulate exaggerated anxiety. To this end the current proof-of-concept study evaluated the feasibility, functional relevance and maintenance of a novel connectivity-informed real-time fMRI neurofeedback training. Methods: In a randomized crossover sham-controlled design, 26 healthy subjects with high anxiety underwent real-time fMRI-guided neurofeedback training to enhance connectivity between the ventrolateral prefrontal cortex (vlPFC) and the amygdala (target pathway) during threat exposure. Maintenance of regulatory control was assessed after 3 days and in the absence of feedback. Training-induced changes in functional connectivity of the target pathway and anxiety ratings served as primary outcomes. Results: Training of the target, yet not the sham control, pathway significantly increased amygdala-vlPFC connectivity and decreased levels of anxiety. Stronger connectivity increases were significantly associated with higher anxiety reduction on the group level. At the follow-up, volitional control over the target pathway was maintained in the absence of feedback. Conclusions: The present results demonstrate for the first time that successful self-regulation of amygdala-prefrontal top-down regulatory circuits may represent a novel intervention to control anxiety. As such, the present findings underscore both the critical contribution of amygdala-prefrontal circuits to emotion regulation and the therapeutic potential of connectivity-informed real-time neurofeedback.
Read a Review of The Article: https://medicalxpress.com/news/2019-03-neurofeedback-anxiety.html
Real-Time Self-Regulation of Emotion Networks in Patients with Depression
David E. J. Linden, Isabelle Habes, Stephen J. Johnston, Stefanie Linden, Ranjit Tatineni, Leena Subramanian, Bettina Sorger, David Healy, Rainer Goebe
Many patients show no or incomplete responses to current pharmacological or psychological therapies for depression. Here we explored the feasibility of a new brain self-regulation technique that integrates psychological and neurobiological approaches through neurofeedback with functional magnetic resonance imaging (fMRI). In a proof-of-concept study, eight patients with depression learned to upregulate brain areas involved in the generation of positive emotions (such as the ventrolateral prefrontal cortex (VLPFC) and insula) during four neurofeedback sessions. Their clinical symptoms, as assessed with the 17-item Hamilton Rating Scale for Depression (HDRS), improved significantly. A control group that underwent a training procedure with the same cognitive strategies but without neurofeedback did not improve clinically. Randomized blinded clinical trials are now needed to exclude possible placebo effects and to determine whether fMRI-based neurofeedback might become a useful adjunct to current therapies for depression.
View The Full Article: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0038115
Deborah A Stokes, Martha S Lappin Behavioral and Brain Functions 2010, 6:9
Traditional peripheral biofeedback has grade A evidence for effectively treating migraines. Two newer forms of neurobiofeedback, EEG biofeedback and hemoencephalography biofeedback were combined with thermal handwarming biofeedback to treat 37 migraineurs in a clinical outpatient setting. Methods: 37 migraine patients underwent an average of 40 neurofeedback sessions combined with thermal biofeedback in an outpatient biofeedback clinic. All patients were on at least one type of medication for migraine; preventive, abortive or rescue. Patients kept daily headache diaries a minimum of two weeks prior to treatment and throughout treatment showing symptom frequency, severity, duration, and medications used. Treatments were conducted an average of three times weekly over an average span of 6 months. Headache diaries were examined after treatment and a formal interview was conducted. After an average of 14.5 months following treatment, a formal interview was conducted in order to ascertain the duration of treatment effects.
View The Full Article: https://behavioralandbrainfunctions.biomedcentral.com/articles/10.1186/1744-9081-6-9
Neurofeedback for Insomnia: A Pilot Study of Z-Score SMR and Individualized Protocols
Authors: Barbara U. Hammer, Agatha P. Colbert, Kimberly A. Brown &Elena C. Ilioi
Published: Applied Psychophysiology and Biofeedback
First published in Applied Psychophysiology and Biofeedback, A single-blind study using Z-score analysis showed that following neurofeedback “all participants were normal sleepers.”
Neurofeedback in ADHD and Insomnia: Vigilance Stabilization Through Sleep Spindles and Circadian Networks
Arns M, Kenemans JL., Neurosci. Biobehav. Rev. (2012), http://dx.doi.org/10.1016/j.neubiorev.2012.10.006
In this review article, an overview of the history and current status of neurofeedback for the treatment of ADHD and insomnia is provided. Recent insights suggest a central role of circadian phase delay, resulting in sleep onset insomnia (SOI) in a sub-group of ADHD patients. Chronobiological treatments, such as melatonin and early morning bright light, affect the suprachiasmatic nucleus. This nucleus has been shown to project to the noradrenergic locus coeruleus (LC) thereby explaining the vigilance stabilizing effects of such treatments in ADHD. It is hypothesized that both Sensori-Motor Rhythm (SMR) and Slow-Cortical Potential (SCP) neurofeedback impact on the sleep spindle circuitry resulting in increased sleep spindle density, normalization of SOI and thereby affect the noradrenergic LC, resulting in vigilance stabilization. After SOI is normalized, improvements on ADHD symptoms will occur with a delayed onset of effect. Therefore, clinical trials investigating new treatments in ADHD should include assessments at follow-up as their primary endpoint rather than assessments at outtake. Furthermore, an implication requiring further study is that neurofeedback could be stopped when SOI is normalized, which might result in fewer sessions.
Brain Injury Concussion
Evaluation of Differentiated Neurotherapy Programs for a Patient After Severe TBI and Long Term Coma Using Event-related Potentials
Maria Pachalska1, Małgorzata Łukowicz, Juri D. Kropotov, Izabela Herman-Sucharska, Jan Talar The Medical Science Monitor, 2011
This article examines the effectiveness of differentiated rehabilitation programs for a patient with frontal syndrome after severe TBI and long-term coma. We hypothesized that there would be a small response to relative beta training, and a good response to rTMS, applied to regulate the dynamics of brain function. Case Report M. L-S, age 26, suffered from anosognosia, executive dysfunction, and behavioral changes, after a skiing accident and prolonged coma, rendering him unable to function independently in many situations of everyday life. Only slight progress was made after traditional rehabilitation. The patient took part in 20 sessions of relative beta training (program A) and later in 20 sessions of rTMS (program B); both programs were combined with behavioral training. We used standardized neuropsychological testing, as well as ERPs before the experiment, after the completion of program A, and again after the completion of program B. As hypothesized, patient M.L-S showed small improvements in executive dysfunction and behavioral disorders after the conclusion of program A, and major improvement after program B. Similarly, in physiological changes the patient showed small improvement after relative beta training and a significant improvement of the P300 NOGO component after the rTMS program. Conclusions The rTMS program produced larger physiological and behavioral changes than did relative beta training. A combination of different neurotherapeutical approaches (such as neurofeedback, rTMS, tDCS) can be suggested for similar severe cases of TBI. ERPs can be used to assess functional brain changes induced by neurotherapeutical programs.
Read The Full Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539468/
For many other studies:
The International Society for Neuroregulation and Research maintains a comprehensive bibliography of research articles discussing conditions that are positively affected by neurofeedback by D. Corydon Hammond, PhD, Professor, Physical Medicine & Rehabilitation, University of Utah School of Medicine and D. Allen Novian, PhD, LMFT, LPC-S, Adjunct Professor, Neurofeedback and Biofeedback, St. Mary’s University. ISNR also has an editorial in defense of EEG biofeedback.
The Association for Applied Psychophysiology and Biofeedback published Evidence-Based Practice in Biofeedback and Neurofeedback (3rd ed.) which provides the most comprehensive and up-to-date evidence-based and neuroscientifically supported information on the subject. They also have more information for consumers.
Researchgate has a compilation of over 9,200 articles as PDF’s on neurofeedback if you really want to dig into the topic.