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What is Neurofeedback Therapy?

Updated: Oct 10, 2022

✓ Fact checked by: Dr. Glen M Doniger, PhD

You're sitting on a sofa facing a screen. You're playing a game. On your head, there's a headset, and an electrode is attached to your scalp. The headset communicates with software on a mobile device programmed to respond to your brain's activity.

From an observer's perspective, you may appear to be simply relaxing and playing video games, but your brain is actually doing hard work. Based on your brain activity, you may be doing well at the game or, alternatively, your player may be struggling.

You’re doing EEG-based neurofeedback, typically referred to as simply neurofeedback, which is a non-invasive methodology that measures your brainwave activity and trains your brain using visual and auditory cues.

But what exactly does this mean? Let's break it down.

Neurofeedback Therapy Explained: Optimizing Your Brain Activity

Neurofeedback is a technique that leverages modern technology and scientific knowledge to train brainwaves. It is one of a broader group of biofeedback therapies relying on the principle that if a person can access information about their bodily functions in real time, they can learn to control them.

Biofeedback can be applied to a variety of bodily processes such as muscle tension, body temperature, or blood pressure, and a variety of conditions, including anxiety, migraines, and chronic pain.

Neurofeedback is a form of biofeedback based on a learning method called operant conditioning, which involves rewards and punishments for behavior. Through operant conditioning, an association is made between a behavior and a consequence (whether negative or positive).

The goal of neurofeedback is to train the brain to regulate itself and help you understand when your brain is in the desired state. Eventually, your brain may be able to maintain a more balanced state even when it's not receiving feedback.

For example, you may not be aware when your brain is in a focused state or notice when your mind is wandering. During neurofeedback training, visual and/or auditory feedback clue you in on exactly when your mind is wandering in real time, and you learn how to restore your focus to the activity at hand.

Brainwave Harmony

Brainwaves are patterns of electrical activity occurring in the brain. They are related to many crucial aspects of brain function, like thoughts, emotions, and behaviors.

Try to think of them as musical notes: the low-frequency waves are like a deep drum beat, while the higher frequency brainwaves are more like a subtle, high-pitched flute. As a symphony, the higher and lower frequencies link and cohere with each other through harmonics.

Depending on what you're doing at the time, a particular brainwave may be dominant over the others. And if your brainwaves are not balanced properly, you may experience both emotional and neuro-physical health concerns.

For example, if the slower brainwaves are dominant, you may feel tired, sluggish, or dreamy. The higher frequencies are dominant when you feel focused or hyper-alert.

5 Types of Brainwaves

The brainwaves recorded by the EEG are measured in frequency (speed of the waves expressed in hertz: number of waves per second) and in amplitude (height of the waves expressed in microvolts). In general, the amplitude decreases as the frequency increases.

Brainwaves are divided into frequency bands as follows:

  • Delta brainwaves (.5 to 3 Hz). Delta is a very slow, low-frequency brainwave generated in deep meditation and dreamless sleep. It tends to be the highest in amplitude and the slowest wave. Healing and regeneration occur when the brain is in this state. Feeling unrested when you wake up is probably a sign that you didn’t spend enough time in the stage of sleep characterized by delta waves.

  • Theta brainwaves (3 to 8 Hz) are slow waves that relate to dreamy, free-flowing, detached unconscious thought. They are dominant during “autopilot” states, or, in other words, instances of automatic tasks and sometimes in deep meditative states. Theta brainwaves are essential for processing information, and they are our gateway to learning, memory, and intuition.

  • Alpha brainwaves (8 to 12 Hz) are faster than theta but slower and higher in amplitude than beta brainwaves. They are typically dominant during meditative and mindful activities and represent non-arousal. During this state, the brain isn’t trying to solve any problems or process a lot of information. Alpha brainwaves help with mental coordination, calmness, alertness, mind/body integration and learning.

  • Beta brainwaves (12 to 38 Hz) are high-frequency waves of relatively low amplitude. They are amplified when your brain is alert and engaged in cognitive tasks that require a lot of attention and focus. They are dominant during instances of problem-solving, judgment, decision-making, or any other focused mental activity.

Beta brainwaves can be subdivided into three categories:

  1. Lo-Beta (Beta1, 12-15Hz), called “sensorimotor rhythm” or “SMR” when recorded over the middle of the brain (sensorimotor strip), is dominant during meditative states and has been shown to be beneficial in reducing anxiety, increasing focus, and promoting overall well-being.

  2. Beta (Beta2, 15-22Hz) is intense, focused brain activity when we are working on solving a problem or actively engaging with our environment.

  3. Hi-Beta (Beta3, 22-38Hz) may reflect complex thought related to integrating new experiences, high anxiety, or excitement.

  • Gamma brainwaves (38 to 42 Hz) are the fastest (i.e, highest frequency) brainwaves with lowest amplitude. They are involved in combining information from different areas of the brain and are prominent when you’re both alert and highly focused. Gamma waves are dominant at times of very deep focus, like when you’re trying to solve a problem.

Regulating Brainwaves

We cycle in and out of different brainwave states throughout the day and night. Even though all brainwave states are essential, they should be experienced appropriately — when engaged in certain activities, at certain times of day and for particular durations of time.

Neurofeedback teaches your brain to regulate your brainwaves so that you can achieve the desired brainwave state.

For example, alpha waves occur when you are relaxed. Beta waves are associated with alertness, but when maintained for too long, they may lead to fear and anxiety.

So, if you are anxious, learning how to increase alpha waves while reducing beta wave activity might be your goal.

A Brief History Lesson

Neurofeedback was pioneered in the 1960s by two researchers: Dr. Joseph Kamiya at the University of Chicago and Dr. Barry Sterman at UCLA.

Dr. Kamiya found that by using a simple reward system, people could control their brainwaves. He trained people to achieve an alpha state by rewarding them with the sound of a bell. This marked the first time that real-time feedback was provided to humans based on EEG monitoring – the first instance of neurofeedback training.

During the same period, Dr. Sterman found that cats in his lab could be trained to increase their brainwaves at a certain frequency when rewarded with food. Dr. Sterman called this frequency, which was in the low beta range (Beta1; 12-15 Hz; see above) and recorded over the middle part of the brain (sensorimotor strip), “sensorimotor rhythm”, or “SMR”.

A few years later, Dr. Sterman was doing an experiment for NASA on whether rocket fuel caused seizures, and he used the same cats as experimental subjects. During this study, he found that the cats who had undergone SMR training were significantly less likely to experience seizures than other cats. Dr. Sterman then applied this technique to humans who have epilepsy and found that 60% of the participants were able to reduce their epileptic seizures by 20-100% and that the results were enduring.

In the 1970s, Dr. Joel Lubar began to run controlled studies applying neurofeedback training to children, adolescents, and ultimately adults, to treat Attention Deficit Hyperactivity Disorder (ADHD).

Since then, a significant body of research on the efficacy of neurofeedback therapy for treating ADHD has emerged, with many studies showing significant and long-term improvements after neurofeedback therapy.

Neurofeedback has been around for more than 50 years! Its origins are fascinating, and there are hundreds of research studies in the scientific literature supporting its efficacy. In the past, neurofeedback was only available in specialized clinics, but today you can use it from the comfort of your home.

What Happens to Your Brain During a Neurofeedback Session?

"The brain electrical activity of human beings is the greatest potential resource for understanding the dynamics of all human behavior." - Barbara Brown, author of Stress and the Art of BiofeedBack

Inhibiting certain brainwave frequencies and enhancing others is usually done by placing electrodes on the scalp and then providing immediate feedback about the brain's activity. This awareness makes it possible to gradually recondition brain activity.

Let's say you're training for attention. EEG helps in detecting alertness in real time. So, each time you're in a mental state reflecting focus, you may get a visual or auditory reward, encouraging your brain to remain/enter this state more often. And that's how the brain self-regulates; it learns from positive or negative feedback.

Over time, the ability to regulate brainwaves can be applied in real-world situations. For example, you may find it easier to stay focused in stressful situations, like on a job interview or during an exam.

Neurofeedback Therapy for Attention Deficit Hyperactivity Disorder (ADHD)

Attention-deficit/hyperactivity disorder (ADHD) is a neuro-behavioral disorder characterized by an ongoing pattern of inattention and/or hyperactivity/impulsivity.

People with ADHD have different brainwave patterns from those who don't have the disorder.

They often have more theta (slow, mind-wandering waves) activity than usual, and less beta (fast, focused, problem-solving) activity than other people (see “5 Types of Brainwaves” above). Thus neurofeedback therapy for ADHD often aims to increase beta waves and diminish theta waves.

For ADHD, the usual recommendation for a full course of neurofeedback is 20–40 sessions twice or three times a week, with a session duration of 20–30 minutes.

People with ADHD may start to see results after 8–10 sessions, but the full course of sessions is recommended to ensure that results are long-lasting.

What Does Science Say About Neurofeedback for ADHD

ADHD is the most well-studied condition in neurofeedback research. Based on meta-analyses and large multicenter randomized controlled trials (RCTs), two frequency neurofeedback protocols researched for more than 40 years have been shown efficacious and specific for ADHD:

  • Theta-beta ratio (TBR) protocol, which aims to decrease theta and/or increase beta power in central and frontal locations. The goal is to reduce the high theta-beta ratios, high theta power, and/or low beta power characteristic of children and adults with ADHD.

  • Enhance SMR, which is known to heighten attention and has been applied to improve cognitive performance.

A series of meta-analyses have shown that the standard TBR and SMR protocols improve ADHD symptoms, especially inattention.

Notably, RCTs suggest that 30–40 sessions of TBR neurofeedback are as effective as methylphenidate (a central nervous system stimulant) in alleviating inattentive and hyperactivity symptoms and are even associated with superior academic performance (studies by Duric and colleagues, Meisel and colleagues).

Frequency neurofeedback for ADHD received a grade 1 (‘‘best support’’) rating from the American Academy of Pediatrics in 2013.

Neurofeedback Therapy for Anxiety: Repairing the Dysregulated Stress Response System

Anxiety is a feeling of fear and distress. It's a normal physical response when you are faced with severe stress or danger. However, it becomes a disorder