Neurofeedback: An Emerging Mental Health Therapy

Lilian White, MD
Posted on December 12, 2022

Is it possible to affect brain waves to improve focus, anxiety, and substance use disorders? The evidence for neurofeedback as a therapy for mental health conditions is growing.

Neurofeedback is a type of mind-body therapy under the umbrella of biofeedback. In general, biofeedback uses sensors (e.g., measuring pulse, respiratory rate, temperature, muscle tension) to detect and promote desired physiologic changes through feedback, typically in the form of audio or video responses. Similarly, neurofeedback is noninvasive and specifically uses electroencephalograph readings, among other methods, to detect brain waves and affect brain activity.

The specific neuropsychological mechanisms by which neurofeedback is thought to work are an active area of research. In part, brain wave patterns are associated with cognitive operations, and encouraging associated brain waves may lead to an increase in desired cognitive operations. For example, beta waves are associated with the cognitive operation of focus; theta waves are associated with anxiety.

Neurofeedback has been studied in a variety of mental health conditions, including the following:

• ADHD and learning disorders

Research supports several clinical reviews for neurofeedback and the treatment of attention-deficit/hyperactivity disorder (ADHD) and learning disorders. Although many different protocols are actively being studied, some of this work focuses on the suppression of theta and encouragement of beta brain waves (referred to as theta/beta training). After only two neurofeedback sessions using this protocol, one small study demonstrated changes in the theta/beta ratio, indicating some degree of neuroplasticity had already begun to occur. Multiple systematic reviews of neurofeedback and ADHD have demonstrated conflicting results—with one review indicating no clinical response and another demonstrating promise with improvements in children in multiple settings.

• Substance use disorders

Alcohol and other substances may be misused as a way to treat anxiety or stress. Chronic misuse in particular affects the reward physiology of the brain. Neurofeedback has been proposed and used as a treatment for substance use disorders. A recent critical review for alcohol use disorder noted protocols specifically rewarding alpha-theta waves promote “relaxation, decreases anxiety or stress, prevents alcohol relapse, maintains abstinence and increases the feeling of well-being.”

• Anxiety and trauma

Although typically not a stand-alone treatment for anxiety or processing traumatic events, neurofeedback is growing in its use as a complementary treatment to more traditional talk therapy. Part of the pathophysiology of these conditions is often overarousal, which may be reflected in brain waves appreciated on electroencephalography. A systematic review of neurofeedback for the treatment of traumatic events in children and adolescents noted the wide variation in neurofeedback treatments and suggested that more research is needed to clarify best practices and recommendations.

The variation in diagnosis- vs. symptom- or patient-driven protocols may also limit the ability of randomized, controlled trials to study neurofeedback’s benefits. As with other individualized or complex treatments, outcomes-based research may offer more direction. To date, studies are generally small and—as with other mind-body/integrative interventions—likely will remain small without the funding typical of pharmaceutical-driven research.

Not much research has been conducted on the adverse effects of neurofeedback. It generally appears to be well tolerated but has the potential to worsen symptoms being treated and cause headaches or fatigue. In some patients being treated for seizure disorder, a subset had worsening of their seizures.

Although neurofeedback is promising as a noninvasive, generally safe treatment option in select conditions, physicians and patients should weigh potential benefits against its expense, accessibility, and the time commitment involved.