Neurofeedback Therapy: What It Is, How It Works, and Its Benefits

Key Takeaways of Neurofeedback:

•  Neurofeedback is a brain training method, where individuals learn to self-regulate their brain activity through positive reinforcement.
• Neurofeedback works through feedback loops on the principle of operant conditioning.
•  Neurofeedback is used for treating different conditions such as ADHD, Anxiety, Depression, etc.

What is Neurofeedback Therapy?

Neurofeedback is a non-invasive brain stimulation procedure using an electroencephalogram to measure the client's brainwaves. It provides feedback on how the brain reacts to different triggers thus helping the client achieve the desired mental states such as relaxation over time.

Neurofeedback is considered a subset of biofeedback. Biofeedback is a technique that consists of using instruments to monitor bodily functions such as heart rate, pulse rate, skin temperature, etc via auditory (tone) or visual (light) feedback. When the same technique is used on brain activity, it is called EEG biofeedback or Neurofeedback.

What is the Principle of Neurofeedback Therapy?

The principle of neurofeedback therapy is based on operant conditioning, where individuals learn to modify their brain activity through feedback received in real-time. During the session, brainwave activity is monitored using EEG, and clients receive audio or visual feedback about their brain states. Upon producing a desired pattern within the brain waves, a reward in the form of a sound or visual cue positively reinforces the client to repeat that behavioural state.

EEG measures brain waves at different frequencies, which reflect particular mental states or functions:

• Delta Waves (0-5 Hz): The slowest brain waves associated with deep sleep and restoration. These are essential waves for conscious healing or regenerative processes.
• Theta Waves (4-8 Hz): Associated with light sleep, relaxation, creativity, and meditation. Often the target for enhancement of creativity and emotional processing through neurofeedback.
• Alpha Waves (8-12 Hz): Reflect a relaxed yet alert state. The thoughts we have during calm or meditative states are represented by alpha waves. Increased alpha activity can reduce anxiety and increase relaxation.
• Beta Waves (12-30 Hz): Associated with active thinking, problem-solving, and focus. Moderately high beta waves may be related to stress and anxiety, optimal beta levels can enhance concentration.
• Gamma Waves (30-100 Hz): The fastest brainwaves, associated with high-level cognitive processing, learning, and memory. Gamma waves are often studied and targeted in higher-level neurofeedback treatments.

Placement for EEG Electrodes is dependent on specific locations determined by standardized measurements. Some Important placements include:

• Frontal Lobe (F3, F4, Fz): Responsible for functions such as decision-making, attention, and emotional regulation.
• Central Region (C3, C4): Associated mainly with motor control and sensory processing.
• Parietal Lobe (P3, P4): Functionally related to sensory integration and spatial awareness;
• Occipital Lobe (O1, O2): Primarily responsible for visual processing;
• Temporal Lobe (T3, T4): Responsible for auditory processing and aspects of memory.

How Neurofeedback Therapy Works?

Neurofeedback operates through a feedback loop mechanism, where real-time information about brain activity is provided to the client, allowing them to self-regulate their brain dynamics towards desired states. 

The brainwave patterns, such as alpha, beta, theta, and delta wave protocols are analysed to identify specific states that may be associated with the individual's symptoms or conditions. 

During neurofeedback sessions, individuals receive immediate feedback based on their brainwave activity. This feedback is typically presented through audio or visual cues, indicating whether they are achieving the desired brainwave patterns. 

For example, if a patient is training to increase alpha waves for relaxation, they might hear a pleasant sound when their alpha activity rises. This creates a feedback loop: the individual learns to associate certain mental states with positive reinforcement, encouraging them to consciously adjust their thoughts and focus to maintain or enhance those brainwave patterns.

Over time, consistent neurofeedback training can lead to long-term improvements in brain function and symptom management. As individuals self-regulate their brain activity, they may experience reduced symptoms of anxiety, improved attention, and enhanced emotional regulation. This process is closely linked to neuroplasticity, the brain's ability to reorganize and form new neural connections in response to learning and experience. 

Neuroplasticity allows the brain to adapt to new patterns of activity, reinforcing the changes achieved through neurofeedback and promoting lasting improvements in mental health and cognitive function. As a result, individuals may find that they can maintain these benefits even after completing their neurofeedback training.

6 Types of Neurofeedback Therapy

Neurofeedback includes a variety of treatment protocols targeting various brainwave patterns and mental health issues.

1. Frequency /Power Neurofeedback: The most common standardized protocol, where 2-4 surface electrodes are used to modify either the amplitude or speed of specific brain waves while treating clients. Common treatment of ADHD, anxiety, and insomnia is done using this protocol.
2. Slow Cortical Potential Neurofeedback (SCP-NF): Protocol based on targeting slow cortical potentials to improve attention and reduce symptoms of some mental health disorders like ADHD and/or epilepsy.
3. Alpha /Theta Neurofeedback: Employed to improve the client's relaxation and creativity by increasing the ratio of theta in relationship to alpha waves, commonly used for those recovering from trauma and managing anxiety.
4. Live Z-score Neurofeedback: Protocol developed to provide continuous feedback while comparing the client's brain activity to normative data, allowing for real-time modifications to the treatment.
5. Low-Resolution Electromagnetic Tomography (LORETA): targets deeper brain structure by utilizing 19 electrodes to monitor brain activity in three dimensions. Helps with conditions like depression and addiction.
6. Functional Magnetic Resonance Imaging (fMRI) Neurofeedback: measures and maps brain activity in deeper subcortical areas by detecting changes in blood flow, allowing for regulation of brain functions.

When is Neurofeedback Therapy Used?

According to research, neurofeedback training is used in the treatment of various diseases and disorders by helping individuals gain self-regulation over their brain activity.

1. Attention Deficit Hyperactivity Disorder  (ADHD): Neurofeedback targets the malfunctioning areas of the brain, improving attention and reducing hyperactive and impulsive behaviours in children and adults. By enhancing beta waves and reducing theta waves, neurofeedback helps optimize brain function associated with focus and concentration.
2. Anxiety and Depression: By training patients to enhance specific brain wave patterns, neurofeedback can alleviate symptoms of anxiety and depression, promoting emotional stability. It helps increase alpha and theta wave activity, leading to a calmer mental state, reduced anxiety symptoms and improved mood stability.
3. Insomnia: Neurofeedback helps improve sleep patterns by training individuals to achieve a relaxed state conducive to sleep.
4. Learning Disabilities: Conditions like dyslexia and dyscalculia can be addressed through neurofeedback by improving cognitive functions related to reading and mathematics.
5. Substance Abuse: Neurofeedback has shown effectiveness in reducing cravings and withdrawal symptoms in individuals struggling with drug addiction.
6. Pain Management: It can also be applied to manage chronic pain by altering brain activity associated with pain perception.
7. Post-Traumatic Stress Disorder (PTSD): Neurofeedback has been used to alleviate PTSD symptoms by helping individuals regulate emotional responses and reduce hyperarousal.

Does Neurofeedback Therapy Work Permanently?

Neurofeedback therapy offers a unique advantage over drug-based treatments because it allows clients to generate their results, leading to lasting symptom relief even after therapy ends. 

Unlike medications, which only provide relief while being taken and often come with side effects and the challenge of finding the right drug and dosage, neurofeedback is a safer and more effective option for long-term results. 

However, drug treatments often see symptoms return once the medication is stopped, the benefits of neurofeedback can persist well beyond the completion of treatment, making it a valuable option for those dealing with stress-related disorders and neurodevelopmental conditions like ADHD and autism.

A research study on the sustained effects of neurofeedback in ADHD talks about a significant improvement in symptoms, such as inattention and hyperactivity-impulsivity, seen in follow-up neurofeedback therapy suggesting that its effects can last for about 6 months and possibly up to a year.  

These improvements were found to be similar to those seen with active treatments like methylphenidate during a 2 to 12-month follow-up. Because of this, neurofeedback can be considered a non-drug treatment option for ADHD, with lasting effects even after the therapy is completed.

What to Expect from a Neurofeedback Therapy Session?

Neurofeedback therapy consists of 30- or 60-minute sessions. The number of sessions depends on the client's requirements. 

Neurofeedback sessions usually consist of the following 5 steps:

1. Goal Setting: Goals depend on the client's condition, and the type of neurofeedback technique being used. For example, the goal of treating anxiety symptoms would be to feel more calm and relaxed after the sessions.
2. Connect to electrodes: The clinician starts by equipping the client with a helmet or headband with electrodes attached.
3. Measuring brain activity: After the set-up, the client may watch a video or listen to music. The electrodes detect electrical signals produced by the brain during the activity and transmit them to a computer program. The clinician keeps monitoring the brainwave activity against the ideal the client wants to achieve.
4. Training with Positive feedback: Once the client's brainwave activity has met the goals of treatment, the brain receives positive feedback in the form of pleasant sounds, a larger screen, etc. For example, in the case of anxiety symptoms, positive feedback will be given when the brain makes more alpha waves than beta waves.
5. Repeat Training: The clinician continues to monitor and give positive feedback across multiple sessions, creating a feedback loop to meet the goals of the session.

Benefits of Neurofeedback Therapy

1. Non-invasive and Safe
2. Shows the reaction of the brain in real time.
3. Helps improve sleep and focus
4. Wide range of applications: Helps in the improvement of disorders such as ADHD, anxiety, depression, epilepsy, ASD, insomnia, drug addiction, schizophrenia, learning disabilities, dyslexia and dyscalculia

Drawbacks and Risks of Neurofeedback Therapy

• Cost: Neurofeedback can be expensive making it less accessible for some individuals.
• Time-Consuming: Treatment often requires multiple sessions over an extended period,
• Variable Effectiveness: The effectiveness of neurofeedback can vary significantly among individuals, and not everyone may experience the desired improvements.
• Mild side effects: Some clients might experience nausea, mild headaches, and sleep disturbance as side effects initially. However, it is important to notify the clinician so they can modify the treatment. If the neurofeedback therapy is administered by a qualified and licensed mental health practitioner, it has a low risk of minor side effects.

When to Seek Professional Help for Neurofeedback Therapy? 

Neurofeedback training may be a great option to consider

• Other Treatments Haven't Worked: Neurofeedback training can be a good option for people who haven't seen much improvement with other treatments, like medication or therapy.
• Avoiding Medication: This therapy is non-invasive and doesn't require medication, making it a suitable choice for those who want to avoid drug therapy or can't handle its side effects.
• Customized Treatment: Neurofeedback is tailored to fit each person's unique brain activity and symptoms, offering a more personalized and potentially more effective treatment.
• Long-Lasting Results: The benefits of neurofeedback can continue even after treatment ends, making it a good option for those seeking a lasting solution to their symptoms.
• Enhancing Cognitive Skills: Neurofeedback can help improve cognitive abilities, such as focus, memory, and processing speed, which is especially helpful for individuals with conditions like ADHD or brain injuries.

Neurofeedback therapy vs.  tDCS

Transcranial Direct Current Stimulation (tDCS) is a non-invasive neuromodulation technique that delivers a low electrical current to the scalp to modulate neuronal activity. The weak electric current is applied through electrodes placed on the head and could be positive (anodal) or negative (cathodal) current. 

The polarity of electrodes used can either have excitatory or inhibitory effects on brain regions. The current delivered by tDCS is at a sub-threshold level, hence it does not trigger action potential in neurons, rather it changes the pattern of already active neurons. 

At the cellular level, tDCS strengthens synaptic transmission promoting neuroplasticity.  tDCS is often used to improve cognitive functions, and mood, and support rehabilitation in various neurological and psychiatric conditions.

Differences between Neurofeedback and tDCS:

• Mechanism: Neurofeedback employs an EEG feedback loop to help individuals modify their behaviour, whereas tDCS directly applies a weak current to the scalp to regulate neuronal activity.
• Application: Neurofeedback requires participants to actively engage with tasks and learn to control their brain activity. On the other hand, tDCS is a passive intervention.
• Effects: Neurofeedback focuses on altering the brainwave patterns to improve cognitive functions via continuous training, while tDCS enhances cognitive performance by directly stimulating neuronal excitation or inhibition.

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Conclusion

Neurofeedback therapy presents a promising non-invasive and safe approach to mental health treatment. It helps with the self-regulation of brain activity in real-time. It has applications in the alleviation of symptoms of various disorders such as ADHD, anxiety, and depression. However, it is also essential to consider the associated drawbacks, including variability in effectiveness, cost and time availability. Before opting for neurofeedback therapy sessions, it is crucial for individuals to discuss their specific needs and treatment with a qualified mental health professional to incorporate neurofeedback in their treatment plan.

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