Why is neurofeedback controversial

Children diagnosed with ADHD tend to have an excess of low frequency theta brain waves and fewer high frequency beta waves in certain regions of the cortex, as detected by EEG Figure 2.

Therefore, neurofeedback training for children with ADHD attempts to minimize the occurrence of lower frequency theta waves and enhance the occurrence of higher frequency beta waves. This is done by rewarding the children each time they demonstrate beta waves during neurofeedback training. Through the process of operant conditioning, the children intuitively learn to promote beta waves and suppress theta waves Figure 2. All of the kids were prescribed Ritalin, while approximately half of them also participated in neurofeedback training.

Furthermore, only those children who underwent neurofeedback training showed promising changes in patterns of brain activity associated with increased focus.

Even more striking was that these behavioral and neurological improvements persisted even after medication was stopped. As promising as many of the studies pertaining to the neurofeedback therapy are, they bear some considerable caveats. One example is the fact that many clinical trials testing the efficacy of neurofeedback training do not randomize the subjects into treatment groups, since it is considered more ethical to let patients choose which treatment group they prefer.

As a result, it is possible that the treatment groups may not be composed of comparable subject populations at the outset of the experiment, which in turn may skew the results of the study. In truth, there is much that is yet to be learned about the potential of neurofeedback to be used for therapeutic purposes.

In addition to increasing the number of truly randomized controlled clinical trials, it seems that the trickiest part of establishing neurofeedback as an effective therapeutic approach to treating psychiatric disorders is to know exactly what our biological measurements are telling us. More basic research into the meaning of neurofeedback signals is needed to fully answer this question. For now, the gold standard for treating psychiatric conditions remains medication and various forms of therapy.

Nevertheless, studies such as that performed by Monastra and colleagues suggest that there may be a bright future for neurofeedback training in the treatment of certain psychiatric disorders. Chances are good that very soon you will be able to ask your doctor about this alternative treatment!

Cover image modified from Mr. Mostly people think that playing video games is perhaps the best brain training, but such games are mostly paid. You cannot increase the efficiency in your brain training by meditating. However I think brain training could be totally free because substitution in your diet and a way to reduce your stress, some physical exercise and simple brain exercise that could be reading or brain teasers can be found profoundly helpful for mental health.

Taking care of these routines could prevent you from later psychiatric treatments. This does not seem like a well thought-out comment. Clearly there is absolutely no understanding of the article or of this therapy. According to a survey there are roundabout million people from are all over the world that are having mental disorders. And sadly it is predicted to be more in Our group has shown that surface neurofeedback training combined with brief, daily LED-based, near infrared light stimulation of the cortex can significantly alter memory and motor performance.

Adding this to regular exercise and diet change offers a low cost and actionable way to impedenandbreverse age related cognitive and physical decline. Clinical trials are being conducted now involving home based use of neurotraining and Photobiomodulation technology.

Vince Monastra and Dr. Joel Lubar, with the goal to create a fast and simple assessment method for ADHD in adults and children as young as 5 years old. The design and methodology of this software suite is based heavily on the hallmark published study by Monastra, Lubar et al.

Statistics are monitored throughout the assessment from a single EEG-Z sensor and the results are arranged in an excel report. The excel report includes notes and norm values for easy comparison and interpretation.

This second sensor is useful but not necessary for assessment. Interesting to read. Its good that we have non-invasive techniques that detect different aspects of brain activity and functioning: electroencephalography EEG and functional magnetic resonance imaging fMRI. The science is an area, that there are so many people in-working,testing,researching,trying, summarizing etc. Still a big amount of people with mental health problems. I want to thank every single who are involved and helping out!

Your work is much appreciated! We badly need you. Better knowledge of brain functioning, the pathologies that affect it, and the development of more precise new technologies can shorten the gap between cutting-edge scientific knowledge and day-to-day clinical practice. Not just for the advantaged, but for all children in our nation. We tend instead to wait so long until real problems arise. At least it did with mine.

One of those videos I go over how NFB impacted each of those issues. Beldan4 — Youtube just look for the one that says Neurofeedback Therapy. Anyway, in short. I wish I could find a school and the funding to go to a school that is open minded enough to let me pursue a clinical psych program that was more interdisciplinary.

My son age 6 just began NF and would love to ask you a few questions about your journey with NF. Sounds like it did.. I would appreciate your thoughts and experience. Autistic spectrum disorder Autistic spectrum disorder ASD is a neurodevelopmental disorder with challenges that maintain in adulthood.

Table 7. Summary of neurofeedback treatment studies on autistic spectrum disorder ASD. Abbreviation: SMR: Sensorimotor rhythm. Epilepsy In about one-third of patients with epilepsy, medical treatment is ineffective.

Table 8. Depression Depression is associated with hypometabolism in the cingulate and occasionally in the frontal cortex, insula, anterior temporal cortices, amygdala, basal ganglia, and thalamus. Anxiety In clinical medicine, anxiety is often defined, at least in part, as high level of muscle tension. Pain management Pain is considered a symptom associated with physical damage, purportedly having an objective element connected with the sensation.

Neurofeedback Softwares Brain-computer interface systems BCI are widely used in clinical and research applications. Conclusion In this paper, we reviewed the clinical applications of neurofeedback, various protocols of treatment and some of the systems designs by BCI and VR technology.

Footnotes Conflicts of Interest: None declared. References Allen J. Psychophysiology , 38 4 , — EEG neurofeedback: a brief overview and an example of peak alpha frequency training for cognitive enhancement in the elderly.

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International Journal of Psychophysiology , 47 1 , 75— Can neurofeedback training enhance performance? An evaluation of the evidence with implications for future research. Applied Psychophysiol Biofeedback , 30 4 , — Applied Psychophysiol Biofeedback , 35 1 , 29— The studies tested the effects of rtfMRI neurofeedback in promoting healthier function of the insula, a brain structure widely implicated in emotional processing and recognition.

In their research, the team found that both left and right insula could be influenced via conscious control using rtfMRI neurofeedback. The results showed altered behavioral tests of facial emotional recognition and simultaneously influenced overall network connectivity, suggesting that feedback influences both neurophysiology- and laboratory-based tests of emotion recognition. The region of interest ROI was selected to be the insula, the left side in psychopathy and both sides in schizophrenia, because the insula is associated with cognitive affect regulation.

A group of paranoid subtype schizophrenia patients performed a two-week, four-session rtfMRI BOLD-based neurofeedback training protocol. Each patient had been receiving anti-psychotic medications for at least four weeks prior to the study. Changes in connectivity were assessed using a Granger Causal Model GCM examining the computed causal density, a metric of temporally directed influences rather than only correlation or coherence.

During training, subjects were encouraged—but not instructed—to recall emotionally relevant past experiences as a possible way to modulate the BOLD upregulation on the feedback monitor graphic, a thermometer.

On each training day, each subject was re-evaluated based on the Positive and Negative Affect Schedule, and on the final training day all subjects performed a transfer session during which they were asked to self-regulate their insula to observe whether self-regulatory training persisted even without neurofeedback.

Results from connectivity analysis in both the schizophrenia and psychopathy studies lend support to the efficaciousness of rtfMRI neurofeedback. Effective connectivity, measured by causal density, was affected by neurofeedback training targeting blood perfusion in the insula, most notably between the insula cortex, amygdala, and medial pre-frontal cortex.

The area appears to be important for the overall continuity of experience, especially emotional and relational memories [ ]. The changes exhibited by schizophrenic patients suggest at least a functional rewiring since Granger causal connections increased overall frontal influence over lower substructures. Further study is warranted to more deeply explore the fundamental mechanisms at play in schizophrenia as well as the possibility of using other modalities like EEG or high-density fNIRS technology to influence insular function.

Future work is also warranted regarding a developmental hierarchy of schizophrenia to explore where the dysfunction begins and how it develops into a complex, multi-regional brain disorder.

In the study on emotional processing in psychopathy, patients underwent a similar training regimen, as described previously for schizophrenia patients. However, training targeted BOLD signatures in the left anterior insula rather than both.

Baseline blocks to isolate global background activity were performed before, after, and in between the four emotional imagining blocks, and the background ROI was selected to insulate the left anterior insular ROI from movement and activations from other subcortical emotional networks and regions. The neurofeedback training included an initial pre-trial, with three days of feedback training four times a day and a final post-trial.

The protocol design included baseline and upregulation blocks; during the baseline blocks, subjects did not actively attempt to influence the on-screen thermometer and during upregulation blocks the subjects were instructed to increase BOLD response, guided by the thermometer graphic. Pre- and post-tests were performed as a behavioral measure of change based on volitional regulation of the BOLD signature in the left anterior insula.

These used a set point, stimulus, response method in which the subjects alternated between upregulation and baseline neurofeedback, followed by brief presentation of an International Affective Picture System IAPS image as stimulus, then response rating block during which participants evaluated their emotional state using the Self-Assessment Manikin test.

Of the four subjects trained, one subject learned to increase BOLD activity in the anterior insula with training. Additionally, learning to upregulate the left insula was also associated with increased connection in the emotional brain network.

To date, previous investigations have suggested that amygdala hemodynamic responses to positive stimuli are attenuated in patients with major depressive disorder MDD [ ] and that these responses normalize when remission is achieved with antidepressants [ ].

Thus, it was hypothesized that NFB-induced increase in amygdala response to recall of happy autobiographical memories would improve symptoms of depression and normalize brain activity. Yuan et al. Subjects received active neurofeedback from the left amygdale LA or from the left horizontal segment of the intraparietal sulcus control region. Additionally, a positive correlation was noted between symptom reduction and connectivity, so that patients with the greatest reduction showed the highest increase in connectivity [ ].

In another study, the same group showed that rtfMRI and NFB training to increase amygdala hemodynamic response to positive memories significantly decreased depressive symptoms and increased the percentage of specific positive memories recalled on an autobiographical memory test [ ].

Amygdala rtfMRI and NFB training was associated with changes in amygdala responses to happy and sad faces and improved processing of positive stimuli during performance of the Emotional Test Battery [ ]. In another study, Hamilton et al. Compared to subjects in a sham condition, subjects in the active condition showed greater reduction in SN node response to negative stimuli, indicating changes in brain connectivity.

Additionally, greater decreases in responsiveness to negative self-descriptors were also noted in the treated group [ 86 , ] trained eight depressed patients to upregulate BOLD activity in the ventrolateral prefrontal cortex and insula during four rtfMRI and NFB sessions. Subjects showed reduced symptom burden and evidence of increased bilateral activations in the areas trained anterior insula, VLPFC , but also in other areas including parts of the hippocampus, right ventral striatum, and left cuneus, as well as deactivation at the temporo-parietal junction, posterior insula, and the right dorsolateral prefrontal cortex DLPFC , indicating network-level changes.

In another study, Zotev et al. Simultaneous scalp EEG recordings were collected during training to assess the relationship between NFB, frontal asymmetry in the upper alpha band FA-alpha , which has been associated with depression, and BOLD activity in regions implicated in emotion regulation.

Conversely, EEG and NFB-induced reduction of frontal alpha asymmetry is postulated to improve connectivity in neural networks that support emotion regulation [ ]. In summary, there is growing evidence that supports the positive effects of NFB on depression. These positive effects are accompanied by both behavioral changes patient self-reported and clinician-administered tasks , as well as neural changes, as measured through fMRI BOLD activity and scalp EEG recordings, and are consistent with changes observed in patients treated with other modalities such as antidepressants.

This renewed interest is coupled with an array of methodologies that allow for neurofeedback of brain electromagnetic activity as well as blood flow. In contrast to this growing enthusiasm, there is ample skepticism about the effectiveness of these methodologies. Many agree that for neurofeedback to earn acceptance as a valid intervention, the clinical significance of its purported therapeutic effects must be clearly established [ 35 ].

First and foremost, proper control conditions are necessary, including sham conditions. Additionally, better ways to separate non-specific factors from the feedback itself, including control strategies, expectations, attentional factors, etc.

In addition to conducting more rigorous studies, we are also suggesting an open discussion of optimal methods to measure the effects of neurofeedback and biofeedback approaches.

Neuroplasticity, as the medium of the brain that is affected by neurotherapeutic interventions, immediately suggests that changes will occur at the level of gene expression and behavior, as well as everything in between. We suggest that brain changes occasioned by specific neurofeedback protocols will be reflected at one level by some biomarkers and not others.

Because of the semi-independent relationship between levels, and differential time courses, changes in physiology may become apparent early in treatment, whereas behavioral changes may take longer to manifest. Additionally, as is true of most treatments of neuropsychiatric disorders, studies that focus heavily on group differences may not be sufficient to determine whether treatment is effective in some patients but not others.

Given these limitations, we suggest a strategy that assesses efficacy at multiple levels and examines data for each subject, as previously suggested by Samuel et al. Returning to the possibility of using NFT for the purposes and goals of social neuroscience, it seems that experimental neurofeedback designs with specific behavioral outcomes would inform both the social neuroscience and clinical communities.

Some markers of neural activation have been relatively well studied and may serve to pioneer such methodology in social neuroscience. For instance, markers of attention, focus, memory, and emotion regulation may be considered manipulated interventions in which social outcomes might be measured.

Such networks have been manipulated in NFT treatment of individuals with autism in the hopes of engaging such networks for better mirroring and subsequent mentalizing function [ 2 ]. Pineda and colleagues found greater activation of such mirroring systems when participants viewed social interactions for participants in the experimental but not the sham condition.

This is only one of many possible applications of NFT that has the potential to cross disciplines. Here we have provided an overview and framework through which to consider the complexities and application of such methodology.

Neurofeedback may be a useful tool in our understanding of neural processes, be that for the goal of treatment or understanding. National Center for Biotechnology Information , U. Journal List Brain Sci v. Brain Sci. Published online Aug 7. Oriana R. Jaime A. Stephanie Cacioppo, Academic Editor. Author information Article notes Copyright and License information Disclaimer.

Received Jan 24; Accepted Aug 4. This article has been cited by other articles in PMC. Abstract Social neuroscience benefits from the experimental manipulation of neuronal activity. Keywords: neurotherapies, perturbative physiological plasticity, self-directed plasticity, biomarkers, functional connectivity. Introduction A goal of social neuroscience is to draw causal conclusions about neural activity in relation to social behavior, thought, perception, and experience.

The Goal of Neurofeedback At its most fundamental level, neurofeedback training provides learners with information about their current behavioral, physiological, and neural processes in the service of self-directed modulations of those processes to achieve specific outcomes. Methodologies EEG-based methods remain the primary and most often used approach in the delivery of neurofeedback, mainly because of their low cost, non-invasiveness, and ease of use [ 36 ].

Infra-Low Frequencies and Slow Cortical Potentials Several developments in low-frequency neurofeedback have been introduced recently. Synchrony, Coherence and Cross-Frequency Coupling Ideas regarding phase synchrony, coherence, and cross-frequency coupling arose from observations regarding interactions between spatially separate regions and spectrally separate oscillations in the frequency domain.

Normative vs. Symptom-Based Protocol Selection Different approaches to neurofeedback training have evolved over its history. Brain Plasticity All the EEG-based approaches described above are predicated on changing the dynamics of brain activity to produce beneficial and long-lasting changes in function and structure.

What Is Neuroplasticity? Perturbative Physiologic and Self-Directed Plasticity In order to capture the unique nature of plasticity-induced changes via neurofeedback, we coin the term perturbative physiologic plasticity PPP. An Organizing Principle for Determining Effectiveness Starting in the s, EEG-based neurofeedback became a treatment vehicle for a host of mental disorders. The Need for Objective Outcome Measures Psychiatrists rely on the classification of symptoms in the Diagnostic and Statistical Manual DSM , but such classification generally lacks objective measures based on brain function, such as neuroimaging scans, to assist in the diagnosis, treatment selection, and measurement of treatment response in major illnesses.

Psychophysiological Biomarkers A current assumption in the neurotherapeutic field is that brain changes following neurofeedback whether functional or structural underlie clinical improvement.

Neuropsychological Assessments Neuropsychological testing provides a level of observation that lies between psychophysiological biomarkers and community functioning. Behavioral and Community Functioning Part of the problem in determining appropriate biomarkers, whether spectral dynamics, functional connectivity, or neuropsychological scores, is that a simplified or reductionist approach, where only a limited aspect of the complexity and dynamic nature of human brain dynamics is characterized, can only give an incomplete view.

Structural and Functional Connectivity Studies We believe that neurofeedback is at a point where the accumulating evidence calls for a re-evaluation of the assessment criteria, including the establishment of standardized and rigorous criteria based on appropriate principles, as outlined above.

Schizophrenia and Psychopathy Previous studies suggest that the three most salient structures in the emotional network include the insula, amygdala, and medial prefrontal cortex [ , , ]. Author Contributions All authors contributed equally to the work. Conflicts of Interest The authors declare no conflict of interest. References 1. Keuken M. The role of the left inferior frontal gyrus in social perception: An rTMS study.

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