What’s Neurofeedback—and How Does It Work?

If you’re wondering: “What does neurotherapy do?” or “Is neurotherapy legitimate?” this article illuminates how neurotherapy works, which conditions it can help with, and the current research. 

Neurofeedback, also referred to as EEG biofeedback, is a therapy based on the tenets of biofeedback and neuroscience.

During neurofeedback, practitioners monitor their clients’ brain waves to identify imbalances that correlate with thought patterns. Then, they work with their clients to adopt healthier thought patterns that may create longer lasting beneficial changes in the brain wave activity. 

Neurofeedback has been shown to effectively treat attention-deficit/hyperactivity disorder (ADHD). Additionally, according to peer-reviewed research, it also holds promise for treating posttraumatic stress disorder (PTSD) and migraines.

Some experts recommend using neurofeedback to complement other therapies like cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT), since they can help your brain become more receptive to change.

How does neurofeedback affect thought patterns?

Neurofeedback, also called EEG biofeedback or neurotherapy, teaches clients to retrain their brain waves. 

Each of us has three waking frequencies of brain waves recognized by an EEG machine—slow, medium, and fast. Each of these frequencies cause us to feel different ways, says Dev Patel, LCSW, a therapist board certified in neurofeedback at Aspire Mental Performance.

The three types of waking brain waves and their corresponding mental states:

• Slow (theta) brainwaves (4-7 Hz): Theta brainwaves occur when we’re deeply relaxed. These are the brain waves associated with daydreaming, feeling spacey, or getting sleepy.

• Medium (alpha) brainwaves (8–12 Hz): Alpha waves are  the Goldilocks type of brain waves—they cause that just-right state of being calm, yet focused.
• Fast (beta) brainwaves (12–35 Hz): Beta brain waves make your mind jumpy. You may feel anxious and restless when you have excess beta brainwaves.

“What neurofeedback does is it teaches you to produce brain waves that put you in a relaxed, but alert, state. It helps you stay in the middle, feel-good zone,” says Patel. 

Neurofeedback therapists use two forms of treatment

Traditional neurofeedback

This therapy encourages the mind to produce more or less of certain brain waves through game-like exercises. The client or patient is an active participant in the treatment.

Neurostimulation

This passive type of therapy applies gentle, minuscule amounts of electrical stimulation, which encourages the brain to mimic the frequencies of balanced brain wave patterns.

What happens during a neurofeedback therapy session?

Initially, a neurofeedback practitioner (often a therapist, psychologist, or psychiatrist), certified by the Biofeedback Certification International Alliance or The Association for Applied Psychophysiology and Biofeedback, may administer a quantitative electroencephalogram (QEEG), a painless test that measures electrical activity in the brain. 

From the results, the therapist sees how their client’s brain operates and what interventions may improve functioning. 

Following neurofeedback therapy sessions may involve traditional neurofeedback or neurostimulation, sometimes along with talk therapy.

During traditional neurofeedback treatment, the therapist has the client watch a video or play a video game while monitoring their brain waves. 

Ideal brain wave activity may be reflected in the video game the client is playing—marked by a bright and easy to see screen, or the corresponding character in the game running faster and progressing. According to Patel, the moment the brain starts drifting out of that ideal state, the screen becomes dark and harder to see, or the game’s character slows to a stop.

The program is constantly responding to the client’s brain waves, monitoring and rewarding the player (client) every time the character reaches the target zone. Eventually, the brain figures out what the program wants it to do and adjusts to receive the reward (i.e. viewing the video or moving faster in the video game).

As a result of doing this multiple times a week, Patel says, the client’s brain starts to prefer being in the target zone.

What is neurostimulation like?

Neurostimulation is a procedure that sends electrical signals to the brain to prompt it to alter brainwave activity. The therapist places electrodes on the patient’s head and chooses from four types of stimulation, depending on the goals of their treatment plan. Clients may feel slight tingling or nothing at all.

“Once the brain experiences the low-level stimulation, it goes: ‘This is better. I can do this myself’ and it emulates the frequencies. So neurostimulation is really showing the brain a different way of operating,” says psychologist and director of the Center for Integrative Psychology, Barry Jay, PhD, BCN.

Unlike electroconvulsive therapy (ECT), which provides a high dose of electrical stimulation, neurostimulation doesn’t require anesthesia or a hospital setting. That’s because the treatment involves only a tiny bit of energy, similar to a watch battery. 

When was neurofeedback created?

Neurofeedback isn’t new. 

Early neurofeedback dates back to the late 1800s when variations in the brain’s electrical activity were first identified and studied in animals. Neurofeedback as it’s practiced today was done in the late 1950s and early 1960s by Joe Kamiya, PhD, and Barry Sterman, PhD.

Neurofeedback is a branch of biofeedback, a therapy that helps people self-regulate physical functions. Whereas biofeedback can help people learn to lower their blood pressure by getting real-time feedback on a screen about their heart rate, neurofeedback focuses on teaching us to manage our brain waves.

What conditions does neurotherapy help with?

Neurotherapy makes people more open and flexible in their thinking, says Jay, who points out that this is why it can be helpful for many brain-based disorders, including ADHD, anxiety, depression, and PTSD.

ADHD

One of the earliest uses of neurofeedback was for children with ADHD. Multiple studies found that it reduced symptoms. A comparative study from 2003 even found neurofeedback to be as effective as stimulant medications. 

In a more recent study from 2020, researchers used the American Psychological Association (APA) guidelines for the “efficacious and specific” application of neurofeedback and confirmed that it’s a well-established treatment for ADHD in children. 

Anxiety

Neurofeedback may be helpful in reducing multiple symptoms of anxiety. For example, a 2015 study found that neurofeedback can relieve anxiety symptoms, such as thought problems and somatic complaints, however more research is needed. 

This study also found statistically significant improvements in other anxiety-related symptoms, such as:

• Avoidance
• Internalizing
• Withdrawal

Depression

Neurofeedback shows promise in treating depression, however more research is needed. To date, a number of small studies have shown that it can reduce depression symptoms, even to the point of remission. A 2016 study found that depression severity decreased significantly for clients who received neurostimulation treatment over the course of eight weeks. 

Post-traumatic stress disorder (PTSD)

The gold standard for treating post-traumatic stress disorder (PTSD) is exposure therapy, however treatment retention in exposure therapy is notoriously low, because reliving trauma is painful. Research suggests neurofeedback may be an effective, less stressful treatment for PTSD.

How successful is neurotherapy?

“When you’re struggling with a mental health condition, any kind of improvement is great, especially if it’s natural and it’s going to be long-lasting,” says Patel, who specializes in treating ADHD and anxiety. “The majority of my clients see their symptoms cut in half or more—and even a 50% reduction in ADHD can create a huge change in someone’s life.”

The science also backs up Patel’s anecdotal experience. There are many years of research showing that  neurotherapy can be an effective treatment for a variety of mental health conditions, especially ADHD in children. However, the number of large studies is lacking because neurotherapy research is time and labor intensive and, therefore, often conducted on small groups of people, in comparison to other types of studies where participants may simply take a pill. Consequently, many existing neurotherapy studies lack placebo-control groups.

Does neurotherapy have any side effects?

One of the main benefits of neurotherapy is that it has minimal side effects. 

Difficulty sleeping is the most common. “Sleep disruptions are a signal to the therapist to change their treatment protocol because it’s overstimulating,” says Jay. 

Sometimes people get headaches the first couple of sessions, Patel reports, because exercising the brain can be tiring.

How long does it take for neurotherapy to work?

The number of neurotherapy treatment sessions needed depends on the conditions being treated and how the client responds to treatment. 

In general, clients may start to notice a difference within three weeks, says Patel. The average length of treatment runs from 20 to 50 sessions.

The good news is that the benefits of neurotherapy may persist months after therapy. For example, one study involving children with ADHD checked in with the participants after six months and found that improvements remained.

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