Abigail Holder (Author) and Sonya A. Ashikyan (Mentor)
Have you ever wanted to train your brain?
Neurofeedback is a behavioral therapeutic technique dating back to the 1930s that presents real-time feedback derived from brain activity in order to obtain healthy brain function and mainly uses electroencephalogram (EEG) technology1. Neurofeedback has been claimed to aid in the treatment of several disorders and cognitive patterns such ADHD2, depression11, epilepsy5, and others–particularly conditions resistant to treatment. The traditional usage of neurofeedback has entailed using electrodes that detect electrical activity in the brain placed on the scalp of the patient and connected to a computer. The activity is then displayed in real-time in a manner digestible by the patient: music or symbolic images, for instance6. The goal is then for the patient to learn how to modulate their brain activity in the moment through this feedback as they are given indications when they have fallen out of the desired range6. One hypothesis for the mechanism of neurofeedback is that it is consciously–that is, the patient is aware of it as opposed to it occurring subconsciously, or under awareness–harnessing neuroplasticity, or the ability of the brain to form new connections and rewire neural networks7. Neuroplasticity is important to aid in the management of these conditions long-term, as the process is physically reshaping the patterns of thinking and responding in the brain.
A new form of neurofeedback was developed fairly recently in 2003, and has been catching on quickly: real-time functional magnetic resonance imaging (fMRI) neurofeedback13. Patients lie in an MRI scanner while engaging in some kind of mental activity, such as focusing on perceiving sensations differently or giving more attention to certain aspects of their body or environment. The scanner uses changes in blood flow in the brain (called the BOLD signal) as a correlate for brain activity. This activity is projected visually in different manners to the patient, very similar to the analogous technique using EEG, while the patients are told to use different cognitive strategies to control their brain activity through this visual cue. For instance, in a 2005 study, researchers trained participants to control pain using real-time fMRI and a virtual flame as a visual cue, with four different control groups–groups that received various aspects of the experiment except for the intervention being tested–to account for various aspects of the neurofeedback process3. This flame represented anterior cingulate cortex (ACC) activity, a brain region known to be involved in the processing of pain. The study found that participants were quick to learn how to control the size of the flame and managed to reduce their levels of self-rated pain by 50%. Since then, the literature on real-time fMRI neurofeedback has grown substantially, exploring its applications to obesity, memory decline, ADHD, and more13. One 2013 study even found that patients with Parkinson’s (a condition characterized by damage to dopamine-producing neurons in a region called the substantia nigra) were able to increase dopamine levels in the substantia nigra12. This means, despite losing the cells that produce this neurotransmitter, these patients were able to consciously increase its levels in the brain.
However, neurofeedback as a therapeutic tool does not come without its criticisms. When the therapy first started emerging as a clinical treatment, it gained fast popularity in popular culture and the general media, making unsubstantiated claims and unproven benefits run wild9. Additionally, given the difficulty of controlling for such a technique, many early studies neglected placebo groups–groups that receive a sham treatment designed to have no real effect. In fact, one theory among some researchers is that the benefits seen through neurofeedback are simply harnessing the placebo effect10. Both sides of this argument are hotly debated8. Additionally, one 2020 literature analysis of 17 real-time fMRI neurofeedback studies suggested a relatively positive effect of the technique on mood disorders, but the effect was more subtle than other studies would imply4. However, the review emphasized the need for much more rigorous, placebo-controlled research on the technique to fully understand how it works, what it works for, and in what conditions it works best.
While neurofeedback shows fascinating potential, it is imperative for more research to be conducted to elucidate the clinical and general applications (or lack thereof) of the technique. For now, it is best met with a balance of curiosity and healthy skepticism.
- Arns, M., Heinrich, H., & Strehl, U. (2014). Evaluation of neurofeedback in ADHD: the long and winding road. Biological psychology, 95, 108-115.
- Barth, B., Mayer-Carius, K., Strehl, U., Wyckoff, S. N., Haeussinger, F. B., Fallgatter, A. J., & Ehlis, A. C. (2021). A randomized-controlled neurofeedback trial in adult attention-deficit/hyperactivity disorder. Scientific Reports, 11(1), 1-17.
- DeCharms, R. C., Maeda, F., Glover, G. H., Ludlow, D., Pauly, J. M., Soneji, D., … & Mackey, S. C. (2005). Control over brain activation and pain learned by using real-time functional MRI. Proceedings of the National Academy of Sciences, 102(51), 18626-18631.
- Dudek, E., & Dodell-Feder, D. (2021). The efficacy of real-time functional magnetic resonance imaging neurofeedback for psychiatric illness: A meta-analysis of brain and behavioral outcomes. Neuroscience & Biobehavioral Reviews, 121, 291-306.
- Hammond, D. C. (2005). Neurofeedback treatment of depression and anxiety. Journal of Adult Development, 12, 131-137.
- Hammond, D. C. (2007). What is neurofeedback?. Journal of neurotherapy, 10(4), 25-36.
- Loriette, C., Ziane, C., & Hamed, S. B. (2021). Neurofeedback for cognitive enhancement and intervention and brain plasticity. Revue Neurologique, 177(9), 1133-1144.
- Pigott, H. E., Cannon, R., & Trullinger, M. (2021). The fallacy of sham-controlled neurofeedback trials: a reply to Thibault and colleagues (2018). Journal of Attention Disorders, 25(3), 448-457.
- Roman, M. W. (2010). Treatments for childhood ADHD part II: Non-pharmacological and novel treatments. Issues in Mental Health Nursing, 31(9), 616-618.
- Schabus, M., Griessenberger, H., Gnjezda, M. T., Heib, D. P., Wislowska, M., & Hoedlmoser, K. (2017). Better than sham? A double-blind placebo-controlled neurofeedback study in primary insomnia. Brain, 140(4), 1041-1052.
- Sterman, M. B., & Egner, T. (2006). Foundation and practice of neurofeedback for the treatment of epilepsy. Applied psychophysiology and biofeedback, 31, 21-35.
- Sulzer, J., Sitaram, R., Blefari, M. L., Kollias, S., Birbaumer, N., Stephan, K. E., … & Gassert, R. (2013). Neurofeedback-mediated self-regulation of the dopaminergic midbrain. Neuroimage, 83, 817-825.
- Watanabe, T., Sasaki, Y., Shibata, K., & Kawato, M. (2017). Advances in fMRI real-time neurofeedback. Trends in cognitive sciences, 21(12), 997-1010.