“People who do bad things often have troubled brains,” claims psychiatrist and brain disorder specialist Dr. Daniel Amen. “Behaviour is really an expression of the problem; it’s not the problem,” he says, commenting on maladaptive conduct resulting from excessive cannabis use.
Amen is known for promoting the possibility that in some cases, the cause of addiction and behaviour disorders may be physiological rather than psychological, like a brain injury. Those therefore require unorthodox diagnoses and treatment methods, such as brain scans like single photon emission computed tomography (SPECT), which monitors blood flow and activity in the brain.
Researchers found that undiagnosed brain injuries are a major cause of homelessness, drug/alcohol abuse, depression, panic attacks, attention deficit hyperactivity disorder (ADHD), and suicide. Patients whose addictions are caused by brain injuries may need brain rehabilitation programs instead of (or in addition to) behaviour therapy, not just medication. Scans like those performed by Amen form part of the backdrop of modern neurofeedback (NFB).
What is neurofeedback?
Parts of the brain manage mood, emotion, attention, or sleep. Everything we think, feel, and do is the result of the activity of brain neurons which produce measurable brainwaves. We can now train these brainwaves to improve brain function.
This is called neurofeedback—a.k.a. neurotherapy, neurobiofeedback, brainwave biofeedback, or formally, electroencephalographic (EEG) biofeedback. Used to overcome mental health conditions, this technique improves the brain’s ability to regulate physical and mental functions by providing real-time audiovisual information about its electrical activity measured from scalp sensors.
Types of neurofeedback
Systems have diversified from simple concentration machines to those with deep brain imaging capability:
- Brand name systems—a.k.a. ‘packaged’ brain training systems are limited by their built-in functions, making it difficult to pinpoint problem areas. Good for beginners.
- EEG (traditional) neurofeedback—more flexible; suited for individualized training.
- QEEG LORETA* neurofeedback—3D brain imaging and training tools enable practitioners to directly train entire brain networks. Training multiple areas at once means fewer sessions.
- LENS** neurofeedback—addresses the underlying causes of anxiety, depression, and confusion that often lead to addiction. It shows the brain how to let go of negative patterns and rebuild healthy neural networks without medication.
- Mobile neurofeedback—portable units that can be used at home. One of them is NeurOptimal Dynamic Neurofeedback, a software program developed by psychologists Dr. Val and Sue Brown of the Zengar Institute in Canada . Patients can buy or rent units, or hire trainers.
Neurofeedback, together with psychotherapy and positive psychology coaching, has proven effective for many illnesses by reducing or eliminating symptoms while optimizing wellness. When combined with mindfulness training and counselling, it enhances recovery.
Neurofeedback is painless, non-invasive, and medication-free. Benefits include:
- Enhanced mental clarity and focus
- Decreased impulsivity and anxiety
- Restful sleep
- Improved mood
Conditions treatable by neurofeedback
Children: ADHD, autism, emotional and behavioural issues, learning and developmental delays, reactive attachment disorder (RAD), which occurs frequently in abused or neglected children.
Adults: addiction, depression, anxiety, irritability, obsessions, sleep disorders, migraines, chronic pain, traumatic brain injury, bipolar disorder, traumatic brain injury, post-traumatic stress disorder (PTSD), seizures, concentration difficulties, procrastination.
These are all brain issues. With neurofeedback, the brain changes itself, resolving these conditions. NFB training doesn’t eliminate chronic conditions such as autism, but it can help the brain function better. It helps with recovery from medications, medical procedures, and withdrawal symptoms. Neurofeedback also improves performance by changing the timing of the brain—useful for advancement in business, school, and sports.
Detractors call it a “pseudo-science,” but its basis is scientific. It uses technology to identify frequency imbalances in the brain. Some feel that the procedure is controversial, expensive and time-consuming.
While neurofeedback is recognized as safe, some patients report side effects. Many of these are temporary and aren’t considered dangerous. Increased risk of adverse effects are higher, though, if operators aren’t skilled professionals, patients aren’t assessed properly, or patients attempt to conduct neurofeedback on their own .
How it works
The patient faces a computer screen. After careful measurements, the practitioner attaches electrodes to the scalp, connecting the parts of the brain the patient needs to train to software that measures brainwave activity.
If the brain is functioning normally, the system will play a movie. If it isn’t, the visual will fade out. The patient learns how to stop this by changing the brain activity being trained. The brain has a way of figuring this out. Once the patient learns new patterns, the brain remembers them. This feedback is delivered in real time and the brain starts to change quickly.
Duration of sessions
At the Perth Brain Centre, Clinical Director Daniel Lane says a typical program consists of 20 training sessions running twice weekly, each lasting for 20-30 minutes. At the Power of Choice concierge addiction services in California, a program may have 12-15 sessions, each lasting only 15 minutes.
How fast does it work and do effects last?
Improvement is typically seen within 10 sessions. Although the lasting effects of NFB have not been extensively explored, patients of NFB pioneer Dr. Lubar reported benefits lasting 20 years after treatment. Other studies have shown continued improvements two and five years post-therapy .
Biofeedback and neurotherapy psychologist Dr. Paul Swingle assures, “With the exception of a few age-related neurological changes that require periodic treatment, once a problem is remedied, it remains in the improved state without further sessions .”
Can neurofeedback free patients from taking medication?
It’s possible for some to eliminate medicine use, but there’s no guarantee. Some patients get off their medication; some reduce dosage; others maintain their regimen. Patients should consult their doctors before adjusting medication.
Neurofeedback has been around since the 1950s. NASA used it to train astronauts, and they are still using it in their training programs. NFB only became widespread in the 1990s, however, due to technological advances.
Bloomberg Businessweek quoted in 2017 the cost of 30 neurofeedback sessions of 40 minutes each at $2,200, plus a $250 initial assessment fee. Renting a mobile unit for a month with unlimited sessions costs $1000. One can buy the same for around $7,000. Few insurers cover the cost, but it’s worth looking into if conventional addiction treatments haven’t been effective.
Is it FDA-approved?
The US Food and Drug Administration regulates all biofeedback equipment as medical devices and general wellness instruments for stress reduction and relaxation. Low Energy Neurofeedback System (LENS) neurofeedback is FDA-certified and meets the guidelines of the International Society for Neurofeedback and Research (ISNR), an advocacy group for neurotherapy practitioners. The FDA may approve neurofeedback for psychiatric conditions one day, but approval costs millions of dollars.
Does it work for everyone?
Most people will respond to NFB training, but a minor percentage won’t. That’s why an initial assessment is important.
How neurofeedback compares with other modalities
Mike Cohen, from the Center for Brain Training in Florida, says that neurofeedback is different from brain games like Lumosity. Those focus on changing skills, behaviour, or how one thinks. Neurofeedback is focused on changing the brain, which affects the mind. Thus, neurofeedback can have a huge impact on an addict’s life.
In contrast, electroconvulsive therapy (ECT), formerly electroshock therapy, is a psychiatric treatment which electrically induces seizures in patients with mental disorders. Though ECT is considered a safe and effective intervention for major depressive disorder, mania, and catatonia, it’s invasive .
Neurofeedback is unregulated, with practitioners differing on procedures and results. That’s why it’s important to carefully choose providers. Those considering neurofeedback should discuss it with their healthcare providers, then contact ISNR or state/provincial licensure boards to ensure their chosen practitioner is licensed and certified with an appropriate organization, such as the Biofeedback Certification International Alliance (bcia.org).
When taking on any treatment, it’s prudent to weigh therapeutic benefits against side effects. So a cost-benefit analysis is appropriate. As for NFB devices, ISNR’s Dr. Kerson cautions that they should never be used without experienced supervision: “Neurofeedback is a powerful therapy and should be treated that way.”
* Quantitative electroencephalography low-resolution brain electromagnetic tomography
** Low energy neurofeedback system
 BreinGoed, a representative for NeurOptimal Dynamic Neurofeedback.
 “Neurofeedback Side Effects, Adverse Reactions, & Dangers”. Mental Health Daily. 2016.
 Ottawa Neurofeedback Centre
 Swingle, Paul. “Biofeedback for the Brain: How neurotherapy effectively treats depression, ADHD, autism, and more”. Rutgers University Press. 2008.
 Rudorfer et al. “Electroconvulsive therapy”. Psychiatry, second edition. Chichester: John Wiley & Sons Ltd, 1865–1901. 2003.