Biofeedback is a method of registering bodily functions to help individuals gain control over certain feelings and behaviors. Biofeedback requires the use of some type of formal measurement system, most often some type of computerized tools that can measure certain bodily functions, such as skin temperature, breathing rate, heart rate, etc. The goal of biofeedback is to assist these individuals in controlling types of bodily functions that are typically perceived as being out of the realm of one’s control. For example, individuals can learn to control their heart rate and breathing in an effort to reduce issues with anxiety by using biofeedback monitors that give them information regarding these functions. This can produce states of relaxation that are inconsistent with feelings of anxiety.

Neurofeedback (NF) is a form of biofeedback where individuals use an electroencephalogram (a machine that registers the electrical patterns in activity of the human brain) to view and help them control certain patterns of brain waves. NF is also sometimes referred to as neurotherapy or neurobiofeedback.

How Does Neurofeedback Work?


In neurofeedback, a special type of electroencephalogram that is known as a qualitative electroencephalogram (qEEG) is used. The qEEG is a specific instrument that analyzes the electrical activity patterns produced by the brain in order to display specific patterns that might be related to certain types of diagnoses or cognitive issues. Other terms to describe qEEG are:

  • BEAM (Brain electrical activity mapping)
  • Brain mapping
  • Topographic EEG
  • EEG biofeedback

The qEEG technique uses more surface electrodes than the standard EEG, and it gathers data from 24 or more brain areas. The electrical data is then mapped onto a picture of the brain or head in different colors or with different shades of color. These images are quite colorful and impressive, but they have no relationship to the neuroimaging procedures used in medicine, such as positron emission tomography (PET scans) or functional magnetic reticence imaging techniques (fMRI). The specific patterns produced by the qEEG are analyzed by someone trained in the procedure.

Individuals with certain types of disorders, such as epilepsy, ADHD, and other mental health disorders are then trained to produce more functional brain patterns associated with what is considered to be “normal” functioning.  The NF technique helps them to control issues associated with their diagnosis, such as issues with attention, distractibility, mood, anxiety, and, in some cases, even seizures.

The technique has several assumptions and applications. Brain functioning is improperly regulated in a number of different conditions, such as epilepsy, ADHD, depression, etc. The causes for this dysregulation of brain patterns activity can be numerous and include genetic causes, trauma, other stressful experiences, learning, or interactions between any or all of these. Over time, the irregular brainwave patterns become the norm for the individual, and they develop some type of disorder. Neurofeedback offers the possibility that the brain can be retrained to function in an optimal manner, even when an individual has significant issues.

Neurofeedback sessions start with a complete assessment designed to specifically identify the underlying problem. The assessment can include a behavioral assessment, medical tests, subjective reports of one’s issues, interviews with significant others or parents, etc. The initial readout from the qEEG is also obtained to identify the particular individual’s dysfunctional brainwave patterns.

The appropriate type of NF protocol is determined, and the individual is instructed how to respond. Sometimes, individuals simply listen to music that has built-in programs to help “correct” the issue, and other times, individuals are instructed to engage in certain behaviors and receive feedback from a computer monitor. The individual is attempting to control specific brainwave patterns by maintaining a specific reading on the monitor as a result of engaging in certain types of instructed mental exercises. Feedback can consist of a number of possible outcomes, such as a tone, color, or specific output reading on the monitor. Maintaining the proper brainwave pattern is associated with the desired feedback. Eventually, the person can learn to induce the proper mental state without the monitor.

NF training is not invasive. There are no shocks or other noxious experiences. For most individuals, the training is relatively simple, pleasant, and relaxing. Because the technique is individualized, proponents of NF claim that it can address the specific needs of the person better than other forms of treatment.

A number of different providers of neurofeedback have different trade names for their product. In addition, a number of rather remarkable claims are made about the effectiveness of the technique for treating rather difficult conditions, including ADHD, epilepsy, posttraumatic stress disorder, etc. Many of these claims border on the fantastic and often cannot be substantiated. Nonetheless, the technique is gaining popularity.

How Does NF Address Substance Use Disorders?


The technique of using neurofeedback for individuals with substance use disorders is basically consistent with the description above. Individuals are instructed to produce certain types of feedback protocols from the qEEG machine by engaging in specific mental exercises or concentrating on certain feelings. This training is theoretically believed to help the individual return their brain functioning to its pre-addictive state and to assist them in controlling their substance use disorder.  NF training is often used in conjunction with traditional forms of substance use disorder treatment.

A number of studies suggest that individuals who undergo neurofeedback for substance abuse have significantly lower dropout rates than individuals who engage in standard forms of treatment alone. As treatment adherence and length in treatment are significant predictors of treatment outcomes for substance use disorders, NF is considered to improve on the normal treatment protocols used in substance abuse treatment.

Drawbacks to Neurofeedback


The major drawbacks to the use of neurofeedback involve the typical issues that occur when a particular form of intervention is described as being a panacea. In fact, according to the book Science and Pseudoscience in Clinical Psychology, the majority of independent reviews of NF rate it as being a promising form of intervention but lacking sufficient empirical evidence to recommend its use for a number of the conditions.

One of the most reliable ways to ascertain the effectiveness of an intervention for a specific disorder is to combine the results of a number of different studies that investigate the treatment effect on different samples with the disorder. It is accepted that evidence from a number of well-controlled studies should be given greater weight when compared to the results from a single study. The technique of meta-analysis is a statistical technique that allows researchers to look at the overall effects of an intervention or treatment as recorded by a number of different studies as opposed to just one study. This means that meta-analytic techniques are far more reliable and telling regarding the overall effectiveness of a particular intervention.

Proponents of neurofeedback have made a number of very positive claims regarding how effective and fast it is at treating individuals with ADHD. However, a recent meta-analytic study reported in the Journal of the American Academy of Adolescent Psychiatry that combined results of several studies failed to find any evidence that NF was effective in controlling the symptoms of ADHD.

Regarding its effectiveness for substance use disorders, a recent study in the journal Child and Adolescent Psychiatric Clinics of North America suggested that the use of NF may have utility in identifying individuals who might be responsive to different types of medications and other treatments for a number of mental health conditions, including substance abuse; however, there appear to be no recent meta-analytic studies regarding the effectiveness of NF for substance use disorders.

In addition, one of the most common observations regarding research associated with the effectiveness of qEEG is that the studies demonstrating that the technique is effective as an intervention are often lacking in sound research methodology. While no one study can ever be perfect, there are a number of specifications that need to be met in order for the study to produce reliable (and therefore possibly valid) results. A great deal of the research dealing with the effects of qEEG appears to have significant methodological limitations.

Another drawback associated with the assumptions of neurofeedback is the theoretical foundation that is associated with the effectiveness of the technique. For instance, it is well known that individuals with certain mental health disorders, including substance use disorders, have abnormalities in brain functioning; however, there is no single identified set of brainwave patterns that can be used to either diagnose any mental health disorder or to signify that any individual is “normal.” Thus, the very foundation of NF rests on assumptions that have no consistent theoretical or factual basis or presentation. Again, it appears that NF can help individuals reduce reactions, such as anxiety and discomfort associated with stress, but it is purely speculative whether participants can produce brainwave patterns that are nonfunctional or “normal.”

Stress management and anxiety-reduction techniques are commonly used in the treatment of substance use disorders, and if neurofeedback can assist or facilitate in these techniques, it certainly can be useful. In addition, there is evidence to suggest that NF is compelling to individuals in substance use disorder treatment, and its inclusion, while not empirically demonstrated to have treatment-specific effects, may help in stress reduction and contribute to the retention of some individuals in treatment programs who might otherwise dropout. Thus, while research is preliminary, NF may benefit some individuals as a complementary technique in formal traditional treatment for substance use disorders.