The evidence base for neurofeedback

When we approach agencies about joining the Neurofeedback Advocacy Project, we are often asked about the evidence base for neurofeedback, and about the ILF Neurofeedback, the type of feedback we use in the project. This is our answer:

First, to get a sense of the breadth and depth of research on neurofeedback, I actually recommend folks at least scan for the term "neurofeedback" and then any other modifier you want to add at https://pubmed.ncbi.nlm.nih.gov/.   There should be over a 1000 published studies. 

Going at it another way, I recommend reading the current NY Times bestseller, The Body Keeps Score  by Dr. Bessel van der Kolk, one of the recognized experts on trauma and its treatment as Dr. van der Kolk includes a chapter on neurofeedback as an invaluable tool. To those interested in the underlying science of trauma and how that relates to neurofeedback, I strongly recommend Sebern F. Fisher’s Neurofeedback in the Treatment of Developmental Trauma. 

Outside the field of trauma, I recommend  Neurofeedback and Attention‐Deficit/Hyperactivity‐Disorder (ADHD) in Children: Rating the Evidence and Proposed Guidelines (2020) which concludes based on two meta-analyses that neurofeedback fits on the continuum of empirically supported treatments, using standard protocols. For a good summary of the underlying science, I recommend Closed-loop brain training: the science of neurofeedback in the distinguished journal Nature Review: Neuroscience.

In regards to the specific neurofeedback modality we use in our work, I direct folks to articles by Dr. Sigfried Othmer. Dr. Othmer and his wife Susan Othmer are responsible for what is now termed Infra Low Frequency (ILF) Neurofeedback. From these pages you can find links to studies in all areas.

Besides sending folks to these other sources, I feel it is appropriate to mention my own professional history including over 30 years using neurofeedback. In my doctoral program at the University of Oregon, my field of interest was behavior disorders in children. Upon graduating I was a Principal Investigator for an NIMH funded field study on the treatment of aggressive children. Later I was the Director of the Center for Attention & Learning in Eugene, Oregon and soon incorporated neurofeedback into my clinical work treating ADD/ADHD and behavior disorders. I have taught seminars and courses in the US and abroad in this area. I stayed current with many approaches to neurofeedback including ones based on quantitative electroencephalography (QEEG). However I was never convinced that this approach could be widely implemented, especially in public and non-profit settings that served the most difficult and underserved cliental. And while there is a proliferation of inexpensive neurofeedback-like devices on the Internet, none had the scrutiny to assure they were safe and/or effective.  

For the Neurofeedback Advocacy Project, I opted for the use of ILF Neurofeedback because I saw how effective it was, especially with clients who also had a history of trauma or co-occurring such as addictions and mental health issues . Furthermore, the Othmer's EEG Institute had developed a training model where new practitioners could be trained in 5 days and with a model I developed for supervision at a distance, could provide safe, competent treatment to real world clients immediately after the training. Furthermore, their Cygnet system of hardware and software has turned out to be nearly bullet-proof, even in the hands of the most technologically phobic clinicians.

Over the years I have introduced many practitioners to this model of neurofeedback and saw how successfully they they were able to implement it with populations not usually seen in private practice. This led Henry Kaiser and I to launch the Neurofeedback Advocacy Project where we implemented ILF neurofeedback in three local agencies and collected data to assess its impact. This data showed significant improvements in what everyone would agree are very difficult client populations. Furthermore, seeing their results, each agency chose to expand their use of neurofeedback.

The project continues to expand its data collection. Our goal is to provide our own evidence base for our work. We believe strongly that such evidence, collected in real world settings, and using meaningful measures of results, is the best way to promote the wide spread use of neurofeedback .