EEG neurofeedback is a non-invasive brain training method with the purpose of changing the electrical activity (EEG) of the brain and bring it closer to normal. It is a specialized form of biofeedback that uses real-time digital technology to measure electrical activity of the brain (EEG) and present this information in a form that enables the individual to perceive moment-to-moment changes in the state of the brain and learn to modify abnormal EEG patterns or brain waves.
Neurofeedback therapy is safe and has emerged as a non-pharmacological treatment option for the management of a variety of neuropsychiatric conditions.
Neurofeedback "meets the American Academy of Child and Adolescent Psychiatry ‘Clinical Guidelines’ for treatment of ADHD, seizure disorders, anxiety (eg, obsessive-compulsive disorder, generalized anxiety disorder, posttraumatic stress disorder, phobias), depression, reading disabilities, and addictive disorders. This finding suggests that (neurofeedback) always should be considered as an intervention for these disorders by the clinician….Specific recommendations based on the body of empirical evidence currently available suggest that (neurofeedback) be considered by clinicians and parents as a first line treatment of ADHD when parents prefer not to use medication and as an empirically supported treatment choice when significant side effects or insufficient improvement occurs with medication.
Hershberg, et al. (2005) Emerging brain-based interventions for children and adolescents: Overview and clinical perspective. Child and Adolescent Psychiatric Clinics of North America, Vol. 14, pp.1-19.
Neurofeedback is also recognized by the American Academy of Pediatrics as a treatment for removing ADD/ADHD symptoms as effectively as medications.
The term “biofeedback” refers to a type of skills training in which persons learn to increase their ability to control biological responses, such as blood pressure, muscle tension, heart rate, or skin temperature, etc. Sophisticated and highly sensitive electronic instruments are commonly used in biofeedback therapy to measure and amplify physiological signals from the body and convert these signals— usually through a computer— to a form that is meaningful to both the therapist and the patient and which can be used to show moment-to-moment changes in the biological response. Biofeedback of muscle tension (electromyogram or EMG) has been successfully used to treat chronic muscle pain, TMJ, and tension headache. Biofeedback of blood pressure has been used to treat hypertension. Biofeedback of heart rate has been used to treat panic attack and anxiety disorders. Biofeedback of skin temperature has been used to treat migraine headache.
EEG neurofeedback simply uses specialized electronic equipment to measure the electrical activity of the brain cortex (i.e., electroencephalogram or EEG) from electrodes placed on the scalp and convert this raw data into a display that the therapist and patient can easily understand and reveals moment-to-moment changes in EEG. With the proper feedback of moment-to-moment brain wave activity it is possible to learn to alter and control brain electrical activity or brain wave patterns to a significant degree.
EEG neurofeedback was first used clinically by Dr. Barry Sterman in the early 1970s to successfully treat persons with epilepsy. Dr. Sterman discovered that increasing the amount of 14 Hz activity as recorded from over the sensorimotor cortex of the brain had the effect of inhibiting seizure activity. In a similar vein, Dr. Joel Lubar in the late 1970s discovered that many persons with attention deficit disorder show too much brain wave activity in the 6-8 Hz range (NOTE: Hz = Hertz = cycles per second or frequency) from the frontal lobes of the brain and EEG neurofeedback could be used to train a shift in brain wave activity to the higher frequencies associated with more focused attention. Through the 1980s and 1990s, numerous well-designed controlled scientific studies have demonstrated the efficacy of EEG neurofeedback in the treatment of both seizure disorders and attention deficit disorder.
There is now good scientific evidence from both controlled research and clinical studies as well as long-term follow-up that EEG neurofeedback can be an effective treatment for seizure disorders and attention deficit disorder when compared to both common drug treatments and placebo, and that treatment affects are long-lasting. There is also growing scientific and clinical evidence supporting the effectiveness of EEG neurofeedback in the treatment of the following conditions: drug addictions, alcoholism, anxiety disorders, PTSD, chronic pain, depression, insomnia, specific learning disabilities, and migraine. There are also increasing numbers of clinical reports suggesting that EEG neurofeedback may be useful in ameliorating some of the symptoms and dysfunctions associated with such conditions as brain injury, autistic spectrum disorders, chronic fatigue syndrome, fibromyalgia, and senile dementia.
Treatment with EEG neurofeedback is based on the theory that once individuals understand their brain activity and learn to manipulate their own brain waves, they will be able to continue to do so, long after the therapy has ended. Some studies have followed patients for as long as 10 years after being treated with EEG neurofeedback and have shown no significant loss of treatment gains.
During a neurofeedback session (whether in the clinic or at home), the patient sits in front of a computer monitor with small, non-invasive electrodes attached with a little paste to the scalp through the hair to measure brain wave activity. This information is then transferred through a special EEG encoder/amplifier device to the computer for processing and display on the monitor. The monitor displays the EEG information in some form that offers feedback on how the EEG is changing from moment-to-moment. In many training situations, this feedback involves some sort of video game or movie that responds to changes in the EEG. For example, when the pattern of brain waves is more "normal" or of the desired type, the video displays becomes bigger and more clear; whereas when the pattern of brain waves is less "normal" or not of the desired type, the video becomes smaller and less clear. To be able to watch the video, the patient's brain must learn to increasingly produce the desired type of brain waves. Basically, the video now rewards the brain for producing the desired brain waves.
Researchers from the University of London Institute of Neurology (Ros, Ruge & Munneke, European Journal of Neuroscience, 2010) have recently demonstrated that a half-hour of voluntary control of brain rhythms is sufficient to induce a lasting shift in cortical exicitability and intracortical function and that these effects are comparable in magnitude to those observed following interventions with brain stimulation using magnetic or electrical pulses. This direct evidence of neuroplastic changes following brainwave training adds greatly to our confidence in EEG neurofeedback as a safe and painless and relatively natural method of modulating brain function.
Currently, there are well over 2000 practitioners in the United States and Canada offering some form of EEG neurofeedback or other form of neurotherapy treatment for one or more of the above listed disorders and tens of thousands of children and adults have been treated over the last 35-40 years.
"Biofeedback and neurofeedback are well-accepted and scientifically supported modalities that have been used in the successful treatment of mental health disorders for many years... ...These modalities provide patients with training and the ability to self-regulate in addressing numerous disorders. In many instances, biofeedback and neurofeedback treatments can eliminate the need for extensive and costly pharmaceutical therapies that can have far-reaching harmful side-effects, none of which are present with biofeedback and neurofeedback." [Dr. David L. Stumph, Executive Director of the Association for Applied Psychophysiology and Biofeedback, May 22, 2009.]
What the Experts Say About EEG Neurofeedback
Frank Duffy, MD, Neurologist, Head of the Neuroimaging Department and of Neuroimaging Research at Boston Children’s Hospital, and Harvard Medical School Professor, conducted an independent review of the literature on neurofeedback for Clinical Electroencephalography (2000). He summarized his findings as follows:
"The literature, which lacks any negative study of substance, suggests that EEG biofeedback therapy should play a major therapeutic role in many difficult areas. In my opinion, if any medication had demonstrated such a wide spectrum of efficacy, it would be universally accepted and widely used."
"In my 38 years of practice, I have never seen any treatment that comes close to producing the results that Neurofeedback offers...I have seen results achieved in days and weeks that previously took months and years to achieve, using the best methods available to us."
- Jack Woodward, M.D. (Board Certified Psychiatrist)
"This is one of the broad reach of tools available, and it's a good tool. Like any tool, it doesn't work for everyone, but it does benefit most people. It accelerates symptom removal and the development of healthy self-regulation—meaning it helps the patient's own body make the proper adjustments."
- Dr. Thomas Brod (Psychiatrist)
Los Angeles, CA
"In my experience with EEG Biofeedback and ADD, many people are able to improve their reading skills and decrease their need for medication. Also, EEG Biofeedback has helped to decrease impulsivity and aggressiveness. It is a powerful tool, in part because the patient becomes part of the treatment process by taking more control over his own physiological processes."
- Daniel Amen, M.D. (CEO and Medical Director, Amen Clinics, Inc.)
Author of Change Your Brain, Change Your Life
"It improves seizures, depression, low self-esteem or congenital head injuries, and it helps the 'craziness' that often comes with these...Patients report they sleep better, they don't have seizures, they are more in control, and that they get more work done. It helps with closed head injury patients. It helps with chronic neurologic disease, where there is no active injury but there are problems with normal functioning. We've had success with multiple sclerosis, with toxic encephalopathy (for example, chemical poisoning interfering with neurologic functioning), with chronic pain, migraines and fibromyalgia. And of course, we get very good results with ADD."
- Jonathan Walker, M.D. (Neurologist)
"Among the newer approaches to managing ADD, the most exciting is a learning process called Neurofeedback. It empowers a person to shift the way he pays attention. After more than twenty-five years of research in university labs, Neurofeedback has become more widely available. This is a pleasing development, because Neurofeedback has no negative side effects." (Page 205)
- William Sears, M.D.
Author of The A.D.D. Book
"Used with behavior therapies that incorporate classroom and homework skills, neurofeedback can help these children become less dependent on stimulants like Ritalin."
- Joel Lubar, Ph.D. (Psychologist)
University of Tennessee, Knoxville
"Used selectively for patients, it is a very good tool. For psychiatry, this is an area to look into. Not everyone gets better with Prozac, or other drugs. This is a biological intervention that gets the brain firing. I've only used Neurofeedback on a limited basis so far, I've gotten good results in my private practice with depression. I've also gotten good results with some children we have used it for. I would like to do more with it."
- Terry Cook (Psychiatrist)
New South Wales, Australia
In a recent paper Update on attention-deficit/hyperactivity disorder published in Current Opinion in Pediatrics Katie Campbell Daley reviewed the research and practice standards on treatment of ADHD. Dr. Campbell serves on the staff of the Department of Medicine, Children's Hospital Boston and in the Department of Pediatrics of the Harvard Medical School. She concluded:
"Overall, these findings support the use of multi-modal treatment, including medication, parent/school counseling, and EEG biofeedback, in the long term management of ADHD, with EEG biofeedback in particular providing a sustained effect even without stimulant treatment...parents interested in non-psychopharmacologic treatment can pursue the use of complementary and alternative therapy. The therapy most promising by recent clinical trials appears to be EEG biofeedback."
A recent special issue of Child and Adolescent Psychiatric Clinics of North America was devoted to emerging interventions that affect brain function. Neurofeedback was featured in seven of the ten chapters in the volume. The volume editors provided an overview and clinical perspective on all the approaches presented. About neurofeedback they concluded:
"EEG biofeedback meets the American Academy of Child and Adolescent Psychiatry criteria for clinical guideline (CG) for treatment of ADHD, seizure disorders, anxiety (OCD, GAD, PTSD, phobias), depression, reading disabilities, and addictive disorders. This suggests that EEG biofeedback should always be considered as an intervention for these disorders by the clinician."
Arns, M., de Ridder, S., Strehl, U., et al. (2009). Efficacy of neurofeedback treatment in ADHD: The effects on inattention, impulsivity, and hyperactivity: A meta-analysis. Clinical EEG & Neuroscience, 40: 180-189.
Budzynski, T., Budzynski, H., Tang, H. (2007). Brain brightening: Restoring the aging mind. In: J.R. Evans (ed.), Handbook of Neurofeedback (pp. 231-265). Binghamton, NY: Haworth Press.
Chapin, T., Russell-Chapin, L. (2014). Neurotherapy and Neurofeedback: Brain-Based Treatment for Psychological and Behavioral Problems. New York, NY: Routledge.
Coben, R., Arns, M., Kouijzer, M. (2011). Enduring effects of neurofeedback in children. In R. Coben & J. Evans (eds). Neurofeedback and Neuromodulation Techniques and Applications. (pp. 403-422). New York, NY: Academic Press.
Coben, R., Linden, M., Meyers, T. (2010). Neurofeedback for autistic spectrum disorder: A review of the literature. Applied Psychophysiology & Biofeedback, 35: 83-105.
Collura, T.F. (2014). Technical Foundations of Neurofeedback. New York, NY: Routledge Monograph Series..
Dehghani-Arani, F., Rostami, R., Nadli, H. (2013). Neurofeedback training for opiate addiction: Improvement of mental health and craving. Applied Psychophysiology & Biofeedback, 38:133-141.
Diaz, A., Deusen, A. (2011). A new neurofeedback protocol for depression. Spanish Journal of Psychology, 14(1): 347-384.
Doidge, Norman (2015). Neurofeedback for ADD, ADHD, Epilepsy, Anxiety, and TBI. In: Doidge, N. (2015), The Brain's Way of Healing. New York, NY: Viking Books USA. ISBN: 0-67-002550-X.
Evans, J.R. (Ed). Handbook of Neurofeedback: Dynamics and Clinical Applications. New York, NY: Informa Healthcare.
Fisher, S. (2014). Neurofeedback in the treatment of Developmental Trauma: Calming the Fear-Driven Brain. New York, NY: W.W. Norton & Company.
Hammond, D. (2005). Neurofeedback treatment of depression and anxiety. Journal of Adult Development, 12(2-3):131-137.
Kaviran, S., Dursun, E, Dursun, N., et al. (2010). Neurofeedback intervention in fibromyalgia syndrome: A randomized, controlled, rater-blind clinical trial. Applied Psychophysiology & Biofeedback, 35(4): 293-302.
Larsen, S. (2012). The Neurofeedback Solution. Rochester, VT: Healing Arts Press.
Levesque, J., Beauregard, M. (2011). Functional neuroimaging evidence supporting neurofeedback in ADHD. In R. Coben & J. Evans (eds). Neurofeedback and Neuromodulation Techniques and Applications. (pp. 353-380). New York, NY: Academic Press.
Lofthouse, N., Arnold, L., Hersch, S., et al. (2012). A review of neurofeedback treatment for pediatric ADHD. Journal of Attention Disorders, 16(5): 351-372.
Loo, S., Barkley, R. (2005). Clinical utility of EEG in attention deficit hyperactivity disorder. Applied Neuropsychology, 12(2): 64-76.
Myers, J., Young, J. (2012). Brain wave biofeedback: Benefits of integrating neurofeedback in counseling. Journal of Counseling & Development, 90(1): 20-28.
Nestroriuc, M., Martin, A. (2007). Efficacy of biofeedback for migraine: A meta-analysis. Pain, 128(1/2): 111-127.
Pigott, H., De Baise, L., Bodenhamer-Davis, E. (2013). The evidence-base for neurofeedback as a reimbursable healthcare service to treat attention-deficit/hyperactivity disorder. White paper published by the International Society for Neurofeedback & Research.
Robbins, J. (2008). A Symphony in the Brain: The Evolution of the New Brain Wave Biofeedback. New York, NY: Grove Press.
Sherlin, L., Arns, M., Lubar, J., et al. (2010). A position paper on neurofeedback for the treatment of ADHD. Journal of Neurotherapy, 14(1): 66-78.
Sokhadze, T., Cannon, R., Trudeau, G. (2008). EEG biofeedback as a treatment for substance use disorders: Review, rating of efficacy, and recommendations for further research. Applied Psychophysiology & Biofeedback, 33(1): 1-28.
Stokes, D., Lappin, M. (2010). Neurofeedback and biofeedback with 37 migraineurs: A clinical outcome study. Behavioral & Brain Functions, 6(1): 1-10.
Surmeli, T., Ertem, A., Eralp, E., et al. (2012). Schizophrenia and the efficacy of QEEG-guided neurofeedback treatment.: A clinical case series. Clinical EEG & Neuroscience, 43(2): 133-144.
Swingle, P. (2008). Biofeedback for the Brain. London, UK: Rutgers University Press.
Tan, G., Hammond, C., Walker, J., et al. (2011). Neurofeedback and epilepsy. In R. Coben & J. Evans (eds). Neurofeedback and Neuromodulation Techniques and Applications. (pp.183-204). New York, NY: Academic Press.
Thompson, L., Thompson, M., Reid, A. (2010). Neurofeedback outcomes in clients with Asperger's Syndrome. Applied Psychophysiology & Biofeedback, 35(1): 63-91.
Thompson, M. & Thompson, L. (2003). The Neurofeedback Book: An Introduction to Basic Concepts in Applied Psychophysiology. Wheat Ridge, CO: AABP.
Hemoencephalography (HEG) is cortical circulatory biofeedback using refracted light tuned to oxygenated hemoglobin, emitted into the skull and detected at the scalp using a photoelectric cell. Red light at 660 nm is used as the probe, with changes in the returning refracted light representing changes in cortical circulation.
Near Infrared Hemoencephalography (nirHEG) is a type of brain imaging technology that indirectly measures neuronal activity of the brain. nirHEG measures changes in relative absorption of red (660 nanometers) and infrared (850 nanometers) light passed through the skull into the brain tissue beneath the HEG sensor. The light passes through the semi-translucent scalp, skull and brain tissue and is reflected back by blood in the tissue. The ratio of red to infrared light scattered back to the HEG sensor is used as a measure of localized blood perfusion and oxygenation. Red blood that carries oxygenated hemoglobin will absorb more of the red light than bluer oxygen depleted blood. On the other hand, whether the blood under the sensor is carrying oxygen or not has no effect on the reflection of the infared light.
This means that as the local oxygenation of the blood under the light source and sensor increases in response to neural activation, the signal from the HEG device changes. In this way the nirHEG device can detect local changes in the brain’s activation.
Photo showing infrared light and sensor inside of nirHEG headband.
The developer of the nirHEG neurofeedback system, Dr. Herschel Toomin found that there was a very good correlation between his device and fMRI systems, which also relies on changes in blood oxygenation to measure brain metabolism.
fMRI uses very powerful magnetic fields to detect localized changes in the magnetic properties of oxygenated blood versus de-oxygenated blood. Areas of the brain that are more active require more oxygenated blood and this demand for more energy is met by localized increases in blood flow. fMRI reveals relative differences in oxygenated blood perfusion across the brain. fMRI technology is very expensive (over $1000 per hour) compared to nirHEG ($100-$200 per hour) and permits a much higher resolution scan of the entire brain’s functioning and is most commonly used in research settings to determine which areas of the brain are involved in particular tasks. Current nirHEG systems can only detect activity in the brain’s outer layer (about 1.5 cm deep)— the cortex, and are almost exclusively used to train cortical activation through biofeedback.
In nirHEG neurofeedback, the trainee tries to increase the signal from the HEG sensor, which is equivalent to activating the cortical region of the brain under the sensor. A computer display shows the change in cortical activation over the course of time. nirHEG neurofeedback directly trains the brain itself. The trainee quickly gains greater control over the flow of blood and the density of oxygenation at the chosen scalp site. Trainees are usually instructed to concentrate and perform a task that directly relates to the region of the brain being trained— e.g., reading, doing math problems, thinking about themselves, or playing a computer game, etc. Training in the left hemisphere of the brain is enhanced by cognitive challenges; whereas training in the right hemisphere is enhanced by spatial activities. Training in the back of the head over the occipital lobes (visual cortex) is a form of relaxation and is enhanced by visualization exercises. Because it is a learning procedure, nirHEG neurofeedback is non-invasive and safe.
Whereas EEG neurofeedback appears to effect neurogenesis and neural connectivity; HEG neurofeedback appears to affect angiogenesis and increases the density of the capillary bed that brings oxygen to the area of the cortex being trained. The one form of neurofeedback appears to support the other.
Graphic display showing change change in signal strength under the HEG sensor with HEG feedback.
Applications of nirHEG Neurofeedback
nirHEG is still a new neurofeedback modality and the published research on its applications and clinical efficacy is still relatively sparse. EEG neurofeedback and audiovisual entrainment (AVE) neurotherapies have been available for a lot longer and have significantly more published research supporting their use in treating various brain-based disorders and problems. But nirHEG neurofeedback is showing some real promise in the treatment of…
- Attention Deficit Disorder
One thing that links these three disorders is the possibility of dysregulation of the prefrontal cortex (PFC) of the brain— the area just above your eyes and behind the forehead. The PFC is a particularly important part of the brain that is most highly evolved in humans and plays a central role in purposeful behavior—making decisions, formulating and carrying out plans and intentions, and maintaining attention and concentration in the face of competing stimuli. It coordinates the brain resources needed to carry out our intentions and evaluate our actions in terms of their success or failure in meeting objectives.
Red shows PFC area of the cortex.
The PFC also plays an important role in emotions and motivation; helping us to keep to a long-term plan by somehow holding in mind the good feelings connected with achieving that goal. As well, the PFC has the ability to inhibit other structures in the brain connected to emotions, allowing you for example to override a fear of water and drowning to learn how to swim. The PFC is especially relevant to social emotions because our ability to imagine what other people might be thinking and feeling depends on the PFC.
Numerous brain scanning studies have shown that activation in the PFC is not optimal in the brains of persons who are depressed or have attention-deficit disorder. Optimizing PFC activity may help increase focused attention and concentration, strengthen control over emotions and impulses, enhance the sense of purpose and self-possession, and increase flexible responding to the demands of a given situation. Among the symptoms of poor executive functioning in the PFC are inattention, poor planning or judgment, slow reaction time, lack of social awareness, and poor impulse and emotional control.
To date, clinical reports of nirHEG neurofeedback have most commonly focused on training the prefrontal cortex of the brain. To a large extent this is because nirHEG does not work very well over parts of the scalp that are covered in hair and, where EEG neurofeedback signals from electrodes placed on the forehead are easily contaminated by electrical noise caused by eye blinks and movement, such small muscle movements do not affect the reliability of the nirHEG signal.
Finally, although the underlying neuropathology of migraine remains unknown, there have been a number of clinical reports describing successful HEG treatment of a few hundred migraine patients to date. It is thought that nirHEG biofeedback over the PFC may strengthen inhibitory control over some part of the brain stem thought to generate migraines.
Is There Research to Support the Use of HEG Neurofeedback?
Research on the HEG device and its use in neurofeedback is still quite limited but has been going on at the University of California in Los Angeles and the Biofeedback Research Institute of Los Angeles by Drs. Herschel and Marjorie Toomin for many years. Additionally, other researchers have studied this technology for the treatment of a number of different brain disorders.
Results have suggested that HEG neurofeedback can enhance cognitive functioning and reduce symptoms associated with hypoperfusion (i.e., reduced cerebral blood flow and oxygenation) in a number of disorders.
Toomin, H. (2002). Hemoencephalography (HEG): The study of regional cerebral blood flow. California Biofeedback, Summer 2002, pp.17-21.
Limsila, P., Toomin, H., Kijvithee, J., et al. (2004). Hemoencephalography (HEG): Additional treatment for autism and ADD. SAMITIVAJ Proceedings 2004.
Tinius, T. (Ed.) (2004). New Developments in Blood Flow Hemoencephalography. Binghampton, NY: Haworth Medical Press.
Toomin, H., Mize, W., Kwong, P., et al. (2004). Intentional Increase of Cerebral Blood Oxygenation Using Hemoencephalography (HEG): An Efficient Brain Exercise Program. Journal of Neurotherapy, Vol. 8, No. 1, pp. 5-22.
Coben, R. (2006). Hemoencephalography for autistic spectrum disorder. Paper presented at the 14th Annual Conference of the International Society for Neuronal Regulation, Atlanta, Georgia.
Coben, R., Pudolsky, L. (2007). Infrared imaging and neurofeedback: Initial reliability and validity. Journal of Neurotherapy, 11(3): 3-13.
Toomin, H., Carmen, J. (2009). Hemoencephalography: Photon-based blood flow neurofeedback. In Budzynski, T., Budzynski, H., Evans, J., Abarbanel, A. (Eds). Introduction to Quantitative EEG and Neurofeedback: Advanced Theory and Applications, 2nd Edition. (pp.169-194). New York, NY: Academic Press.
Are There any Side-Effects Associated With HEG Neurofeedback?
Subjects in studies of HEG neurofeedback have not reported any significant or long lasting adverse effects. The most commonly reported side-effect is transient mild headache or fatigue following treatment sessions and lasting no longer than a day or two following. Such unpleasant side-effects appear to be the result of working too hard or too long in a training session.
How Long Does HEG Neurofeedback Take?
HEG neurofeedback sessions are typically 30-45 minutes in length and consist of some number of 10-15 minute training trials with a short rest between each trial. While many patients will experience a positive response within the first couple of sessions, successful and longer-lasting reduction of clinical symptoms, especially in chronic conditions, will commonly require 10-20 sessions of training. It is usually best to begin training with anywhere from 2-4 sessions per week for the first few weeks and then reduce the frequency of sessions as symptom improvement is solidified. It is generally best not to do more than 20-40 minutes of training per day and to have a night of sleep between training sessions.
To see two brief YouTube videos on hemoencephalography (HEG), please click on these links...