Neurofeedback

Neurofeedback is a type of therapy that uses real-time displays of brain activity to teach you how to regulate your brain function. Also called EEG biofeedback, it involves placing sensors on your scalp to monitor brainwaves while you watch a computer screen or listen to audio feedback. When your brain produces the desired patterns, you receive positive feedback (like a sound or visual reward). Whether that training changes symptoms is contested. In the best-controlled trials people do improve, but no more than people given a convincing sham, which points to the attention and structure around the training rather than to the brainwave training itself.

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How It Works

During neurofeedback, small sensors are placed on your head to measure electrical activity in your brain (brainwaves). This information is sent to a computer that shows your brain activity in real-time through games, videos, or sounds. When your brainwaves move towards the pattern the practitioner has set as the target, you get positive feedback. The idea is that the brain learns to produce that pattern more often, in the way you might learn to ride a bike through practice and feedback. Whether the chosen pattern is a healthier one, and whether producing it more often changes symptoms, is what the trials have struggled to establish.

What to Expect

During Your Session:

• You'll sit comfortably in a chair with sensors placed on your scalp (this doesn't hurt)
• You'll watch a screen or listen to sounds that respond to your brain activity
• Sessions typically last 30-60 minutes
• You might play simple computer games controlled by your brainwaves
• Most people find it relaxing and interesting to watch their brain activity

Treatment Process:

• Initial assessment to map your brain patterns
• Practitioners commonly propose 20 to 40 sessions. This is a convention of practice rather than a figure established by trials, and it is what drives the total cost
• Sessions are typically 1-3 times per week
• Progress is monitored through brain mapping and symptom tracking
• Some people notice improvements within a few sessions, others need more time

Conditions It Has Been Studied For

Neurofeedback has been studied in the conditions below. Being studied is not the same as being shown to work, and for most of this list the evidence is thin or contested. Read the section on the science before drawing a conclusion from the length of the list:

• ADHD (most researched application)
• Anxiety and stress
• Depression
• Sleep problems
• Traumatic brain injury
• Autism spectrum disorders
• Epilepsy (only ever alongside neurological care, never as a replacement for anti-seizure medication)
• Peak performance training (a commercial application, not a clinical one)

What It Offers

• Non-invasive - nothing enters the body and no medication is involved, which is not the same as no side effects; see Safety below
• Personalised - training is based on your specific brain patterns
• Sustained - gains tend to hold after training ends, though in the blinded trial the sham group's gains held just as well
• Drug-free - can be used alone or with other treatments
• Objective feedback - you can see your progress in real-time
• Generally well tolerated - serious adverse events are rarely reported, though adverse-effect reporting in this field is inconsistent and practitioners have been calling for practice standards since 2008

Safety and Considerations

Generally Safe:

• No known serious side effects
• Non-invasive and painless
• Can be used with most other treatments
• Suitable for children and adults

Temporary Effects Some People Experience:

• Mild fatigue after sessions
• Temporary headaches
• Slight mood changes as brain adjusts
• These usually resolve quickly

Important Notes:

• Results vary significantly between individuals
• More research is needed for many conditions
• Not a cure-all - works best as part of comprehensive treatment
• Quality of equipment and practitioner training matters

Finding Help

Neurofeedback is not a regulated profession in most countries. There is usually no protected title, no licensing board and no required training, so the person offering it may or may not be a registered health professional. Certification through bodies such as the Biofeedback Certification International Alliance is voluntary and is not a licence. What is worth checking first is therefore not the neurofeedback credential but the professional registration standing behind it.

Look for practitioners who:

• Are licensed mental health professionals
• Have specific neurofeedback certification
• Are straight about what their equipment is cleared for. In the United States, EEG biofeedback devices hold FDA 510(k) clearance for biofeedback and relaxation training; no device is FDA-approved to treat ADHD, anxiety or depression. Other countries regulate these devices differently, and some barely at all
• Provide clear explanations of their approach
• Offer realistic expectations about outcomes

Questions to Ask:

• What type of neurofeedback do you use?
• How many sessions do you typically recommend?
• What are your qualifications and training?
• Can you provide references or outcome data?
• How do you measure progress?

Cost and Insurance

• Fees are set by each practice and differ widely between countries, so ask for the per-session fee in your own currency before you start
• Because a course usually runs to dozens of sessions, the total is the number that matters. Multiply the session fee by the number of sessions proposed, and treat that figure as the price
• Most medical schemes and insurers do not cover neurofeedback, and several classify it as investigational. Assume you are paying privately unless your scheme confirms otherwise in writing
• Get any coverage promise in writing from the scheme or insurer itself, not from the practice
• Some practitioners offer payment plans

Note: These are typical ranges but can vary depending on several factors. Always verify with your provider for personalised quotes.

The Science

ADHD is the most studied application, and it is where the picture is clearest. When a child's symptoms are rated by a parent who knows which treatment the child received, neurofeedback looks effective. When they are rated by someone kept blind to the treatment, most of that advantage disappears.

A meta-analysis of 13 randomised trials covering 520 children concluded that evidence from well-controlled trials with probably blinded outcomes currently fails to support neurofeedback as an effective treatment for ADHD (Cortese et al., 2016). The 2014 meta-analysis listed below found the same split: under blinded assessment there was no significant effect on the overall ADHD score, and only inattention reached significance (Micoulaud-Franchi et al., 2014).

The strongest single test came in 2021. The ICAN trial randomised 142 children to real or sham neurofeedback, with neither families nor raters knowing which. Both groups improved substantially and the difference between them did not reach significance, at the end of treatment and again at 25 months. The investigators concluded that the improvement reflects nonspecific effects rather than the brainwave training itself.

No blinded trial supports the claim that neurofeedback matches stimulant medication. Where the two have been compared directly, medication shows a large effect and neurofeedback a moderate one, and the trial most often cited for equivalence had 23 children and raters whose blinding was not clearly established.

Neither the NICE guideline on ADHD in the United Kingdom nor the Australian evidence-based clinical practice guideline makes a recommendation on neurofeedback. Both groups reviewed the evidence and judged it insufficient to recommend for or against.

For anxiety, depression, autism, traumatic brain injury and epilepsy the evidence is thinner again: smaller studies, fewer sham controls, little replication.

None of this means nothing happens during a course of neurofeedback. People do improve. What the blinded trials suggest is that the improvement comes from the weekly attention, the structure, the expectation and the relationship with the practitioner. Those are real, and they are also available at a fraction of the cost.

Remember

Some people find a course of neurofeedback helpful, and there is no evidence that it does harm. What there is not, yet, is evidence that it works through the mechanism it describes. If you are considering it, weigh the cost and the months of weekly appointments against treatments with a clearer evidence base, and ask your prescriber or therapist what they would do with the same money and the same year. If you go ahead, go ahead with a registered professional and with your eyes open.

References

International Society for Neuroregulation and Research, the professional membership body for neurofeedback practitioners, whose account of what neurofeedback treats is broader than the controlled evidence supports. (n.d.). What is neurofeedback? https://isnr.org/what-is-neurofeedback

Arns, M., Heinrich, H., & Strehl, U. (2014). Evaluation of neurofeedback in ADHD: The long and winding road. Biological Psychology, 95, 108-115. https://pubmed.ncbi.nlm.nih.gov/24321363/

Marzbani, H., Marateb, H. R., & Mansourian, M. (2016). Neurofeedback: A comprehensive review on system design, methodology and clinical applications. Basic and Clinical Neuroscience, 7(2), 143-158. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4892319/

Micoulaud‑Franchi, J.‑A., Geoffroy, P. A., Fond, G., Lopez, R., Bioulac, S., & Philip, P. (2014). EEG neurofeedback treatments in children with ADHD: An updated meta‑analysis of randomised controlled trials. Frontiers in Human Neuroscience, 8, 906. https://doi.org/10.3389/fnhum.2014.00906

Sitaram, R., et al. (2017). Closed-loop brain training: The science of neurofeedback. Nature Reviews Neuroscience, 18(2), 86-100. https://pubmed.ncbi.nlm.nih.gov/28003656/

Cortese, S., Ferrin, M., Brandeis, D., Holtmann, M., Aggensteiner, P., et al. (2016). Neurofeedback for attention-deficit/hyperactivity disorder: Meta-analysis of clinical and neuropsychological outcomes from randomised controlled trials. Journal of the American Academy of Child & Adolescent Psychiatry, 55(6), 444-455. https://doi.org/10.1016/j.jaac.2016.03.007

Neurofeedback Collaborative Group. (2021). Double-blind placebo-controlled randomised clinical trial of neurofeedback for attention-deficit/hyperactivity disorder with 13-month follow-up. Journal of the American Academy of Child & Adolescent Psychiatry, 60(7), 841-855. https://doi.org/10.1016/j.jaac.2020.07.906

Australian ADHD Professionals Association. (2022). Australian evidence-based clinical practice guideline for ADHD: Neurofeedback. https://adhdguideline.aadpa.com.au/non-pharmacological/neurofeedback/