Neurofeedback as a non-pharmacological method

Neurofeedback (or EEG Biofeedback) has a long and successful history, particularly in the USA and Europe but as Thibault and Raz pointed out recently in the Lancet Psychiatry, the UK the medical community is still sceptical about the clinical utility of this approach. 

But wait a minute, the fact is that despite the impression that modern psychiatry and medicine are evidence based, only few treatment recommendations are actually based on level A evidence (multiple randomised trials)

Neurofeedback appears both to improve normal brain function and In the domain of psychiatry to treat a wide range of mental disorders, including attention deficit hyperactivity disorder (ADHD), epilepsy, depression, anxiety, insomnia, autism spectrum disorder, and alcoholism.

The "standard" approach for evaluating the potential therapeutic effect of a treatment is a double-blind randomised controlled trial, and double-blind trials in the field of neurofeedback would certainly help to ease the skepticism. There are some challenges though which are common to adpting this trial approach which is fundamentally suited to pharmacological interventions.

Protocols are much more difficult to conduct when non-pharmacological interventions are tested. To study neurofeedback, in addition to controlling neurophysiological parameters, many psychosocial factors (eg, perceptibility and controllability of the signal, motivation, learnability across the session) must be controlled.

In a response to Thibault and Raz, Jean-Arthur Micoulaud-Franchi and Thomas Fovet (see reference) suggest that despite this gap, neurofeedback research is not at an embryonic stage, particularly for attentional deficit hyperactivity disorder (ADHD). Indeed, findings from several single randomised trials and non-randomised studies have supported the clinical efficacy of EEG-neurofeedback in ADHD.

They propose that these results should not be minimised for ADHD, a mental disorder for which scientific evidence-based treatments are scarce.  The authors argue that innovative methods cannot be rejected from clinical application exclusively on the basis of a lack of double-blind randomised trials.


Jean-Arthur Micoulaud-Franchi, Thomas Fovet
Correspondence: Neurofeedback: time needed for a promising non-pharmacological therapeutic method.
The Lancet PsychiatryVol 3, No.9, e16, September 2016