Most people who choose to pursue brain training using neurofeedback really just want to know if it works and, more specifically, whether neurofeedback will work for them or their family member. Usually the answer is yes, but the unknown is how much it will change a person’s life. Some people experience extraordinary, life-changing events. Most get satisfactory change. A small number experience mild changes (this is especially true for people with “stuck” brains such as those with an autism diagnosis). A tiny minority experience no change at all—in my practice, I’ve had fewer than five people with no change; these were frustrating experiences for everyone involved. For those with no change, a few were overscheduled teenagers whose family structure and school/extracurricular commitments meant that they never got good sleep, which is the foundation for any body change. Only once has the lack of shift been a bit of a mystery, and that was for a healthy adult whose brain map did not match her lived experience. We stopped sessions before too much time and effort was wasted, and her situation will probably sit with me for the rest of my career.

Every now and then, though, the question that those who are considering neurofeedback want answered is whether it’s scientifically proven. That is a fraught question, so I’ll unpack it a bit here.

First, neurofeedback has been around since the late 1960s. During the Apollo era, NASA scientists approached a neuroscience researcher at UCLA who was doing an early version of brain training on cats and asked him to explore rocket fuel toxicity, because people were falling ill, and they suspected it was from rocket fuel. In testing that now is famous among all well-trained neurofeedback practitioners, the UCLA researcher injected his cats with the rocket fuel. Half the cats had seizures and died within two hours. The other half had seizures at the 5-6-hour mark, yet survived. It turned out that the ones who survived all had been part of the researcher’s brain-training experiments. Later, a graduate assistant from the lab who suffered from epilepsy decided to try brain training on herself. It worked, and neurofeedback has evolved from there. Unfortunately, the UCLA researchers did not write up the graduate assistant’s experiment as a case study, so there is nothing in peer-reviewed literature about the dramatic reduction in seizures she experienced. This means that very few neurologists are aware of neurofeedback as an intervention for seizures and most discount the process as invalid.

Nonetheless, the past almost-60 years have seen a steady flow of research into neurofeedback. Most of the studies are small and use DSM diagnoses as a baseline for interventions. Unfortunately, the Diagnostic Statistical Manual of Mental Disorders categories, which encode the criteria for identifying and labeling mental health conditions, are committee-created and bear very little relationship with electrical brainwave patterns. This makes research difficult on many levels. If, for example, one gathers 50 people with a diagnosis of ADHD, their brains are not likely to all look alike.

Another hindrance to scientific studies is that it is quite a challenge to do sham neurofeedback so that one can have a control population. Quite often, those experiencing fake neurofeedback figure out quite quickly that they are not receiving the real thing. However, in my opinion—an opinion shared by others—neurofeedback research should not be following a pharmaceutical model of double-blind, placebo-controlled studies anyway. A more apt comparison would be the way that surgical advances are achieved—practitioners discover new and better ways to implement good surgical outcomes, then share their results with other practitioners. Indeed, this is how most of the advances in neurofeedback approaches and protocols occur—from practitioners to researchers for validation rather than from researchers to practitioners.

Finally, there is the pathology model of neurofeedback research, which aims to treat or control disorders. I fundamentally disagree with this and do not do brain training to treat disorders (especially because of my views of the DSM). Instead, I believe in brainwave optimization. I train the brain that presents in front of me to optimize performance, because unless one has a physical/structural problem in the brain, each of us has a perfect brain. It has evolved over time to respond to our environment and keep us alive and safe.  The trick of neurofeedback is to work with what’s there and improve its performance. I like using a gym analogy. Just as someone joins a gym for better fitness, my clients work with me to work out their brains.  The difference is that once one stops working out, body fitness fades, but with brain training, that growth and learning lasts long-term. How wonderful is that!

For those who are interested in seeing the body of scientific literature on neurofeedback, there is an annotated bibliography that members of the International Society for Neuroregulation and Research have compiled. It is available here.