When I was a child, my mother suffered from horrible migraine headaches. Sometimes they were so bad that she’d have to close herself up in her bedroom for days with the shades drawn. Traditional pain medications didn’t work, so she began to search for alternative methods of relief.
Eventually, she found biofeedback, which is a technique of gaining awareness and control of certain body functions — such as heart rate, muscle responses and breathing — in order to relieve pain or reduce tension.
People perform biofeedback unconsciously all the time. My mother began to intentionally do biofeedback through daily practice during which she would try to clear her mind of everything and enter a deep state of relaxation. Today, we call this mindfulness.
She used a small hand-held device that measured her sweat gland activity, the galvanic skin response (GSR), also known as electrodermal activity (EDA). When she pressed her fingers into the machine, it emitted a humming sound, which grew louder and softer depending on her stress level.
By the time I was in high school, the frequency and severity of my mother’s migraine headaches had significantly decreased. She still had them occasionally, but once she began to consciously practice biofeedback, her quality of life greatly improved.
That was 40 years ago, when biofeedback was considered eccentric. Today, it has gone mainstream. In particular, neurofeedback, a type of biofeedback, has gained in popularity and acceptance.
But what exactly is neurofeedback, and does it work?
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What Is Neurofeedback Therapy?
Like biofeedback, neurofeedback is a noninvasive procedure, but instead of measuring physiological functions, it focuses solely on the brain to help improve a variety of neurological issues, such as chronic pain, epilepsy and psychiatric conditions.
Neurofeedback uses a variety of methods, including:
— Electroencephalogram (EEG), which is a common method of measuring electrical activity in the brain
— Functional MRI (fMRI), which monitors brain activity by mapping blood flow in different parts of the brain
— Hemoencephalography (HEG), which measures brain blood oxygenation
“Neurofeedback is a nonpharmacological intervention that uses the brain’s capacity to change and regulate electrical activity,” says Dr. Diana Martinez, co-founder and co-director of Boston NeuroDynamics.
The most important factor for neurofeedback is that it addresses or improves the source of the problem rather than the symptoms, Martinez adds, but neurofeedback is not curative. Anecdotally, she says most of her clients’ symptoms improve by 40% to 80%.
[READ: How to Relieve Stress and Calm Your Nerves]
What Is Neurofeedback Therapy Used to Treat?
Neurofeedback therapy is used to treat a variety of disorders and medical conditions, including:
— Anxiety
— Attention-deficit/hyperactivity disorder (ADHD)
— Chronic pain
— Epilepsy
— Insomnia
— Migraine headaches
— Obsessive-compulsive disorder (OCD)
— Post-traumatic stress disorder (PTSD)
— Stress
— Stroke
— Traumatic brain injury
The technique is also increasingly being used for nonmedical purposes. For example, NASA uses neurofeedback in astronaut training to help improve their focus and concentration. Professional athletes incorporate neurofeedback into their training to improve their performance, while dancers, musicians and actors use it to enhance their creativity.
[READ Pain and the Mind-Body Connection]
How Does Neurofeedback Work?
In a typical neurofeedback session, electrodes are placed on the patient’s scalp (different placements track different parts of the brain) to monitor and analyze in real time their brainwave activity, which is displayed on a computer screen.
The practitioner will give the patient different audio or visual prompts to see how their brain reacts to them. The patient will then work with the practitioner to learn how to control those reactions and, eventually, learn to manipulate something on the screen through their brainwaves.
Martinez likens the process to a video game in which it advances if the EEG achieves prescribed settings through the patient’s brain activity.
“You are going to play a video game, but instead of having a controller in your hands, your brain activity is going to be conducting the game,” says Martinez, who specializes in neurological rehabilitation.
Patients typically undergo 20 and 40 sessions, each lasting from 30 to 60 minutes. With practice, the patient progressively learns to control their brain activity to get the desired result. For example, a person suffering from anxiety may learn to calm their mind by manipulating their brain patterns during their therapy sessions.
The theory is that eventually, the person will become so proficient at manipulating their brain waves to calm their mind that they can do it on their own.
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Is Neurofeedback Effective?
Numerous studies have found neurofeedback therapy to be effective in treating various disorders, particularly in treating ADHD. However, critics of the practice say many studies rely on small samples and are not rigorous enough and that more double-blind placebo controlled trials are needed.
Of 11 double-blind placebo controlled trials, only one showed that real EEG-neurofeedback was better than placebo neurofeedback for stroke rehabilitation, explains Robert Thibault, an open science consultant who previously conducted research at the Meta-Research Innovation Center at Stanford University. The other 10 all showed that placebo neurofeedback, in which patients looked at pre-recorded brain activity of someone else instead of seeing a readout of their own brain activity, was just as effective as receiving the real treatment.
“You improve just as much as people who get the real neurofeedback,” Thibault explains.
Referring to the numerous studies on the treatment of ADHD, both the placebo treatment and real treatment help people, Thibault says, but not for the reasons people think. He believes that people feel they are getting better (or in most cases, that their child is improving) because of expectations and the fact that people often do neurofeedback therapy repeatedly over a long period of time.
“If you’re doing anything every week for a full year, you’re putting in a lot of dedication to it, you’re going to monitor your improvement or hope you’re getting better,” Thibault says, adding that many of the conditions people are treating with neurofeedback are subjective based on patients self-reporting their behavior, rather than results being measured objectively, such as using a scale to measure if someone loses weight.
Thibault also notes that some people simply improve over time.
What Are the Potential Risks and Considerations of Neurofeedback?
As a noninvasive procedure, neurofeedback therapy is mostly safe.
The most common reported side effects are fatigue and headaches. Because these side effects can exacerbate the symptoms being treated, it’s important to work with a qualified clinical expert.
The biggest risk is using neurofeedback as a substitute for other types of interventions, as this could delay getting proper treatment, Thibault says. This is one reason it’s important to consider going to a medical professional, such as a psychiatrist, who uses neurofeedback as one tool in their toolbox.
In addition, there are many people who offer neurofeedback therapy who don’t have formal clinical training, even though they may have a certificate from the Biofeedback International Certification Alliance or another organization. There are two levels of certification, clinician for those with a current license in a clinical health care field and technician. Martinez believes that technicians should always work with clinicians.
“You always need to be linked with somebody with a clinical license that supervises you, and this is an ethical way to do it,” Martinez says. “Unfortunately, not everybody does it right.”
How Much Does Neurofeedback Cost?
Each neurofeedback session can cost between $100 and $300.
Whether or not the treatment is covered by health insurance depends on the individual policy, what is being treated and the state in which the treatment takes place.
According to the Centers for Medicare & Medicaid Services, Medicare covers biofeedback therapy, specifically, when it is reasonable and necessary and only for certain issues, such as urinary incontinence and those related to muscles, but only after more conventional treatments — such as heat, cold, massage, exercise and support — have not been successful. However, home use of biofeedback therapy is not covered.
Because Medicare contractors may decide whether or not to cover biofeedback as an initial treatment modality, it’s important to talk with your health care provider and health insurance representative to make sure your plan covers it.
The Veterans Administration covers biofeedback and neurofeedback under the veteran’s medical benefits package when the therapy is determined to be clinically necessary by their care team. Additionally, the practitioner must be a licensed health care professional and trained in the specific modality being performed.
Bottom Line
Neurofeedback therapy is still an emerging therapy, and there is not yet a definitive answer as to how effective it is in treating various medical conditions and disorders. It’s up to the individual to do their research and work with their health care provider to discuss whether or not neurofeedback should be part of their treatment plan.
However, because neurofeedback may not be covered by insurance, it’s important to talk directly with your health insurance company to see if your plan covers the treatment. If not, be sure to get a complete list of rates from your health care provider, including the initial consultation fee.
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What Is Neurofeedback Therapy? originally appeared on usnews.com
