Neurofeedback has long been touted as a non-medical, non-invasive treatment for ADHD, but many experts remain skeptical. Unlike medication, neurofeedback hasn’t been tested in many well-designed, double-blind studies, which makes it hard to tell if positive results are based on the treatment itself or on other confounding factors like the placebo effect.
Now, however, a new study with a randomized, placebo-controlled design showed that neurofeedback may change brain activity in healthy adults, strengthening its case as an alternative treatment for ADHD, anxiety, and related disorders.
The study, presented at the 63rd Annual Meeting of the American Academy of Child and Adolescent Psychiatry (AACAP), recruited 21 healthy male subjects between the ages of 19 and 30 — all medical students from the Ludwig Maximilian University of Munich in Germany, where the study was conducted. The subjects underwent fMRI scans and EEGs to measure their base level of brain activity — specifically their alpha, beta, theta, and delta waves, which are often abnormal in people with ADHD, anxiety, or other brain-based conditions. Afterward, the subjects were randomly assigned to 30 minutes of either neurofeedback or a placebo “sham” activity.
After completing the session, brain activity was measured again. The group who underwent neurofeedback experienced significant increases in beta and alpha waves — the types of waves associated with alertness, concentration, and deep relaxation — and decreases in delta and theta waves, the waves most associated with drowsiness and deep sleep. Subjects who underwent the sham condition showed significantly less improvement — particularly in their delta waves, which are often overactive in the brains of people with ADHD. The comparative lack of results from the sham activity seemed to rule out the placebo effect, the researchers said.
“These are healthy subjects, so it’s basic research on feasibility,” said the lead author of the study, Daniel Keeser, Ph.D., of the Institute for Clinical Radiology, at Ludwig Maximilian University. “The question is: Can we modulate brain activity using neurofeedback?” In this study, the answer appeared to be yes, he said — but he acknowledged that much more research was needed to come to a definite conclusion.
“There’s a strong lack of clinical studies [on neurofeedback],” he said. “We need more proof of the mechanisms of action.”
“We need to reproduce these results,” he added. “There’s a reproduction crisis in neuroscience.”
The discussant on Keeser’s presentation, Jean Frazier, M.D., director of the Division of Child and Adolescent Psychiatry at the University of Massachusetts Medical School, said she was impressed with his results. Frazier saw a larger implication for using neurofeedback as a treatment for ADHD.
“Training the brain makes a lot of sense to me,” she said. “Neurofeedback may be better than stimulants, and there are cases where medications could be decreased or eliminated” and replaced with neurofeedback.
“Such research is sorely needed,” she added, praising Keeser’s work. “You’re taking a very rigorous approach, and that’s exactly what’s needed.
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