Practice in Clinical & Health Psychology
What is EEG Biofeedback?
Training the Brain to Function Better





EEG Biofeedback
EEG biofeedback or neurofeedback uses real-time digital technology to measure electrical activity of the brain (EEG) and present this information in a form that enables the individual to perceive changes in the state of the brain and learn to modify abnormal EEG patterns.
Neurofeedback "meets the American Academy of Child and Adolescent Psychiatry ‘Clinical Guidelines’ for treatment of ADHD, seizure disorders, anxiety (eg, obsessive-compulsive disorder, generalized anxiety disorder, posttraumatic stress disorder, phobias), depression, reading disabilities, and addictive disorders. This finding suggests that (neurofeedback) always should be considered as an intervention for these disorders by the clinician….Specific recommendations based on the body of empirical evidence currently available suggest that (neurofeedback) be considered by clinicians and parents as a first line treatment of ADHD when parents prefer not to use medication and as an empirically supported treatment choice when significant side effects or insufficient improvement occurs with medication.

Hershberg, et al. (2005) Emerging brain-based interventions for children and adolescents: Overview and clinical perspective. Child and Adolescent Psychiatric Clinics of North America, Vol. 14, pp.1-19.
The term “biofeedback” refers to a type of skills training in which persons learn to increase their ability to control biological responses, such as blood pressure, muscle tension, heart rate, or skin temperature, etc. Sophisticated and highly sensitive electronic instruments are commonly used in biofeedback therapy to measure and amplify physiological signals from the body and convert these signals— usually through a computer— to a form that is meaningful to both the therapist and the patient and which can be used to show moment-to-moment changes in the biological response. Biofeedback of muscle tension (electromyogram or EMG) has been successfully used to treat chronic muscle pain, TMJ, and tension headache. Biofeedback of blood pressure has been used to treat hypertension. Biofeedback of heart rate has been used to treat panic attack and anxiety disorders. Biofeedback of skin temperature has been used to treat migraine headache.
EEG biofeedback (also called EEG Neurofeedback) simply uses specialized electronic equipment to measure the electrical activity of the brain cortex (i.e., electroencephalogram or EEG) from electrodes placed on the scalp and convert this raw data into a display that the therapist and patient can easily understand and which shows moment-to-moment changes in EEG. With the proper feedback of moment-to-moment brain wave activity it is possible to learn to alter and control brain electrical activity or brain wave patterns to a significant degree.
EEG biofeedback was first used clinically by Dr. Barry Sterman in the early 1970s to successfully treat persons with epilepsy. Dr. Sterman discovered that increasing the amount of 14 Hz activity as recorded from the sensorimotor cortex of the brain had the effect of inhibiting seizure activity. In a similar vein, Dr. Joel Lubar in the late 1970s discovered that many persons with attention deficit disorder show too much brain wave activity in the 6-8 Hz range (NOTE: Hz = Hertz = cycles per second or frequency) from the frontal lobes of the brain and EEG biofeedback could be used to train a shift in brain wave activity to the higher frequencies associated with more focused attention. Through the 1980s and 1990s, numerous well-designed controlled scientific studies have demonstrated the efficacy of EEG biofeedback in the treatment of both seizure disorders and attention deficit disorder.
There is now good scientific evidence from both controlled research and clinical studies as well as long-term follow-up that EEG biofeedback can be an effective treatment for seizure disorders and attention deficit disorder when compared to both common drug treatments and placebo, and that treatment affects are long-lasting. There is also growing scientific and clinical evidence supporting the effectiveness of EEG biofeedback in the treatment of the following conditions: drug addictions, alcoholism, anxiety disorders, PTSD, chronic pain, depression, insomnia, specific learning disabilities, and migraine. There are also increasing numbers of clinical reports suggesting that EEG biofeedback may be useful in ameliorating some of the symptoms and dysfunctions associated with such conditions as brain injury, autistic spectrum disorders, chronic fatigue syndrome, fibromyalgia, and senile dementia.
Treatment with EEG biofeedback is based on the theory that once individuals understand their brain activity and learn to manipulate their own brain waves, they will be able to continue to do so, long after the therapy has ended. Some studies have followed patients for as long as 10 years after being treated with EEG biofeedback and have shown no significant loss of treatment gains.
Currently, there are well over 2000 practitioners in the United States and Canada offering some form of EEG biofeedback or other form of neurotherapy treatment for one or more of the above listed disorders and tens of thousands of children and adults have been treated over the last 30 years.
What the Experts Say About EEG Biofeedback
Frank Duffy, MD, Neurologist, Head of the Neuroimaging Department and of Neuroimaging Research at Boston Children’s Hospital, and Harvard Medical School Professor, conducted an independent review of the literature on neurofeedback for Clinical Electroencephalography (2000). He summarized his findings as follows:
"The literature, which lacks any negative study of substance, suggests that EEG biofeedback therapy should play a major therapeutic role in many difficult areas. In my opinion, if any medication had demonstrated such a wide spectrum of efficacy, it would be universally accepted and widely used."

"In my 38 years of practice, I have never seen any treatment that comes close to producing the results that Neurofeedback offers...I have seen results achieved in days and weeks that previously took months and years to achieve, using the best methods available to us."
- Jack Woodward, M.D. (Board Certified Psychiatrist)

"This is one of the broad reach of tools available, and it's a good tool. Like any tool, it doesn't work for everyone, but it does benefit most people. It accelerates symptom removal and the development of healthy self-regulation—meaning it helps the patient's own body make the proper adjustments."
- Dr. Thomas Brod (Psychiatrist)
 Los Angeles, CA

"In my experience with EEG Biofeedback and ADD, many people are able to improve their reading skills and decrease their need for medication. Also, EEG Biofeedback has helped to decrease impulsivity and aggressiveness. It is a powerful tool, in part because the patient becomes part of the treatment process by taking more control over his own physiological processes."
- Daniel Amen, M.D. (CEO and Medical Director, Amen Clinics, Inc.)
 Author of Change Your Brain, Change Your Life

"It improves seizures, depression, low self-esteem or congenital head injuries, and it helps the 'craziness' that often comes with these...Patients report they sleep better, they don't have seizures, they are more in control, and that they get more work done. It helps with closed head injury patients. It helps with chronic neurologic disease, where there is no active injury but there are problems with normal functioning. We've had success with multiple sclerosis, with toxic encephalopathy (for example, chemical poisoning interfering with neurologic functioning), with chronic pain, migraines and fibromyalgia. And of course, we get very good results with ADD."
- Jonathan Walker, M.D. (Neurologist)
 Dallas, TX

"Among the newer approaches to managing ADD, the most exciting is a learning process called Neurofeedback. It empowers a person to shift the way he pays attention. After more than twenty-five years of research in university labs, Neurofeedback has become more widely available. This is a pleasing development, because Neurofeedback has no negative side effects." (Page 205)
- William Sears, M.D.
 Author of The A.D.D. Book

"Used with behavior therapies that incorporate classroom and homework skills, neurofeedback can help these children become less dependent on stimulants like Ritalin."
- Joel Lubar, Ph.D. (Psychologist)
 University of Tennessee, Knoxville

"Used selectively for patients, it is a very good tool. For psychiatry, this is an area to look into. Not everyone gets better with Prozac, or other drugs. This is a biological intervention that gets the brain firing. I've only used Neurofeedback on a limited basis so far, I've gotten good results in my private practice with depression. I've also gotten good results with some children we have used it for. I would like to do more with it."
- Terry Cook (Psychiatrist)
New South Wales, Australia

In a recent paper Update on attention-deficit/hyperactivity disorder published in Current Opinion in Pediatrics Katie Campbell Daley reviewed the research and practice standards on treatment of ADHD. Dr. Campbell serves on the staff of the Department of Medicine, Children's Hospital Boston and in the Department of Pediatrics of the Harvard Medical School. She concluded:
"Overall, these findings support the use of multi-modal treatment, including medication, parent/school counseling, and EEG biofeedback, in the long term management of ADHD, with EEG biofeedback in particular providing a sustained effect even without stimulant treatment...parents interested in non-psychopharmacologic treatment can pursue the use of complementary and alternative therapy. The therapy most promising by recent clinical trials appears to be EEG biofeedback."

A recent special issue of Child and Adolescent Psychiatric Clinics of North America was devoted to emerging interventions that affect brain function. Neurofeedback was featured in seven of the ten chapters in the volume. The volume editors provided an overview and clinical perspective on all the approaches presented. About neurofeedback they concluded:
"EEG biofeedback meets the American Academy of Child and Adolescent Psychiatry criteria for clinical guideline (CG) for treatment of ADHD, seizure disorders, anxiety (OCD, GAD, PTSD, phobias), depression, reading disabilities, and addictive disorders. This suggests that EEG biofeedback should always be considered as an intervention for these disorders by the clinician."