Beneath the obvious question of does it work are many more questions to make the training more effective and efficient. There are perhaps 6 distinct schools of thought on how to do neurofeedback. The method in the research studies is only one kind. And that method is in the minority because research is always backward looking.

It is an exciting time to be a neurofeedback provider. I would invite anyone to get some neurofeedback training, become a home trainer, or add neurofeedback to your practice. A wave of acceptance is coming.

http://www.coping-with-epilepsy.com/forums/f37/pushing-neurofeedback-into-mainstream-5418/

Research groups have consistently reported on behavioral and cognitive improvements of children with ADHD after neurofeedback. However, neurofeedback has not been commonly accepted as a treatment for ADHD. This is due, in part, to several methodological limitations. The neurofeedback literature is further complicated by having several different training protocols. Differences between the clinical efficacy of such protocols have not been examined. This study addresses previous methodological shortcomings while comparing the training of theta-beta-frequencies (theta-beta-group) with the training of slow cortical potentials (SCP-group). Each group comprised of 19 children with ADHD that were blind to group assignment. The training procedure consisted of 30 sessions and a six months follow-up training. Pre-/post measures at pretest, the end of the training and the follow-up included tests of attention, intelligence and behavioral variables. After having already reported intermediate data (Strehl et al. 2004), this paper gives account on final results: Both groups are able to voluntarily regulate cortical activity, with the extent of learned self-regulation depending on task and condition. Both groups improve in attention and IQ. Parents and teachers report significant behavioral and cognitive improvements. Clinical effects for both groups remain stable six months after training. Groups do not differ in behavioral or cognitive outcome variables.

U L, T H, S K, F S, C W, U S. [Neurofeedback for children with ADHD: a comparison of SCP- and theta/beta-protocols]. Praxis der Kinderpsychologie und Kinderpsychiatrie [serial online]. 2006;55(5):384-407. Available from: Cochrane Central Register of Controlled Trials, Ipswich, MA. Accessed October 15, 2008.

The program that had most evidence behind for that specific context is Cogmed Working Memory Training.

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“The most conclusive test of neurofeedback treatment would include random assignment and a control condition that closely matched the neurofeedback condition. For example, children could receive video game coaching from a supportive adult for the same time period. Or, even better, they could do exactly what children getting the neurofeedback were doing but not receive direct feedback on their EEG states.” – Dr. Rabiner

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EEG neurofeedback is not a “treatment” in the classical sense. It is a training program that requires tailoring over time by the practitioner and active participation from the patient. It is not possible to simulate this effectively over time for a “blind” study, much less a double blind study.

But the larger answer as to why no one attempts the type of study he proposes is $$$:

“For a very promising treatment targeting such a
serious condition as epilepsy, the number of large-scale clinical trials of neurofeedback
training to date is disappointing. A likely reason for this state of affairs is that
neurofeedback research is a very time- and work-intensive enterprise that has
traditionally not received extensive research funding and has, for obvious reasons, not
been pursued by the pharmaceutical industry.”

http://sica.stanford.edu/events/brainwaves/FoundationsofNeurofeedback.pdf

As I mentioned previously, no company owns a patent on EEG neurofeedback – it’s a training process, not a drug or specific medical device. It is not economically justifiable for a for-profit company to sponsor the necessary research. There is no ROI. So, it’s up to non-profit groups/charities to sponsor this kind of research. While some have sponsored small studies recently (such as FACES at NYU), there hasn’t been and isn’t anything being done on the scale that appears to be necessary for the skeptics.

I don’t mind if you republish the comment.

Play Attention is not a full fledged neurofeedback machine like the ones used in studies. It only processes (IIRC) the alpha wave channel. EEG Neurofeedback machines like Brainmaster’s Atlantis system, Zengar Institute’s NeuroCare system, etc. manage up to 5 wave channels – alpha, beta, theta, delta and (sometimes) gamma. It also doesn’t perform QEEG mappings, so it is not on the same level as a treatment option as EEG neurofeedback as defined in the studies.

You raise many good points. And I am happy that neurofeedback helped your wife. Now, nothing that you have written, in my view, contradicts Dr. Rabiner’s conclusion. Furthermore, the fact that neurofeedback has been around for so long, may make one question why no one attempts the type of study he proposes.

In fact, in those same ratings you link to, one can see only one application reaches Levels 5, and it is not ADD/ ADHD. Which is basically what Dr. Rabiner is saying, with other words.

This is not about drugs vs. no drugs. Some non-drug-based approaches, such as cognitive therapy or forms of computer-based working memory training are starting to show efficacy as complement to drugs in well-designed trials. And it is not about biofeedback in general, which has clear research support for specific applications.

You may know that companies like Play Attention sell neurofeedback machines direct to parents, for use with kids who have ADD/ ADHD. Have you seen research supporting an investment of more than $1,000 in such programs? They may work, and parents are free to spend their money as they want- but they deserve to know that it is not proven.