Article: I think, therefore I heal: the weird science of neurofeedback

Imagine if treating a mental illness was as simple as playing a video game — except your mind is the controller. That idea isn’t only real, it’s a therapy gaining traction in the medical community and among patients, who swear by its healing effects. Called neurofeedback, the procedure purports to treat a variety of illnesses — from alcoholism to post-traumatic stress disorder — for which mainstream medicine still hasn’t found adequate long-term solutions. While it’s been relegated to the realm of pseudoscience for decades, advocates are now hoping that new research can catalyze a revolution — one that’ll transform the therapy into a standard of care for thousands of patients.

Practitioners of neurofeedback describe it as a procedure that harnesses brainwave activity for the treatment of various health conditions. Ailments they say can be addressed with neurofeedback run the gamut: in addition to PTSD and addiction, patients suffering from autism, ADHD, depression, anxiety, migraine headaches, insomnia, age-related cognitive decline, and even PMS, can all purportedly find relief after a series of sessions. In other words, if a problem has bearing on your brain, neurofeedback can help solve it.

THE PRACTICE HAS ALSO QUIETLY GAINED TRACTION IN MILITARY CIRCLES

It’s a lofty claim, but several neurofeedback patients interviewed by The Verge credit the therapy with fixing what ailed them. One, an investment banker and self-described former skeptic, even credits neurofeedback with her recovery from the debilitating problems — double vision, trouble walking, severe memory deficits — that she suffered following surgery to remove a brain tumor. The practice has also quietly gained traction in military circles: doctors at Fort Hood are using neurofeedback as part of a PTSD treatment program and researchers at San Diego’s Naval Medical Center are conducting a clinical trial on neurofeedback for that same condition. One military psychologist, Maj. Michael Villanueva, nicknamed “The Wizard” by soldiers under his care, relied on the practice during a 12-month stint in Afghanistan last year.

“The military can be an extremely skeptical, conservative community,” he told The Verge. “But if it works, they’ll use it, and neurofeedback works. I have no doubt the military will adopt it.” Villanueva estimates that he completed 4,000 neurofeedback sessions in Afghanistan, mostly to treat combat trauma, depression, and insomnia. Dozens of patient testimonials he shared with The Verge describe neurofeedback in terms like “amazing” and “life-changing.”

On its face, the process of neurofeedback sounds simple enough: a clinician affixes various electrodes onto a patient’s scalp, their placement meant to target the brainwaves involved in whatever ailment is being treated. The patient then plays a video game, designed specifically for neurofeedback, using nothing more than their mind. Positive results in the game — your rocket ship soars more quickly through the cosmos, for instance — occur when brainwave frequencies reach a target range. “Imagine this as something like a feedback loop,” practitioner Siegfried Othmer, Ph.D., told The Verge. “The brain responds to positive reinforcement and is motivated to behave more optimally. Over time, this leads to enduring changes.” Othmer, a physicist by training, left his burgeoning career in academia in 1989 to launch a neurofeedback clinic, the EEG Institute, after seeing how the therapy helped his epileptic son.

Until recently, however, most experts in the realm of neuroscience and psychiatry didn’t lend much credence to this far-out technique of retraining brainwaves. The process was first devised by neuroscientists at UCLA and the University of Chicago in the 1960s, before falling out of favor. And whenever neurofeedback did garner mainstream attention, little of it was positive: several recent meta-analyses have cautioned that the practice holds little-to-no potential, and that studies extolling neurofeedback’s benefits are poorly designed and typically evaluate small numbers of patients. “If proponents of [neurofeedback] wish to promote their treatment, they must do so on the basis of efficacy experiments that provide strong experimental tests,” reads one analysis published inScience & Pseudoscience.

But more scrupulous studies are starting to happen, and the results are intriguing. In one newly published study, a team at the University of Montreal performed a trial of neurofeedback designed, for the first time, to look for changes in the structure of the brain following treatment. Over a span of 13 weeks, 15 patients underwent thrice-weekly neurofeedback sessions designed to enhance attention levels, while 15 others partook in sham sessions instead. Patients who received genuine neurofeedback experienced improvements in their visual and auditory attention levels, and — most notably — MRI scans revealed that the brains of those patients showed structural changes in regions linked to attention skills.

“This is the first study to look at changes in brain structure following neurofeedback,” study co-author Jimmy Ghaziri, an M.Sc. candidate in neurology at the University of Montreal, told The Verge. “To me, this is a big result, and I hope that doctors skeptical of neurofeedback look at this and rethink their perspective.”

AT LEAST SOME FORMER DOUBTERS ARE TAKING NOTE

After examining the results of this new study, at least some former doubters are taking note. “What this shows is that neurofeedback did, in fact, have an effect on the brain and enhances pathways where you’d want them enhanced,” Andrew Leuchter, M.D., a professor in the Department of Psychiatry and Biobehavioral Sciences at UCLA, told The Verge. “That’s a strong step and an encouraging finding.”

Others, however, are less optimistic that this research will be a game-changer for the field. “This isn’t going to convince any scientists,” John Kounios, Ph.D., a professor of psychology at Drexel University and a specialist in cognitive neuroscience, told The Verge. In particular, Kounios notes, the study didn’t include enough participants, and it wasn’t what scientists consider “the gold standard” for research into potential new treatments: a double-blind, randomized controlled trial in which neither participant nor clinician knows who is receiving placebo. In this study, only participants were in the dark. “When people’s time, money, and health are at stake, it’s imperative to do the tightest research possible,” Kounios said.

When that kind of conclusive research will happen, however, remains an open question. Trials on neurofeedback are inevitably costly because of the equipment involved, and require a lofty time commitment on the part of both patients and clinicians. Most importantly, advocates argue, the research protocols mandated by mainstream medicine are designed for pharmaceutical trials — where it’s easy to blind all parties as to which patients are getting the sugar pill. “It is a longer and less pleasant road” to find broad acceptance without following the conventional approach, Othmer said. “[But] such a definitive study is beyond the reach of clinicians.”

Even Kounios himself readily admits that neurofeedback holds promise. Science just might not unlock it anytime soon. “There is a lot of potential,” he said. “But we may never know exactly how much potential there is.”