Comments on: Neurofeedback and the Need for Science-Based Medicine

By: r34498

r34498 — Thu, 25 Aug 2011 21:50:04 +0000

It’s easy enough to double blind the “Brain State” neurofeedback, because the software essentially “records” the session in order to show “results” to unsuspecting clients. When trainers select the protocol to use (PP alpha up, or FF theta down, etc.) the study designer could randomly assign subjects to a treatment group or a control group and the program protocol called out for their session could simply be a previously recorded session of another person, rather than a so called live feedback session. The musical tones being played to the client would not be discernable as the “correct” “encouragers” or “discouragers”. The company claims that the brain will only change if it “sees itself”, so conveniently, clients are reassured, there is no way to harm a client by accidentally running a protocol with sensors that fell off or something. It’s brilliant marketing. I’d bet cash that responsive clients would report feeling the effects. The whole operation is classic placebo effect….warm blanket, cold bottled water, soothing ambiance and a person paid to listen to their problems for two hours at a time! The company employs a reputation monitoring company that electronically tails ex-employees and threatens to sue them if they report their experience to the Better Business Bureau or the state board of mental health examiners and FLOODS the search engines with positive “testimonials”. The prisoner “research” involved FOUR inmates, selected not at random, but by the warden who knew their temperaments (and gullibility). It’s a crime what they get away with.

By: adriancmvd

adriancmvd — Fri, 20 Mar 2009 05:27:24 +0000

Hi there,

I’m here to provide you with a complete and well organized resource that studies Neurofeedback.

1- http://isnr.org/ComprehensiveBibliography.cfm
Compiled by D. Corydon Hammond, PhD Professor, Physical Medicine & Rehabilitation University of Utah School of Medicine

Also
Frank H. Duffy, M.D., Professor and Pediatric Neurologist at Harvard Medical School, stated in an editorial in the January, 2000 issue of the journal Clinical Electroencephalography that the scholarly literature suggests that neurofeedback 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” (p. v). “It is a field to be taken seriously by all” (p. vii).

My comment:
The suggestion by Dr. Novella for a DOUBLE BLIND research design applied to this Behavioural learning procedure not adequate, because THE PERSON IN TRAINING PERCEIVES HIMSELF- there is no way to blind it.
When false feedback is provided, a subject recognizes this and so the Blind unfolds.

The AAPB, in it’s 40th year, publishes an efficacy guide that is quite skeptical and also critical. It is called Evidence Based Practice in Biofeedback and Neurofeedback. The 2008 edition is released but being sold at present. I can thus merely offer you the 2004 version.
2- http://aapb.org/tl_files/AAPB/files/Yucha-Gilbert_EvidenceBased2004.pdf

The results of these Efficacy ratings is possible because the resource used to train, THE EEG, is as exacting and specific as any hospital EEG. So when a person progresses in “real life”, the concurrent phenomenological manifestation can be tracked and studied.
I ask you if there is a simple, cost effective and real-time accurate method to do say the same for pharmacological interventions…? Other than, of course, EEG readings.

May this message be read along with the above to INFORM the reader.

All the best, And Thanks to Steven,

Adrian Machado Van Deusen

By: alec_s

alec_s — Fri, 06 Mar 2009 20:02:45 +0000

Actually there are some fairly rigorous studies involving treatment of ADHD with neurofeedback, for example:

http://www.add.org/articles/TheRoleofNeurofeedbackintheTreatmentofADHD.html

Although this was a clinical study, it looks as though they were reasonably strict in testing for and statistically controlling any systematic differences between groups. Their results look impressive, although I wish the article had also included some measure of statistical significance.

However, many more studies are needed. An article I read:

http://www.odemagazine.com/doc/61/neurofeedback/

points out there as of yet there are no theories as to why neurofeedback actually works. It seems the field has a promising start, but needs more rigorous (non-case) studies to form a clearer picture of what’s going on.

By: krissncleo

krissncleo — Sat, 12 Jan 2008 00:13:47 +0000

The other day I asked about a company called Brain State Technologies that uses Brain State Conditioning-their “unique form of biofeedback-to treat troops returning home from the war. Said company claims that biofeedback can cure/heal everything from adhd, depression, migraines to anger management problems and seemingly, and host of other ailments. My question, does boifeedback work in these situations, was anwsered in your blog “Neurofeedback and the Need For Science Based Medicine.” Veterns and Families.org and The warrior Transition Project use anecdotal testimony and media pieces to promote their product. They claim that because neurofeedback has been around for decades and that it can cure a wide variety of ailments, but they do not say how measuring beta and alpha waves will do this. I’m still in college so I didn’t know if this was a new treatment or pseudoscience.

There is a very nice lady that comes into the cafe where I work and she told me her son is going through the program so she asked me what I thought about it. Now I have something to tell her. For the sake of the veterns comming home I hope that their other treatments are based in science.

Thank you so much.

Kriss

By: Rgevirtz

Rgevirtz — Fri, 16 Nov 2007 19:59:56 +0000

While I agree with your skepticism and actually teach my graduate students to adopt this kind of attiude, I think you need to look with a little more depth at the research that some of us are doing to determine not only efficacy but mechanism for the techniques mentioned. You mention HRV biofeedback and dismiss it as not having any empirical basis. A number of us have published several well controlled studies using heart rate variability feedback for disorders that have a likely autonomic pathway (IBS, Asthma, Headache, etc. ) I would call you attention to the study published in Chest by my colleage Paul Lehrer, Ph.D. showing efficacy for the procedure against a credible placebo condition. If interested, I can supply more citations of our work as well.

Just because clinicians make irresponsible claims, it doesn’t mean that the baby needs to tossed with the bathwater.

Lehrer, Vashillo, and Vashillo (2004) Biofeedback as a treatment for asthma, Chest, 126,352-361

By: Steven Novella

Steven Novella — Tue, 23 Oct 2007 17:58:47 +0000

The fact that some treatments have broad legitimate applications does not invalidate the notion that practitioners that are not evidence-based will tend to apply their treatments to an ever broader list of indications. The question is, how to tell the difference.

One criterion is to consider the potential for the mechanism of action – can it reasonably be applied to a range of disorders? The other is to consider how much the target disorders have in common – do they have a common underlying contributor that can be the target of the common treatment?

Meditation causes relaxation, so it could theoretically benefit any symptom or disorder that relaxation would help, or that is worsened by stress.

The list of disorders for neurofeedback given above, however, do not share a common mechanism. Headaches, ADHD, urinary incontinence and hypertension? Not much of a common theme here.

What they do have in common is that they are common problems for which people frequently seek treatment, many people may not be responding to conventional treatment, or may simply desire a non-drug solution. Similar lists crop up for most dubious treatments. It’s not a coincidence.

By: mas

mas — Tue, 23 Oct 2007 16:41:04 +0000

Not sure i agree with the ‘indication creep’ idea – seems a bit limiting.
If new discoveries in psychoneuroimmunology are anything to go by, then things are a lot more complex than that!
There is some evidence now, for instance, on the benefits (and possible underlying processes) of meditation. Does it’s credibility become reduced because it has the potential to impact on all bodily systems?

By: Skeptyk

Skeptyk — Sat, 20 Oct 2007 00:33:02 +0000

On the AAPB’s homepage, they advertise a conference on Heart Rate Variability, another therapy for which popularity and hype outstrips evidence.

That said, HRV and NF practices, AFAIK, are not as invasive as, say, “acu-”puncture, and have some elaborate ritual elements which can contribute to enhanced placebo effect. As Steven said, retraininng your own brain waves is sexier than behavioral therapy. “Behave yourself” vs “Rewire yourself”? If presented that way, who would not prefer the cybercool of NF?

By: Nevar

Nevar — Wed, 17 Oct 2007 18:25:48 +0000

This brings to mind those brain wave entrainment techniques using binaural beats or what not. I assume that listening to music (or rhythms) probably does create certain responses in the brain, but can one really entrain one’s brainwaves to a certain frequency using these methods? I’m rather sceptical towards the whole idea.

I mean; if I need to concentrate on something, I’m sure many physiological changes start occuring including changes in brainwave activity. So how do we know their concentration enhancement CD does anything without proper tests? This all sounds like a do-nothing-but-still-get-the-benefit thing to me.