Does Neurotherapy Really Work?

Scientists have made amazing progress measuring the electrical fields of the brain, especially in recent decades.

Does medical science now know enough to be able to use that knowledge to change the brain's electrical state, so that patients with medical problems benefit?

For the better part of a century, researchers and clinicians have been able to put sensors on a patient's scalp to measure how the brain's 100 billion nerve cells generate electricity. The patterns produced when electric fields are recorded by the sensors as waves are known as an electroencephalogram, or EEG.

These electrical fields that the brain generates are exceedingly complex, and only very partially understood by physicians and scientists. While it is possible in some settings to record electrical events from inside the brain, or intracranially, more commonly, sensors are placed outside of the brain, on the scalp.

How medically useful is it to perform these recordings from the scalp? According to Scholarpedia Neuroscience these "...provide important measures of brain dysfunction for clinical work", giving MDs a valuable tool.

Physicians and other clinicians who collect EEG scalp recordings have been able to find patterns in the data that are useful for diagnosis. There are clinically important associations between the psychological states of the patient and the electrical waves the brain produces.

Can these electrical patterns that are generated by a patient's brain be "fed back" to the patient for therapeutic purposes? The jury is still out, but there are data that suggest that some patients do in fact benefit from this form of "biofeedback". What needs to happen next is serious testing of the real medical value of technologies that use EEG recordings for biofeedback, labeled "neurofeedback or "neurotherapy".

What is neurofeedback/neurotherapy?

Various psychiatric and neurological disorders have been associated with differences in brain waves. Generations of doctors have been trained to recognize and interpret the medical significance of various peaks and troughs on an EEG chart, and now computers support ever more sophisticated analysis of this data.

EEGs have well known uses for diagnosis. For instance, abnormalities in activity in the outer part of the brain known as the cortex, an area especially associated with higher mental functions, can be detected quite well with EEG.

EEG, in conjunction with specialized software for analysis, gives clinicians a tool for determining the relationship between brain activity abnormalities and emotional, perceptual, cognitive and behavioral problems.

As EEG technology for diagnosis of mental and neurological disorders was becoming more sophisticated, biofeedback technology, which uses a patient's own biological rhythms for therapeutic purposes, was being developed.  

For a number of decades there has been interest by psychologists and others in using biological waves from a patients for therapeutic purposes. Wave data is recorded from the rhythmic pulsing of systems in the body, such as with heartbeat, and the data can be presented to a patient using a computer.

In the 21st century, EEG rhythms can be fed into a computer, then represented as visuals or sounds to a patient as "feedback" to change the electrical state of the brain. Psychologists have been intrigued by the potential benefits of this feedback for relaxation, stress relief, heightened attention and other clinical uses.

Some researchers use EEG biofeedback in conjunction with additional technology to induce electrical changes inside the brain. These biofeedback technologies have been named neurotherapy or neurofeedback. Other labels include "EEG feedback therapy", "bioneurofeedback" and so forth.

Clinicians can now use EEG waves as a tool for stimulating a patient's brain, which is potentially helpful for treating conditions such as attention deficit disorder, post-traumatic stress disorder or traumatic brain injury.

Neurotherapy as a tool for clinicians

Does neurotherapy or neurofeedback really work? Do patients benefit if doctors use EEG-based biofeedback to stimulate areas of the central nervous system associated with mental and emotional problems?

The evidence is mixed, but there are data that suggest that some post-traumatic stress disorder and traumatic brain injury patients can benefit.

One study by David Nelson, PhD and Mary Etsy, PhD, using the Flexyx Neurotherapy System, measured how seven Afghanistan and Iraq war veterans who suffer from mixed traumatic brain injury and post-traumatic stress disorder symptoms responded to neurotherapy. The system allows clinicians to use biofeedback to stimulate the patient's brain, with the hope that this will change the electrical state of certain brain networks and improve the patient's symptoms.

The authors report in a 2012 article in the Journal of Neuropsychiatry and Clinical Neurosciences that the patients who were given this neurotherapy treatment showed "significant decreases in bothersome neurobehavioral and post-traumatic stress symptoms."

If a patient feels better and shows measurable improvement on clinical tests after neurotherapy sessions, does this not prove that the therapy works?

It does not. While patients have reported feeling better from these systems, more rigorous studies are needed to determine the actual clinical usefulness of the approach. Other factors may be producing some or all of the seeming medical benefits.

Conclusion

Neurotherapy involves one of a number of approaches that use a person's brainwaves for therapy. Recordings of these electrical waves can be used to therapeutically stimulate the brain of the patient via a neurofeedback device.

Some patients with traumatic brain injury or post-traumatic stress disorder who use this technology may show improvement with clinical tests, such as feeling fewer unwanted symptoms. However, neurotherapy and neurofeedback studies generally do not examine whether or not other factors may be producing some or all of the seeming medical benefits.

Neurotherapy may be beneficial for some patients suffering from post-traumatic stress disorder or traumatic brain injury.  More rigorous science will be needed to determine the real clinical usefulness of the approach.