Neurotherapy (NT) is a variant on biofeedback, a process where certain physical functions can be monitored and measured to allow a person to maintain certain physiological and mental states. Biofeedback provides concrete feedback to an individual regarding physiological processes, such as their respiration, heart rate, skin temperature, or some other process, and an individual can learn to maintain or even alter these involuntary processes by maintaining certain moods or performing certain behaviors (e.g., diaphragmatic breathing). Biofeedback has been used successfully to help individuals better manage stress, which can help them control their blood pressure, reduce headaches associated with muscle tension, maintain relatively anxiety-free states, etc.
Neurotherapy uses and electroencephalogram (EEG) as its biofeedback monitor. EEGs are designed to measure brainwave patterns. NT operates on the biofeedback principle by helping individuals to maintain brainwave patterns in order to control certain moods, states, and even certain types of behaviors that may be dysfunctional. NT goes by a number of alternate names including neuromodulation, neurobiofeedback, neurofeedback, EEG biofeedback, brain electrical activity mapping (BEAM), topographical EEG, etc.; however, all of these labels essentially refer to the same process.
The Proposed Mechanism of NT
Several books have been written on the applications of NT. The text Neurofeedback and Neuromodulation Techniques and Applications is an attempt at a scholarly text that proposes to document the different techniques and applications of NT.
The EEG technique used in neurotherapy is a specialized version, often referred to as qualitative EEG (qEEG), which is proposed to be more suited to studying brainwave patterns associated with emotions and thinking. This technique requires more connections (service electrodes) than the standard EEG technique and typically collects data from a minimum of 24 different areas of the brain. The information from the qEEG is then superimposed onto an image of a brain or cranium. Individuals trained in the NT procedure are able to interpret these images and analyze the results from the qEEG printouts. The ability to interpret these printouts requires specialized training, and there are several organizations around the country that offer this training. It should be noted that the results from qEEG printouts are not the same type of results that occur in neuroimaging studies, such as positron emission tomography (PET) or magnetic resonance imaging (MRI) techniques. Neuroimaging studies use entirely different methods and data sets than qEEG studies.
According to the above text and proponents of NT, the NT process makes the following assumptions:
- Specific patterns of brain activity are associated with different issues/disorders. Neurotherapy assumes that people who have certain types of mental health disorders, such as ADHD, depression, anxiety disorders, etc., will produce patterns of brain activity that are unique to each disorder. These patterns of brain activity are dysfunctional when compared to “normal” levels of brain activity and most likely the result of the individual’s genetic makeup, past experiences, and/or the interaction of genes and environmental experiences. This assumption assumes that bold “normal” patterns of brain wave activity are identified and widely accepted, and that it is possible to diagnose a specific type of disorder, a mental health disorder, or another medical condition from a readout of brainwave activity.
- Neurotherapy can recognize dysfunctional patterns of brain activity. The NT technique can identify and distinguish between patterns of “normal” brain activity and specific dysfunctional patterns of brain activity associated with certain disorders. The dysfunctional brain activity patterns associated with any particular disorder become habitual for that individual. NT can help the person to retrain their brain in order for them to produce “normal” brainwave patterns.
- Comprehensive assessments are required. The assessment process used in neurotherapy includes comprehensive testing that can involve psychological testing, medical tests, cooperation from family and friends, and a qEEG assessment to identify that person’s specific brainwave pattern.
- Treatment is based on the assessment. Because the comprehensive assessment produces a profile based on the individual’s brainwave patterns, experiences, etc., the treatment approach is also individualized. The basis of the treatment approach is to help the individual to control their abnormal brainwave patterns with the use of qEEG techniques. The specific technique will vary depending on both the individual and the specific disorder or problem that is being addressed. Some NT programs may have the person listen to music with subliminal messages while hooked up to a qEEG to monitor their brainwave patterns; other programs may have individuals concentrate on certain thoughts, breathing rates, etc.
- NT is a noninvasive treatment. The treatment used in neurotherapy is noninvasive, and those being treated undergo no significant discomfort. Proponents of the technique state that this is advantageous over using medications (that often produce side effects), surgeries (that are obviously invasive), and traditional psychotherapy or behavioral modification, which can be lengthy and can produce some discomfort in certain individuals.
Neurotherapy for Substance Abuse
When applying NT to individuals who have substance use disorders or who are being treated for substance abuse, the technique follows the general protocol that has been previously described. Many individuals who support the use of NT recommend that it be used in conjunction with some of the formal traditional approaches to treating substance use disorders, such as physician-assisted withdrawal management programs, substance use disorder therapy, social support group participation, etc.
Major Research Findings Regarding NT and Associated Techniques
Neurotherapy and other similar techniques have developed a sort of cult following of individuals who claim that the techniques are more effective than traditional approaches (e.g., medication or psychotherapy) for dealing with numerous issues that can include seizure disorders, ADHD, depression, anxiety issues, substance use/abuse, etc. Part of the issue with the technique is that there are no empirically validated EEG patterns that can be used to diagnose any type of mental health disorder. EEGs can be useful in identifying certain aspects of functional behavior and are certainly useful in identifying seizure activity in individuals; however, the notion that a person can “retrain their brain” and produce “normal” brainwave patterns that will result in many of these serious issues being remitted is not supported in the research.
Neurotherapy proponents often reference studies performed within their specific clique as evidence that their technique works; however, many of these studies have serious methodological limitations. It is well-known that the results from numerous studies or an overall body of research can be analyzed using a statistical technique known as meta-analysis. This technique allows reviewers to examine the effectiveness of an intervention as observed over multiple studies. The results of meta-analytic research studies are far superior to the results of any single study and considered preferable when determining whether or not a treatment intervention should be considered effective. It should be obvious to the reader that the overall results of multiple studies or an entire body of research is more significant than the results of any single study. Meta-analytic research looking at the effectiveness of NT interventions has not been supportive.
For instance, one of the disorders that proponents of NT claim effectiveness for remitting is attention deficit hyperactivity disorder (ADHD). However, a 2016 study published in the Journal of the American Academy of Child and Adolescent Psychiatry presented a meta-analytic study of 13 methodologically sound studies that investigated the effectiveness of NT approaches for treating ADHD. The findings indicated that the NT methods were not effective in addressing the issues associated with ADHD and were no more effective than a placebo. There are no meta-analytic studies that suggest that the use of NT offers any advantages over traditional treatment approaches for mental health disorders.
Regarding substance abuse treatment, there is research to suggest that neurotherapy can have utility in determining what type of treatment approach might be more suitable for individuals with substance abuse and other mental health disorders. NT techniques may also be used to increase compliance with other forms of treatment, such as the use of medications in individuals with substance use issues. In addition, the use of NT may reduce dropout rates in psychotherapy even though the evidence that it is effective according to its own principles/assumptions is lacking.
The book Science and Pseudoscience in Clinical Psychology reviews the treatment evidence for several different approaches that have dubious reputations, including neurotherapy. The book reports that the use of NT is most likely best conceptualized as an adjunctive form of intervention that can assist with main interventions; however, there is no direct evidence to suggest that the assumptions used in the technique, and the technique itself, can serve as a formal primary intervention for any major mental health disorder.
The Utility of Neurotherapy
Neurotherapy does have a significant utility in assisting individuals to learn stress management techniques. The use of biofeedback-based approaches has a large body of empirically sound research to support the use of these techniques to help individuals deal with stress and anxiety; however, it has not been demonstrated that the use of these techniques is superior to traditional psychotherapeutic approaches to teaching stress management.
Helping individuals with substance use disorders learn how to deal with stress and anxiety can be a useful component in fostering recovery. However, many individuals in therapy very easily learn to apply standard techniques, such as progressive muscle relaxation, diaphragmatic breathing, imagery, etc., to deal with stress. While biofeedback approaches like NT can be useful in helping individuals learn these methods, they are not required by most individuals in treatment. NT may also be useful at teaching individuals to learn to concentrate more efficiently, which could help individuals in recovery learn new coping methods, acquire stress management skills, understand their issues with substance abuse, etc.
Thus, there is not valid empirical research that suggests that neurotherapy should be used as the main treatment approach for addressing mental health disorders, including substance use disorders. Instead, NT is most useful as an adjunctive or complementary therapy that may bolster the treatment effectiveness of more standard treatment approaches, including the use of medications for stress reduction. However, one of the drawbacks to the use of NT as an adjunctive intervention is its cost, which may run into the thousands of dollars and may not be covered by insurance companies.
Neurotherapy is a form of a biofeedback therapy that teaches individuals to maintain certain physical or emotional states by attempting to control their patterns of brain activity. Many of the assumptions of NT have not been empirically validated, including the notion that specific brainwave patterns for specific types of mental health disorders can be identified and that individuals can be “retrained” to produce “normal” patterns of brainwave activity that will result in these disorders being remitted. Proponents of NT and other similar techniques make a wide variety of claims regarding its usefulness for treating numerous conditions; however, these claims are largely unsupported by solid research.
One critic of NT programs observed that these programs were akin to believing that opening one’s umbrella causes it to rain. This observation describes the faulty reasoning associated with many questionable forms of treatment. Proponents of NT believe that due to the interaction of genetic factors and experience, individuals develop psychological disorders that produce dysfunctional brainwave patterns. This may be true. However, one of the major flaws in the logic is believing that trying to alter dysfunctional brainwave patterns can reverse the damage associated with genetic and environmental factors and/or on their interaction. As a result, some believe proponents of NT make a critical error in assuming cause and effect.
Neurotherapy does not have sufficient research support to endorse its use as a major treatment intervention for most mental health disorders. It does have utility in increasing the effectiveness of stress management techniques; it may be useful in increasing treatment compliance; and it may be useful in reducing dropout rates in psychotherapy. However, due to its high cost, its utility as an adjunctive treatment is most likely limited.