Neurofeedback as placebo: a case of unintentional deception?

Neurofeedback: potential for abuse and regulatory frameworks in the United States

Neurofeedback is a brain-training technique that continues to develop via ongoing innovations, and that has broadening potential impact. Once confined primarily to clinical and research settings, it is increasingly being used in the general population. Such development raises concerns about the current regulatory mechanisms and their adequacy in protecting patterns of economic and political decision-making from the novel technology. As studies have found neurofeedback to change subjects' preferences and mental associations covertly, there is a possibility it will be abused for political and commercial gains. Current regulatory practices (including disclaimer requirements, unfair and deceptive trade practice statutes and undue influence law) may be avenues from which to regulate neurofeedback influence. They are, however, limited. Regulating neurofeedback will face the line-drawing problem of determining when it induces an unacceptable level of influence. We suggest experiments that will clarify how the parameters of neurofeedback training affect its level of influence. In addition, we assert that the reactive nature of the traditional models of regulation will be inadequate against this and other rapidly transforming technologies. An integrated and proactive regulatory system designed for flexibility must be adopted to protect society in this era of modern technological advancement. This article is part of the theme issue 'Neurofeedback: new territories and neurocognitive mechanisms of endogenous neuromodulation'.

A systematic review of EEG neurofeedback in fibromyalgia to treat psychological variables, chronic pain and general health

This paper is the first up-to-date review of the various EEG-neurofeedback treatments for fibromyalgia patients and their psychological, physiological and general health consequences. Searches were made of the PubMed, PsycNet, Google Scholar and Scopus databases according to PRISMA guidelines for empirical peer-reviewed articles on EEG-neurofeedback treatment of fibromyalgia, yielding a final selection of 17 studies that met the inclusion criteria: (1) published articles and doctoral theses; (2) conducted between 2000 and 2022; (3) reporting empirical and quantitative data. These articles show that there is a wide range of protocols with different designs and procedures to treat fibromyalgia using EEG-neurofeedback techniques. The main symptoms that showed improvement were anxiety, depression, pain, general health and symptom severity, whilst the most commonly used method was traditional EEG neurofeedback based on a sensorimotor rhythm protocol. It may be concluded from the review that the lack of consistency and uniqueness of the protocols makes it very difficult to generalise results, despite the individual improvements identified. This review provides instructions and information that could guide future research and clinical practise, with the data extracted helping to gain a deeper understanding of the state of the art and the needs of the technique for this population group.

Unintentional deception still deceives

In my recent article, Pretending to care, I argue that a better understanding of non-doxastic attitudes could improve our understanding of deception in clinical practice. In an insightful and well-argued response, Colgrove highlights three problems with my account. For the sake of brevity, in this reply I focus on the first: that my definition of deception is implausible because it does not involve intention. Although I concede that my initial broad definition needs modification, I argue that it should not be modified by involving intention but by involving responsibility.

Opportunity Cost or Opportunity Lost: An Empirical Assessment of Ethical Concerns and Attitudes of EEG Neurofeedback Users

Background

Electroencephalography (EEG) neurofeedback is a type of biofeedback that purportedly teaches users how to control their brainwaves. Although neurofeedback is currently offered by thousands of providers worldwide, its provision is contested, as its effectiveness beyond a placebo effect is unproven. While scholars have voiced numerous ethical concerns about neurofeedback-regarding opportunity cost, physical and psychological harms, financial cost, and informed consent-to date these concerns have remained theoretical. This pilot study aimed to provide insights on whether these issues were supported by empirical data from the experiences of neurofeedback users.

Methods

Semi-structured telephone interviews were conducted with individuals who had used EEG neurofeedback for themselves and/or for a child.

Results

The majority of respondents (N = 36) were female (75%), white (92%), and of higher socioeconomic status relative to the U.S. population. Among adult users (n = 33), most (78.8%) resorted to neurofeedback after having tried other therapies and were satisfied with treatment (81.8%). The majority paid for neurofeedback out-of-pocket (72.7%) and considered it to be good value for money (84.8%). More than half (57.6%) considered neurofeedback to be a scientifically well-established therapy. However, of those, 78.9%were using neurofeedback for indications not adequately supported by scientific evidence.

Conclusion

Concerns regarding opportunity cost, physical and psychological harms, and financial cost are not substantiated by our findings. Our results partially support concerns regarding insufficient understanding of limitations. This study underlines the disconnect between some of the theoretical concerns raised by scholars regarding the use of non-validated therapies and the lived experiences of users.