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.

Offering Neurofeedback as an Intervention for Children with Attention Deficit/Hyperactivity Disorder in Indonesia: A Feasibility Study

BACKGROUND

EEG Neurofeedback training is an accepted non-pharmacological therapy for attention deficit/ hyperactivity disorder (ADHD). Although stimulant medication is known to decrease ADHD symptoms, possible adverse effects, concerns about prolonged drug use on neural development, and problems related to the compliance with the medications are often reported. In Indonesia, research on the feasibility of EEG Neurofeedback to treat ADHD is still lacking. The current study aimed to investigate whether setting up an EEG neurofeedback training program for children with ADHD would be feasible in Indonesia.

METHODS

Nine children (aged 6-12 years) participated in the study. ADHD was diagnosed using the Vanderbilt ADHD Diagnostic Rating Scale (VADRS). Children received twenty-five sessions of sensorimotor rhythm (SMR) neurofeedback training twice a week. Each session consisted of a 3-minute baseline, followed by 5*3 minutes of training. IQ scores and VADRS scores were collected at baseline, after completion of the intervention, and at 3 months follow-up, while school reports were provided by the schools. The EEG spectral content was determined for all 25 training sessions. In addition, a Go/No-Go Task, was administered at the first 5 training sessions, and at session 10, 15, 20 and 25.

RESULTS AND CONCLUSION

An overview of all the collected data is provided descriptively, given the small group size. One child dropped-out during the training because of parental request, but the remaining eight children completed the full intervention program. Descriptive data suggested improvement with respect to both the ADHD symptomatology and performance IQ. These findings are in line with previous studies. Although a control arm was not included, we propose that the abovementioned SMR neurofeedback protocol may still be offered as a suitable non-pharmacological intervention for children with ADHD in Indonesia and deserves further research.

Volitional modification of brain activity in adolescents with Autism Spectrum Disorder: A Bayesian analysis of Slow Cortical Potential neurofeedback

Autism spectrum disorder is (ASD) characterized by a persisting triad of impairments of social interaction, language as well as inflexible, stereotyped and ritualistic behaviors. Increasingly, scientific evidence suggests a neurobiological basis of these emotional, social and cognitive deficits in individuals with ASD. The aim of this randomized controlled brain self-regulation intervention study was to investigate whether the core symptomatology of ASD could be reduced via an electroencephalography (EEG) based brain self-regulation training of Slow Cortical Potentials (SCP). 41 male adolescents with ASD were recruited and allocated to a) an experimental group undergoing 24 sessions of EEG-based brain training (n1 = 21), or to b) an active control group undergoing conventional treatment (n2 = 20), that is, clinical counseling during a 3-months intervention period. We employed real-time neurofeedback training recorded from a fronto-central electrode intended to enable participants to volitionally regulate their brain activity. Core autistic symptomatology was measured at six time points during the intervention and analyzed with Bayesian multilevel approach to characterize changes in core symptomatology. Additional Bayesian models were formulated to describe the neural dynamics of the training process as indexed by SCP (time-domain) and power density (PSD, frequency-domain) measures. The analysis revealed a substantial improvement in the core symptomatology of ASD in the experimental group (reduction of 21.38 points on the Social Responsiveness Scale, SD = 5.29), which was slightly superior to that observed in the control group (evidence Ratio = 5.79). Changes in SCP manifested themselves as different trajectories depending on the different feedback conditions and tasks. Further, the model of PSD revealed a continuous decrease in delta power, parallel to an increase in alpha power. Most notably, a non-linear (quadratic) model turned out to be better at predicting the data than a linear model across all analyses. Taken together, our analyses suggest that behavioral and neural processes of change related to neurofeedback training are complex and non-linear. Moreover, they have implications for the design of future trials and training protocols.

Cognitive rehabilitation in addictive disorders

Substance use disorders are frequently associated with neuropsychological deficits. A comprehensive assessment of attention, memory, executive functions, language and mental speed is often warranted. Cognitive rehabilitation is a therapy programme designed as an intervention to help people with cognitive, behaviour and emotional deficits. Using systematic approaches such as cognitive retraining and EEG neurofeedback, the individuals are helped to be integrated into society.