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Twice a week, Stephanie, a 37-year-old artist living in Boston, meets with her therapist to work on improving symptoms associated with PTSD, including flashbacks, nightmares and suicidal thoughts.

“I had nightmares where I was screaming so loud my partner could hear and transcribe what I was saying on another floor of the house,” said Stephanie, who asked not to reveal her last name due to the stigma surrounding it. mental health.

His sessions, however, are not your typical armchair therapy. At some point during each meeting, her therapist, Ainat Rogel, places Stephanie in front of a computer, places several electrodes on her skull, and instructs her to control a video that appears on the screen, using only her thoughts.

The treatment is known as neurofeedback, a therapy that some say can improve our attention, mood, sleep habits and even our athletic ability measuring brain activity and showing it to us, either on a screen or through headphones, in real time. A doctor places electrodes on a patient’s head that detect (but do not stimulate) brain activity. This is then analyzed by a computer that sends it back to the patient as images or sounds. As the patient completes the tasks, the computer encourages healthy patterns of brain activity.

People who suffer from anxiety, for example, can lessen their symptoms by being repeatedly guided to generate brain patterns correlated with a calmer state of mind. Just as we learn to ride a bicycle by doing it repeatedly, the theory goes, our brains can learn to be less depressed, more focused, and better prepared for a good night’s sleep.

In Stephanie’s case, Dr. Rogel sets a video to play full screen when sensors detect brain activity corresponding to a reduction in her PTSD symptoms. The video is reduced and becomes more difficult to see when the electrodes detect unhealthy patterns.

Stephanie said she’s not entirely sure what she’s doing to get the video to play full screen. “Sometimes I put a thought in my mind or focus on something that I need to work on,” he said. “Sometimes I focus on a memory.”

The important part, said Dr. Rogel, who founded the Boston Neurodynamics neurofeedback clinic, is repeated exposure to beneficial brain activity. If done often enough, he said, exercises like these can help patients retrain their brains into healthier patterns.

“This is the only thing I’ve tried that has given me any relief,” Stephanie said, adding that her symptoms have steadily improved since her first week of treatment last May.

Over the last decade, neurofeedback has entered mainstream culture. Tobias Harris of the Philadelphia 76ers uses it to improve your focus. Motivational speaker Tony Robbins credits neurofeedback with increasing his multitasking ability. Wealthy investors, including former Education Secretary Betsy DeVos, continue to invest millions in neurofeedback companies that promise dramatic improvements in the way our brains work.

However, neurofeedback is not yet accepted as a conventional treatment within mental health circles, and the strongest research on the intervention to date suggests that it is no more effective than placebo.

So… Does it work?

Neurofeedback is a type of biofeedback that uses sensors to record and provide feedback on a variety of biological processes such as breathing, heart rate The tension muscular. Those who suffer from panic attacks, for example, can use a device that tracks the respiratory system and promotes measured breathing.

Doctors across the country use neurofeedback to treat conditions such as hyperactive disorder and attention deficit, major depressive disorder, anxiety disorder, epilepsy and traumatic brain injuries. The Food and Drug Administration has authorized a wide range of neurofeedback devices to treat these and other conditions, and the Centers for Disease Control and Prevention lists it as an option in cases of ADHD in children, although they do not approve it.

But a 2020 meta-analysis of 17 neurofeedback studies examining its impact on disorders like depression and anxiety was less inspiring. He suggested that it is possible to coax our brains into producing certain patterns through repetitive feedback, but the impact on mood disorders was relatively small.

“It’s one thing to be able to say, ‘Hey, we can change the brain,’ and another to show that inducing these changes will actually have an impact on symptoms,” said David Dodell-Feder, an assistant professor of psychology and neuroscience at the University of Rochester. and study author.

Robert Thibault, postdoctoral fellow at the Meta-Research Innovation Center at Stanford University, is also skeptical. He said that proponents of neurofeedback aim to peer reviewed research that have “impressive results,” but most are not rigorous double-blind, placebo-controlled trials. Of the a dozen or so such essays, he said, “all but one concluded that sham neurofeedback works just as well as real neurofeedback.”

Dr. Thibault said that neurofeedback therapy success stories are likely due to the placebo effect and not the treatment. He suggested that the success of the therapy may have something to do with the “healing environment” practitioners create in their clinics or the appeal of using sophisticated brain-monitoring technology.

Although Dr. Rogel said she has personally witnessed the positive impact of neurofeedback on her patients, she would still “welcome the opportunity” to demonstrate the efficacy of neurofeedback through double-blind, placebo-controlled trials. “I can say, well, this client benefited from neurofeedback, and this is great,” he said. But he also wants to see more comprehensive studies that support the success he sees in his clinic every day.

An ill-defined industry

Neurofeedback practitioners vary widely in their training, backgrounds, and services they provide, contributing to confusion within the industry about who should administer the therapy and what is involved.

“There are so many professionals out there who, frankly, don’t have to do neurofeedback,” said Rhonda Potter, associate executive director of the International Biofeedback Certification Alliance, which offers a neurofeedback certification program. To date, BCIA has certified 1,300 neurofeedback professionals, primarily in North America. Ms Potter surmised that there are “many thousands” more operating across the country, however, who have not sought certification.

He said formal mental health training is not a prerequisite for becoming a neurofeedback provider. In many cases, an online course is all that is needed to obtain the certificate required to operate one of the dozens of neurofeedback devices in the market.

Some companies skip the practitioner altogether sale of expensive neurofeedback devices directly to consumers. Although it’s unlikely to do much harm, Ms Potter said she would be skeptical of any person or product “that claims they can just take a piece of equipment out of a box, apply some sensors and say we’re doing neurofeedback.”

Even among experienced practitioners, therapy varies widely. some insist on create a reference “brain map” Before a patient’s first neurofeedback session: Apply sensors to the skull for two hours to observe and document brain activity. Others say that such maps are optional or unnecessary.

Through its accreditation program, the BCIA is attempting to provide more stringent standards for the industry, Ms. Potter said. To win the group credentials, professionals must have a degree in a relevant health care field, take courses in neuroscience, complete a training program, and pass an exam. However, the one-of-a-kind certification program is voluntary.

before i try

Although its efficacy is still debated, neurofeedback is generally believed to be safe. Even critics admit that there are few side effects or drawbacks for those with the time and money. So if you have read the studiesIf you understand the criticism and still want to try your luck (or head) with neurofeedback—here are a few things to keep in mind.

Know the costs and find out if your insurance will cover it.

Neurofeedback therapy costs can be prohibitive and few insurance plans will cover it. A single session costs $100 to $300, but most doctors say patients need at least 10 exposures, and often more, to benefit. A brain map and analysis, which some professionals use to establish a baseline for future sessions, can cost $1,000 or more.

Neurofeedback practitioners said the costs are similar to what you might pay for traditional talk therapy, and potentially less, depending on the number of sessions you undergo. Some insurers cover it, so call your provider for their policies. Many neurofeedback clinics offer worksheets with talking points and questions to help you advocate for coverage.

Choose your doctor carefully.

Ms. Potter from BCIA pointed out a search database on the organization’s website as a good place to find a professional, though she added that there are also many professionals who lack these credentials and still do good work. He suggested interviewing several practitioners before making a decision and preparing the questions in advance.

“Find out exactly what training they’ve had and what kind of machinery they’re trained to use,” he said. “If there is a specific disorder you want to treat, make sure they have experience treating that disorder.”

Explore all recommended treatment options.

Although there are no known side effects of neurofeedback, it could still pose a danger to those seeking the therapy to the exclusion of other treatment options recommended by health professionals.

“One of the biggest problems is delaying the right treatment that has been shown to really work,” said Dr. Thibault. “If you have a learning disorder and you seek neurofeedback instead of accepted therapies that would help correct your learning disorder, then you are doing yourself a disservice.”

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