How does neurofeedback or EEG biofeedback work

How does neurofeedback work in ADHD?

Questioner: Christian Kast from Berlin via email

Published: 07/19/2014

They find it difficult to concentrate and control their attention: People with ADHD. Neurofeedback is a relatively new treatment method. How exactly does this therapy work?

The answer from the editors is:

Answer from PD Dr. Ute Strehl, Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen:

Neurofeedback is a variant of biofeedback. In doing so, people learn to better perceive and control a certain body function. The target organ in neurofeedback is the brain, and that is exactly what presents us with a major challenge: the body has no receptors for brain activity and therefore cannot perceive them.

Neurofeedback therefore uses tools to depict brain activity. The electrical activity of the brain is usually recorded using an electroencephalogram (EEG). Metabolic processes are measured less often and so far mainly in research - for example with functional magnetic resonance tomography or near-infrared spectroscopy.

The measurement results can be displayed on the computer screen in real time as simple signals. This can be a bar that grows in height or moves from right to left if the test person influences his or her brain activity in the desired way. Sometimes computer games are also used to motivate people to exercise. According to the principle of “trial and error”, over time a feeling for how the brain activity can be controlled develops.

Two particularities can be exploited in ADHD. It is characterized by under-excitation of the brain. The basic activity of the thinking organ is composed of electrical excitation waves of different speeds. Compared to those who are not affected, people with ADHD have a higher proportion of slow frequencies. Put simply, this means that the nerve cells communicate more slowly, which is then expressed in a reduced attention. Through neurofeedback, those affected learn to activate faster brain frequencies and thus to increase their attention.

The second point of attack are the so-called slow cortical potentials or readiness potentials. What is meant is a state of the brain that puts us in readiness to act in the same way. We use this, for example, when we stand at a red light and prepare to drive off immediately when it is “green”. People with ADHD find it difficult to put their brains in such a "watchful position". In neurofeedback training they learn to activate and deactivate this state in a targeted manner.

Today we assume that what we have learned will be automated over time and thus also available in everyday situations. The success of the learning can be checked in the training by the test person establishing the desired state without aids. The EEG shows the success. In everyday life, simple stimuli later help, such as a picture on the computer screen, which the person concerned looks at before doing homework, for example. This signal helps him to call up the desired brain activity and thus to concentrate better on his task.

The clear advantage of the method is the learning effect. Not only does it treat symptoms, it actually causes a change in the brain. In order to definitively prove its effectiveness, we need even more data. As things stand now, we can say that the effect for the patient is better than with behavioral therapy and at least as good as with drug treatment. And in 2014 a study in which 144 children with ADHD were examined showed: Neurofeedback is superior to muscular feedback, a method that trains targeted tension and relaxation on the computer screen. The children who were most affected by the attention disorder benefited most from neurofeedback.

Recorded by Stefanie Reinberger