A study indicates that successful treatment for insomnia may not actually require complicated neurofeedback (direct training of brain functions). Rather, it appears patients who simply believe they’re getting neurofeedback training appear to get the same benefits.
Researchers recruited 30 patients with primary insomnia, who underwent neurofeedback treatment and placebo-feedback treatment over several weeks. The results are published in Brain.
In the study researchers sought to test whether earlier findings on the positive effect of neurofeedback on sleep quality and memory could also be replicated in a double-blind placebo-controlled study. Patients spent 9 nights and 12 sessions of neurofeedback and 12 sessions of placebo-feedback training (sham) in researchers’ laboratory.
As this study focuses on neurofeedback effects on EEG, sleep and quality of life in insomnia patients, insomnia patients underwent this procedure before and after real as well as placebo neurofeedback training. In between the first and second, as well as the third and fourth of these visits, insomnia patients completed 12 sessions of neurofeedback treatment and 12 sessions of placebo-feedback treatment, ie a placebo or sham condition (with real EEG feedback, yet on varying frequency bands). The order of trainings, that is, real or placebo neurofeedback treatment was counterbalanced across subjects and the 12 sessions were completed within 4 weeks. Participants’ sleep-wake cycle was assessed using 8 sleep laboratory nights, as well as sleep diaries and actigraphy over the course of the whole protocol.
Researchers found both neurofeedback and placebo-feedback to be equally effective as reflected in subjective measures of sleep complaints, suggesting that the observed improvements were due to unspecific factors such as experiencing trust and receiving care and empathy from experimenters. In addition, these improvements were not reflected in objective EEG-derived measures of sleep quality.
Researchers conclude that for the treatment of primary insomnia, neurofeedback does not have a specific efficacy beyond unspecific placebo effects. They did not find an advantage of neurofeedback over placebo-feedback.
The results show that patients benefitted from any treatment on some subjective measures of sleep and life quality. Objectively, however, this improvement was not verified in any EEG-derived measures of sleep or oscillatory brain activity.
“Given our results,” says lead author Manuel Schabus, in a release, “one has to question how much of published neurofeeback effects are due to simple expectations on the side of the participants or, in other words, unspecific placebo effects”.
Researchers find that improvement of symptoms was not specific to neurofeeback training, but rather seems to have been brought about by unspecific factors such as affection and care. Altogether, it therefore has to be questioned whether sensorimotor-rhythm neurofeedback can be promoted as an alternative to established therapeutic approaches. The findings may also stimulate a discussion regarding the usefulness of neurofeedback on a more general level. Especially in patient populations where various complaints are often associated with learning difficulties positive neurofeedback effects beyond the subjective level may be hard to achieve.
I’ve been woking with Neurofeedback since 2002, after more than 15,000 sessions on more than 1,000 clients I can surely say Neurofeedback works and it is not a placebo. How can you do a placebo on a kid within the Autistic Spectum, or even on a child with ADHD. Read in detali how they made that study and you will understand how they got to that wrong assumption. And I will ask: who is behind (paying) for that study?
I’ve done neurofeedback since 1991 with a very wide range of patients. I evaluate each patient with a 19 channel EEG and examine it with the Neuroguide normative database. Further, I record eyes closed, eyes open, and during reading, listening, writing and drawing, followed by a final eyes closed recording to assess reliability of the default mode. Based on these observations, knowledge of functional neuroanatomy and the patients history and symptoms, I establish rational training targets. One size does NOT fit all. The study used a primitive “protocol based” method that is inadequate. Typical patients with insomnia have diminished delta and/or theta over the central vertex and often have excessive high beta over the same region; others have high beta excess over parietal association regions. In many cases I train for 30 minutes and observe clear Stage 2 sleep signatures after 15 – 20 minutes. If one wanted to do clinical research, one would want to determine what the clinical brain problem is, then use operant conditioning of the appropriate derived signal to correct the problem. Further, the process of properly targeted neurofeedback takes 30 – 40 sessions to reach maximum improvement (except in TBI and autism, which take more), so the 12 sessions these people used are wholly inadequate. Were these people even qualified by training and experience to do neurofeedback? Did they demonstrate learning curves during each session and across sessions? If not, they don’t know how to do operant conditioning of the EEG. This study was designed out of either innocent ignorance, or it was designed to fail. Brain surgery doesn’t work very well either, if you don’t do it correctly.
John K Nash, PhD, Licensed Psychologist
Board certified neurofeedback, Sr. Fellow, BCIA
Diplomate, QEEG Certification Board
Because of the importance of placebo in research that attempts to discredit Neurofeedback, I think it would be very important to have several semesters of “placebology” in medical schools. This research is ridiculous and journals should demand better quality of research they publish.
I recently did 20 sessions of neurofeedback with the NeurOptimum program, administered by The Sleep Recovery Center. My insomnia is very long term and has become quite debilitating to my life, so I was hopeful of a change. I paid way too much for the program and it did nothing at all for my sleep. Will someone please comment–I don’t know whether to pursue having more sessions or just consider it a loss. Don’t know where to go from here…..
Thanks!
I have also heard that neuroptimal does not work well… The type of neurofeedback that is suppose to be effective is called Infra-low Frequency (ILF) neurofeedback…
More info needed on the study and the research- just a link to a journal that requires a membership fee. Seems like it proves that 12 sessions of neurofeedback are no better than a placebo. But it does not show anything about more than 12 sessions. And it would be good to know the backgrounds of the “researchers for all studies and why they are doing the study, how the study design was decided on – and the limits of what is learned from it.
My hat goes off to Juan Diaz, MFT for his up-to-date comments regarding neurofeedback for insomnia and other conditions.
Having looked more in-depth at this sited study, what stands out is the actual protocol that was used on every test subject.
A single placement at C4, (right hemisphere)up-training exclusively 12-15 hertz is historically, a woefully ancient protocol for our field. This 12-15 hertz protocol started with a 1968-69 NASA project to attempt to treat seizures in astronauts, not for the amelioration of insomnia. Our field is now light years ahead of this protocol.
The other major problem with this study (as mentioned before here) is the limited number of sessions provided to its test subjects. The scientific question of integrity that begs to be ask of its Austrian funding source and authors is this:
“Why in the world would you choose an almost 50 year old protocol, with grossly insufficient training duration and dare to call it empirical or even publishable?” Were there other agendas at play here?
Its safe to assume that the authors, nor funding entity FWF bothered to contact ISNR or AAPB to pulse where the field is now with its latest approaches to applying neurofeedback for insomnia.
The majority of major media here in the US also picked up and parroted this study with absolutely no back-end research whatsoever.
Even Google trots this out on the very top of every global search-query page for “Neurofeedback for insomnia”. This is unethically dissuading at worst and source-point murky at best.
The woman commentator Leah Song made a wonderful point. Neurofeedback, Neuroptimal or other systems, are not meant to be panaceas, aka all things to all people. However, I did find several peer reviewed and published insomnia studies on Google regarding the Neuroptimal system she had mentioned. And the results were in fact favorable, but again not perfect for everyone who participated.
I challenge the authors and FWF to reach out to our fields leadership, and have the most recent technology be provided, and re-do their study to bring it out of a Pre-Columbian era of science and appropriately into the new Millennium.