Is Neurofeedback just a "placebo effect"?

I had a great question the other day from a reader:

"My question is this:  What objective proof will  Ihave that these treatments are doing what's intended as opposed to any ''placebo effect''."

This is such a common worry, either for people considering the use of neurofeedback or from other professionals that know very little, if anything, about neurofeedback that it seemed a good idea to share part of my answer with all my readers...

Objective proof: How do we know it's working?

Depending on who you work with, you could get:

  • changes in QEEG variables
  • changes in test measurements
  • changes in other measures (e.g., balance, grades, whatever's relevant to the goals)

But here's the tricky part....

"Placebo" doesn't mean nothing is happening. It simply means we don't know the mechanism and it doesn't seem to be what we were thought we were doing. There are studies looking at the brain from a metabolic point of view (fMRI studies looking at what bits of brain are being used and how much they are being used for a particular activity) that show extended improvements in pain associated with specific changes in levels and types of brain activity -- all due to a "placebo effect".

Changes in brain measures (QEEG; neuropsychological tests) aren't clearly associated with the degree of change in Real Life. So you would know whether things were changing as "intended" in terms of brain activity (QEEG) or on a formal, structured estimate of a real function (psych test), but this objective change doesn't relate all that well to whether things seem better as a result of the training.

So -- the best test is whether you are seeing the effects you are looking for in your life.

And you can gauge your susceptibility to a short-term placebo effect on whether you have experienced these kinds of short-term improvements when you've tried other things. I also use people's reporting of their response to the training as a measure of sorts. For example, with HEG people frequently use the same words to describe the effects they first notice. So I don't give them those words ahead of time -- I ask for feedback and listen for indicators they are experiencing what the technique "does". This is sometimes reassuring to them that they aren't just "making it up".

Also, people frequently notice changes they don't expect and that can be a nice reassurance that they aren't "making it happen". (Not to mention that these are often the most exciting and satisfying changes in the long run...)

FWIW, there are case studies showing animals responding to several neurofeedback approaches, so there is more evidence that it's not "just" a placebo effect. ;-)

So -- what do you think? What would be most convincing to you?