Are you thinking about purchasing a Direct-to-Consumer Neurofeedback Device. Think again! Here is some food for thought on these devices.

A patient recently forwarded a device she found online that was direct to consumer neurofeedback and asked my thoughts. This is a general opinion until I am given reason to change it. I and it seems to me most clinically based NF providers are concerned about "one size fits all” home devices -- even if u “dial in” symptoms. The protocols seem to be not personalized enough for the unique brains we see.   One brain may benefit — particularly a “standard” (“normal/ average brain”)(If that exists) then another brain is “bothered” by it. The more unusual your brain is, whether a less frequent personality type, neuro-divergent type, or concussed or inflamed brain or say “bipolar-ish” or full blown major depression or PTSD, the more one needs not only a close assessment, but a sophisticated neurofeedback clinician.  At least to help interpret the clinical interview, maybe neuro cognitive tests, maybe a Qeeg and promptly assess early responses to initial protocols.  

Think of it like the way a physical therapist gently approaches a dysregulated body part in assessing and initial interventions and most definitely a clinician is needed to coordinate care in a collaborative way with the prescribing clinicians.  Most patients seeking NF for mental health conditions have chronic conditions which respond best to a comprehensive approach rather than a “silver bullet”—one med or just Neurofeedback is usually less effective in chronic complex conditions..

A well trained NF clinician will first identify a “stabilizing “ protocol as a “go to” should the first selected protocol be problematic in some way.(Neurofeedback can create increased symptoms/ problems.  It is not innocuous. The problems can be indicators of need to adjust the training parameters, like frequencies or bandwidth offer being targeted.  Or the site on the scalp / brain region underneath being trained.)These home systems —-often provide no strategy for troubleshooting negative side effects.  Often —almost always— the brain will self-right from a problematic response, IF the individual simply stops training —that way— quickly. But for example a patient with unrecognized bipolar disorder or seizures or ADHD or sleep problems could have a distressing or problematic response to initial protocols if they were not good for that brain. But some people left to themselves will either not recognize the problem or doggedly keep training the brain in the wrong direction —actually training the brain into a more dys regulated state. This can even result in mania or a seizure.

 Neurofeedback is potent brain training. Thus the need for frequent contact with a strong clinician till an effective rescue (often a calming) protocol then an effective target-specific protocol is selected and training the brain “toward normal” may not be good for a uniquely gifted or highly intelligent individual.  Thus, broadly described “z-score training” or 19-channel training is not only less evidence-based, it can also be problematic, potentially harder to reverse than trainings using a single scalp electrode. In TBI, especially so if recovered decently, different brain regions have taken over function from dead or extremely dysregulated regions.   So you can’t train the brain based on research from averages and computer algorithms…which may only have one or 2 research articles supporting that training for that function.  Impressive graphics and slick marketing can look impressive but be misleading.  All that to say, in addition, the sampling rate, the time delay for the reinforcement parameters, etc, may be marginal at best in devices that do not offer that info re the device, or be advanced enough (in providing personalized protocols and fine tune-ability) to have clinicians willing to purchase them.  Granted they may offer “quiet focused” time that benefits some people in general broad ways in the relaxation category.

Hogan Pesaniello, MD