Neurofeedback is a non-invasive, therapeutic technique that uses real-time displays of brain activity to teach individuals how to regulate their own brain function. This form of biofeedback is being explored for its potential to help with various conditions, including depression. The approach is based on altering brainwave patterns to improve mental state and cognitive performance.
The Brainwave Connection to Depression
The human brain produces electrical impulses that form rhythmic patterns known as brainwaves, which are associated with different mental states. Research has identified links between specific brainwave patterns and the symptoms of depression. A commonly observed pattern in individuals with depression is frontal alpha asymmetry, which is an imbalance in alpha wave activity between the left and right frontal lobes.
Alpha waves (8-12 Hz) are associated with a state of relaxed wakefulness. In many people with depression, there is excessive alpha wave activity in the left frontal lobe compared to the right. The left frontal area is linked to positive emotions and motivation, while the right is more involved with negative emotions. When the left frontal region shows more alpha activity, it reflects under-arousal, which can manifest as low motivation and a persistent negative mood.
This neurological marker provides a tangible target for neurofeedback therapy. By focusing on this asymmetry, the treatment aims to guide the brain toward a more balanced and functional state. This approach targets the neurological basis of depressive symptoms, offering a modality distinct from chemical or psychological treatments.
The Neurofeedback Process
The process begins with an assessment involving a Quantitative Electroencephalogram (qEEG), or brain map. A cap with multiple sensors is placed on the scalp to measure electrical activity from different brain regions. This data is then compared to a database of brainwave patterns from healthy individuals of a similar age, highlighting areas of dysregulation that may be linked to depressive symptoms.
Following the brain map, a personalized training protocol is developed. A neurofeedback session lasts between 30 and 45 minutes. During a session, sensors are placed on the scalp to monitor brainwave activity in real-time; this process is passive and does not involve sending any electrical current into the brain. The individual sits comfortably, watching a screen that provides visual or auditory feedback, such as a movie or video game.
This setup creates a feedback loop based on operant conditioning. When the brain produces healthier brainwave patterns, the individual receives positive reinforcement, such as a movie playing clearly or a video game character succeeding. When the brain reverts to the undesirable pattern, the feedback stops or becomes negative, like the screen dimming. This process reinforces the brain’s ability to maintain more regulated states, with lasting change requiring a series of sessions over several months.
Types of Neurofeedback Protocols
Various neurofeedback protocols can be used, with the choice based on the initial qEEG and the individual’s symptoms. The most traditional approach is amplitude or frequency training. This method focuses on increasing or decreasing the power of specific brainwave frequencies at particular locations. A primary goal is correcting the frontal alpha asymmetry by rewarding more balanced activity between the hemispheres.
A more recent development is Z-score neurofeedback. This technique compares a person’s real-time brain activity against a normative database of healthy brain function for their age. The feedback guides the brain to move its patterns closer to the average, or “norm,” across multiple brain regions simultaneously. This allows for a more complex and holistic training approach.
For targeting deeper brain structures, clinicians may use Low-Resolution Electromagnetic Tomography (LORETA) neurofeedback. LORETA uses information from the sensors on the scalp to create a three-dimensional, real-time image of electrical activity sources within the brain. This allows the practitioner to target and train activity in deeper cortical regions, such as the anterior cingulate or the insula, which are involved in emotion regulation and depression.
Evaluating Neurofeedback as a Treatment Option
Research into neurofeedback for depression shows promising results, with studies reporting significant reductions in symptoms and some meta-analyses finding large effect sizes. Despite this, it is still considered an emerging treatment compared to more established options like pharmaceuticals. While many individuals experience lasting benefits, its research base is less extensive.
Neurofeedback is frequently used as an adjunctive therapy, complementing treatments like psychotherapy and medication. For some, it can enhance the effects of these therapies or provide an alternative when other methods have been ineffective. Individuals may be able to reduce or discontinue their medication over time, but this should only be done under the strict supervision of a medical doctor.
Practical factors must be weighed when considering this treatment. Finding a qualified practitioner is important; certifications from organizations like the Biofeedback Certification International Alliance (BCIA) indicate a provider has met rigorous training standards. Cost is another consideration, as a full course of treatment is a significant investment. Initial assessments can range from $250 to over $1,000, with sessions often costing $90 or more. Insurance coverage is inconsistent, as many plans deem it “investigational” for depression, so prospective patients should discuss the benefits and burdens with their healthcare providers.