Are EEG neurofeedback benefits due to placebo effects?
Posted 09 August 2016 - 10:49 AM
"Few consumers and practitioners appreciate that EEG-neurofeedback helps patients regardless of the feedback source. In other words, sham neurofeedback
(e.g., from irrelevant brain activity or even from a different brain) improves treatment outcomes as much as true neurofeedback"
Article - https://www.mcgill.c...-effects-261120
The full paper is avail on .pdf here - http://razlab.mcgill...ThibaultRaz.pdf
Posted 09 August 2016 - 11:35 AM
An informative reply to this article on another site by Dr. Hammond;
It should be recognized that the psychiatric/medical community, evidence-based databases, and insurance companies routinely rely upon psychiatric treatments as “efficacious” without a preoccupation with whether these treatments involve substantial placebo influences, without apparent consideration of the serious flaws in medication treatment research design, or even the common side effects. Expectation of effectiveness has been shown to be the largest variable in antidepressant improvement and yet it is considered evidence based. There are many potential problems in utilizing what many persons consider to be the “gold standards” in designing placebo controlled studies to evaluate the efficacy of neurofeedback. These include: controlling for the nuances of therapist-subject interaction in a training paradigm; the lack of genuine feedback reward in utilizing sham feedback; the inherent transparency to an experienced clinician who is coaching neurofeedback when only sham feedback is being provided; the significant number of sessions required in effective neurofeedback treatment; and the issue of experienced versus clinically inexperienced neurotherapists. It could be argued that double blind placebo controlled studies, therefore, have limited applicability in evaluating neurofeedback outcomes. It is as unrealistic as trying to do a placebo-controlled study of psychotherapy.
Medication outcome research helps to provide an invaluable perspective that must be kept in mind with regard to the degree to which medical and psychiatric treatments are actually evidence based. Despite the aura that modern psychiatry and medicine are evidence-based, Tricoci, Allen, Kramer, Califf, and Smith (2009) in the Journal of the American Medical Association recently revealed that only 11% of 2711 treatment recommendations in a medical specialty were based on level A evidence (multiple randomized trials). Of the remaining recommendations, 41% were based on level B evidence (a single randomized trial or non-randomized studies), and 48% were based on level C evidence (expert opinion or case studies). Thus although all scientifically minded neurofeedback practitioners acknowledge a need for additional outcome research, much of current medical and psychiatric treatment is not based on sound scientific evidence. Medical ethicists (Andrews, 2001; Lurie & Wolfe, 1997; Rothman, 1987), neurofeedback advocates (La Vaque, 2001), and the Declaration of Helsinki (World Medical Association, 2000) have expressed the view that requiring placebo controlled studies in conditions where there is a known effective treatment already available is considered unethical.
Some placebo controlled studies have demonstrated efficacious and specific effects of neurofeedback with learning disabilities (Fernandez, Herrera, Harmony, Diaz-Comas, Santiago, Sanchez, et al, 2003), anxiety (Raymond, Varney, Parkinson & Gruzelier, 2005), sleep latency and declarative learning (Hoedlmoser, Pecherstorfer, Gruber, Anderer, Doppelmayr, Klimesch, & Schabus, 2008), cognitive enhancement in the elderly (Angelakis, Stathopoulou, Frymiare, Green, Lubar, & Kounios 2006) and depression (Choc, Chi, Chung, Kim, Ahn, & Kim, 2011). Certainly animal studies (e.g., Sterman, 1973; Larsen, Larsen, Hammond, Sheppard, Ochs, Johnson, Adinaro, & Chapman, 2006) also suggest that neurofeedback has therapeutic effects independent of placebo effects. We would not anticipate that cats would form positive expectancies about being more seizure resistant simply because an experimenter was putting electrodes on their heads.
For purposes of arguing with skeptical academics, let us consider, “What if the majority of the positive effects of neurofeedback treatment were nothing more than placebo effects?” If this were the case it would not be so different from the findings of research documenting that the effects of psychopharmacological medications primarily represent placebo effects. But, if this were the case, the major difference would still be that the risk/benefit and side effect profile appears much better with neurofeedback (the Monastra et al.  review of neurofeedback with ADD/ADHD estimated side effects to occur in 1-3%). In addition to side effects and withdrawal effects, medication treatments are disempowering because improvements are attributed to the effects of continuing to take the medication, whereas neurofeedback presents treatment effects to the patient as representing an enduring reconditioning of brain patterns or as a self-regulation skill, which increases their sense of self-efficacy and confidence in their ability to cope with future eventualities.
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