Overview of Neurofeedback Evidence

Seventy years of evidence supports neurofeedback as an intervention worth considering for ADHD and/or anxiety. 

Download a summary of recent evidence that supports NFB to treat ADHD and anxiety.

Neurofeedback is an efficacious and effective treatment for ADHD.  

With more than seven decades of research and real-life applications ranging from school-aged children to veterans to adults, there is robust evidence that neurofeedback (NFB) is an effective standalone or adjunct treatment for ADHD.  

Over the past 11 years, at least four major research reviews by leading researchers in the U.S. and internationally have shown NFB to be an efficacious intervention for the treatment of ADHD. Several studies have found NFB improvements lasting up to a year post-treatment, which compares positively to improvements from ADHD medication which tend to end immediately with the conclusion of treatment. Highlights from key studies and reviews include: 

  • A 2020 review that investigated 2 major meta-analyses, 4 random controlled trials (RCTs), and 3 open-label studies found NFB treatment of ADHD to be efficacious and produce remission rates of 32-47%, as well as sustained post-treatment effects for 6-12 months.11 
  • A 2018 meta-analysis reviewed 10 studies, finding significant effect of NFB on ADHD symptoms of inattention and hyperactivity/impulsivity, comparable to medication, and that improvements were sustained 2 to 12 months beyond the end of treatment.22 
  • A 2014 review found that standard NFB treatment protocols have been well-investigated and are specific and effective at treating ADHD.33
  • A 2014 study found that NFB resulted in greater improvements in ADHD symptoms compared to cognitive training or control groups in public elementary schools.44 
  • A 2009 meta-analysis found NFB treatment for ADHD to be efficacious and specific: meaning treatment outcomes were statistically superior to fake treatment (known as sham treatments) or alternative treatment in at least two independent research settings.55 

Scientific research supports both stand-alone NFB and a combination of NFB and medication as potential best practices for treatment of ADHD, underscoring several key points: 1) NFB is efficacious and effective in treating ADHD; 2) NFB is a viable treatment either standalone or as an adjunct to stimulant medication; and 3) NFB treatment results in long-lasting (6-12 months) improvement in symptoms even after treatment has ended, which compares favorably to medication.  

These findings support the position that NFB is effective as a first-line independent or adjunct treatment for ADHD.  

Neurofeedback is efficacious for treating anxiety.  

Neurofeedback (NFB) has been found to be effective as a treatment for anxiety. NFB equipment is FDA-approved for relaxation training. Research shows that relaxation is a primary treatment for anxiety and other symptoms of stress- and adjustment-related disorders. As a non-pharmacological option, NFB can be used to treat symptoms of anxiety.  

Results from research on NFB as a treatment for anxiety include: 

  • A 2020 meta-analysis of 21 studies with 779 participants concluded that neurofeedback is efficacious in the treatment of anxiety and reactive stress disorders.6
  • A 2008 meta-analysis that reviewed 27 studies found significant efficacy for relaxation training as a treatment to reduce anxiety.77 
  • A 2011 study found that NFB reduced anxiety related symptoms.88 
  • A 2010 study found that NFB was approximately as effective as medication in treating anxiety and more effective in women with anxiety.99 

While research in this area is not as robust as for ADHD, NFB equipment and its functions, including modulating alpha brainwaves, is approved by the FDA for relaxation.1010 Relaxation, in turn, is a broader term that acts as the basis of more specific improvements and outcomes for anxiety and stress-related issues.  

A handful of other studies have explored NFB as a treatment for symptoms of anxiety, PTSD, depression, stress and other emotional and mental conditions. Many of the studies are smaller, but all show promise at and effectiveness in relieving symptoms of various conditions. Given the propensity for NFB to be effective as a treatment or adjunct treatment for such symptoms, NFB is an excellent option for non-invasive, non-pharmacological treatment for states of anxiety resulting from a host of mental health conditions.    

For more information: Read a summary of recent evidence that supports NFB to treat ADHD and anxiety, or download BrainFutures’ full NFB report

[1] Arns, M., Clark, C. R., Trullinger, M., deBeus, R., Mack, M., & Aniftos, M. (2020). Neurofeedback and Attention-Deficit/Hyperactivity-Disorder (ADHD) in Children: Rating the Evidence and Proposed Guidelines. Applied Psychophysiology and Biofeedback, 45(2), 39–48. https://doi.org/10.1007/s10484-020-09455-2
[2] Van Doren, J., Arns, M., Heinrich, H., Vollebregt, M. A., Strehl, U., & K. Loo, S. (2018). Sustained effects of neurofeedback in ADHD: a systematic review and meta-analysis. European Child & Adolescent Psychiatry, 28(3), 293–305. https://doi.org/10.1007/s00787-018-1121-4
[3] Arns, M., Heinrich, H., & Strehl, U. (2014). Evaluation of neurofeedback in ADHD: The long and winding road. Biological Psychology, 95, 108–115. https://doi.org/10.1016/j.biopsycho.2013.11.013
[4] Steiner, N. J., Frenette, E. C., Rene, K. M., Brennan, R. T., & Perrin, E. C. (2014). Neurofeedback and Cognitive Attention Training for Children with Attention-Deficit Hyperactivity Disorder in Schools. Journal of Developmental & Behavioral Pediatrics, 35(1), 18–27. https://doi.org/10.1097/dbp.0000000000000009
[5] Arns, M., de Ridder, S., Strehl, U., Breteler, M., & Coenen, A. (2009). Efficacy of Neurofeedback Treatment in ADHD: The Effects on Inattention, Impulsivity and Hyperactivity: A Meta-Analysis. Clinical EEG and Neuroscience, 40(3), 180–189. https://doi.org/10.1177/155005940904000311
[6] Anxiety Disorders: Rethinking and Understanding Recent Discoveries. (2020). In Y.-K. Kim (Ed.), www.springer.com. Springer Singapore. https://www.springer.com/gp/book/9789813297043
[7] Manzoni, G. M., Pagnini, F., Castelnuovo, G., & Molinari, E. (2008). Relaxation training for anxiety: a ten-years systematic review with meta-analysis. BMC Psychiatry, 8(1). https://doi.org/10.1186/1471-244x-8-41
[8] Moradi, A., Pouladi, F., Pishva, N., Rezaei, B., Torshabi, M., & Mehrjerdi, Z. A. (2011). Treatment of Anxiety Disorder with Neurofeedback: Case Study. Procedia – Social and Behavioral Sciences, 30, 103–107. https://doi.org/10.1016/j.sbspro.2011.10.021
[9] Bhat, P. (2010). Efficacy of Alfa EEG wave biofeedback in the management of anxiety. Industrial Psychiatry Journal, 19(2), 111. https://doi.org/10.4103/0972-6748.90341
[10] CFR – Code of Federal Regulations Title 21. (n.d.). www.accessdata.fda.gov. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=882.5050