A new study published in the Journal of Cognitive Enhancement investigated the websites of 371 neurofeedback providers in the United States. The overwhelming majority of these providers made claims in relation to at least one clinical condition (e.g., anxiety, ADHD), and a quarter of them used hype words (e.g., “miracle cure”) to do so. Only 36% of providers had a medical degree or a doctoral degree in psychology.
Electroencephalographic (EEG) neurofeedback is a highly controversial form of therapy that provides patients with immediate biofeedback of their brain activity and teaches them to self-regulate their brain waves. The therapy is conducted across as many as 40 training sessions, at costs estimated between $3,000–10,000 in the United States.
Importantly, the scientific literature has called to question the efficacy of neurofeedback training, with experimental studies suggesting that the benefits of training can be achieved with placebo and may be driven by “psychosocial suggestion.” Given that neurofeedback services are being widely offered to the public, study authors Anna Wexler and her team wanted to explore the claims being made by providers. The researchers embarked on the first systematic study of the advertising claims of neurofeedback providers in the US.
The study authors first identified 371 websites of neurofeedback providers in the US, after consulting four different directories. Two coders analyzed the websites, coding for clinic type, target audience, interventions offered, products being sold, language use, clinical indications advertised, and patient testimonials.
While neurofeedback clinics were identified across the US map, there were particular “hotspots” in the major cities of Los Angeles, Dallas, Chicago, and New York. The overwhelming majority of websites (97%) made claims regarding at least one clinical issue, the most common being anxiety (92%), ADHD/ADD (86%), and depression (82%).
Additionally, 90% suggested improvements related to cognitive enhancement (e.g., focus, concentration). Wexler and her team note that there is little empirical evidence that neurofeedback is effective in any of these ways — and some websites listed conditions for which there is even less evidence, like Asperger’s syndrome (19%) and bipolar disorder (16%).
About three-quarters of the websites used language suggestive of complementary and alternative medicine, for example, using words like “holistic” and “natural.” About a quarter used hype language to advertise unrealistic benefits, adopting expressions like “miracle cure.” Many websites appeared to target vulnerable populations, with 75% targeting parents and 27% targeting the elderly. Other common targets were athletes (33%) and business executives (23%).
Alarmingly, only 32% of providers had a doctoral degree related to psychology and 4% had a medical degree. Most (74%) were certified by the Board Certified in Neurofeedback (BCN), which is a credential intended to show competency but not a legal license to practice. “While the BCN certification that most providers reported having does require a significant investment of time—a university-level neuroanatomy course, 36 hours of didactic education, 25 hours of mentoring, and 100 neurofeedback sessions—only two hours of training are devoted to the “research evidence base for neurofeedback” (BCIA 2004; BCIA 2019),” Wexler and colleagues point out.
The study authors note that their study was limited since they were unable to include all neurofeedback providers in the US, investigating only those they identified from four directories. Still, the findings offer a snapshot into the advertising claims of neurofeedback clinics and raise concern that some providers are presenting overblown claims that are not justified by the current scientific data.
“While it is not unethical per se to offer the public an experimental treatment, the provision of such services requires informing clients of the mixed evidence and of the experimental nature of the procedure (at minimum),” the authors say. “Given that a quarter of websites in our sample utilized hype language, and that 43.9% made use of patient testimonials, it seems likely that at least some of these providers are not accurately representing the current state of the science regarding enhancement.”
The study, “Neuroenhancement for sale: assessing the website claims of neurofeedback providers in the United States”, was authored by Anna Wexler, Ashwini Nagappan, Deena Kopyto, and Rebekah Choi.