Neuroenhancement for Sale: Assessing the Website Claims of Neurofeedback Providers in the USA

Abstract

Although electroencephalographic (EEG) neurofeedback is a technique that has been in existence for many decades, it has remained controversial, largely due to questions about efficacy. Yet neurofeedback is being widely offered to the public, often at great expense. To date, however, there has not been empirical data on which providers are utilizing neurofeedback, what they are offering it for, and how they are advertising the technique. The present study aimed to fill that gap by systematically analyzing the websites of neurofeedback practitioners in the USA. To that end, we obtained data from four directories of neurofeedback providers, extracting practitioner names, geographical locations, professional training, and website URLs. Only websites offering neurofeedback services (N = 371) were included in the next step, wherein two coders independently coded the websites based on a codebook developed from preliminary analyses. We found that nearly all websites (97.0%) contained claims about at least one clinical indication, most commonly anxiety, ADHD/ADD, and depression; however, only 36.0% of providers had either a medical degree (MD) or a doctoral-level degree in psychology. The majority of websites advertised neurofeedback for cognitive (90.0%) or performance (67.9%) enhancement, and roughly three-quarters utilized language related to complementary and alternative medicine (CAM). In sum, there is a considerable divergence between the scientific literature on neurofeedback and the marketing of neurofeedback services to the general public, raising concerns regarding the misrepresentation of services and misleading advertising claims.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. AAPB (Association for Applied Psychophysiology and Biofeedback). (2011). About AAPB. https://www.aapb.org/i4a/pages/index.cfm?pageid=3285. Accessed 20 Dec 2019.

  2. Arnold, E. L. (2018). Ask the expert: neurofeedback treatment for ADHD. https://chadd.org/webinars/ask-the-expert-neurofeedback-treatment-for-adhdask-the-expert/. Accessed 20 September 2019.

  3. Arnold, E. L., Lofthouse, N., Hersch, S., Pan, X., Hurt, E., Bates, B., et al. (2012). EEG neurofeedback for ADHD: double-blind sham-controlled randomized pilot feasibility trial. Journal of Attention Disorders, 17(5), 410–419. https://doi.org/10.1177/1087054712446173.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Arns, M., Batail, J.-M., Bioulac, S., Congedo, M., Daudet, C., Drapier, D., et al. (2016). Neurofeedback: one of today’s techniques in psychiatry? L’Encéphale, 43(2), 135–145. https://doi.org/10.1016/j.encep.2016.11.003.

    Article  PubMed  Google Scholar 

  5. BBB (Better Business Bureau), National Programs. (2018). NARB affirms NAD decision following panel’s review of advertising claims made for neurocore brain performance centers. https://asrcreviews.org/narb-affirms-nad-decision-following-panels-review-of-advertising-claims-made-for-neurocore-brain-performance-centers/. Accessed 25 Sept 2019.

  6. BCIA (Biofeedback Certification International Alliance). (2004). Blueprint of knowledge statements for board certification in neurofeedback. https://www.bcia.org/files/public/EEG/2015NeurofeedbackBlueprint.pdf. Accessed 18 Dec 2019.

  7. BCIA (Biofeedback Certification International Alliance). (2015). How does state license impact biofeedback and neurofeedback? https://bcia.org/files/public/How%20Does%20State%20License%20Impact%20Neurofeedback.pdf. Accessed 18 Dec 2019.

  8. BCIA (Biofeedback Certification International Alliance). (2017). Acceptable degrees for BCIA certification neurofeedback. http://www.bcia.org/files/public/EEG/AcceptableDegreesforBCIACertification_Neurofeedback.pdf. Accessed 18 Dec 2019.

  9. BCIA (Biofeedback Certification International Alliance). (2019). Overview of entry-level neurofeedback certification. https://www.bcia.org/i4a/pages/index.cfm?pageid=3435. Accessed 18 Dec 2019.

  10. Better Brain Balance. (2015). Wellness store. https://betterbrainbalance.com/wellness-store/. Accessed 16 July 2019.

  11. Boser, U. (2017). Betsy DeVos has invested millions in this ‘brain training’ company. So I checked it out. https://www.washingtonpost.com/posteverything/wp/2017/05/26/betsy-devos-neurocore/. Accessed 24 September 2019.

  12. Center for Brain. (2019). Introducing two brain light helmets by Vielight for better brain health. https://www.centerforbrain.com/the-brain-light-helmet/. Accessed 16 July 2019.

  13. Cohen, M. H. (1998). Complementary & alternative medicine: legal boundaries and regulatory perspectives. Baltimore: John Hopkins University Press.

    Google Scholar 

  14. Cohen, M. H. (2014). Neurofeedback laws & licensing: unlock brains’ potential but be legally safe–part 1: unlicensed practice. https://cohenhealthcarelaw.com/2014/07/neurofeedback-laws-licensing-unlock-brains-potential-but-be-legally-safe-part-1-unlicensed-practice/. Accessed 19 December 2019.

  15. Cortese, S., Ferrin, M., Brandeis, D., Holtmann, M., Aggensteiner, P., Daley, D., et al. (2016). Neurofeedback for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. Journal of the American Academy of Child & Adolescent Psychiatry, 55(6), 444–455. https://doi.org/10.1016/j.jaac.2016.03.007.

    Article  Google Scholar 

  16. Dessy, E., Puyvelde, M., Mairesse, O., Neyt, X., & Pattyn, N. (2018). Cognitive performance enhancement: do biofeedback and neurofeedback work? Journal of Cognitive Enhancement, 2(1), 12–42. https://doi.org/10.1007/s41465-017-0039-y.

    Article  Google Scholar 

  17. Di Blasi, Z., Harkness, E., Ernst, E., Georgiou, A., & Kleijnen, J. (2001). Influence of context effects on health outcomes: a systematic review. The Lancet, 357(9258), 757–762. https://doi.org/10.1016/s0140-6736(00)04169-6.

    Article  Google Scholar 

  18. Ellison, K. (2010). Neurofeedback gains popularity and lab attention. https://www.nytimes.com/2010/10/05/health/05neurofeedback.html. Accessed 10 Oct 2019.

  19. Ernst, E., Cohen, M. H., & Stone, J. L. (2004). Ethical problems arising in evidence based complementary and alternative medicine. Journal of Medical Ethics, 30(2), 156–159. https://doi.org/10.1136/jme.2003.007021.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Fink, S., Eder, S., & Goldstein, M. (2017). Betsy DeVos invests in a therapy under scrutiny. https://www.nytimes.com/2017/01/30/us/politics/betsy-devos-neurocore-brain-centers.html. Accessed 24 September 2019.

  21. Foddy, B. (2009). A duty to deceive: placebos in clinical practice. The American Journal of Bioethics, 9(12), 4–12. https://doi.org/10.1080/15265160903318350.

    Article  PubMed  Google Scholar 

  22. Gruzelier, J. H. (2014a). EEG-neurofeedback for optimising performance. I: A review of cognitive and affective outcome in healthy participants. Neuroscience & Biobehavioral Reviews, 44, 124–141. https://doi.org/10.1016/j.neubiorev.2013.09.015.

    Article  Google Scholar 

  23. Gruzelier, J. H. (2014b). EEG-neurofeedback for optimising performance. II: creativity, the performing arts and ecological validity. Neuroscience & Biobehavioral Reviews, 44, 142–158. https://doi.org/10.1016/j.neubiorev.2013.11.004.

    Article  Google Scholar 

  24. Hamilton, J. (2010). Train the brain: using neurofeedback to treat ADHD. https://www.npr.org/templates/story/story.php?storyId=130896102.

  25. Hamlin, E. (2018). Growing the evidence base for neurofeedback in clinical practice. In J. J. Magnativa (Ed.), Using Technology in Mental Health Practice (pp. 101–122). Washington: American Psychological Association.

    Google Scholar 

  26. Hammond, C. D. (2011). What is neurofeedback: an update. Journal of Neurotherapy, 15(4), 305–336. https://doi.org/10.1080/10874208.2011.623090.

    Article  Google Scholar 

  27. Ienca, M., Haselager, P., & Emanuel, E. J. (2018). Brain leaks and consumer neurotechnology. Nature Biotechnology, 9, 805–810. https://doi.org/10.1038/nbt.4240.

    Article  Google Scholar 

  28. IQCB (International QEEG Certification Board). (2019). Get mentored. https://qeegcertificationboard.org/get-mentored/. Accessed 18 Dec 2019.

  29. ISNR (International Society for Neurofeedback & Research). (2017). In defense of neurofeedback. https://isnr.org/in-defense-of-neurofeedback. Accessed 18 Dec 2019.

  30. ISNR (International Society for Neurofeedback & Research). (2019). 2019 membership directory. https://isnr.org/find-a-member#directory. Accessed 18 Dec 2019.

  31. ISNR (International Society for Neurofeedback & Research). (n.d.). About ISNR. https://isnr.org/about-isnr. Accessed 18 Dec 2019.

  32. Kamiya, J. (2011). The first communications about operant conditioning of the EEG. Journal of Neurotherapy, 15(1), 65–73. https://doi.org/10.1080/10874208.2011.545764.

    Article  Google Scholar 

  33. Kreitmair, K. V. (2019). Dimensions of ethical direct-to-consumer neurotechnologies. AJOB Neuroscience, 10(4), 152–166. https://doi.org/10.1080/21507740.2019.1665120.

    Article  PubMed  Google Scholar 

  34. Krieger, S.. (2016). Our services. https://sharonkrieger.com/our-services#1532449451032-44e034d9-2eda. Accessed 16 July 2019.

  35. Logemann, A. H., Lansbergen, M. M., Os, T. W., Böcker, K. B., & Kenemans, L. J. (2010). The effectiveness of EEG-feedback on attention, impulsivity and EEG: a sham feedback controlled study. Neuroscience Letters, 479(1), 49–53. https://doi.org/10.1016/j.neulet.2010.05.026.

    Article  PubMed  Google Scholar 

  36. Maslen, H., Douglas, T., Kadosh, R. C., Levy, N., & Savulescu, J. (2014). The regulation of cognitive enhancement devices: extending the medical model. Journal of Law and the Biosciences, 1(1), 68–93. https://doi.org/10.1093/jlb/lst003.

    Article  PubMed  PubMed Central  Google Scholar 

  37. McCall, I., Lau, C., Minielly, N., & Illes, J. (2019). Owning ethical innovation: claims about commercial wearable brain technologies. Neuron, 4, 728–731. https://doi.org/10.1016/j.neuron.2019.03.026.

    Article  Google Scholar 

  38. Michigan Brain Health. (n.d.). ADHD: empowering your child so they can realize their true potential. https://michiganbrainhealth.com/adhd/. Accessed 16 July 2019.

  39. Miller, F. G., & Colloca, L. (2009). The legitimacy of placebo treatments in clinical practice: evidence and ethics. The American Journal of Bioethics, 9(12), 39–47. https://doi.org/10.1080/15265160903316263.

    Article  PubMed  Google Scholar 

  40. Miller, F. G., & Kaptchuk, T. J. (2008). The power of context: reconceptualizing the placebo effect. Journal of the Royal Society of Medicine, 101(5), 222–225. https://doi.org/10.1258/jrsm.2008.070466.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Miller, F. G., Emanuel, E. J., Rosenstein, D. L., & Straus, S. E. (2004). Ethical issues concerning research in complementary and alternative medicine. JAMA, 291(5), 599–604. https://doi.org/10.1001/jama.291.5.599.

    Article  Google Scholar 

  42. Mirifar, A., Beckmann, J., & Ehrlenspiel, F. (2017). Neurofeedback as supplementary training for optimizing athletes’ performance: a systematic review with implications for future research. Neuroscience & Biobehavioral Reviews, 75, 419–432. https://doi.org/10.1016/j.neubiorev.2017.02.005.

    Article  Google Scholar 

  43. Mirifar, A., Keil, A., Beckmann, J., & Ehrlenspiel, F. (2018). No effects of neurofeedback of beta band components on reaction time performance. Journal of Cognitive Enhancement, 3(3), 251–260. https://doi.org/10.1007/s41465-018-0093-0.

    Article  Google Scholar 

  44. Mueller, S. (2019). TINA.org files FTC complaint against “Brain Training” company neurocore. https://www.truthinadvertising.org/tina-org-files-complaint-against-brain-training-company-neurocore/. Accessed 15 Nov 2019.

  45. Murdoch, B., Zarzeczny, A., & Caufield, T. (2018). Exploiting science? A systematic analysis of complementary and alternative medicine clinic websites’ marketing of stem cell therapies. BMJ Open, 8(2), 1–11. https://doi.org/10.1136/bmjopen-2017-019414.

    Article  Google Scholar 

  46. NARB (National Advertising Review Board). (2018). Report of NARB panel 225, 1–10. https://blogs.edweek.org/edweek/DigitalEducation/6099_225%20%28003%29.pdf. Accessed 16 Sept 2019.

  47. Racine, E., Forlini, C., Aspler, J., & Chandler, J. (2016). Complementary and alternative medicine in the context of earlier diagnoses of Alzheimer’s disease: opening the conversation to prepare ethical responses. Journal of Alzheimer's Disease, 51(1), 1–9. https://doi.org/10.3233/jad-150534.

    Article  PubMed  Google Scholar 

  48. Ramsay, R. (2010). Nonmedication treatments for adult ADHD: evaluating impact on daily functioning and well-Being. Washington, DC: American Psychological Association.

  49. Rosenthal, R. (2011). New guidelines for third party reimbursement for biofeedback. https://www.aapb.org/m/pages.cfm?pageid=3387. Accessed 21 Dec 2019.

  50. Rossettini, G., Carlino, E., & Testa, M. (2018). Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain. BMC Musculoskeletal Disorders, 19(27), 1–15. https://doi.org/10.1186/s12891-018-1943-8.

    Article  Google Scholar 

  51. Schabus, M., Griessenberger, H., Gnjezda, M.-T., Heib, D. P., Wislowska, M., & Hoedlmoser, K. (2017). Better than sham? A double-blind placebo-controlled neurofeedback study in primary insomnia. Brain, 140(4), 1041–1052. https://doi.org/10.1093/brain/awx011.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Schönenberg, M., Wiedemann, E., Schneidt, A., Scheeff, J., Logemann, A., Keune, P. M., & Hautzinger, M. (2017). Neurofeedback, sham neurofeedback, and cognitive-behavioural group therapy in adults with attention-deficit hyperactivity disorder: a triple-blind, randomised, controlled trial. The Lancet Psychiatry, 4(9), 673–684. https://doi.org/10.1016/s2215-0366(17)30291-2.

    Article  PubMed  Google Scholar 

  53. Seifert, A., & Lubar, J. (1975). Reduction of epileptic seizures through EEG biofeedback training. Biological Psychology, 3(3), 157–184.

    Article  Google Scholar 

  54. Smith, L., & Patten, B. (2019). Neurocore, LLC’s use of unsubstantiated medical treatment claims. https://www.truthinadvertising.org/wp-content/uploads/2019/11/11_12_19-Neurocore-complaint-letter-to-FTC.pdf. Accessed 15 Nov 2019.

  55. Sterman, B. M., & Egner, T. (2006). Foundation and practice of neurofeedback for the treatment of epilepsy. Applied Psychophysiology and Biofeedback, 31(1), 21–35. https://doi.org/10.1007/s10484-006-9002-x.

    Article  PubMed  Google Scholar 

  56. Stone Mountain Counseling Center. (n.d.). Treatment for animals. http://stonemountaincenter.com/site/treatments/treatment-for-animals/. Accessed 16 July 2019.

  57. Thibault, R. T., & Raz, A. (2016). When can neurofeedback join the clinical armamentarium? The Lancet Psychiatry, 3(6), 497–498. https://doi.org/10.1016/s2215-0366(16)30040-2.

  58. Thibault, R. T., & Raz, A. (2017). The psychology of neurofeedback: clinical intervention even if applied placebo. American Psychologist, 72(7), 679–688. https://doi.org/10.1037/amp0000118.

    Article  PubMed  Google Scholar 

  59. Thibault, R. T., Lifshitz, M., Birbaumer, N., & Raz, A. (2015). Neurofeedback, self-regulation, and brain imaging: clinical science and fad in the service of mental disorders. Psychotherapy and Psychosomatics, 84(4), 193–207. https://doi.org/10.1159/000371714.

    Article  PubMed  Google Scholar 

  60. Thibault, R. T., Lifshitz, M., & Raz, A. (2016). The self-regulating brain and neurofeedback: experimental science and clinical promise. Cortex, 74, 247–261. https://doi.org/10.1016/j.cortex.2015.10.024.

  61. Thibault, R. T., Lifshitz, M., & Raz, A. (2017). Neurofeedback or neuroplacebo? Brain, 140(4), 862–864. https://doi.org/10.1093/brain/awx033.

    Article  PubMed  Google Scholar 

  62. Thibault, R. T., Lifshitz, M., & Raz, A. (2018). The climate of neurofeedback: scientific rigour and the perils of ideology. Brain, 141(2), e11–e11. https://doi.org/10.1093/brain/awx330.

    Article  PubMed  Google Scholar 

  63. Thompson Neurofeedback. (n.d.). What is the BioMat? https://thompsonneurofeedback.com/biomat-info/. Accessed 16 July 2019.

  64. Vollebregt, M. A., van Dongen-Boomsma, M., Buitelaar, J. K., & Slaats-Willemse, D. (2014). Does EEG-neurofeedback improve neurocognitive functioning in children with attention-deficit/hyperactivity disorder? A systematic review and a double-blind placebo-controlled study. Journal of Child Psychology and Psychiatry, 55(5), 460–472. https://doi.org/10.1111/jcpp.12143.

    Article  PubMed  Google Scholar 

  65. Wexler, A. (2015). A pragmatic analysis of the regulation of consumer transcranial direct current stimulation devices in the United States. Journal of Law and the Biosciences, 2(3), 669–696.

    PubMed  PubMed Central  Google Scholar 

  66. Wexler, A. (2018). Who uses direct-to-consumer brain stimulation products, and why? A study of home users of tDCS devices. Journal of Cognitive Enhancement, 2(1), 114–134.

    Article  Google Scholar 

  67. Wexler, A., & Thibault, R. T. (2018). Mind-reading or misleading? Assessing direct-to-consumer electroencephalography (EEG) devices marketed for wellness and their ethical and regulatory implications. Journal of Cognitive Enhancement, 3(1), 131–137. https://doi.org/10.1007/s41465-018-0091-2.

    Article  Google Scholar 

  68. Xiang, M.-Q., Hou, X.-H., Liao, B.-G., Liao, J.-W., & Hu, M. (2018). The effect of neurofeedback training for sport performance in athletes: A meta-analysis. Psychology of Sport and Exercise, 36, 114–122. https://doi.org/10.1016/j.psychsport.2018.02.004.

    Article  Google Scholar 

Download references

Acknowledgments

Thanks to Ashutosh Mishra for assistance with extracting information from provider directories; and thanks to Robert Thibault and three anonymous reviewers for their feedback on the manuscript.

Funding

This project was supported by the Office of the Director, NIH, under Award Number DP5OD026420.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Anna Wexler.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 32 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wexler, A., Nagappan, A., Kopyto, D. et al. Neuroenhancement for Sale: Assessing the Website Claims of Neurofeedback Providers in the USA. J Cogn Enhanc 4, 379–388 (2020). https://doi.org/10.1007/s41465-020-00170-8

Download citation

Keywords

  • Neurofeedback
  • Neuroethics
  • Cognitive enhancement
  • EEG
  • Neuroscience and society