Level 4 Efficacy
Depression Research
Neurofeedback has been ranked as a Level 4 ("Efficacious") treatment for alpha asymmetry depression!
Level 4 Efficacy Meaning
According to the Association for Applied Psychophysiology and Biofeedback (AAPB) and the International Society for Neurofeedback and Research (ISNR), neurofeedback for anxiety has achieved a Level 4: Efficacious rating. This designation means that multiple well-controlled studies have demonstrated that neurofeedback is significantly more effective than placebo treatments in reducing anxiety symptoms.
In practical terms, this means that neurofeedback is not just a promising therapy—it is a proven method for helping individuals manage and alleviate anxiety.
Supporting Reseach
Neurofeedback is an emerging, drug-free option for depression that shows promise, outside of just alpha asymmetry, especially in individuals who haven’t responded well to medication or talk therapy. While it’s not yet classified as a “gold standard” treatment for other presentations of depression, ongoing studies are building support for its long-term effectiveness in mood regulation.
Article: Effects of neurofeedback on major depressive disorder: a systematic review
| Feature / Benefit | Neurofeedback | Medication | Talk Therapy (CBT) | Transcranial Magnetic Stimulation (TMS) |
|---|---|---|---|---|
| How it Works | Trains brainwaves to improve mood regulation | Alters brain chemicals (e.g., serotonin, dopamine) | Explores thought patterns and coping strategies | Uses magnetic pulses to stimulate mood-related brain areas |
| Evidence-Based for Depression | ✔ Yes – growing support, especially for treatment-resistant depression | ✔ Yes – SSRIs and SNRIs are standard treatments | ✔ Yes – CBT is a gold standard for depression | ✔ Yes – FDA approved for major depressive disorder |
| Non-Invasive | ✔ Yes | ✘ No – chemical intervention | ✔ Yes | ✔ Yes |
| Side Effects | Minimal to none | Possible (e.g., weight gain, fatigue, emotional blunting) | Minimal | Possible (e.g., headache, scalp discomfort) |
| Addresses Root Brain Patterns | ✔ Yes – targets mood-related dysregulation | ✘ No – symptom-focused | ✘ No – focuses on thought/emotion patterns | ✔ Yes – targets specific brain regions |
| Duration of Benefits | Long-lasting with consistent training | May require lifelong use | Medium to long-term depending on consistency | Results may last for months or longer |
| Custom-Tailored | ✔ Yes – guided by brain mapping (QEEG) | ✘ Usually standardized dosing | ✔ Yes – tailored by therapist session to session | ✘ Standard treatment protocols |
| Works Well with Other Treatments | ✔ Yes – complements therapy and medication | ✔ Yes – often used alongside therapy or neurofeedback | ✔ Yes – combines well with meds or neurofeedback | ✔ Yes – used after meds or therapy have limited effect |
| Typical Treatment Duration | 30–40 sessions (2–4 months average) | Ongoing; may take weeks to show effect | Weekly sessions for several months | 4–6 weeks, 5 sessions per week |
Research Supporting Neurofeedback for Depression Therapy
1) Brown, S. B. R. E., et al. (2023). “Review of EEG-Based Neurofeedback as a Therapeutic Intervention to Treat Depression.” Biological Psychology.
Summary: This systematic review analyzed 12 studies on EEG neurofeedback (EEG-NF) for depression. The findings suggest that EEG-NF is associated with improvements in cognitive, clinical, and neural outcomes in patients with depression. Due to its non-invasive nature and minimal side effects, EEG-NF is recommended as an adjunctive therapy, particularly for patients with persistent symptoms despite standard treatments. The review provides evidence that EEG-NF can effectively modulate brain activity linked to depressive symptoms, supporting its role as a viable adjunctive therapy.
Article: Review of EEG-Based Neurofeedback as a Therapeutic Intervention to Treat Depression
2) Schönenberg, M., Wiedemann, E., & Schneidt, A. (2021). “Efficacy of Bio- and Neurofeedback for Depression: A Meta-Analysis.” Clinical Psychology Review, 87, 102037.
Summary: This meta-analysis evaluated the effectiveness of heart rate variability (HRV) biofeedback and neurofeedback in reducing depressive symptoms in major depressive disorder (MDD). The results indicate that both modalities are associated with reductions in depressive symptoms, supporting their use as complementary strategies. By aggregating data from multiple studies, this analysis provides evidence that neurofeedback is an effective tool for alleviating depressive symptoms.
3) Nelson, R., & Esty, M. L. (2015). “Infra-Low Frequency Neurofeedback in Depression: Three Case Studies.” NeuroRegulation, 2(3), 137–143.
Summary: This study involved three unmedicated individuals with depression who underwent 20 sessions of infra-low frequency (ILF) neurofeedback. Post-treatment assessments showed reductions in depressive symptoms, as measured by standard depression rating scales. Quantitative EEG analyses revealed decreased theta power over frontal and central brain regions, suggesting enhanced cortical activation associated with mood regulation. The study provides preliminary evidence that ILF neurofeedback can contribute to symptomatic improvement and measurable changes in brain activity related to depression.
Article: Infra-Low Frequency Neurofeedback in Depression: Three Case Studies
4) Wang, S. Y., Hung, C. I., & Huang, C. J. (2021). “Neurofeedback Training Improves Anxiety Trait and Depressive Symptom in Generalized Anxiety Disorder.” Journal of Clinical Medicine, 10(3), 432.
Summary: This study investigated the effects of neurofeedback training, targeting brain activity in patients with generalized anxiety disorder (GAD). The findings showed that neurofeedback training reduced both anxiety and depressive symptoms in GAD patients, as measured by standardized scales. The study suggests that neurofeedback can positively impact depressive symptoms in patients with anxiety disorders, highlighting its potential applicability for addressing comorbid depression.Article: Neurofeedback Training Improves Anxiety Trait and Depressive Symptom in Generalized Anxiety Disorder
5. Zotev, V., Phillips, R., Misaki, M., Wong, C. K., Bodurka, J. (2020). “Emotion Self-Regulation Training in Major Depressive Disorder Using Simultaneous Real-Time fMRI and EEG Neurofeedback.” NeuroImage: Clinical, 27, 102331.
Summary: This proof-of-concept study applied simultaneous real-time fMRI and EEG neurofeedback (rtfMRI-EEG-nf) for emotion self-regulation training in patients with major depressive disorder. Participants in the experimental group showed upregulation of brain activity in regions associated with emotion regulation and reported improved mood after training. The study highlights the potential of advanced neurofeedback techniques to help patients modulate brain activity linked to depressive symptoms, contributing to mood improvements.