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Objective: To determine whether theta/beta-ratio (TBR) electroencephalographic biofeedback (neurofeedback [NF]) has a specific effect on attention-deficit/hyperactivity disorder (ADHD) beyond nonspecific benefit. Method: In a 2-site double-blind randomized clinical trial, 144 children aged 7 to 10 years with rigorously diagnosed moderate/severe ADHD and theta/beta-ratio (TBR) ≥4.5 were randomized 3:2 to deliberate TBR downtraining versus a control of equal duration, intensity, and appearance. Two early dropouts left 142 children for modified intent-to-treat analysis. The control used prerecorded electroencephalograms with the participant's artifacts superimposed. Treatment was programmed via Internet by an off-site statistician-guided co-investigator. Fidelity was 98.7% by trainers/therapists and 93.2% by NF expert monitor. The primary outcome was parent- and teacher-rated inattention; analysis was mixed-effects regression. Because the expense and effort of NF can be justified only by enduring benefit, follow-ups were integrated. Results: Blinding was excellent. Although both groups showed significant improvement (p

The quantitative electroencephalographic (QEEG) theta/beta power ratio (TBR) has been shown to have an association with attention-deficit hyperactivity disorder (ADHD), with a previous tacit assumption of equivalence across hardware and software systems. Therefore, the International Collaborative ADHD Neurofeedback (ICAN) randomized clinical trial used a fixed TBR ≥ 4.5 cutoff as measured by the Thought Technology Monastra-Lubar Assessment Suite as an inclusion criterion, 1.5 SD above norms collected with that system. However, a difference was noted between the TBR calculated by that assessment suite and the TBR computed by EEGer, the neurofeedback software used for treatment, leading us to investigate the discrepancy. The difference may arise from different calculation methods. This article explains and compares various computational methods used to calculate and display EEG values, including TBR, elucidating why the values are not equivalent across equipment and software programs. Two major sources of variance are (1) how “spectral leakage” at the ends of bands is handled and (2) whether voltages of bins within a band are first averaged and then squared to get bandwidth power or are first squared to get power (turning negative voltages into positive power) and then averaged to get the bandwidth power; the latter method results in higher band power. This article compares methods of computing the TBR. Biofeedback practitioners and investigators should be aware of the algorithms their systems use when interpreting TBRs and require normative comparison data collected with the same system.

Research in the field of biofeedback has suffered both for lack of adequate methodological rigor and lack of adequate funding. The ISNR Research Foundation and the AAPB Foundation for Education and Research in Biofeedback are nonprofit foundations developed to promote and support a broad program of research in biofeedback and neurofeedback. A previous article featured an interview with the director of the ISNR Research Foundation, David Trudeau. The present article provides an interview with Paul Lehrer, Chair of the AAPB Foundation for Education and Research in Biofeedback. This interview series provides insight into the two foundations and invites professionals in the broad field of self-regulation therapies to support both.

Research in the field of biofeedback is not always effective for the development of the field. In particular, neurofeedback has had spotty success, with many studies failing to meet rigorous methodological standards. Many researchers are lacking in the basic understanding of neuromodulation and its inherent learning model. And many clinicians, while knowledgeable in clinical applications, lack understanding of the rigors of good research. However, the International Society for Neurofeedback and Research (ISNR) Foundation and the Association for Applied Psychophysiology and Biofeedback (AAPB) Foundation for Education and Research in Biofeedback are rich in expertise, yet that expertise is seldom tapped. The following interview with the president of the ISNR Research Foundation, David Trudeau, will spotlight the foundation's impact on the field of neurofeedback. A second interview with Paul Lehrer, Chair of AAPB's Foundation for Education and Research in Biofeedback (FERB) will appear in the summer 2014 issue of Biofeedback. It is hoped that this interview series will provide insight to both foundations and facilitate future collaboration.

Objective: Additional treatments with persisting benefit are needed for ADHD. Because ADHD often shows excessive theta electroencephalogram (EEG) power, low beta, and excessive theta-beta ratio (TBR), a promising treatment is neurofeedback (NF) downtraining TBR. Although several nonblind randomized clinical trials (RCTs) show a medium-large benefit for NF, a well-blinded, sham-controlled RCT is needed to differentiate specific from nonspecific effects. Method: Experts in NF, ADHD, clinical trials, and statistics collaborated to design a double-blind multisite RCT. Results/Conclusion: At four sites, 180 children aged 7 to 10 years with rigorously diagnosed ADHD and TBR ≥ 5 will be randomized to active TBR-NF versus sham NF of equal duration, intensity, and appearance. Sham, utilizing prerecorded EEGs with participant artifacts superimposed, will keep participants and staff blind. Treatment fidelity will be trained/monitored by acknowledged NF leaders. Multidomain assessments before, during, and after treatment (follow-up to 2 years) will also include tests of blinding and sham inertness.

Brain activity assessed by electroencephalography (EEG) has been demonstrated to respond to conditioning techniques. The concept of modulating this activity has been called EEG biofeedback, more recently neurofeedback, and is based on operant learning principles. Technological advancements have significantly enhanced the ease and affordability of recording and analyzing brain activity. Thus, properly trained practitioners can implement these conditioning strategies in their practice. Recent research indicating evidenced-based efficacy has made this technique a more viable option for clinical intervention. The objective of this article is to highlight the learning principles that have provided the fundamentals of this neuromodulatory approach. In addition, it is recommended that future applications in clinical work, research, and development adhere to these principles.

Introduction. Twenty-eight anxious adults were assessed for frontal lobe alpha asymmetry, a brain state associated with depression and anxiety. Fifteen of the 28 exhibited significant asymmetry and 12 agreed to participate in a biofeedback program addressed at reducing frontal alpha asymmetry. Method. The program consisted of earlobe temperature biofeedback (ETB) and two forms of neurofeedback, alpha suppression and alpha symmetry training. Individuals were instructed to warm their right earlobe for six sessions, and half succeeded, though success was not required to advance to the next stage of training. For subsequent EEG training, two anterior sites were selected on the basis of poor alpha coherence. Individuals were trained to reduce alpha magnitude at these sites by 10% for 30 min or more, which took from 6 to 16 sessions to achieve. Once successful with alpha suppression, individuals were trained to improve alpha symmetry between the sites by 15% for 30 min or more. Results. This feat took ...