Women experience mental health differently than men. While both can struggle with psychological distress, the reasons behind women’s suffering are often rooted in a mix of biological, social, and systemic factors that require their own conversation. From hormonal shifts and heightened stress to misdiagnosis and chronic emotional strain, women face unique hurdles that deserve focused attention and effective support.
In this article, we take a closer look at five key areas that influence women’s mental health: the higher prevalence of depression and anxiety, hormonal influences such as menopause, the impact of mental load and chronic stress, gender-based disparities in diagnosis, and the potential of Neurofeedback as a supportive therapy.

Higher Rates of Depression and Anxiety
Statistically, women are nearly twice as likely as men to experience anxiety and depression. According to the National Center for Health Statistics, over 10 percent of women report symptoms of depression over a two-week period, compared to just over 5 percent of men (Anxiety and Depression Association of America, n.d.). More than one in three women has been diagnosed with depression at some point in her life (Mental Health America, n.d.).
These numbers highlight a clear gender gap that cannot be ignored. For many women, mood disorders are not isolated experiences but long-standing challenges shaped by complex life contexts (Albert, 2015).

Hormonal Changes Across Life Stages
Hormonal fluctuations can play a major role in mental health. Whether related to the menstrual cycle, pregnancy, postpartum changes, or menopause, these shifts affect brain chemistry and emotional balance (Verywell Mind, 2023).
Take menopause, for instance. Many women report mood swings, irritability, fatigue, and sleep problems during this time. While these symptoms are common, they are not always recognized as part of a broader mental health picture. This can leave women feeling confused or dismissed rather than supported (Zender & Olshansky, 2009). For deeper insights on this topic, see our dedicated articles on menopause and emotional health.

Mental Load and Chronic Stress
Mental load refers to the invisible cognitive labor many women carry every day. It includes remembering appointments, managing the household, caring for others, and often putting others’ needs ahead of their own. This ongoing mental juggling act can lead to chronic stress and burnout (Mental Health America, n.d.).
Over time, this type of stress can affect both mood and physical health. What makes it especially difficult is that it often goes unnoticed or unspoken, leaving women to cope in silence.

Gender Bias in Diagnosis
Another challenge many women face is being misdiagnosed or not diagnosed at all. Much of the medical research and diagnostic criteria in mental health has historically focused on male patients. As a result, symptoms in women are sometimes interpreted as emotional sensitivity or stress rather than signs of deeper issues (Zender & Olshansky, 2009).
Conditions like ADHD or even heart disease can present differently in women, leading to delays in care or treatment that does not fully address the root of the problem. Recognizing these biases is a key step in improving how we approach women’s mental health.

How Neurofeedback Can Support Recovery
It is important to acknowledge the specific challenges women are facing and to explore holistic approaches. One tool that can play a role in this approach could be Neurofeedback. Neurofeedback is a non-invasive technique that measures brainwave activity and provides real-time feedback, helping individuals train their brains to function in more balanced and stable ways (BEE Medic GmbH, n.d.).
Research suggests that Neurofeedback can help reduce symptoms of depression, anxiety, and ADHD. It has also shown promise for women navigating hormonal transitions like menopause, offering support for mood swings, fatigue, and irritability (Verywell Mind, 2023). Read more about that in one of our latest blog articles.
Unlike medication, Neurofeedback is drug-free and designed to support the brain’s natural ability to regulate itself.  It can offer a gentle yet effective path toward improved clarity and emotional balance.
While a holistic approach is needed to overcome the various complex challenges, neurofeedback can contribute to this.

References

• Albert, P. R. (2015). Why is depression more prevalent in women? Journal of Psychiatry & Neuroscience, 40(4), 219–221. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4472929/
• Anxiety and Depression Association of America. (n.d.). Women and Depression. https://adaa.org/find-help-for/women/depression
• BEE Medic GmbH. (n.d.). Was ist Neurofeedback? https://beemedic.com/de/ueber-neurofeedback
• Mental Health America. (n.d.). Depression in Women. https://mhanational.org/depression-women
• Pan, A., Lucas, M., Sun, Q., van Dam, R. M., Franco, O. H., Willett, W. C., Manson, J. E., & Hu, F. B. (2011). Increased mortality risk in women with depression and diabetes mellitus. Archives of General Psychiatry, 68(1), 42–50.
• Verywell Mind. (2023). The link between hormones and mental health. https://www.verywellmind.com/the-link-between-hormones-and-mental-health-7500077
• Zender, R., & Olshansky, E. (2009). Women’s mental health: Depression and anxiety. Nursing Clinics of North America, 44(3), 355–364.
   

Menopause is becoming more and more a focus of society. At a mean age of around 50, most women experience first menopause symptoms, which can vary according to the cultural, familiar and social background, but also according to the general health condition and well-being (Parazzini, 2006; Hu et al., 1999). According to the National Institute of Aging, menopause symptoms are reported to last around 2- 8 years with a large variety depending on genetics, but also external factors such as ethnicity, culture, lifestyle and environment (National Institute on Aging, 2024). 

Symptoms are manifold and embrace hot flushes, night sweat, vaginal dryness, sleep disturbance, depression, anxiety, memory loss, fatigue, concentration disorder, mood changes, headache, joint pains and weight gain (Makara-Studzińśka et al., 2014). Around 50 million women annually go globally into menopause, which shows the high prevalence of this condition (Massart et al., 2001). A standard treatment to alleviate symptoms is hormone replacement therapy (Patel & Dhillo, 2021), but also the uptake of medication to ease symptoms like headaches, sleep disturbance or depression is commonly used. All of them can cause side effects, so alternative methods that help without adverse effects are needed. 

One of the main causes of menopausal symptoms is the decrease in estrogen levels in the female body. The release of estrogen is controlled in the brain as well as the brain interacts also with it. It was shown that there are several brain regions that respond to estrogen such as the hypothalamus, the neocortex, but also hippocampus and brainstem, so a change in the estrogen levels also has an influence on the brain functions (Morrison et al., 2006), resulting in several symptoms with neurological origin.

Therefore the application of Neurofeedback, which can help to improve the brain's self-regulatory capacity, seems to be a promising approach. Several studies have shown that Neurofeedback can help with various of the above mentioned symptoms. In a publication with three case studies, it was shown that ILF Neurofeedback can help to alleviate symptoms of depression (Grin-Yatsenko et al., 2018). In addition, Virtual Reality ILF Neurofeedback has been used to address centralized pain accompanied by insomnia (Orakpo et al., 2022). A multicenter study involving 196 clients in an outpatient setting applied ILF Neurofeedback over approximately 30 sessions per participant, with continuous performance tests indicating improved attention (Schneider et al., 2021). Anxiety disorders, which encompass a wide range of symptoms, have also been explored in relation to Neurofeedback. A review on anxiety and depression highlighted the positive impact of Neurofeedback on these conditions (Hammond, 2005). Fatigue—commonly experienced by (post-)cancer patients and increasingly recognized as a component of Post-Covid syndrome—has also been a focus of recent research. A pilot study with 16 participants found that Neurofeedback may help alleviate fatigue-related symptoms. 

These studies show that Neurofeedback can be an effective therapy for a variety of conditions. Since many of these indications—such as depression, anxiety, insomnia, and fatigue—are also common symptoms during menopause, Neurofeedback holds promise as a supportive treatment option for menopausal women as well. Especially ILF Neurofeedback seems to be a promising method as it is a symptom based approach. 

Interested in more insights? 

Dr. Dawn Harris, founder and CEO of Kedras Clinics, has been working successfully with Neurofeedback for years. In an article, she shares how neurofeedback can also be used in dealing with symptoms of menopause. 

Sources:

Grin-Yatsenko, V., Othmer, S., Ponomarev, V., Evdokimov, S., Konoplev, Y., & Kropotov, J. (2018). Infra-Low Frequency Neurofeedback in Depression: Three case studies. NeuroRegulation, 5(1), 30–42. https://doi.org/10.15540/nr.5.1.30

Hammond, D. C. (2005). Neurofeedback treatment of depression and anxiety. Journal of Adult Development, 12(2–3), 131–137. https://doi.org/10.1007/s10804-005-7029-5

Hu, F. B., Grodstein, F., Hennekens, C. H., Colditz, G. A., Johnson, M., Manson, J. E., Rosner, B., & Stampfer, M. J. (1999). Age at natural menopause and risk of cardiovascular disease. Archives of Internal Medicine, 159(10), 1061. https://doi.org/10.1001/archinte.159.10.1061

Makara-Studzińśka, M. T., Kryś-Noszczyk, K. M., & Jakiel, G. (2014). Epidemiology of the symptoms of menopause – an intercontinental review. Menopausal Review, 3, 203–211. https://doi.org/10.5114/pm.2014.43827

Massart, F., Reginster, J. Y., & Brandi, M. L. (2001). Genetics of menopause-associated diseases. Maturitas, 40(2), 103–116. https://doi.org/10.1016/s0378-5122(01)00283-3

Morrison, J. H., Brinton, R. D., Schmidt, P. J., & Gore, A. C. (2006). Estrogen, menopause, and the aging brain: How basic neuroscience can inform hormone therapy in women. Journal of Neuroscience, 26(41), 10332–10348. https://doi.org/10.1523/jneurosci.3369-06.2006

National Institute on Aging (2024).  What is Menopause. https://www.nia.nih.gov/health/menopause/what-menopause#:~:text=Symptoms%20related%20to%20menopause%20can,culture%2C%20lifestyle%2C%20and%20environment.

Orakpo, N., Yuan, C., Olukitibi, O., Burdette, J., & Arrington, K. (2022). Does virtual reality feedback at Infra-Low frequency improve centralized pain with comorbid insomnia while mitigating risks for sedative use disorder?: a case report. Frontiers in Human Neuroscience, 16. https://doi.org/10.3389/fnhum.2022.915376

Parazzini, F. (2006). Determinants of age at menopause in women attending menopause clinics in Italy. Maturitas, 56(3), 280–287. https://doi.org/10.1016/j.maturitas.2006.09.003

Patel, B., & Dhillo, W. S. (2021). Menopause review: Emerging treatments for menopausal symptoms. Best Practice & Research Clinical Obstetrics & Gynaecology, 81, 134–144. https://doi.org/10.1016/j.bpobgyn.2021.10.010

Schneider, H., Riederle, J., & Seuss, S. (2021). Therapeutic Effect of Infra-Low-Frequency Neurofeedback Training on Children and Adolescents with ADHD. In Artificial intelligence. https://doi.org/10.5772/intechopen.97938

Meike Wiedemann and Kirsten Segler's successful neurofeedback book, originally written in German, is now finally available in English.Under the title ‘Neurofeedback: A Gentle Therapy to Help the Brain Help Itself’, even more people can now discover the authors’s exciting insights into this effective method.  
The book explains in a clear and easy-to-understand way how neurofeedback works and helps the brain to better regulate itself. Whether ADHD, migraines, anxiety disorders or depression - the authors use many case studies to show how neurofeedback can improve life in the long term.

The book is for people considering neurofeedback for themselves and wanting to know more about how it works, what to expect and where to use it. Equally, professionals who are considering integrating neurofeedback into their practice will also find valuable insights into working with neurofeedback.
The English edition is available as a paperback and e-book and offers an ideal opportunity to familiarise yourself with this effective treatment method. Order now and discover the fascinating world of neurofeedback! 

Click here for the book
 

We conducted an interview with neurobiologist and neurofeedback expert Meike Wiedemann on the subject of synchrony training. She explains what synchrony training actually is, why it is a method of self-care and how it can be combined with alpha-theta training.
 

BEE Medic: Hi Meike, thank you for taking the time for another interview with us. Today we would like to talk about Synchrony training. What exactly is Synchrony training?

Meike: We have been working with Synchrony Training since 2014. In this form of Neurofeedback, we promote synchronous activity across two areas in the brain, just like in Alpha-Theta-Training. We have used this kind of training extensively, oftentimes in preparation for Alpha-Theta training. Within the Synchrony application we have different training capabilities, depending on the desired training outcome. We can choose to train in the upper ILF range at 0.05 Hz, but we can also train 10 Hz or 40 Hz Synchrony. Those different frequencies have different training effects and address different areas and networks. We train 0.05 Hz on the midline, to achieve more calming, grounding and to restore one’s core sense of self and early attachments. It therefore has a great impact on the relationship with oneself and thus also on the relationship with others. Alpha (10 Hz) Synchrony training, like Alpha-Theta-Training, would be trained in the posterior areas of the brain for more calming and a relaxed focus. Then we have the Gamma (40 Hz) Synchrony, trained in the anterior areas of the brain especially for increased mental clarity and focus. The therapist then has the option of selecting the most beneficial training for the patient.

The difference between Synchrony and Alpha-Theta training is that the Synchrony training is done sitting upright and with eyes open, more like mindfulness training. The emphasis in this application is on the audio feedback, which makes the approach suitable even when clients close their eyes. This offers a viable option to clients who are not yet comfortable keeping their eyes closed, as is the case in Alpha-theta training. With Infra-Low Neurofeedback clients are used to keeping their eyes open, talking to us and watching animations. And then they are supposed to close their eyes during the Alpha-Theta-Training? This is something very intimate for some people. Synchrony training prepares clients and allows us to build the trust needed for Alpha-theta training. During that training clients will close their eyes and completely let go of conscious control to allow the brain to find resolution of trauma.

While promoting synchronous states in Synchrony and Alpha-Theta brings significant benefits to clients, this kind of training might not be tolerated by all individuals. People who present with major instabilities, which show up in Neurofeedback as seizure-like symptoms, such as migraine, epilepsy, panic attacks, or bipolar mood swings, can be triggered by synchronous states, so one must be careful with clients with instabilities. One advantage of the Synchrony modality is that it can be done in short increments of time, five- or ten-minute sessions showing great benefits and allowing us to test the clients’ tolerance of this kind of training. Any instabilities that occur can be addressed afterwards through ILF awake-state training. If the client tolerates the Synchrony training well, then the duration of the sessions can be increased, according to the client’s preference, although, for most people ten minutes of Synchrony is enough to reap the benefits.

BEE Medic: Is it necessary to do ILF neurofeedback before introducing Synchrony training? 

Meike: The ILF training is always the foundation, and the Synchrony training builds on it. If the patients have a great effect, then of course you keep that and say 'Okay, now I would like to reach even deeper and enable processing of even more things', then the Alpha-Theta-Training can be added. The individuality of Synchrony training is demonstrated by the fact that some clients love it and benefit greatly from it and have the feeling of being grounded within themselves and their environment, a feeling that many clients have completely lost. If we achieve that with the training, then that's fantastic and then you don't necessarily have to move on to Alpha-Theta training. Some patients respond very well to Synchrony training, whereas with Alpha-Theta training they say: "It was nice and relaxed, but that's all that happened" - with other clients, of course, it can be the other way around. The therapist can then work with the individual to determine the most appropriate training approach.

BEE Medic: You mentioned synchronous states. What are those?

Meike: In essence, synchronous means that the brain wave oscillations are similar at different places in the brain, i.e. right and left hemispheres or the front and the back. When we train in a training band, for example Alpha, the more we do the same thing on both sides at the same time, the higher the amplitudes of the feedback - that is, the more we really swing simultaneously in a regular pattern. So, if the amplitude goes up at one site, it goes up at the other, and if it goes down at one site, it goes down at the other. You can imagine this like two sinusoidal curves that are exactly in-phase, their ebbs and flows coinciding in time. Desynchronized would mean they are out-of- phase. With ILF awake-state training, we promote desynchronized states, while with Synchrony and Alpha-Theta training, we promote in-phase activity in resting states.

BEE Medic: Who benefits from Synchrony training?

Meike: Like it is the case with the Alpha-Theta-Training, every person can benefit from Synchrony training if they tolerate it well. This feeling of being with yourself, being grounded, being calm, being comfortable with yourself and being comfortable with other people - we all need that. The 40 Hz Synchrony training for example, done mostly in the prefrontal cortex, tends to promote meditative states. For some people it's a way of clearing the mind so that there are really no thoughts at all. It's very similar to what we can experience in some states of meditation. And as I said, all clients with whom I would like to pursue Alpha-Theta training later, would do the Synchrony training as preparation for that. People with instabilities might have problems tolerating Synchrony and/or Alpha-Theta training.  Again, you need extensive preparation with the ILF training, to avoid abreactions. This can happen if not enough ILF-HD training is done to stabilize brain function, because the brain might experience too much synchronous activity, which can trigger instabilities, such as migraines or panic attacks or dissociation. People who are not yet able to properly let go and relinquish control do not benefit as much from Synchrony training because they are internally resisting it and are not yet able to engage with it

BEE Medic: Synchrony or Alpha-theta training is not used for specific indications, but you decide from person to person whether you want to use these techniques, right?
 
Meike: In principle, after taking a detailed medical history and tracking the symptoms, we draw up a treatment plan based on the symptoms, the developmental history and, above all, the problems that the person describes or the goals they want to achieve. We use the treatment plan to decide what type of training might be useful, e.g. which training placements we would like to use to address the symptoms and achieve the training goals. The treatment plan includes Synchrony and/or Alpha-Theta if we decide based on the anamnesis that they might be useful for the client. Whether it is still necessary or whether the person has already achieved their goals with ILF-HD awake-state training alone, it can all be decided later in the training process. It also always depends on what the patient wants. In my opinion, you are never done regarding personal development or working on yourself. But in the end, the client decides and then says: "Yes, the problem is gone, I'm very pleased with the outcomes. Thank you!" And then you can decide together whether to end training at this point or to continue. You can offer Synchrony and Alpha-Theta to the person as next steps. And that varies from person to person and is ultimately an individual decision for each client. Some say: "I'm satisfied now, this is how I imagined it, and we'll stop here", others say: "Nope, now I'm just getting started, I want to know what else is possible". Some patients say: "I'm satisfied now, that's how I imagined it, and we'll end here," while others say: "No, we're just getting started, I never thought that I could change in the way I did,  now, I want to know what else is possible.”

BEE Medic: When you train yourself, which training do you prefer?
 
Meike: I've been doing Neurofeedback for about 25 years now and I also started very early with Alpha-Theta training. Depending on what new developments are available I always have a favorite training. For years, Alpha-Theta was my favorite training until the Synchrony modality became available. For a while I also liked working with the 40 Hz Synchrony because it always put me in a highly meditative state in which the mind is totally clear and free and I don't even notice the body anymore, the feeling of being present in the moment is extremely pleasant. Then there is the 0.05 hertz training, which I got to know when I was visiting the Othmers in the USA. 
 
And it's been my favorite training ever since because it's given me all the things that I've always read that Alpha training is supposed to achieve. So now when I'm just talking about Neurofeedback, it's alternating between Alpha-Theta, the Synchrony at 0.05 Hz on the midline, and 40 Hz prefrontally. Those are my three favorites.

BEE Medic: Is there anything you would like to say in conclusion about Alpha-Theta or Synchrony?
 
Meike: What I always like to conclude with, and it’s something I always notice in our advanced courses, is that Neurofeedback therapists, while caring for all their clients, unfortunately, don’t take enough time to take care of themselves and their own well-being. Doing so would not only be good for them, but also making them better therapists for their clients. Finally, I would like to suggest to therapists: It's so easy and convenient when you have these training modalities readily available to you. And of course, what I always hear is, "First everyone else and then me". But I like to emphasize the importance of self-care and then I sometimes say, "Please, please, take care of yourself and do Neurofeedback for yourself. Both Synchrony and Alpha-Theta training are so beneficial for your personal development helping you to relax at a very deep level, promoting calmness and serenity, which help support us as therapists both in everyday life and in our interactions with our clients.

BEE Medic: Thank you Meike for your time and this valuable input!

You can find an interview with Meike about alpha-theta training here.

Neurofeedback is becoming more and more well-known and many terms are becoming more common. But what do they actually mean? We would like to explain the most important of these terms in this blog post. 

What is Neurofeedback?
Neurofeedback is a computer-assisted therapy method for clinical use, in which selected parameters of one's own brain activity are made perceptible. For this purpose, brain waves are measured in real time on the surface of the head (neuro), which influence an audiovisual animation, often similar to a computer game (feedback). Neurofeedback is like a kind of mirror for the brain. Direct feedback based on proven treatment protocols and electrode positions aims to improve the brain's ability to self-regulate. In this way, symptoms of diseases can be alleviated.

What is Biofeedback?
In Biofeedback, peripheral physiological parameters are measured and fed back to the screen as feedback. The parameters can be, for example, respiration, heart rate variability or skin conductance. The feedback can be used to draw conclusions about the patient's current stress level. Biofeedback can be used in the therapy of mental and physical illnesses, as well as in performance and concentration training. Especially in symptom-based ILF - Neurofeedback, Biofeedback can be a good complement. Especially for patients who are not able to perceive or verbalize changes in their state of stress or relaxation well, Biofeedback is a way to better perceive and experience the changes. It can also be beneficial for therapists. For example, skeptical patients can be made aware of the connection between psyche and physiology. Therapists can also derive signs of stress and relaxation and optimize therapy accordingly.

How does self-regulation work in Neurofeedback?
In Neurofeedback, the brain's ability to self-regulate is trained. For this purpose, EEG signals are derived from the surface of the head. Based on a thorough survey of the symptoms of the person being treated, specific frequency ranges of brain activity are measured and evaluated to control feedback in real time in the form of an animation on a screen. The brain "recognizes" that it can influence the animation and, for example, the image becomes clearer and sharper or the music louder and softer. Through this continuous process, the treated persons can learn to improve their self-regulation ability. Especially in the case of mental illnesses, often associated stress symptoms, sleep disorders or disturbances of the attention and concentration spectrum can be significantly improved in this way. It is important to know that there is no optimal frequency that is the same for every person. Instead, the optimal frequency is very individual and depends on both the person and the given situation. Through self-regulation, the brain learns to find the optimal arousal frequency for itself in order to avoid over- and under-excitement, as well as associated symptoms.

Heart rate and heart rate variability in Biofeedback.
The pulse is a biological parameter that changes according to external and internal demands. Not only a steady pulse, but also the adaptability of the heart rate to different demands - the so-called heart rate variability (HRV) - is a central parameter in Biofeedback. 
Heart rate variability is the variation of the time interval between two heartbeats (also: beat to beat interval). This is longer in times of relaxation than in times of physical or emotional stress. A high heart rate variability speaks for a good (peripheral) self-regulation, because it indicates that the organism is able to adjust the heart rate depending on the requirements and finds the optimal frequency for the respective situation. Low heart rate variability is often related to a problem in dealing with stressful situations, memories or stress in general. Especially for patients with anxiety disorders, depression or chronic pain, Biofeedback with heart rate variability training can be helpful. Often these patients are not aware of the connection between their emotional stress and physical reactions and the perception of their own body does not work well because they have a permanently very high stress level. Training here to perceive, influence and synchronize central parameters such as heartbeat and breathing and thus lower the general stress level can be a key experience in therapy and make patients aware that they do have control over their physical and psychological state.

Breathing in Biofeedback
You probably know the tip that lay literature and grandmothers like to give whenever someone is stressed: take three deep breaths. Does that really help? Here's a little experiment: put your hand on your stomach. Breathe deeply into your belly, feel how the hand rises, how your belly bulges, when the belly is bulging to the maximum, hold your breath for a moment and then breathe out again slowly and evenly. Feel the air flowing first out of the belly and then out of the tops of the lungs, over both lungs and out the airway. Repeat this three times. What do you notice? How are you conducting yourself? How has your heartbeat changed? The Heartbeat?! Exactly - breathing and heartbeat are physiologically closely related. In a relaxed state, heart rate and breathing rate correlate, this is also called "respiratory sinus arrhythmia". When breathing in, the heart rate thereby becomes higher, the sympathetic nervous system is activated, and when breathing out, the heart rate becomes lower, the parasympathetic nervous system is activated. Breathing deeply in and out three times in stressful situations can thus help not only to gain better awareness and control over one's own breathing, but subsequently also to synchronize the correlation of breathing and heartbeat.

What is actually the skin conductance?
The skin on the palm of our hand is characterized by a particularly large number of sweat glands. In times of high stress, the glandular activity also increases rapidly. Since sweat is a salty liquid, the skin conductance increases as a result. This is measured by two electrodes on the fingers. In healthy people, skin conductance is constant and low at rest. If the skin conductance increases due to the presentation of a stressor, it usually returns to its initial level after 1 - 2 minutes. If the value remains at a high level for a long time, this indicates problems with emotional regulation. Fluctuations without any apparent reason can indicate that even stimuli that are actually neutral are perceived as stressful. Since skin conductance responds quickly to stressful stimuli and is easy to measure, it is particularly well suited as a psychophysiological mirror in therapy - and reflects the change between tension and relaxation. However, it can also be used as a support in relaxation training or in learning various relaxation techniques.

The body temperature in Biofeedback
Temperature is usually measured by a sensor on the finger. In a relaxed state, the smooth muscles in the walls of the blood vessels usually also relax, which causes more blood to flow into the extremities - we often recognize this by the feeling of warmth in the hands. Thus, an onset of relaxation is accompanied by an increase in temperature in the extremities. Under stress or tension, the muscles in the vascular walls contract, the vessels become narrower and less blood reaches the extremities, often resulting in a drop in body temperature. The body temperature usually reacts somewhat delayed, from the beginning of the stress reaction to a drop in body temperature in the extremities may well take 1-2 minutes. The body temperature skin conductance can be used in therapy, for example, to demonstrate the influence of thoughts and ideas on physiology, in fact some patients succeed in achieving a change in temperature by imagining warmth/cold, and body temperature can also play a role in relaxation training.

The combination of Biofeedback and Neurofeedback
In symptom-based infra low frequency (ILF) Neurofeedback, the patient's symptoms and state changes are the central components. Many of these symptoms also relate to correlates of stress and relaxation. Accordingly, the addition of Biofeedback parameters can be a useful complement to ILF Neurofeedback. This makes it possible for patient and therapist to include the physiological correlates of state changes in the therapy. Patients who are not able to perceive or verbalize changes in their stress and relaxation state very well will get another possibility to experience changes through Neurofeedback. Even changes that are partially below the threshold of perception can be made visible by measuring peripheral signals and can be incorporated into the therapy. For skeptical or tense patients, the inclusion of Biofeedback parameters in the sense of psychoeducation can also help to make the connection between psyche and physiology visible and tangible, to familiarize the patient with the setting with electrodes, and to gradually reduce the possible fear of changes through therapy in order to gently introduce the patient to Neurofeedback. The therapist can deduce signs of stress and relaxation in the physiological parameters and optimize the therapy accordingly, for example by changing the frequency.

What is Alpha-Theta Neurofeedback/ Synchrony Training?
Alpha-Theta Neurofeedback and Synchrony Training are two special types of neurofeedback. Alpha-Theta Neurofeedback is mainly about calming down cortical activity and being able to "shut down" better, both physically and psychologically. We like to call the synchrony training "mindfulness training" guided by one's own brain activity. Both methods ideally complement ILF neurofeedback and are used especially for post-traumatic stress disorders, anxiety and sleep disorders, but also in peak performance.
 

Dr. Dawn Harris, founder and CEO of Kedras Clinics, has been working successfully with Neurofeedback for years. In an article, she shares how neurofeedback can also be used in dealing with symptoms of menopause. The article appeared in the British journal Menopause in June 2023.

The hormonal changes that accompany menopause can be a not insignificant burden for some women, which can be associated with a number of challenges for the women affected. Dr. Dawn Harris explains how Neurofeedback can help patients regain a better quality of life. The perimenopausal changes in a woman's body begin on average at age 47 and last about four to five years (Krug 2022:93). This hormonal reprogramming can be accompanied by a number of physical, neurological as well as psychological changes. In particular, these changes can manifest themselves in hot flashes, sleep disturbances, forgetfulness, mood swings, changes in weight, development of anxiety, skin changes, and relationship problems, to name just a few of the possible symptoms. Since both the intensity of perimenopausal symptoms and the coping strategies associated with them vary, some women may find it challenging to find a therapy that suits them and is associated with as few undesirable side effects as possible.

According to a study from 2021, menopause causes dynamic neurological transformations that have a significant impact on the structure of the brain. Against this background, it is obvious to use therapy components that address these neurological dysregulations. This is where Neurofeedback comes in - with the help of the non-invasive and at the same time safe and fast technology, the brain and the body can learn to regenerate from the neurological changes.

What benefits can Neurofeedback have in the context of symptomatic menopause?

Neurofeedback can work on the regulation of subcortical areas of the brain, including the amygdala, the control center of emotions. In addition, neurofeedback can also work on the regulation of the hypothalamus, which can affect the patient's body temperature. The hippocampus, which is primarily associated with memory, can also be trained through neurofeedback. In addition to the brain areas already mentioned, neurofeedback training also focuses on the regulation of the prefrontal cortex, so that, for example, the ability to concentrate can be trained. Neurofeedback can thus address many of the symptoms associated with menopause by acting on these parts of the brain.

Read the full article in the June issue of Menopause Life magazine.
https://menopauseexperts.com/product/menopause-life-june-2023/

We would also like to advance the knowledge in this area. We are therefore looking for interested therapists who would like to be part of a study investigating case studies on this topic. If you are interested, please let us know here:
https://docs.google.com/forms/d/e/1FAIpQLScoACLdNJnqX8g4We7BVTKfHoVrzD8ix-g4oj7WYlpT_p3RAw/viewform?usp=sf_link

Additional sources:

Krug, M. (2022): Menopause - ein Organ verabschiedet sich. EHK; 71: 89-96. a-1718-1360.pdf (thieme-connect.com)

Together with neurobiologist and neurofeedback expert Meike Wiedemann, we conducted an interview on the topic of alpha-theta training. She explains what Alpha-Theta-Training actually is, how she uses it in her everyday practice and why it is a method of self-care.

BEE Medic: Dear Meike, thank you very much for taking time for us today. Can you start by describing what Alpha-Theta-Training actually is? 
Meike: Alpha-Theta-Training is a component of the so-called Othmer Method. With Alpha-Theta, we basically resort to frequency band training. In contrast to awake training, we also speak of deep state training with alpha-theta training, because the state you want to achieve with it is a kind of trance state. In Alpha-Theta-Training, patients sit on a comfortable chair with their eyes closed. Patients should keep their eyes closed throughout the process in order to have better access to processing psychological issues in these deep state areas. ILF awake training is mainly used for physiological regulation. Alpha-Theta-Training goes one layer deeper to address psychodynamic processes and also access unconscious processing. The idea behind Alpha-Theta-Training is to create an access between the conscious and the unconscious level. Alpha-Theta-Training therefore aims more at psychodynamics and less at physical regulation. Whereby it must be said that inner-psychic processes that shape our behavior are also closely connected to physical sensations and vice versa. In Alpha-Theta-Training one opens the pipeline so that the conscious and unconscious systems can be "connected" and thus the resources in the unconscious can also be used.

BEE Medic: What does alpha actually stand for and what does theta stand for?
Meike: These are the classic frequency bands. Alpha is a frequency band around ten hertz and theta is lower, between four and seven hertz. The state in alpha is a slight relaxation, you can speak of a relaxed focus. In comparison, theta is even lower. When we talk about the whole spectrum of waking states, there is this relaxed focus and then when you "go inward" more and more and withdraw into yourself, then we are more in the theta range and the subconscious states.

BEE Medic: How do you use the Alpha-Theta-Training in your practice?
Meike: The Alpha-Theta-Training is always an addition to the ILF-Training, to the so-called awake training. With ILF Neurofeedback, a basis is first created over several sessions, there is no fixed number. That is, you first have many sessions of awake training to reduce symptoms and stabilize the person to be treated. Then you can work with it for topics that involve psychodynamic processes. For example, changing beliefs, letting go of old habits, or even in processing traumatic content. The next step is to dive one layer deeper to resolve things as well. In the further course of an alpha-theta session, neurofeedback promotes both alpha and theta waves. In the beginning, patients feel a slight relaxation in the alpha range. After five to ten minutes, the patients usually go one step deeper into these trance-like states. As a rule, they then switch between alpha and theta, or sometimes have longer states in theta. This is the area in which one has access to the unconscious areas. The application of Alpha-Theta-Training differs between patients. For some it is advisable to do Alpha-Theta-Training every second session, for others it may be necessary to work with it every three, four, five sessions first, in order to maintain the symptom reduction achieved in the waking training and not to cause any regression. But what the patients experience in Alpha-Theta-Training are dream-like states. Things come together and they find solutions that they would never have thought of with conscious thought. However, it is not always consciously that things "click". It often happens on an unconscious level.

BEE Medic: Why is it so important to prepare for Alpha-Theta-Training with ILF Neurofeedback?
Meike: You want patients to experience Alpha-Theta-Training from a safe position, and that needs preparation and physiological regulation through ILF-HD training first. Patients who are very loaded, whether it's emotional problems or neurological instabilities, something like migraine attacks or headache symptoms, can be re-triggered by alpha-theta training. Or if I do Alpha-Theta-Training without ILF Training with people who have had traumatic experiences, they may find themselves with their whole experience in that trauma. If someone is still extremely anxious and controlled, then he or she will not be able to engage in Alpha-Theta-Training either. What might happen then is that the patient:inside opens their eyes and says "I'm not doing that!" because they feel that they are losing control. The letting go and the relaxed state is then perceived as dangerous and too overwhelming, thus unnecessary fears can be triggered.
Therefore, a good preparation is needed, on the one hand with the ILF training and on the other hand, of course, a correspondingly good relationship with the therapist.

BEE Medic: With which patients do you do the Alpha-Theta-Training?
Meike: Alpha-Theta-Training can really consolidate the effects of ILF-HD-Training. For patients who are "not yet ready" after ILF training, Alpha-Theta-Training can give another boost to their further development. The person should only tolerate it well or be sufficiently prepared by ILF training or other self-regulation methods. I have had patients in training where I have said "Great, the headaches are gone, now we can phase out the training". And the patients have then said: "No, now we are really starting. I never thought I would get this far in my life and now I have this and that wish." Alpha-Theta-Training is also often used in peak performance. For example, an skier may go through certain stretches or an actor/ actress or singer may prepare for performance or exam in this state.

BEE Medic: What advantage does the Alpha-Theta-Training offer to your patients?
Meike: The Alpha-Theta-Training can give a further push in the change work, in the whole therapy process and allows a processing on a deeper level. When I train the Alpha-Theta, then I also train for the future: How can I get involved in such states? One can then create much more access to resources that lie in the subconscious and use more of them.

BEE Medic: Why do you do Alpha-Theta-Training with your eyes closed? And how does the feedback actually work?
Meike: In Alpha-Theta-Training it is important to close your eyes so that you can get into this deep state at all. In this state, Alpha-Theta-Training makes it possible to experience things again in a kind of dissociation. That is, it allows you to feel yourself in a safe state to be able to process things again from a different perspective. It's like an "inward look." You turn your focus away from the outside world and into the inside world. And that is of course difficult when you are distracted by images from the outside. Only with closed eyes do the alpha waves emerge to the extent that you can look inside yourself. The tricky thing about neurofeedback is that all the feedback you need, i.e. how the alpha amplitudes, theta amplitudes, steep rises in amplitudes are behaving, is all fed back auditorily. You don't have to worry about missing any feedback with your eyes closed. Nevertheless, we have the possibility to give visual feedback at the beginning of the software module Alpha-Theta-Reflections. This often makes it easier for the patient to get started. These are so-called guided imagery, which can be switched on in different languages, so that the patients are supported in reaching such a state.

BEE Medic: What are your previous experiences with Alpha-Theta-Training?
Meike: I have also worked with alpha-theta training in earlier times at the university. The experience is that patients get into such trance states relatively quickly without needing much guidance. In a therapeutic sense it is a fantastic opportunity for patients to support psychodynamic processes on an unconscious level, to process, to re-learn and to really use this deep state, just like you do with other methods. I also work with hypnotherapy. There are relatively many parallels to that.

BEE Medic: As a therapist, can you also use Alpha-Theta-Training on yourself?
Meike: I would recommend it to every therapist to train him/herself and to use these tools. And not only in the sense that one makes a self-awareness, but so that one knows what the patients experience during the process. For myself, the most profitable ones are Synchrony and Alpha-Theta-Training. There are different methods for self-care, but when I do neurofeedback, Synchrony and Alpha-Theta are my favorites. It really brings you down from the day-to-day, to another level, like a nice deep meditation. And it's super simple. You don't have to do anything except stick on the electrodes, start the program, and then let yourself be sprinkled, so to speak. I can then really dive into this deep state. I find that very beneficial and the rest of the day is completely different, much more relaxed and calm. From that point of view, if you have a Neurofeedback system available, I find Alpha-Theta-Training a relatively simple way of self-care.

This year, the first Annual Conference for Applied Neurofeedback, ACAN for short, will take place in Birmingham. From 16 to 17 June, international experts will give insights into modern Neurofeedback research and the latest scientific findings in lectures and discussion panels, with a focus on the topic of trauma. Practical Neurofeedback workshops will cover innovative technologies such as virtual reality, QEEG, Neurofeedback in peak performance and biofeedback. 

"We are delighted to have some renowned figures such as Sebern Fisher and Siegfried Othmer attending the conference to share their expertise. The conference offers concentrated expertise and the ideal opportunity to gain new impetus and inspiration for practice. I am sure that the conference will offer great added value for all participants," says Alan Beresford, UK Manager of BEE Systems Limited. Participants of the conference can expect insights into daily clinical practice and the integration of innovative technologies such as virtual reality Neurofeedback and biofeedback applications into Neurofeedback practice. Renowned experts will give keynote presentations on how and why Neurofeedback is playing an increasingly relevant role in the field of trauma therapy. In addition, current experiences with Neurofeedback treatments at Long-Covid will be discussed.

Mental health professionals from all over the world attend ACAN. The conference thus also offers a valuable platform for intensive exchange and enables all participants to receive new impulses for improved practice and optimized application of Neurofeedback as well as to expand their network internationally. "With ACAN, we want to create an international platform for application-oriented Neurofeedback," says Johannes Spallek, Managing Director of BEE Medic GmbH, and continues: "Participants can not only get into personal contact with colleagues and be inspired by like-minded people, but also leave the conference with a bundle of knowledge and implementable ideas to achieve even more with Neurofeedback.

More information and details on the conference as well as the opportunity to purchase tickets can be found here.

We all know of the importance of sleep, which we notice in particular when we have problems with it: Difficulties falling asleep and sleeping through the night, constantly waking up and having trouble getting back to sleep - sleep disorders are multifaceted, and so are their causes. In this blog post we want to explain why sleep is so important, what the consequences of poor sleep can be and how Neurofeedback can help with sleep problems.

If you sleep a lot, you sleep well, right?

Of course, it's not quite that simple. The need for sleep differs according to age and gender. Generally, women need more sleep than men and children more than adults. But also other factors influence our need for sleep such as season, habit, health or life circumstances (Hirshkowitz et al., 2015). In Central Europe, the average sleep duration is seven hours per day, varying between five and nine hours. However, the duration of sleep does not necessarily say anything about the quality of sleep and the feeling of being refreshed (Crönlein et al., 2017). Whether we feel refreshed and fit throughout the day depends primarily on our subjective perception.

What are the different sleep types?  

Science distinguishes between three chronotypes: Evening, morning and normal type. These differ in their time of peak performance, alertness and sleep preference (Crönlein et al., 2017). As the word already suggests, the morning type is particularly efficient in the morning hours and has difficulty staying awake for a long time in the evening. The evening type on the other side can achieve high performance especially at a later hour and finds the morning hours torturous. However, these two extreme types are rather rare (Crönlein et al., 2017). The normal type is most often found in society. These people wake up neither particularly early nor late, so they are a mixed type of the "lark" (morning type) and "owl" (evening type).

How do we know when we need to sleep?

Clearly, when we are tired. But why do we get tired? Regardless of whether we are evening, morning or normal type, our tiredness and the urge to sleep is caused by two factors: the circadian rhythm and the hormone adenosine. The circadian rhythm is, so to speak, the "inner clock" that our organism and all our cells follow. It lasts about 24 hours (hence the term circadian, which is derived from the Latin word circa, roughly meaning day). Among other things, this circadian rhythm influences hormone release and metabolic processes, including the sleep-wake rhythm. By releasing the hormone melatonin this rhythm signals the body to sleep. But melatonin is not the only thing that makes us tired. Our cells work at full speed all day and need energy. This produces adenosine. The longer the day, the more adenosine accumulates in the body. And the more adenosine accumulates  in the body, the higher the sleep pressure becomes and we get tired. During sleep, the adenosine is broken down again and the sleep pressure decreases over night. When we wake up, the process starts all over again (Birbaumer & Schmidt, 2010).

What happens in case of a lack of sleep - sleep as a symptom

Different types of sleep disorders can be distinguished: Insomnias, hypersomnias, parasomnias, sleep-wake rhythm disorders or motor disorders such as restless leg syndrome (Spiegelhalder, Backhaus & Riemann, 2011). Between 2010 and 2017, the number of sleep disorders among working people increased by 66%, with about one in ten people suffering from insomniac complaints (DAK, 2017). These include problems falling asleep, sleeping through the night and not getting restful sleep.

Who can’t relate? Stress at work, bad sleep at night which causes low performance at work the next day - a vicious circle. It seems logical that this is not good for our organism, but what exactly are the consequences of sleep disorders? If we do not sleep well, increased risk of falling asleep, a lack of energy and motivation, tension, headaches, moods and concentration problems can be the consequence (DAK, 2017). And mental disorders can also worsen as a result of lack of sleep (Crönlein et al., 2017). Sleep quality and an exact assessment of sleep problems are therefore an important part of the assessment before Neurofeedback therapy.

Sleep as a symptom - How neurofeedback can help 

Because sleep problems often occur as a symptom of other diseases, Neurofeedback can be used for various sleep problems. Especially at the beginning of Neurofeedback therapy, sleep is an important indicator to determine suitable starting positions for ILF Neurofeedback. It makes a difference whether patients have difficulties falling asleep or problems sleeping through the night, which means they need better regulation of the sleep phases. A combination of both can also be present. It influences which electrode positions one starts with in ILF Neurofeedback. 

Furthermore, sleep disorders are a well-describable symptom that causes a high level of suffering for many of those affected. The effects are noticeable in everyday life. Sleep is therefore often a symptom where the first treatment successes with ILF Neurofeedback can become visible quickly. For many patients, being able to fall asleep or sleep through the night "at last" brings a significant improvement to everyday life.

Studies also support the positive effects of Neurofeedback on sleep disorders. For example, study participants reported a subjective improvement in their sleep quality and better performance during the day (Hammer et al., 2011; Schabus et al., 2013). Neurofeedback can also minimise sleep latency, i.e. the time needed from going to bed to actually falling asleep (Wu et al., 2021). Another study shows that sleep problems in burnout patients could be improved (Kratzke et al., 2020). 

ADHD patients in particular report sleep problems repeatedly. An improvement of these problems was observed through SMR Neurofeedback training (Arns, Feddema & Kenemans, 2014). An explanation for this is given in a review article by Arns & Kenemans (2014), in which the effects of Neurofeedback on the so-called sleep spindle circuit are discussed. Increased sleep spindle density leads to a normalisation of insomnia, which in turn reduces ADHD symptoms. "In a [...] randomised controlled trial, 27 healthy adults were trained with SMR conditioning to improve sleep and declarative learning. After 10 sessions, positive changes were observed in sleep parameters such as sleep spindles and latency to fall asleep" (author's translation, Hoedlmoser et al., 2008).

Sleep problems were also improved in a patient treated with ILF Neurofeedback in a virtual reality setting. These improvements persisted after a one-year follow-up. (Orakpo et al., 2021). In another case study, treatment with ILF Neurofeedback in the virtual reality setting improved a patient's pain-related insomnia. Again, the sustained improvement was confirmed after one year (Orakpo et al., 2022).

Based on current research and clinical experience, Neurofeedback can be a useful therapeutic component in the treatment of insomnia or symptoms of disturbed sleep. We are currently working with other researchers to support further Neurofeedback studies. 

For more detailed information on Neurofeedback and scientific work, please contact us.

Sources:

Arns, M., Feddema, I. & Kenemans, J. L. (2014) Differential effects of theta/beta and SMR neurofeedback in ADHD on sleep onset latency. Front. Hum. Neurosci. 8, 1–10.

Birbaumer, N., Schmidt, R. (2010) Wach-Schlaf-Rhythmus und Aufmerksamkeit, in: Schmidt, R. F.,Lang, F.,Heckmann, M. (Hrsg.), Physiologie des Menschen, 31., überarbeitete und aktualisierte Auflage, Heidelberg, Springer Medizin-Verlag, 181–200.

Crönlein T, Galetke W, Young P. (2017) Schlaf und Schlafmedizin – Grundlagen. In: Crönlein T, Galetke W, Young P, Hrsg. Schlafmedizin 1×1. Berlin, Heidelberg: Springer Berlin, Heidelberg.

Hammer, B. U., Colbert, A. P., Brown, K. A. & Ilioi, E. C. (2011). Neurofeedback for insomnia: A pilot study of Z-score SMR and individualized protocols. Appl. Psychophysiol. Biofeedback 36, 251–264.

Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J.,

Katz, E. S., Kheirandish-Gozal, L., Neubauer, D. N., O'Donnell, A. E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R. C., Setters, B., Vitiello, M. V., Ware, J. C., Adams Hillard, P. J. (2015) National Sleep Foundation's sleep time duration recommendations: methodology and results summary. Sleep health 1, 1, 40–43.

Hoedlmoser, K., Pecherstorfer, T., Gruber,G., Anderer, P., Doppelmayr, M., Klimesch, W., Schabus, M. (2008) Instrumental Conditioning of Human Sensorimotor Rhythm (12-15 Hz) and Its Impact on Sleep as Well as Declarative Learning. SLEEP 31, 1401–1408.

Kratzke, I. M., Campbell, A., Yefimov, M. N., Mosaly, P. R., Adapa, K., Meltzer-Brody, S., Farrell, T. M., Mazur, L. M. (2020) Pilot Study Using Neurofeedback as a Tool to Reduce Surgical Resident Burnout. Journal of the American College of Surgeons 232, 74-80.

Marschall, J., Hildebrandt, S., Sydow, H., Nolting, H.-D. (2017) Gesundheitsreport 2017. Analyse der Arbeitsunfähigkeitsdaten. Update: Schlafstörungen, 1. Auflage, Heidelberg, Neckar, medhochzwei Verlag.

Orakpo, N., Vieux, U. & Castro-nuñez, C. (2021) Case Report : Virtual Reality Neurofeedback Therapy as a Novel Modality for Sustained Analgesia in Centralized Pain Syndromes. Front. Hum. Neurosci 12, 3–7.

Orakpo, N., Yuan, C., Olukitibi, O., Burdette, J., Arrington, K. (2022) Does Virtual Reality Feedback at Infra-Low Frequency Improve Centralized Pain With Comorbid Insomnia While Mitigating Risks for Sedative Use Disorder?: A Case Report. Front. Hum. Neurosci 16, 1-5.

Schabus, M., Heib, D. P. J., Lechinger, J., Griessenberger, H., Klimesch, W., Pawlizki, A., Kunz, A. B., Sterma, B. M., Hoedlmoser, K. (2013) Enhancing sleep quality and memory in insomnia using instrumental sensorimotor rhythm conditioning. Biol. Psychol. 95, 126–134.

Spiegelhalder, K., Backhaus, J. & Riemann, D. (2011) Schlafstörungen (2. Aufl.). Hogrefe eLibrary: Band 7. Hogrefe.

Wu, Y., Fang, S., Chen, S., Tai, C. & Tsai, P. (2021) Effects of Neurofeedback on Fibromyalgia : A Randomized Controlled Trial. Pain Manag. Nurs. 21, 755-763.
 

What is ASD?

Autism Spectrum Disorder (ASD) is a profound developmental disorder that begins in (early) childhood. Diagnostic criteria include deficits in social communication and interaction, limited repetitive behavioral patterns such as inflexible holding on to routines and hyper-/ or hypoactivity to sensory stimuli. Functions of speech, visual spatial skills and movement coordination are often affected by developmental limitations or delays. The term spectrum disorder indicates that different forms of autistic disorders can be distinguished, especially early childhood autism, atypical autism and Asperger syndrome. 

Indicating a prevalence for ASD is not trivial, as there is no uniform approach or criteria, and numbers are not available for all regions worldwide. It may be possible to estimate a prevalence of approximately 1.5% for ASD in industrialized countries (see literature 1). The clinical appearance of ASD changes considerably over the life span from infancy to adulthood, both in core symptoms and compensation strategies. 

Neurofeedback as an option in a multimodal therapy approach
 

Neurofeedback can be used as a block of therapy for those affected by the autism spectrum. Recent research into the neurophysiology of autism spectrum disorders has shown that autistic individuals have different connectivity networks and specific regions of hyper- and hypo-connectivity than healthy subjects in comparison with a control group (see literature 2). Other theories, such as those on altered mirror neuron activity, or hypotheses on the Theory of Mind and the Polyvagal Theory, also emphasize neurological differences for patients with ASD. 

The effect of Neurofeedback is alteration of dysregulated brain activity. It is known from studies that patterns of resting EEG and evoked potentials in patients with ASD differ from those of healthy populations. The effect of neurofeedback on the brain has been confirmed in a recently published study. The functional connectivity (communication between neurons) in the brains of subjects was examined by fMRI before and after a 30-minute neurofeedback session. After the neurofeedback session, an increased connectivity of neurons in the brain was found (see literature 3). From these results it can be deduced, among other things, that neurofeedback not only has a positive effect on the symptoms of illnesses but can also cause effects in the brain and thus possibly change connectivity patterns in the long term, such as those that occur in chronic pain. These results support the hypothesis of neurofeedback as a method of improving the self-regulating capacity of the brain.   

State of Research: Neurofeedback in Autism Spectrum Disorders 

Due to the functional neuroanatomical abnormalities in patients with ASD, neurofeedback can be an effective treatment method for reducing the symptoms of dysregulation (see literature 4). This hypothesis is strengthened in a controlled study, in which ASD patients had a reduction of cerebral hyper-connectivity after 20 sessions of Neurofeedback as well as a significant reduction of the symptoms by the treatment (see literature 5). It is also shown that neurofeedback in combination with other treatment methods is a possibility to improve the patients' performance (see literature 6). A follow-up study shows that 12 months after the Neurofeedback treatment, the obtained improvements are still present (see literature 7), which indicates that Neurofeedback not only helps with the current symptoms, but it also helps the brain to improve the executive functions. 

Previous work (literature 8) and a recent review of the existing literature concludes that neurofeedback is a promising treatment for autism and cites the evaluation of numerous studies and case reports (see literature 9). However, it is also noted that further studies, particularly controlled and randomized studies, should be conducted to evaluate further details of treatment conditions.

Literature
1.    Fombonne, E. Editorial: The rising prevalence of autism. J. Child Psychol. Psychiatry Allied Discip. 59, 717–720 (2018).
2.    Holiga, Š. et al. Patients with autism spectrum disorders display reproducible functional connectivity alterations. Sci. Transl. Med. 11, (2019).
3.    Dobrushina, O. R. et al. Modulation of Intrinsic Brain Connectivity by Implicit Electroencephalographic Neurofeedback. Front. Hum. Neurosci. 14, 1–13 (2020).
4.    Thompson, L., Thompson, M. & Reid, A. Functional neuroanatomy and the rationale for using EEG biofeedback for clients with Asperger’s syndrome. Appl. Psychophysiol. Biofeedback 35, 39–61 (2010).
5.    Coben, R. & Padolsky, I. Assessment-Guided Neurofeedback for Autistic Spectrum Disorder. J. Neurother. 11, 37–41 (2008).
6.    Knezevic, B., Thompson, L. & Thompson, M. Pilot Project to Ascertain the Utility of Tower of London Test to Assess Outcomes of Neurofeedback in Clients with Asperger’s Syndrome. J. Neurother. Investig. Neuromodulation 14, 3–19 (2010).
7.    Kouijzer, M. E. J., de Moor, J. M. H., Gerrits, B. J. L., Buitelaar, J. K. & van Schie, H. T. Long-term effects of neurofeedback treatment in autism. Res. Autism Spectr. Disord. 3, 496–501 (2009).
8.    Coben, R., Linden, M. & Myers, T. E. Neurofeedback for autistic spectrum disorder: A review of the literature. Appl. Psychophysiol. Biofeedback 35, 83–105 (2010).
9.    Van Hoogdalem, L. E., Feijs, H. M. E., Bramer, W. M., Ismail, S. Y. & Van Dongen, J. D. M. The Effectiveness of Neurofeedback Therapy as an Alternative Treatment for Autism Spectrum Disorders in Children: A Systematic Review. J. Psychophysiol. (2020). doi:10.1027/0269-8803/a000265