Much proposed research on neurofeedback has faltered over the years on the issue of uniformity of approach. The protocol to be investigated needs to be narrowly constrained or the research will be criticized for a lack of specificity. We have had a number conversations over the years with researchers who were willing to give Neurofeedback research a go, provided we would give them a fixed protocol to work with. In recent years, we have been increasingly unwilling to do this, and by now the point has been reached where such fixed protocols are plainly inappropriate.

The best neurofeedback requires one to react to how the client is reacting to the training, and to make appropriate adjustments. The moment we know this, it becomes ethically questionable to proceed in a manner that sweeps such particularity under the carpet. As it happens, however, the way we proceed in practice is not very different from the way a psychiatrist might proceed in optimizing medication. The choice of medication is often driven more by side effects than by bare-bones efficacy, particularly in the case of the most common medications, the antidepressants. And in many instances medications are combined in various ways. Research by classical methods is not of help when it comes to polypharmacy, and it is not of help with regard to handling side effects. To some degree, therefore, ‘Personalized Medicine’ has already emerged in pharmacotherapy, but this has not yet succeeded in feeding back to rewrite the rules for research. A recent analysis of the status of the science at the FDA, requested by FDA Commissioner Andrew von Eschenbach, came up with the recommendation that the FDA could help to define personalized medicine. “This is the science that the FDA can really take a lead on.” [Science, 318, p.1537, 7 Dec 2007] In neurofeedback, we are in the same boat. (more…)