Is Neurofeedback an Effective Treatment for OCD?

Neurofeedback for OCD: How it Works Effectiveness & How to Try It

Neurofeedback is not a first-line treatment for OCD but may be considered with other approaches. The research for neurofeedback for OCD is still developing but promising for future directions. Neurofeedback is often recommended a few times weekly and is not typically covered by insurance. People usually report feeling better within weeks, and improvement can last up to several years.

What Is Neurofeedback?

Neurofeedback is a treatment used with individuals who have mental, intellectual, and physical health conditions. In neurofeedback, individuals are shown information about their brain waves and encouraged to practice self-regulation to change brain activity. Rooted in classical and operant conditioning learning theories, people learn how to sustain these practices to promote positive brain activity over time.¹ Neurofeedback has been shown to be effective with conditions such as attention-deficit/hyperactivity disorder (ADHD), anxiety, depression, sleeping disturbances, addictions, and many more.^2,3

While there are different types of neurofeedback, most approaches use biofeedback from electroencephalogram (EEG) devices. Brain activity is measured using sensors attached to one’s scalp that record the data about brain waves to an electronic program operated by a trained professional. Individuals are then provided immediate audio and/or visual feedback in response to their brain activity and are taught how to practice self-regulation, often reducing anxiety and improving concentration.^1,2

How Can Neurofeedback Help With OCD?

Many individuals with obsessive compulsive disorder (OCD) seek out various treatment options to manage their intrusive thoughts and compulsions, including therapy and medications. Neurofeedback offers a non-invasive alternative method of OCD treatment. Neurofeedback for OCD works by helping people regulate brain activity within the regions of the brain OCD impacts the most, such as the prefrontal cortex, basal ganglia, and thalamus.^4,5

Neurofeedback also helps regulate the central nervous system (CNS). For individuals with OCD, their CNS is frequently activated by anxiety-inducing intrusive thoughts, which leads them to do compulsions. Research findings show that neurofeedback reduces distressing and ruminating thought patterns for those with OCD by helping them regulate their CNS and, therefore, decreasing their compulsions.^2,6

Can Neurofeedback Effectively Treat OCD?

Most mental health professionals are still skeptical about using neurofeedback for OCD and many agree that additional research needs to be done regarding its efficacy. However, the studies so far have been promising and suggest that neurofeedback is beneficial for treating OCD when compared to other evidence-based treatments.^3,7 One small study showed that almost 92% of people in a case study group showed improvement in OCD symptoms in response to neurofeedback.⁵

It is important to remember that research supporting OCD and neurofeedback is lacking, with many of the studies having small sample sizes and limited research conditions.^3,7 Therefore, more research is needed to support that neurofeedback is as effective for OCD as first-line treatments, such as cognitive-behavioral therapy and medications for OCD.

How Fast Does Neurofeedback Work for OCD?

Timelines for neurofeedback treatment will vary for everyone. This may depend on how often people attend treatment sessions, other health factors, and how quickly they can learn and sustain new self-regulation strategies. However, research supports that many individuals feel better within weeks of neurofeedback treatment.^8,5

Session frequency may vary, but most people attend neurofeedback sessions 1-2 times weekly over several months. A neurofeedback treatment provider may have patients complete assessments or questionnaires, such as the Yale-Brown Obsessive-Compulsive Scale (YBOCS), to measure treatment progress and symptom improvement over time.

Is Neurofeedback a First or Last Resort for OCD Treatment?

Neurofeedback is often not considered a first resort for OCD treatment due to the lack of research for it and overwhelming support for other treatment approaches. First-line treatments for OCD typically include cognitive-behavioral therapy (CBT) for OCD, exposure and response prevention (ERP), and/or medication management. Sometimes alternative approaches, such as acceptance and commitment therapy (ACT), can be used supplementary to first-line treatments.

Second-line treatments often include more intensive CBT/ERP treatment programs and additional medications. Individuals who do not benefit from these treatment approaches may seek out brain stimulation procedures, such as transcranial magnetic stimulation (TMS). For extreme symptom severity and treatment-resistant OCD, people may consider invasive neurological surgeries, including ablative neurosurgery and deep brain stimulation (DBS), as a last resort.⁹

As research continues to support the benefits of neurofeedback treatment for OCD, people are likely to consider it as a non-invasive treatment option supplementary to first or second-line approaches. It is important to discuss which treatment option is best for you with a mental health professional.

Neurofeedback Vs. TMS for OCD

Neurofeedback may be confused with transcranial magnetic stimulation (TMS) but the two treatments differ in how they work. TMS uses magnetic fields to stimulate specific brain areas associated with mental health conditions. The procedure can result in desired mood or mental health changes by activating these specific nerve cells with TMS.⁹

While neurofeedback does not use magnetic fields to excite cells during the procedure, individuals can change their brain activity in response to the brain wave data recorded and biofeedback given. Both neurofeedback and TMS are effective for OCD treatment and are considered relatively safe and non-invasive.

How Long Do the Benefits of Neurofeedback for OCD Last?

Long-term benefits from neurofeedback are possible as individuals learn new strategies to regulate their anxiety. If people can sustain these regulation strategies, then it is likely that the advantages will be experienced over time.¹ Studies have shown that individuals in neurofeedback therapy for OCD reported substantial improvement or remission from their OCD symptoms up to two years following treatment.⁵

Treatment for OCD

NOCD: Online OCD Treatment Covered by Insurance – Regain your life from OCD. Do live video sessions with a licensed therapist specialized in treating OCD. Treatment from NOCD is covered by most major insurance plans. Learn how you can use your insurance benefits. Visit NOCD

Talkiatry: Is OCD Medication Right for You? Speak with a Doctor – Talkiatry can match you with a psychiatrist who takes your insurance and is accepting new patients. They’re in-network with major insurers and offer medication management with supportive therapy. Free Assessment

What to Expect at a Neurofeedback Therapy Session for OCD

Neurofeedback is usually facilitated in outpatient healthcare practices. While treatments vary per setting, sessions typically include the patient sitting in a chair while sensors that record brain activity using a computer are attached to their scalp. Individuals may be shown videos or photos, hear noises, or be asked to play a game or complete tasks on a computer. When they respond favorably, in a way that creates positive brain waves, this is reinforced through visual or audio cues.^1,2

Most individuals report that they do not feel any physical sensations during neurofeedback, although some report side effects after. Neurofeedback sessions can last anywhere from 30-60 minutes. A neurofeedback provider may recommend attending a few sessions weekly to see results.^1,2,10

Risks & Precautions of Neurofeedback for OCD

Although neurofeedback is considered a safe and non-invasive treatment, risks and precautions associated with neurofeedback therapy for OCD should be considered. Side effects from neurofeedback are rare but can occur. Adverse reactions are typically mild and short-lived following the neurofeedback session.

Research supports that the majority of side effects are due to individuals receiving inadequate neurofeedback therapy from unqualified providers. To reduce the likelihood of adverse reactions to neurofeedback, people should only seek treatment and medical advice from qualified neurofeedback providers.^11,12

Rare but potential side effects of neurofeedback for OCD include:^{11,12,13,14,15}

• Headaches
• Fatigue
• Feeling “foggy”
• Confusion, dissociation, or disorientation
• Concentration issues
• Anxiety/panic
• Agitation or irritability
• Fluctuating emotions
• Seizures
• Depression
• Manic-like behaviors
• Sleep disturbances
• Nausea
• Incontinence
• Enuresis
• Tics or twitches
• Worsening symptoms of existing mental health conditions

Who May Not Be A Good Fit for Neurofeedback Therapy?

Neurofeedback is generally considered safe for most people, with very few contraindications noted. However, individuals with pre-existing physical and mental health conditions, especially neurological conditions (i.e., seizure disorders, migraines, narcolepsy), should consult with their physician about the risks and benefits of starting neurofeedback therapy for OCD.

People who have not tried first-line treatment for OCD may not be a good fit for neurofeedback therapy and should first seek out treatments with strong evidence-based research. It is important for individuals to consult with their medical provider(s) before starting neurofeedback therapy for OCD so that they can be evaluated for the appropriateness of the treatment.

How to Know If Neurofeedback for OCD Is Right for You

Neurofeedback for OCD may be an appropriate treatment option for people who have not had symptom improvement with first-line treatments for OCD or want to add another therapy approach to their current treatment.

As research continues to support these treatments as effective for OCD, neurofeedback should be considered supplementary to these treatments. It is important to consult with a qualified mental health professional about appropriate treatment recommendations for OCD.

How to Find a Neurofeedback Therapist for OCD

Individuals can ask their current healthcare practitioners to provide recommendations for neurofeedback therapists who treat OCD. Qualified neurofeedback therapists can also be found online using an online therapist directory, as many practices and organizations have websites regarding their services, training backgrounds, and credentials.

The Biofeedback Certification International Alliance (BCIA) and the International Society for Neuroregulation & Research (ISNR) also provide directories of neurofeedback therapists by state. When contacting neurofeedback therapists, individuals should ask about their training and experience treating OCD with neurofeedback.

Alternative OCD Treatment Options

Neurofeedback is beneficial when used with first-line treatment approaches for OCD.¹⁷ A comprehensive treatment plan for OCD may include neurofeedback with some of the following treatments below: 

• Exposure-response therapy (ERP): ERP is an exposure therapy for OCD and a type of cognitive-behavioral therapy (CBT) that is considered the most effective treatment for OCD. In ERP, individuals are gradually exposed to feared stimuli and taught to reduce compulsive behaviors in response, thus improving distress tolerance and adaptive behaviors.
• Medications: Medications for OCD typically include selective serotonin reuptake inhibitors (SSRIs), which can help reduce symptoms of OCD. Individuals often use medications for OCD while participating in therapy for OCD. If SSRIs don’t work, medication providers may recommend alternative antidepressants or antipsychotics.
• Cognitive behavioral therapy (CBT): CBT for OCD includes various techniques, including ERP, to help individuals challenge their maladaptive thoughts and practice more adaptive, non-compulsive behaviors.
• Acceptance and Commitment Therapy (ACT): Based on relational frame theory, ACT promotes acceptance of distress, mindfulness, and living within one’s values to form adaptive behaviors. ACT is often used as a supplement to ERP and/or CBT for OCD.
• Transcranial Magnetic Stimulation (TMS): TMS for OCD is a safe, non-invasive method that involves stimulating brain regions through magnetic fields. The process excites nerve cells associated with adaptive thoughts and behaviors.