The Fallacy of Sham-Controlled Neurofeedback Trials: A Reply to Thibault and Colleagues (2018).

Sham-controlled neurofeedback (NFB) trials consistently find no separation on ADHD outcome measures leading many to conclude that NFB's beneficial effects are due to placebo. We deconstruct the NFB training methodology and findings of six sham-controlled trials that assessed for evidence of learning. All six studies found no evidence NFB subjects learned to self-modulate the targeted electroencephalogram (EEG). Careful analyses revealed these studies' training methodologies were antithetical to the established science of operant conditioning thereby preventing subjects from learning to self-modulate. These findings are in marked contrast to NFB studies whose methodology mirror the best practices of operant conditioning. The premise that NFB's beneficial effects are due to placebo phenomenon is unproven as these studies compared two forms of false-feedback, not operant conditioning of the EEG. Because these studies are highly cited and considered the gold standard in scientific rigor, a reappraisal of the evidence is urgently needed.