Neuroenhancement for Sale: Assessing the Website Claims of Neurofeedback Providers in the USA

Ethical and Legal Considerations of Alternative Neurotherapies

“…Our use of this term is further supported by the manner in which many providers of these services define themselves. For example, in previous empirical work, we found that nearly three-quarters of websites of neurofeedback providers in our sample utilized language that is commonly defined as CAM-related, such as "alternative," "integrative," or "holistic" (Wexler et al 2020). Similarly, in the realm of off-label TMS, our scoping review found that many providers of off-label TMS utilize this same terminology.…”

“…In this regard, it is important that the information presented to patients through promotional materials and public representation by clinics (e.g., via their websites), as well as during consultations with health care providers, is accurate and complete. However, in previous work examining the websites of neurofeedback providers, we found that many used misleading claims-for example, advertising for indications for which there was little evidence-and exaggerated the benefits of the treatment (Wexler et al 2020). One neurofeedback company that operates a chain of "brain performance centers"-and is supported by U.S. Education Secretary Betsy DeVos (Boser 2017;Fink, Eder, and Goldstein 2017)-has been the subject of recent investigations by the National Advertising Division (NARB 2018(NARB , 2020 and Truth in Advertising (TINA 2019) for misleading claims (see also FTC 2020).…”

“…The total cost of treatment of up to 40 sessions (Thibault et al 2015) has been estimated to range from $3,000-10,000 (Ellison 2010;Thibault et al 2015). EEG neurofeedback is typically marketed for the treatment of both clinical indications-such as anxiety, attention deficit/hyperactivity disorder (ADHD), and depression (Hammond 2011;-as well as non-clinical indications such as cognitive and performance enhancement (Wexler et al 2020). According to one major neurofeedback organization, there are likely over 15,000 providers offering neurofeedback globally (ISNR 2017).…”

“…In addition, both neurofeedback providers and some SPECT clinics often use anecdotes and testimonials to highlight the efficacy of the services offered (Farah and Gillihan 2012;Wexler et al 2020). Considering that testimonials appearing on providers' websites are inherently biased-they are handpicked by providers, and it is usually impossible to verify their authenticity-they may lead to misinterpretations and create an erroneous impression about the efficacy and evidence base of certain therapies.…”

“…For example, even though single-photon emission computerized tomography (SPECT) imaging is not sanctioned by any professional physician society for use as a neuropsychiatric diagnostic, it is being marketed by the Amen Clinics and others for these purposes (Anderson, Mizgalewicz, and Illes 2013;Chancellor and Chatterjee 2011;Farah and Gillihan 2012). Electroencephalography (EEG) neurofeedback is offered by hundreds of practitioners in the United States (U.S.) to treat a variety of clinical indications, even though there is little evidence of efficacy for many of its advertised uses (Thibault et al 2015;Wexler et al 2020). Furthermore, a variety of experimental brain stimulation techniques, such as transcranial direct current stimulation (tDCS) and off-label transcranial magnetic stimulation (TMS), are often offered by providers that lack medical training (Wexler 2020) and by those that self-identify as practicing holistic and integrative medicine.…”