Neurofeedback for Emotional Dysregulation and Oppositional Defiant Disorder (ODD)

Oppositional defiant disorder (ODD) is a disorder characterised by a pattern of disruptive and angry moods, especially towards authority figures, and difficulty managing these explosive moods (Hamilton & Armando, 2008; Mars et al., 2025).

This behaviour will usually appear in childhood, around the preschool years, and if not addressed, can become a stable issue throughout the rest of their education and into their adulthood (Hamilton & Armando, 2008). Additionally, there are a number of social challenges that might come with this behaviour, such as strained relationships with parents and difficulties socialising with their peers (Hamilton & Armando, 2008). Comorbidities for this disorder can be the development of mood disorders, conduct disorders, and antisocial behaviour during adulthood (Hamilton & Armando, 2008).

One of the behaviours that is found inside ODD is emotional dysregulation. Emotional regulation can be defined as the ability to change one’s emotional state to be more efficient and achieve one’s goals (Shaw et al., 2014). Through this definition, emotional dysregulation is when one is not able to modify their emotional state when needed, such as having quick, excessive, explosive reactions (Seymour et al., 2019; Shaw et al., 2014). Again, emotional dysregulation described outside of ODD is associated with a series of comorbidities, i.e. mood and anxiety disorders as well as poorer quality of life (Seymour et al., 2019).

Although emotional dysregulation is a behaviour we might find in other disorders, most researched in ADHD, it is when it goes untreated and becomes more severe that an ODD diagnosis might be put in place (Hatsu et al., 2022). Therefore, it is when we see emotional dysregulation in tandem with such behaviours as the defiance of authority that we can conclude the presence of ODD.

This behaviour will usually appear in childhood, around the preschool years, and if not addressed, can become a stable issue throughout the rest of their education and into their adulthood (Hamilton & Armando, 2008).

The primary neurobiological dysfunction in ODD

The primary neurobiological dysfunction in ODD centres on disrupted communication between the prefrontal cortex and limbic structures, particularly the amygdala (Noordermeer et al., 2016).

It has also been shown that dysfunction will usually affect the “hot”, or reactionary executive functions, such as impulse control, problem solving, social behaviour, and empathy, showing an anatomical difference in the regions that perform these tasks (Noordermeer et al., 2016).

Studies divide the affected ODD framework into punishment processing, reward processing, and cognitive control (Matthys et al., 2013).

Impaired punishment processing can be linked with a lack of fear, where if the child does not understand the link between behaving antisocially and the consequences of it, they will continue to behave in risky ways that might be dangerous for them and the people surrounding them (Matthys et al., 2013). Lack of fear is also associated with the autonomic nervous system (ANS), where decreased skin conductance is related to aggression in young children (Lorber, 2004; Matthys et al., 2013). The inability of the body to react to adverse stimuli.

The emotional dysregulation characteristic of ODD appears to stem from compromised top-down control mechanisms. In typical emotional regulation, the prefrontal cortex, particularly the ventromedial prefrontal cortex (vmPFC), modulates amygdala reactivity. This system allows for appropriate emotional responses and impulse control. In ODD, this regulatory circuit appears compromised, leading to heightened emotional reactivity and difficulty with behavioural control.

In terms of treatments, the most recommended direct route currently is that of behavioural therapy, and not medication, although this can be used as treatment for those pathologies with which ODD might be a comorbidity to alleviate symptoms (Riley et al., 2016).

Neurofeedback for emotional responses and behaviour

Neurofeedback naturally trains the brain to function calmly and more efficiently. Those with oppositional defiant disorder will experience direct improvements in mood, which will decrease oppositional, impulsive, and/or aggressive behaviour. Neurofeedback can help regulate the dysfunctional brain patterns associated with emotional dysregulation in ODD.

Neurofeedback therapy has been used for years to help shape good behaviour by establishing better brainwave communication in neural centres that are responsible for the symptoms. This approach targets the underlying neurobiological mechanisms that contribute to ODD symptoms (Muratori et al., 2017).

There is a significant lack of research for neurofeedback as a direct treatment for ODD, but there are a plethora of studies which discuss ODD and emotional dysregulation as a comorbidity of ADHD and can be used as a guide on this topic. Nonetheless, there exists descriptions of research which show that neurofeedback can be used to treat emotional dysregulation (Morawetz et al., 2016).

Nonetheless, there are studies regarding neurofeedback as a treatment for emotional dysregulation, as seen in Table 3. Studies have shown that it is possible to ameliorate emotional dysregulation; an example is a study which used a combination of virtual reality simulations and EEG-neurofeedback to help the subjects improve their emotion regulation (Yu et al., 2023).

Additionally, several reviews and collections of literature show that emotional regulation is one of the targets that is most successfully addressed by neurofeedback training (Tosti et al., 2024). This review showed how in young athletes, neurofeedback allowed for better managing of anxiety, stress, and a better ability to maintain calm and focused, on top of other physiological benefits (Tosti et al., 2024). With this in mind, we can speak about neurofeedback as a treatment for ODD as well as emotional dysregulation.

Current Research: how Neurofeedback can improve ODD behaviour

As previously discussed, there are not many clinical trials addressing neurofeedback as a treatment for ODD, or even as a comorbidity to ADHD, as seen in Table 1. Therefore, we chose to search for studies regarding precursors of ODD, such as related behaviours in ADHD (i.e. impulsivity, conduct disorders, aggression, etc.) (Table 2) or emotional dysregulation in different disorders (Table 3).

Table 1. ODD as a comorbidity of ADHD research.

Table 2 -1. ODD-associated symptoms in ADHD studies

Table 2 - 2. ODD-associated symptoms in ADHD studies

Table 3 - 1. Neurofeedback for emotional dysregulation treatment in non-ADHD patients

Table 3 - 2. Neurofeedback for emotional dysregulation treatment in non-ADHD patients

Conclusion

Based on the research evidence, several specific neurofeedback protocols have shown effectiveness for ODD and emotional dysregulation: Theta/Beta Ratio (TBR) Protocols and emotional regulation protocols (Albrecht et al., 2015).

The most extensively studied protocol for behavioural and emotional regulation involves decreasing theta activity and increasing beta or SMR activity. Additionally, high beta frequencies will always be reduced in every protocol. This approach targets the elevated theta/beta ratio commonly observed in children with attention and behavioural difficulties. As seen in studies targeting the behavioural, conduct, and emotional issues related to ODD, many of them chose as their neurofeedback protocol Theta/beta training.

Furthermore, all of these studies found an improvement in the symptomology, both immediately post-treatment and in the follow-up months after training. This was seen in both the targeting of the behavioural conduct issues related to ODD, such as impulsivity or antisocial behaviours (Tables 1 and 2) and in the research focusing specifically on emotional dysregulation, both in ADHD and in other disorders (Table 3).

In addition to theta and beta protocols, other protocols have also been proven to aid with enotional dysregulation, even when not related to ADHD or ODD. Targeting emotional dysregulation specifically aims to modulate brain regions involved in emotional processing. Training protocols aim to modulate beta (12-30 Hz) and gamma (>30 Hz) activity in the amygdala and prefrontal cortex regions of the brain, promoting desensitisation and relaxation.

Neurofeedback naturally trains the brain to function calmly and more efficiently. Those with oppositional defiant disorder will experience direct improvements in mood, which will decrease oppositional, impulsive, and/or aggressive behaviour.

Overall, the evidence suggests that theta/beta ratio protocols remain the most established approach, with the traditional theta-down/beta-up protocol being most commonly used. However, we can also see some research evolving toward other approaches that consider brain connectivity patterns and individual neurophysiological profiles. Like all treatments, the effectiveness varies among individuals, and protocols may need to be tailored based on specific EEG findings and clinical presentation. For this reason, much more research must be done on the specifics of how neurofeedback can be used as a treatment for ODD, not only its symptoms as part of other pathologies. However, with the research available, we can infer that neurofeedback training would be a beneficial treatment for those struggling with Oppositional Defiance Disorder and emotional dysregulation.

This article was written by our trainer Marta Molina Asensi

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References

Albrecht, B., Uebel-von Sandersleben, H., Gevensleben, H., & Rothenberger, A. (2015). Pathophysiology of ADHD and associated problems-starting points for NF interventions? Front Hum Neurosci, 9, 359. https://doi.org/10.3389/fnhum.2015.00359

Hamilton, S. S., & Armando, J. (2008). Oppositional defiant disorder. Am Fam Physician, 78(7), 861-866.

Hatsu, I. E., Eiterman, L., Stern, M., Lu, S., Johnstone, J. M., Leung, B. M. Y., Srikanth, P., Robinette, L., Tost, G., Odei, J. B., Gracious, B. L., & Arnold, L. E. (2022). Household Food Insecurity Is Associated with Symptoms of Emotional Dysregulation in Children with Attention Deficit Hyperactivity Disorder: The MADDY Study. Nutrients, 14(6), 1306. https://www.mdpi.com/2072-6643/14/6/1306

Lorber, M. F. (2004). Psychophysiology of aggression, psychopathy, and conduct problems: a meta-analysis. Psychol Bull, 130(4), 531-552. https://doi.org/10.1037/0033-2909.130.4.531

Mars, J. A., Aggarwal, A., & Marwaha, R. (2025). Oppositional Defiant Disorder. In StatPearls. StatPearls Publishing

Copyright © 2025, StatPearls Publishing LLC.

Matthys, W., Vanderschuren, L. J. M. J., & Schutter, D. J. L. G. (2013). The neurobiology of oppositional defiant disorder and conduct disorder: Altered functioning in three mental domains. Development and Psychopathology, 25(1), 193-207. https://doi.org/10.1017/S0954579412000272

Morawetz, C., Bode, S., Baudewig, J., & Heekeren, H. R. (2016). Effective amygdala-prefrontal connectivity predicts individual differences in successful emotion regulation. Social Cognitive and Affective Neuroscience, 12(4), 569-585. https://doi.org/10.1093/scan/nsw169

Muratori, P., Pisano, S., Milone, A., & Masi, G. (2017). Is emotional dysregulation a risk indicator for auto-aggression behaviors in adolescents with oppositional defiant disorder? J Affect Disord, 208, 110-112. https://doi.org/10.1016/j.jad.2016.08.052

Noordermeer, S. D., Luman, M., & Oosterlaan, J. (2016). A Systematic Review and Meta-analysis of Neuroimaging in Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) Taking Attention-Deficit Hyperactivity Disorder (ADHD) Into Account. Neuropsychol Rev, 26(1), 44-72. https://doi.org/10.1007/s11065-015-9315-8

Riley, M., Ahmed, S., & Locke, A. (2016). Common Questions About Oppositional Defiant Disorder. Am Fam Physician, 93(7), 586-591.

Seymour, K. E., Macatee, R., & Chronis-Tuscano, A. (2019). Frustration Tolerance in Youth With ADHD. Journal of Attention Disorders, 23(11), 1229-1239. https://doi.org/10.1177/1087054716653216

Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion Dysregulation in Attention Deficit Hyperactivity Disorder. American Journal of Psychiatry, 171(3), 276-293. https://doi.org/10.1176/appi.ajp.2013.13070966

Tosti, B., Corrado, S., Mancone, S., Di Libero, T., Carissimo, C., Cerro, G., Rodio, A., da Silva, V. F., Coimbra, D. R., Andrade, A., & Diotaiuti, P. (2024). Neurofeedback Training Protocols in Sports: A Systematic Review of Recent Advances in Performance, Anxiety, and Emotional Regulation. Brain Sci, 14(10). https://doi.org/10.3390/brainsci14101036

Yu, M., Bai, Y., & Li, Y. (2023, 24-27 July 2023). Emo-regulator: An emotion-regulation training system fusing virtual reality and EEG-based neurofeedback. 2023 45th Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC),