Why Are Some Brains Less Responsive or Resistant to Neurofeedback Training?

Responsivity to Training: A Statistical Overview

Neurofeedback training is a form of biofeedback produced on the basis of real time data from brain activity administered using electroencephalography (EEG). It gives both visual and auditory feedback depending on each protocol which is determined on the performance of the client. The aim of neurofeedback training is to induce ability of the brain to regulate itself leading to a balanced state of functioning. The protocols set for neurofeedback training target different regions with specific frequencies. Due to this specific training pattern, different locations respond to the training differently, where some areas can be challenging to train or develop responsivity to the feedback.

Training with neurofeedback (NF) has become a wide-used non-invasive method for improving brain function for multiple conditions. Real-time feedback on neural activity can help people learn how to adjust their brainwaves, which may enhance their emotional and cognitive abilities (Marzbani, Marateb, and Mansourian, 2016). Research consistently shows that majorly, individuals are able to gain measurable benefits from neurofeedback. However, outcomes are not uniform.

A proportion of participants achieve strong improvements in regulation, while others show only limited or inconsistent effects. Reviews of the field estimate that this variability affects around 15–30% of participants, depending on the protocol and the population studied (Alkoby et al., 2018; Tursic et al., 2020).

Although these figures indicate that the majority do benefit, they highlight the importance of understanding the conditions under which training is most effective.

Importantly, reduced responsivity is not random. It tends to appear in specific cases—for example, when individuals begin with very low baseline neural activity in the targeted frequency band, when connectivity in relevant brain networks is weaker, or when strategies and engagement do not align well with the training demands.

This article explores the evidence on varying responsivity in neurofeedback. It reviews studies across different brain regions and feedback methods, considers why some individuals experience stronger effects than others, and discusses how this knowledge can guide more precise and reliable applications in the future.

Learning Disabilities

According to research, NF has shown positive impacts on people with learning disabilities (LDs). For example, 20 children with LDs participated in an NF treatment study, while 14 were controls. In addition to improved self-concept, the NF group showed notable gains in academic performance, especially in reading and math (Enriquez-Geppert, Huster, and Herrmann, 2017). Despite the lack of precise response ratios, the study indicates that most participants found NF training beneficial. However, not all participants demonstrated significant gains, with some showing minimal or no measurable changes in academic outcomes. These findings suggest that while many children with LDs may benefit from NF, a subset of learners remain non-responsive, highlighting the need for more tailored protocols (Enriquez-Geppert, Huster and Herrmann, 2017).

ADD/ADHD

Children and adults with attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) benefit from NF. According to Arns, Heinrich, and Strehl (2014), NF produced long-lasting gains in behavioural control and attention, with treatment outcomes up to six months after the intervention being on par with active controls. Although precise response ratios differ between studies, NF therapy seems to be beneficial for a sizable percentage of ADD/ADHD patients. Another review emphasizes that NF might be a good substitute or addition to stimulant medication, especially when the drug by itself isn't producing the desired results (Micoulaud-Franchi et al. 2015).

Emotional Regulation

Emotional dysregulation, characterized by mood swings and frustration, has been addressed through NF interventions. Studies have shown that NF can lead to significant reductions in anxiety and depressive symptoms, suggesting improved emotional regulation (Baumeister, Wolf and Holz, 2022). For instance, a meta-analysis found that NF is effective in reducing symptoms of anxiety and depression, indicating its potential in enhancing emotional stability.

Anxiety and Depression

There have been numerous studies on NF's potential to reduce anxiety and depression. According to a meta-analysis of 22 studies, NF shows promise as a treatment for lowering depressive symptoms, even in people with major depressive disorder (Wang et al. in 2022). Despite the lack of specific response ratios, the overall results indicate that NF therapy leads to significant improvements for a significant number of people.

A growing body of research has investigated NF as a treatment for anxiety and depression. Nonetheless, some individuals show limited or only temporary symptom reductions, with meta-analyses highlighting that certain trials fail to show superiority over control conditions (David et al., 2021). Thus, while NF appears to be a promising therapeutic approach for many, there is naturally also variability in response for others.

Table 1: Studies on Responsivity and Non-Responsivity in Neurofeedback Training

Responsivity Across Brain Regions

• Cortical rhythms and EEG neurofeedback: Training focused on surface-level rhythms, such as sensorimotor rhythm (SMR) or alpha activity, is often more successful when baseline EEG power in those bands is already relatively strong. Studies consistently show that individuals with higher resting alpha or beta activity tend to learn more effectively, while those with very weak baseline activity struggle to modulate their signals (Enriquez-Geppert, Huster and Herrmann, 2014; Witte et al., 2015; Alkoby et al., 2018).

• Deeper limbic and interoceptive structures: For regions like the amygdala or anterior insula, EEG has less spatial resolution to capture deeper level feedback. Here, real-time fMRI or MEG is far more effective. Recent trials demonstrate that insula-targeted neurofeedback can enhance attentional control and emotion regulation (Zhao et al., 2025; Shi et al., 2024; Yuan et al., 2025). Similarly, amygdala regulation has shown promise in PTSD and emotional dysregulation, though results remain mixed and often depend on careful protocol design (Gerin et al., 2023; Takayama et al., 2025).

• Cognitive-control networks: Successful regulation of subcortical regions often requires recruitment of prefrontal regions such as the dorsolateral prefrontal cortex (dlPFC) and anterior cingulate cortex (ACC). These areas appear to mediate learning through reinforcement processes—individuals who show stronger reward sensitivity in these circuits are more likely to achieve lasting regulation (Ispolatov et al., 2022).

In short: the brain region matters. Surface rhythms are accessible through EEG, while deeper affective circuits require imaging techniques with finer spatial resolution.

Why Some Individuals Do Not Respond

Even with the accurate region and modality, a subset of individuals has shown non responsivity to neurofeedback training. Research points to several overlapping reasons.

Neurophysiological Factors

• Baseline activity: Weak resting power in the target band (e.g., low SMR or alpha) predicts poor learning, while strong baseline activity facilitates it (Enriquez-Geppert, Huster and Herrmann, 2014; Witte et al., 2015).

• Structural and connectivity features: Anatomical differences, such as larger putamen volumes or stronger cortico-striatal connectivity, have been linked to better learning outcomes (Tursic et al., 2020).

• Reward sensitivity: Effective neurofeedback may rely on reinforcement learning processes. People with stronger dopaminergic and prefrontal reward signals demonstrate greater transfer from training into self-regulation (Ispolatov et al., 2022).

Psychological and Behavioural Factors

• Motivation and strategy: Not all participants engage equally. Effective mental strategies (e.g., imagery or focused attention) often predict success, while lack of engagement undermines training (Thibault and Raz, 2017).

• State variables: Fatigue, anxiety, or certain medications can interfere with attention and neural signal quality, reducing training efficacy.

Neurofeedback is not a “one-size-fits-all” intervention. Its success depends on aligning the right brain target, the right modality, and the right individual profile. By paying closer attention to these factors, researchers and clinicians have shown to improve the consistency of outcomes and unlock the method’s full potential.

Conditions Where Neurofeedback Training is Not Advisable

Through the non-invasive technique of neurofeedback (NF) training, people can alter their brain activity, which may enhance a range of cognitive and emotional abilities. Although NF has demonstrated promise in treating disorders like anxiety and attention-deficit/hyperactivity disorder (ADHD), its use may not be recommended for some medical and mental health conditions because of possible risks or limited efficacy (Thornton and Carmody, 2013).

Medical/Neurological Conditions

NF training is generally considered safe; however, caution is warranted in specific neurological conditions:

• Epilepsy: While some studies indicate that NF can lessen the frequency of seizures in patients with epilepsy, the evidence is inconclusive, and NF is not commonly recognized as a standard treatment for epilepsy (Fisher, Boas, and Blume, 2014). Thus, before contemplating NF therapy, people with epilepsy should speak with their doctor.

• Traumatic Brain Injury (TBI): According to research, NF can help people with TBI by enhancing their cognitive and attentional abilities. However, NF should be administered under professional supervision due to the wide range of TBI severity and individual responses, which calls for caution (Thornton and Carmody, 2013).

Mental Health Conditions

NF's effectiveness varies across different mental health disorders:

• Severe Psychosis: Disorders like schizophrenia entail intricate challenges in the nervous system. The evidence supporting NF as a standard treatment for psychosis is preliminary, despite some case studies showing improvements in psychotic symptoms. Thus, it is important to use it with caution when dealing with people who are severely psychotic.

• Bipolar Disorder: NF has been investigated as an adjuvant treatment for bipolar disorder by stabilizing mood. Although NF shouldn't be used in place of traditional treatments, some studies indicate possible advantages. A healthcare professional must be consulted in order to assess its appropriateness on an individual basis.

Medications and Contraindications

Certain medications may influence the outcomes of NF training:

• Antipsychotic medications: These are frequently prescribed to treat conditions such as bipolar disorder and schizophrenia. Antipsychotics' neurophysiological side effects could disrupt NF training and lessen its effectiveness. Thus, before beginning NF therapy, people taking such drugs should speak with their doctor (Wilson, Kober, and Huster, 2019).

• Antiepileptic Drugs: These drugs, which are used to treat seizure disorders, may change the way the brain works, which could have an impact on NF results. When taking NF with antiepileptic drugs, careful observation and expert advice are crucial (Wilson, Kober, and Huster, 2019).

Figure 1: Responsiveness and non-responsive cases to neurofeedback (NF) training across different conditions.

Here is the statistical data represented in a bar chart, comparing the responsiveness to neurofeedback (NF) training across different conditions (Figure 1). The chart includes both responsive and non-responsive cases, with hypothetical data for each condition (Epilepsy, Traumatic Brain Injury, Severe Psychosis, and bipolar disorder). The percentages represent the proportion of individuals who responded positively to NF training versus those who did not.

Conclusion

Neurofeedback (NF) training has shown variable responsiveness in a variety of conditions, and its effectiveness varies according to the particular disorder being treated. According to Enriquez-Geppert, Huster, and Herrmann (2017), most NF study participants with learning disabilities (LDs) saw significant improvements, especially in academic domains like reading and math. Similar to this, NF seems to be a successful treatment for attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD), as evidenced by multiple studies that demonstrate long-lasting improvements in behavior and attention after the intervention (Arns, Heinrich & Strehl, 2014; Micoulaud-Franchi et al. in 2015). NF tends to benefit a large percentage of people in these populations, though precise response ratios are not always reported in research.

According to Baumeister, Wolf, and Holz (2022), NF has demonstrated efficacy in mitigating anxiety and depression symptoms, indicating a general improvement in emotional stability. NF has the potential to improve emotional regulation, according to the results of several meta-analyses; however, specific response rates were not always provided. With meta-analytic evidence demonstrating its ability to reduce symptoms, even in more severe cases like major depressive disorder, NF has demonstrated great promise as a treatment option for anxiety and depression.

The evidence also makes clear that responsivity to neurofeedback training is highly variable, shaped by the brain region targeted, the modality employed, and the individual’s neurophysiological and psychological profile. Even within appropriate paradigms, baseline neural activity, brain structure, connectivity, and reward sensitivity strongly influence outcomes, while motivation, mental strategies, and expectancy effects add further layers of complexity.

However, there are some situations where using NF training should be done with utmost consideration. It may be helpful in cases of bipolar disorder, traumatic brain injury (TBI), and epilepsy, but the evidence in these areas is still conflicting or lacking, so its application should be carefully monitored (Thornton and Carmody, 2013; Fisher, Boas & Blume, 2014). Studies on NF's use in severe psychoses like schizophrenia are still in their infancy, and the results have been conflicting. Similarly, NF has demonstrated promise as a supplemental therapy for bipolar disorder patients; however, it should not be used in place of traditional treatments (Bleich-Cohen et al. and Jensen & Steiner, 2022).

This article was written by Hitashi Sharma

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