Effect of EEG neurofeedback therapy on addiction disorders: A systematic review and meta-analysis

Abstract

Background and aim: Recently, electroencephalogram neurofeedback (EEG-NF), a non-invasive neuromodulation technique, has shown promising potential in treating addiction disorders. However, the heterogeneity of clinical populations and research methodologies make it challenging to reach consistent conclusions regarding its efficacy. This meta-analysis investigated the therapeutic effects of EEG-NF on addiction disorders, including both substance and behavioral addictions.

Methods: A systematic review was conducted in PubMed, Cochrane Library, Embase and Web of Science, including 17 randomized controlled trials (RCTs) published between 2000 and 2025 that utilized EEG-NF for addiction treatment, with a total of 662 participants. Subgroup analyses were carried out based on addiction type and neurofeedback modality, alongside meta-regression analyses considering publication year, sample size, age, sex, number of sessions and duration.

Results: EEG-NF statistically significantly alleviated addiction symptoms (Hedges'g = 0.85, P < 0.001), with stronger effects on substance addiction than behavioral addiction. Auditory feedback was the most effective modality, while audio-visual feedback was less effective and visual feedback was the weakest. Despite significant heterogeneity, subgroup and meta-regression analyses suggested that neurofeedback modalities and the number of neurofeedback sessions may be the primary factors influencing therapeutic efficacy.

Conclusion: This systematic review and meta-analysis provides robust evidence supporting the efficacy of electroencephalogram neurofeedback (EEG-NF) in the treatment of addiction disorders, with particularly promising results for substance use disorders. Our findings underscore the critical need for protocol optimization, emphasizing both modality selection and careful dose-response calibration to maximize treatment outcomes.

Keywords: addiction disorder; behavioral addiction; brain stimulation; drug addiction; electroencephalogram; meta‐analysis; neurofeedback; neuromodulation; substance use disorder; systematic review.