Ethical challenges in EEG neurofeedback: a systematic review of gaps, risks, and responsibilities

Abstract This systematic review examines the ethical landscape of electroencephalographic neurofeedback (EEG-NFB). In accordance with the PRISMA 2020 guidelines, a comprehensive search of six databases was conducted between December 2024 and February 2025, yielding 23 studies that met the predefined inclusion criteria. A qualitative thematic synthesis identified seven recurring ethical challenges: (1) concerns regarding informed consent and autonomy, shaped by uncertainty surrounding efficacy and the influence of placebo and contextual effects; (2) issues related to non-maleficence and the psychological risks associated with participation; (3) challenges pertaining to justice and equitable access to EEG-NFB interventions; (4) tensions between scientific validity and the ethical use of placebo-controlled designs; (5) questions surrounding data privacy and the governance of brain-derived data; (6) ethical vulnerabilities affecting specific populations; and (7) neuroethical concerns arising from enhancement-oriented applications. Taken together, the findings indicate that ethical analysis has not consistently kept pace with the technological expansion and commercial dissemination of EEG-NFB. Persistent limitations were identified in data governance practices, practitioner training, and regulatory oversight. The present review therefore underscores the need for standardised ethical frameworks, sustained interdisciplinary collaboration, and further empirically grounded research to support the responsible, transparent, and equitable integration of EEG-NFB into both research and practice.