What is Neurofeedback?
Neurofeedback is most fundamentally a process of relaxation, and not a goal in and of itself. It is is provided for purposes of relaxation and to reduce stress. Clients who participate in Neurofeedback training may present with a variety of medical, psychological, physical and mental disorders, diseases and conditions, but Neurofeedback is never used to diagnose, treat, cure or attempt to cure any such things.
How does Neurofeedback work?
Neurofeedback training sessions are relaxing and non-invasive. A few tiny sensors are placed on the scalp at sites that correspond with the chosen protocols. The sensors continuously monitor and transmit EEG brain activity. The brain signals are amplified just enough to play back the wave forms on a computer screen, where the clinician can watch the “live” information.
These same signals activate specialized computer-based “games” that the trainee or client watches on a separate screen. Playing the game consists of interacting with a representation of your “live” brain activity and learning to relax.
The games reward the brain for changing its own activity; that is, for self-regulating. Over time, a relaxation response is “learned” as the brain sustains improved self-regulation.
Does Neurofeedback work with individuals who cannot respond to visual / auditory cues?
Neurofeedback can be administered successfully to all individuals. Alternative cueing devices are available for those who have special needs; technologies with vibrating tactile cues are used along with the standard devices.
Are there age restrictions on who can receive Neurofeedback?
Neurofeedback providers make individual choices about age groups they train. Some will not train children under the age of six, others will. There is no conclusive evidence to suggest any particular age is or is not appropriate for receiving Neurofeedback.
How long are Neurofeedback sessions?
Sessions are usually approximately 50 minutes long, with 15 to 20 minutes devoted to a progress review and twenty minutes to a half hour for Neurofeedback training.
How often must I attend Neurofeedback sessions?
It is very important to train 2 or 3 times a week (and perhaps even more often with more difficult challenges) for the first 20 or so sessions to foster noticeable stress reduction. At an absolute minimum, 1 training session a week is required, but results may be slowed by such infrequency. Generally speaking, after adequate progress in stress reduction has been made (this as defined by the provider and trainee relative to individually defined benchmarks for success) sessions may be titrated to once a week, and later to bi-monthly visits. Consistency is as important as frequency, especially in the earlier stages of training.
How many sessions of Neurofeedback will I need?
Because Neurofeedback is a natural relaxation process, no exact number of sessions can be predicted for any one individual. No two people experience the same rate of relaxation in exactly the same way. Unique environmental factors influence each person’s journey to stress reduction, as do individual aims. That said, there are some general rules of thumb. Often, though not always, a relaxation response may be noticed between the first few sessions and no later then the tenth treatment, with a minimum of 20 training sessions required for clients to experience a tangible reduction of stress levels with related functional performance improvements. Very often 40 sessions or more may be needed to ensure long-lasting results, with the average number of sessions completed by most individuals being somewhere around 50. Very serious stress-related conditions may require 60 to 80 training sessions or more. It is important to keep in mind that we are dealing with organic processes. Therefore it is helpful not to form rigid ideas about how training will progress or how many sessions one will undergo. Booster follow-up sessions are a good idea, and individuals often schedule ‘tune-ups’ on a quarterly basis after completing more intensive training. Often, there appears to be a cumulative benefit with the number of sessions undergone.
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How long do the effects of Neurofeedback last?
Results often appear to be long lasting. There appears to be a cumulative benefit with the number of sessions completed. However, the effects may less likely be sustained without completing around 40 and sometimes more sessions and titrating down over time. This allows the brain to learn to adjust its own regulatory activities without the cues provided by neurofeedback. Occasionally, a tapering effect after cessation of training is experienced given the passage of time or trauma-induced stressors (unforeseen accidents or other environmental or emotional precipitating events). Quarterly preventative booster sessions are recommended and a new round of training in the event of a trauma-induced relapse. Some serious conditions where organic decay has occurred may require indefinite treatments, in which case it is possible to transition to doing Neurofeedback training in the home.
Are there any side effects to Neurofeedback?
After more then 35 years of research and use, Neurofeedback has never produced a known negative, lasting side effect. Some individuals have reported experiencing subjective temporary iotragenic symptoms such as fatigue, frustration, sleep disruption, and so on, either while undergoing training or shortly after. These negative side effects usually last for only a short period of time and can be easily corrected using a substitute protocol. It is similar to starting a medication and needing to adjust the dosage or substituting one medication with another that is better tolerated. Another side effect of Neurofeedback is its impact on family dynamics. As the family member who is being trained learns to relax, other previously under addressed family issues may suddenly surface, causing temporary disruption as adjustments are made.
Can I continue to use my prescription medication?
Neurofeedback is an effective complement to medical prescriptive protocols and clients may exercise a number of options for medication use while undergoing Neurofeedback. These options should be managed with the oversight of a prescribing physician. Individual choices are based on specific needs and aims. Some trainees start their Neurofeedback while on medication and then choose to titrate off under the supervision of their prescribing physician. If timely and successful results are not forth-coming, referrals for further evaluation by a physician will be required and a medical prescriptive intervention will be called for in addition to Neurofeedback. Newly prescribed medications targeting brain function can be accommodated at any time during Neurofeedback, with the oversight of your prescribing physician.
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Is Neurofeedback covered by insurance?
Neurofeedback is sometimes covered under insurance codes in the United States. Some European providers reimburse for stand alone Neurofeedback training. The Insurance and Deductions section of this website provides more specific information.
Is it necessary to get a qEEG before starting Neurofeedback?
Several philosophies of practice dominate the field. Some clinicians require a quantitative analysis of EEG or qEEG, with a written report and interpretation before administering Neurofeedback training, while others do not. No data exists indicating traditional q-EEG-based training is any more or less efficacious then other training approaches. Consider whether a qEEG is really warranted (as in the case of brain injury), is affordable (can be prohibitive), and is an effective use of time (the procedure takes an hour or more depending on the equipment used, and may be an alienating experience, especially for children). Some Neurofeedback providers administer an abbreviated qEEg or “mini” Brain Map using EEG measured at 6 to 8 or more sites (a qEEG captures data at 22 or more). A data-based mini Brain Map is a statistically valid instrument, and is recommended over those that are not compared with a normative database. Hospitals specializing in head injuries provide comprehensive EEGs but without the quantitative analysis that a qEEG offers. Conventional imaging technologies like CT, MRI and PET may not capture abnormalities that a qEEG sometimes can, but a qEEG is not a diagnostic stand-alone procedure.
For a better understanding of comparative testing procedures , or for a more comprehensive description and comparison see neurological testing procedures.
Why isn't Neurofeedback more widely known and recognized?
In the last seven years, the number of Neurofeedback clinicians in practice world-wide has at least doubled. Although practitioners and clinics in the United States tend to be clustered in the Northeast and California, almost every state has at least one or two Neurofeedback providres. Professionals from many relevant backgrounds who have entered the field bare testament to a track record of efficacy. Prominently recognized affiliated organizations of the field include:
An impressive body of Neurofeedback research has been compiled over the last 38 and counting years. Neurofeedback provides evidence-based practices on par with health care establishment demands (Gemon, Devon & Ramsey (2000), Sacket et al, (2000), where "Efficacy" determination is derived from systematic evaluation in controlled clinical trials (La Vaque et al (2002) in which investigational treatment has been shown to be statistically superior to credible placebo, pill or alternative bona fide treatment in at least two independent researcher settings.
The field can be expected to grow and become more widely accepted, particularly as media coverage has increased, and as the field becomes more research-based.
Are Neurofeedback clinicians required to be licensed or certified in order to practice?
Some of the oldest and most respected leaders in the field today are not medically licensed, reflecting the fact that Neurofeedback extends well beyond the concerns of a single discipline. Consequently, it has been difficult to license the practice of Neurofeedback, given its' interdisciplinary proclivities. Providers who are nationally certified in EEG Biofeedback have completed the same training and national certification exams, regardless of licensure status. Theories of applied practice differ within the field, and results are similarly efficacious, though widely debated. The average consumer is well advised to be informed, and to also be wary of alarmist claims by some that licensure supercedes experience and other criteria in choosing a provider. After all, Neurofeedback is a learning and relaxation intervention, and NOT specifically a medical or psychological treatment.
Dr. Donald. C. Ferguson, Ph.D., MPH, of the Department of Psychiatry at the Uniformed Services University in Bethesda, Maryland, has written an article entitled "Licensure and Biofeedback". He suggests that " licensure in a health care field does not imply...[competence]...to practice biofeedback...In order to qualify to effectively and competently practice... professionals [should] obtain specific biofeedback training as well as supervised clinical experience...after completing training in a basic health discipline...There are a few exceptions to this general rule". A health discipline can include master's or doctoral prepared individuals in related fields, such as the Applied Behavioral sciences, where clinical licensure is not available, yet the professional is trained in multiple aspects of human behavior.
Dr. Ferguson stresses the "value of referring problems beyond the scope of [an individual's] practice [where applicable], and the desirability of actively collaborating with physicians and other health professionals as appropriate...No single physician, medical specialty or health discipline is uniquely qualified to deal with all aspects of the 25,000 plus medical diagnoses and ailments (see the International Classification of Diseases) humans may experience, nor is any single professional ordinarily equipped to deal with all aspects of certain single or multi-problem patients."
In Virginia, Maryland, District of Columbia and most U.S. jurisdictions, there is no law specifically regulating who can and cannot provide neurofeedback services. In the case of no previous training as a licensed health professional it is important for each consumer or prospective patient to check if a provider of neurofeedback has been trained, has relevant credentials, is experienced in providing the training being sought, and is nationally certified in EEG Biofeedback. The Neurotherapy and Biofeedback Certification Board (NBCB) certifies neurofeedback specialists, as does the Biofeedback Certification Institute of America and EEG Institute.
Perhaps the strongest indicator of competence in a Neurofeedback provider is number of years of experience. Consider all of these markers of competence in choosing a provider:
Five or more years of experience, national EEG Biofeedback certification, advanced professional credentials (relevant Master or PhD degree) completion of advanced Neurofeedback training with reputable institutions, and/or license for practice in relevant fields.
Remember, certification is one indicator of competence, but not a sole indicator, just as holding a mental health or medical license does not automatically confer competence.
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Is it possible to do Neurofeedback in my home?
Neurofeedback for purposes of relaxation can be administered in the home by a provider who is willing to do home calls with portable equipment in cases where the client is bedridden or home-bound. Individuals may be challenged with life-long intractable conditions, yet can improve their quality of life with indefinite Neurofeedback training. In such cases, it is highly advisable to explore arrangements for purchasing or leasing equipment to do home training.
The recommended path to home training is to complete 20 to 40 sessions with a professional Neurofeedback provider. Once the trainee is ready the provider can offer transitional consultation on a schedule to monitor progress and ensure proper instruction for the efficient use of Neurofeedback technology.
Are there cases where Neurofeedback does not work?
Neurofeedback has a good record of efficacy but it is not a stand-alone panacea; positive results cannot always be guaranteed given some mitigating circumstances.
For good results, trainees should attend sessions at least twice a week in the beginning stages of training and must be willing to maintain a consistent schedule for sessions; once a week or less initially will not yield efficacious and timely results.
Clients with recalcitrant stress-related conditions who have protracted functional deficits may need to exercise patience; relaxation responses may come more slowly then hoped for. typically, at least 20 sessions will be needed to yield a satisfactory relxation response, and up to 40 sessions or more to make lasting reductions in stress levels. Given these "rules of thumb", there is a natural tendency to cling to preconceived notions about how many sessions will be undertaken. It is helpful to remember we are dealing with organic functional processes, and set notions about how training will progress or how many sessions one will undergo may prove counterproductive.
In some cases, Neurofeedback is simply not enough in and of itself; psychotherapy, medication, neutraceuticals and other interventions may be required for the client to achieve ample progress, and appropriate referrals will be provided. Unheeded advice for supplementary care may well mean less efficacious results.
Neurofeedback training cannot replace sound life-style choices. An unstable home environment, poor nutritional practices, poor breathing habits, unstructured sleeping habits, substance abuse, improper medication titration, a lack of willingness to improve or not heeding professional advice or requirements are all factors that can make the difference between successful or mediocre results in receiving Neurofeedback.
Neurofeedback is a function-driven learning process, meaning that technicians make adjustments to ensure increased relaxation based on known functional base-lines. Sleep quality, appetite, anxiety levels, ability to concentrate, etc. are all indicators that guide providers during a course of training. Successful relaxation results are quantitatively more possible when a client can offer succinct information with regard to functional changes observed between sessions. Without adequate reporting from clients on changes observed between sessions, providers have no clear basis for making adjustments if needed. Collaboration and communication between trainee and Neurofeedback provider are of the essence.
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