What is Neurofeedback?
Neurofeedback training, also referred to as EEG Biofeedback, is a learning strategy that enables persons to alter their brain waves. When information about a person's own brain wave characteristics is made available to him/her, they can learn to change them. Because all behaviors, sensations, and emotions are based on brainwave functioning, training the EEG (electroencephalogram) can help the client reduce stress and stress related symptoms, regulate emotions, improve attention, concentration, and performance, and in many cases reduce or eliminate the need for medications for a variety of disorders. You can think of it as exercise for the brain that enhances flexibility and stability of the EEG.
How is it done?
An initial interview is done to obtain a description of symptoms, and to get a picture of health history and family history. Some testing may be done as well. The Neurofeedback training is a painless, non-invasive and healthy procedure. One or more sensors are placed on the scalp, and one to each ear. These sensors are merely reading a signal from the client. No electricity is being administered to the client. The brainwaves are displayed on the therapist’s computer while the client watches a training screen on a separate monitor. As clients produce more of the desired brainwave patterns and less of the unwanted activity, they receive auditory and visual feedback reflecting their progress on the training screen. The therapist can adjust the challenge level as necessary to increase learning. This process is essentially an advanced form of operant conditioning that has been successfully used in more traditional types of biofeedback for over 30 years.
The brain waves are monitored by means of an amplifier and a computer-based instrument that processes the signal and provides the proper feedback. This is displayed to the trainee by means of a video game along with audio signals. The trainee is asked to make the video game go with his brain. As activity in a desirable frequency band increases, the video game moves faster. As activity in an adverse band increases, the video game is inhibited. Gradually, the brain responds to the cues that it is being given, and a "learning" of new brain wave patterns takes place. The brain is amazingly adaptable, and capable of learning. It can learn to improve its own performance, if only it is given cues about what to change.
During the training sessions, you cannot force your brainwaves to change, and, in fact, if you try too hard to make it happen or worry about your performance, you won’t do as well. Brainwaves naturally and constantly change. The computer catches the brain whenever it creates the desired pattern and rewards it with visual and auditory feedback. This encourages the brain to spend more time producing the desired pattern. Your brain is hard-wired to want to succeed and will do the work for you. It helps to physically relax, set the intention to learn, and then pay soft attention to the visual and auditory feedback on the training screen. In addition, good nutrition, regular sleep, exercise, and other stress-reducing techniques enhance results.
Neurofeedback utilizes the same learning process that occurs whenever we acquire any new skill. The brain learns by forming connections between nerve cells, thereby making certain nerve pathways more readily and easily available for use. The more frequently these pathways are employed, the more efficient the brain becomes at performing the associated task. For example, when you’re first learning to ride a bike, you have to really concentrate on every part of the process. With enough practice, however, riding becomes easier. Eventually, you’re able to think about something else entirely while your brain effortlessly handles the details of riding the bike. Likewise, by repeatedly practicing desired brainwave patterns, your brain gets better at automatically regulating itself.
What Therapeutic Applications have clinical evidence?
Studies have shown Neurofeedback to be effective with the following disorders:
• Attachment Disorder
• Chronic Fatigue Syndrome
• Conduct Disorder
• Chronic Pain
• Sleep Disorders
• Stroke/Brain Injury
Case studies indicate that neurofeedback is effective with many other conditions, including migraine headaches, bipolar disorder, eating disorders, memory problems, learning and developmental disorders, behavior problems, speech disorders, TMJ, and multiple other stress induced symptoms. Moreover, neurofeedback is used for peak performance training in sports, the performing arts, and business applications. Ongoing research is addressing additional ways neurofeedback can be used to optimize health and brain functioning.
Can a successful outcome be predicted?
As is true with any medical or therapeutic intervention, it’s impossible to guarantee a positive outcome. But for the more common conditions we see, a reasonable prediction of outcome is usually possible. The likelihood of effectiveness in each specific case is assessed with an in depth interview, scientifically validated assessment measures, and basic brainwave recordings. More important, however, the effectiveness of the training can usually be assessed early in the course of training.
For the routine sessions it is best to come well rested, if possible, and with the intention to let your brain learn. Clean hair helps us record a better signal. If you’re sick or feel as if you’re coming down with something, it’s best to postpone your appointment until you’re feeling better. Brainwaves are affected by physical illness.
In certain situations, we may also recommend that a more comprehensive brain map (QEEG) or other testing be performed before proceeding with training. Personal factors such as nutritional status or co-occurring conditions can affect outcome and may need to be addressed before an individual can truly maximize the benefits of neurofeedback.
How long does training normally take?
EEG training is a learning process, and therefore results are seen gradually over time. For most conditions, initial progress can be seen within about ten sessions. Initial training goals may be met by twenty sessions, at which time the initial retests are usually performed. In the case of hyperactivity and attention deficit disorder, training is expected to take about forty sessions, or even more in severe cases. Teeth grinding usually responds in twenty sessions. Some symptoms of head injury often respond in less than twenty sessions (quality of sleep; fatigue; chronic pain), whereas others may require longer training before they show an initial response (memory function, for example).
The most unpredictable variable is how many training sessions it will take to achieve your goals. A person’s presenting problems may be the result of a simple brainwave irregularity or the expression of a very complex situation that will require training at multiple sites around the brain. Profound disabilities, longstanding problems, or disorders secondary to brain injury may take much longer to resolve, although exceptions are always possible. In many cases, positive changes are noticed by the end of 20 sessions, so it’s helpful to begin training with a commitment to complete at least 20 sessions. (Neurofeedback is much like exercise for your brain: you wouldn’t expect to be in excellent physical shape after only 10 visits to the gym.)
How frequent should the training sessions be?
In the initial stages of learning, the sessions should be regular and frequent, at two or three sessions per week. After learning begins to consolidate, the pace can be reduced.
Is Neurofeedback training covered by insurance?
Many medical and psychological insurance plans now cover biofeedback for various conditions. Some require co-payments. Other plans have annual caps. A prescription for the training, along with a diagnosis, may be required from a physician under the medical part of the plan, or from a licensed psychologist under the mental health services part of the plan. Medicare pays for EEG biofeedback for some conditions.
My doctor is not familiar with Neurofeedback training. What can I do?
Your doctor may not know of this specific type of biofeedback. He or she will maintain a healthy skepticism about any new approach claiming numerous benefits. If your doctor is familiar with EEG biofeedback in general, he may still be thinking in terms of the more common early experiments with alpha wave training, rather than with the training we are dealing with here. Ask your doctor to examine the recent research on the effectiveness of EEG biofeedback in treating various disorders such as attention deficit disorder and epilepsy. The following references are a place where he or she can start:
▪ Duffy FH (2000). The state of EEG biofeedback therapy (EEG operant conditioning) in 2000: an editor’s opinion Clinical Electroencephalography, 31, v-vii.
▪ Egner T, & Gruzelier JH (2004). The temporal dynamics of electroencephalographic responses to alpha/theta neurofeedback training in healthy subjects. Journal of Neurotherapy, 8, 43-57.
▪ Fernández T et al (2003). EEG and behavioral changes following neurofeedback treatment in learning disabled children Clinical Electroencephalography, 34, 145-52
▪ Hirshberg LM (2005). Emerging brain-based interventions for children and adolescents: overview and clinical perspective. Child and Adolescent Psychiatric Clinics of North America, 14, 1-19
▪ Lubar JF & Lubar JO (1999). Neurofeedback assessment and treatment for attention deficit/hyperactivity disorders (pp. 103-143). In JR Evans & A Abarbanel (Eds), Introduction to quantitative EEG and neurofeedback. San Diego: Academic Press.
▪ Rossiter T. (2004). The effectiveness of neurofeedback and stimulant drugs in treating AD/HD: Part I. Review of methodological issues. Applied Psychophysiology and Biofeedback, 29, 95-112; Part II, Replication. 29, 233-43.
▪ Sterman, M.B. (1996). Physiological origins and functional correlates of EEG rhythmic activities: Implications for self-regulation. Biofeedback and Self-Regulation, 21, 3-33.
▪ Trudeau DL (2005). Applicability of brain wave biofeedback to substance use disorder in adolescents. Child and Adolescent Psychiatric Clinics of North America, 14, 125-36