Frequently Asked Questions About Neurofeedback
1. What is EEG Neurofeedback? Neurofeedback is an advanced form of biofeedback that allows a client to see and train his/her brainwaves to cultivate healthy, effective, and efficient patterns of activity. Since all behaviors, sensations, and emotions are based on brainwave functioning, neurofeedback training can 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. It is essentially a form of exercise for the brain that enhances flexibility and stability of the EEG.
2. What is it used for? Studies have shown neurofeedback to be effective with the following issues:
addictions, chronic fatigue syndrome, sleep disorders, anxiety/PTSD, conduct disorder, stroke/brain injury, attachment disorder, depression, Tourette’s syndrome, ADD/ADHD, epilepsy, chronic pain, OCD
Continuing research indicates effectiveness in many other conditions, including migraine headaches, bipolar disorder, eating disorders, memory disorders, learning and developmental disorders, behavior problems, speech disorders, TMJ, and multiple other stress induced symptoms. Ongoing studies are addressing ways neurofeedback can help optimize health.
In addition, EEG Neurofeedback is being used for Peak Performance Training in sports, performing arts, and business applications. It may also be helpful in reducing test anxiety and improving SAT scores.
3. How can it help so many problems? Because the electrical activity in the brain is responsible for controlling our attention, thoughts, behaviors, and the regulation of all of our bodily systems, any changes in brain functioning can have a broad impact. Brain mapping with Quantitative EEG actually lets us see what specific brainwave irregularities are behind certain cognitive, emotional, and behavioral disorders. Neurofeedback then allows us to train the brain to correct the irregularities as the brain learns about itself, strengthens communications, and develops better self-regulation. The results include positive changes in cognitive functioning, behavior, and mood, as well as decreased frequency of problems related to brain irritability, such as seizures, headaches, and panic attacks. If no particular problem is being targeted, then neurofeedback can help to optimize health by increasing the brain’s ability to self-regulate, focus, relax, and become more resilient.
4. How is it done? Sensors are placed on the client’s head to read the electrical activity or EEG in that area of the brain. (Note: These sensors are merely reading a signal from the client. No electricity is being administered to the client.) The brainwaves are displayed on a therapist’s computer while the client watches a game on a separate monitor. As the client produces more of the desired brainwaves and less of the unwanted patterns of brain activity he/she hears beeps and sees progress in the game on the client monitor. The therapist can adjust the challenge as necessary to increase learning. This is essentially an advanced form of the operant conditioning that has consistently proven to be successful in various forms of biofeedback for over 30 years.
5. How can I do well? This is the most frequently asked question! “Just make beeps,” is the answer. You cannot consciously control your brainwaves, and, in fact, if you try too hard to analyze it or worry about your performance, you will probably not “beep” as well. Brainwaves change constantly. The system is catching the brain making the desired pattern and rewarding it with visual game progress and beeps. This encourages the brain to produce more of that pattern. Your brain is hard-wired to want to do well and will do the work for you. Being physically relaxed, having the intention to learn, and paying soft attention to the training screen and beeps all help. In addition, good nutrition, regular sleep, exercise and other stress-reducing techniques enhance results. Take a tip from the little kids- they just plop in the chair and watch pacman eat the dots on the game screen.
6. Why does this work? Just as you can learn to play the piano by practicing, your brain can learn to create new connections and improve its own performance. Scientists have proven that the brain is much more adaptable, or plastic, than was originally believed. The brain learns by forming connections between nerve cells, making certain nerve pathways more readily and easily available for use. For example, when you first learn to ride a bike, you have to think about every part of the process. As you practice, it becomes easier until you are even able to think about something else while your brain handles the riding details effortlessly.
In the 1960s Dr. Barry Sterman measured a particular EEG rhythm in cats and then showed that the cats could be trained to produce more of that rhythm by rewarding them with sweet, warm broth. By chance he found out that the cats that had learned to do this were markedly less likely to have a seizure when exposed to large amounts of seizure inducing chemicals. Subsequently, experiments on humans proved that the frequency of seizures could be reduced with the same type of training. It turns out that humans could also produce more or less of a specific rhythm by merely rewarding them with beeps! It was later observed that, in the process of treating seizures with neurofeedback, the symptoms of ADHD were also decreased. Since these original neurofeedback studies were conducted, continued research has expanded the scope of applications and the clinical evidence in this field.
Many physicians, including neurologists, are still not familiar with this specific type of biofeedback and may be somewhat skeptical about a new approach. You may refer them to the websites or references we provide for scientific evidence. We are always happy to speak with them as well.
7. How will I know if this will work for me? There is strong evidence for success in training the previously listed conditions, but as with any medical or other type of therapeutic intervention, it is not possible to predict a particular individual’s response. We work hard to assess the likelihood of effectiveness in your specific case with an in depth interview. In addition, we will sometimes recommend that a brain map (QEEG) or other testing be performed before proceeding. Personal factors such as nutritional status or co-occurring conditions can affect outcome and may need to be addressed before one can maximize the benefits of neurofeedback.
It is important to realize that we are conditioning brain pathways, but often the best results occur when neurofeedback is combined with other forms of treatment and/or some homework. For example, we may recommend some forms of muscle relaxation or breathwork for you to practice. Your commitment and involvement are crucial to your progress. In some cases, after the original presenting symptoms are relieved, it is then time to address the situations and/or sources that may have caused the development of those symptoms in the first place. This can be as simple as learning not to automatically respond with muscle tension or it can involve more in depth work. We want the best outcome and lasting results for each of our clients.
8. Are there any adverse effects? In most cases there are no adverse effects of training, provided you are well supervised by a professional. This is a major advantage over many medications. The most common adverse effect is temporarily feeling tired, too “cloudy” or too “revved-up” briefly after a session. This is usually an indication that your training setting was a little too high or too low for you and is easily adjusted in the next session. (The sites for training are chosen by clinical assessment, but the most comfortable brainwave frequency varies by individual, much like your car has its favorite idling setting.) Your input and reactions help guide the course of therapy. One other important side effect can occur as treatment progresses. If you start neurofeedback training while taking a medication for your condition, as training progresses your need for the medication may be reduced and you may start feeling overly medicated. If this happens, we work with your prescribing physician to safely and appropriately reduce your medication.
9. How long does training take? After an initial one-hour interview and completion of any additional recommended testing, thirty-minute neurofeedback sessions will be scheduled twice a week. Sleeping between sessions allows the brain to process its learning. In addition, at certain intervals we may schedule a longer session to review progress and cover other matters. In some cases we may suggest incorporating additional forms of biofeedback or other therapies to maximize positive outcomes.
The most unpredictable variable is how many sessions it will take to achieve your goals. For uncomplicated ADD in children the average number of sessions is 40, but can still vary widely with individuals and severity of symptoms. Profound disabilities, longstanding disorders, or disorders secondary to brain injury may take much longer, although exceptions are always possible. Headache is an example of a condition that may respond very quickly or take months. The symptoms a person feels may be the result of a simple brainwave irregularity or the expression of a very complex situation that will require training at multiple sites. In many cases you may experience some initial positive response by the end of 20 sessions, so it is a good idea to begin with a commitment to complete 20 sessions. (This is much like exercise for your brain: you would not be in shape physically by going to the gym 10 times.)
Also, much like exercise, in many cases you do not do “the workout” for 40 sessions then quit cold turkey. We often wean the frequency of visits as you put your new brain pathways to work, and then offer review sessions as needed. For example, some ADD children may need a few sessions as they change hormonally. Some adults also come for occasional “touch-ups”.
10. What should I do to prepare? Please bring any relevant medical/psychological/educational information as well as your insurance information and form of payment to the initial one-hour intake visit. 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 are sick or feel as if you are coming down with something it is best to cancel your appointment because our brainwaves are different when we are physically ill.
11. Where can I find out more about neurofeedback? There are several informative websites, books, and articles. Here is a sampling-
www.aboutneurofeedback.com. This is an easy to use site with a great deal of information regarding neurofeedback.
www.eegspectrum.com This site also has a large number of links for specific conditions.
www.eegresearch.com Contains links to many research articles.
www.isnr-jnt.org This site includes an extensive bibliography of references.
A Symphony in the Brain by Jim Robbins
Getting Rid of Ritalin by Hill and Castro
Healing ADD by Daniel Amen
ADD The 20-Hour Solution by Steinberg and Othmer
Articles: There are far too many articles in both clinical and popular publications to list, but a number of them are available on the websites above.
EEG Neurofeedback For Treating Psychological Disorders”, Alondra Oubre, PhD., Psychiatric Times, Feb 25, 2002
Clinical EEG, January 2000 (Entire journal dedicated to neurotherapy).
Copy courtesy of Mary Ammerman, PsyD, Institute for Applied Neuroscience.