Frequently Asked Questions
What is EEG Neurofeedback?
EEG Neurofeedback is a learning strategy that enables people to alter their brain waves. When information about a person's own brain wave characteristics is made available to him, he can learn to change them. You can think of it as exercise for the brain. There are a number of specific treatment protocols, and various ways to adjust each protocol, so that EEG Neurofeedback is not just one treatment, it is a technology which allows many specific treatments for specific objectives.
What is it used for?
EEG Neurofeedback is used for many conditions in which the brain is not working as well as it might, and to optimize function in healthy people.
Clinical conditions include Attention Deficit Hyperactivity Disorder, conduct problems, learning disabilities, issues such as sleep problems, teeth grinding, and various forms of chronic pain such as frequent headaches or stomach pain, or migraines. The training is also helpful with the control of mood disorders such as anxiety and depression, as well as for more severe conditions such as traumatic brain injury or autism.
Neurofeedback is being used with professional athletic teams and individual competitors to provide the highest levels of focus yet the ability to take micro-breaks. Performance enhancement applications include gaining the ability to optimize function in sports, academics or work.
How is it done?
An initial interview is done to obtain a description of symptoms and goals, and to get a picture of the health and family history. In most cases we do a full brain map (quantitative EEG) and some computerized neuropsychological testing, which will require a separate office visit. Subsequent training sessions last about an hour, and are conducted from one to three times per week. Some improvement is generally seen within ten sessions. Once learning is consolidated with additional training, the benefit appears to be permanent in most cases. There are published 10-year case followup reports of sustained gains.
The Neurofeedback training is a painless, non-invasive procedure. One or more sensors are placed on the scalp, and one to each ear. The brain waves are monitored by an amplifier and computer-based instrument that process the signal and provides the proper feedback. Feedback is displayed to the client by a video game or other video display along with audio signals. The client learns to make the video game go with his brain. As activity in a desirable frequency band increases, the video game moves faster, or some other reward is given. As activity in an adverse band increases, the video game is inhibited. Gradually, the brain responds to the cues being given, and a "learning" of new brain wave patterns takes place. The new pattern is one which is closer to what is normally observed, or closer to optimum.
Are There Contraindications for EEG Neurofeedback?
Generally there are no known contraindications for Neurofeedback. There are certain patient conditions for which the wrong kind of training would be highly undesirable. It is important that you receive training from an experienced, certified clinician. If you are under active medical treatment or in early stages of recovery from a medical problem, it is necessary to coordinate care with your other doctor(s). In some cases we may advise that you schedule Neurofeedback after other treatment is completed.
From a Performance Enhancement perspective, generally Neurofeedback is deep retraining, comparable to a specialized weight-training program or key-skills development. You do not delay a new program like that until the week before the major contest, exam, or project. That being said, training often will show initial results in a matter of a few sessions.
What disorders have clinical evidence?
All of the following disorders have clinical reports or case histories for Neurofeedback, and many have scientific reports: Alcoholism, Attention Deficit Disorder, Anxiety, Autoimmune Dysfunctions, Conduct Disorder, Chronic Fatigue Syndrome (CFS), Chronic Pain, Depression, Epilepsy, Sleep Disorders, Stroke/ Traumatic Brain Injury, and Tourette Syndrome.
What results do we expect in clinical situations?
In the case of ADHD, the impulsiveness, distractibility, and hyperactivity may all respond to the training. This may lead to much more successful school or work performance. Cognitive function may improve as well. In several controlled studies, increases of 10 points in IQ score were found for a representative group of ADHD children. And in two clinical studies, average increases of 19 and 23 points were demonstrated.
Behavior may improve in other ways as well: If a child has a lot of temper tantrums, is belligerent, and even violent or cruel, these aspects of behavior may come under the child's control.
In the case of depression, there can be a gradual recovery of emotional responsiveness, and a reduction of effort fatigue. In the case of anxiety and panic attacks, there is gradual improvement in "regulation", with a drop-off in frequency and severity of anxiety episodes and panic attacks until the condition normalizes.
In the case of epilepsy, many clinicians observe a reduction in severity and incidence (frequency of occurrence) of seizures. In many cases the dosage of anticonvulsant medication may ultimately be reduced (if ordered by the referring neurologist), and side effects of such medication may diminish.
Can a successful outcome be predicted?
It is not possible to predict with certainty that training will be successful for a particular person. But for the more common conditions we see, a reasonable prediction of outcome is usually possible. More important, however, the effectiveness of the training can usually be assessed early in the course of training. Very occasionally there can be transitory unpleasant effects when a new protocol is first being adjusted to a person's needs. For most conditions, there are no known adverse lasting side effects of the training, provided that it is conducted under professional guidance.
Please also see the page, "How Neurofeedback Works," by Jay Gunkelman
Why does this training procedure work?
The brain is amazingly adaptable and capable of learning. It can also learn to improve its own performance, if only it is given cues about what to change. By making information available to the brain about how it is functioning and asking it to make adjustments, it can do so. When the mature brain is doing a good job of regulating itself and the person is alert and attentive, the brain waves (EEG) show a particular pattern. We challenge the person to maintain this "high-performance" alert and attentive state. Gradually the brain learns, just like it learns anything else. And as with other learning, the brain tends to retain the new skill.
Please also see the page, "How Neurofeedback Works," by Jay Gunkelman
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. In some cases initial training goals may be met by twenty sessions, at which time the initial re-tests may be performed. I generally recommend a minimum of 20 sessions to assure that results of a particular protocol are lasting, but usually there are several protocols for a client. I suggest that people expect 40 -50 sessions, which is reported to be average by clinicians across the country.
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).
As indicated earlier, once learning is consolidated, the benefit appears to be permanent in most cases. However, you may benefit from additional refresher-session training. If you have some injury to the brain after training, or receive electrical stimulation treatment of the brain, then problems may return and you may benefit from additional training. If you have a progressive or cyclical disorder, you may benefit from a maintenance schedule of training.
Finally on a very positive note, as a result of your training you may realize that your options are broader than before so that you take on new opportunities. When you are then given new challenges you may want to return for refresher sessions to optimize your functioning.
Performance enhancement training duration is a matter of the objectives and circumstances. High-functioning brains acquire most tasks faster, including neurofeedback. Yet over-learning is the basis of permanance, very high skill levels, and execution under intense pressure.
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. If you are training several protocols at home, it is easy and economical to train more frequently. After learning begins to consolidate, the pace can be reduced.
Is EEG Neurofeedback covered by insurance?
The first step is an intake evaluation, generally covered by insurance. Neuropsychological testing is often covered as well. Then comes the qEEG in most cases, for which we require a prepayment. You should be prepared to pay out of pocket for qEEG and the training. For the training sessions we offer a cash prepayment volume discount. We will help you submit billing to your insurer when appropriate.
Some insurance plans now do cover Neurofeedback for various conditions. Most require co-payments, annual caps and pre-approval. A prescription for the training, along with a diagnosis, may be required from a physician under the medical part of the plan for medical conditions. Medicare does not pay for Neurofeedback in Kansas. We do not accept write-downs (required discounts imposed by insurers) that place our fees below our prepayment discount.
What can I tell my doctor about Neurofeedback?
Your doctor may not know of this specific type of Neurofeedback. He or she will maintain a healthy skepticism about any new approach claiming numerous benefits. If your doctor is familiar with Neurofeedback in general, he may still be thinking in terms of the more common early experiments with alpha wave training, rather than the training we offer. Ask your doctor to examine the recent research on the effectiveness of EEG Operant Conditioning in treating various disorders such as attention deficit disorder and epilepsy. The following references describe some of the research and are a place to start:
Evans, J.R. and Abarbanel, A. (1999) Introduction to Quantitative EEG and Neurofeedback. Academic Press.
Clinical EEG Vol. 31 No. 1 Jan. 2000. (Entire issue devoted to Neurofeedback.)
Lubar, J.O. and Lubar, J.F. (1984). Electroencephalographic biofeedback of SMR and beta for treatment of attention deficit disorder in a clinical setting. Biofeedback and Self-Regulation, 9, pp.1-23.
Shouse, M.N. and Lubar, J.F. (1979). Operant conditioning of EEG rhythms and Ritalin in the treatment of hyperkinesis. Biofeedback and Self-Regulation,4, pp.301-312.
The Journal of Neurotherapy is a peer-reviewed professional journal devoted entirely to Neurofeedback. The abstracts can be viewed at www.snr-jnt.org.
Or check these web pages: www.snr-jnt.org, www.eegspectrum.com, www.aapb.org, www.biofeedback.org
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