Absolutely Everything You Need To Know About Neurofeedback Therapy

By November 29, 2017Neurofeedback

What is Neurofeedback Therapy?

Neurofeedback is a technique that retrains the brain using advanced technology. By employing biofeedback and learning techniques to change activity in different areas of the brain, neurofeedback has been used to help improve conditions such as ADD, ADHD, autism, anxiety, chronic pain, depression, PTSD, auditory processing disorders, to name just a few. It is important to note that neurofeedback is training not medical treatment.

In the 1920s, the first EEG machine was devised which allowed for the monitoring of different brain waves. These waves were an indication of neural activity in different areas of the brain. Unlike imaging devices such as an MRI, which takes photos of brain structures, an EEG allows for the active monitoring of brain activity.

Neuroptimal therapy treatment

In the 1950s the pioneers of neurofeedback started using training methods to modify brain waves and thus the activity at different brain sites.  These early adopters showed that the brain could be modified using these methods, although at this time the accepted medical wisdom was that the brain couldn’t be changed and was fixed after a certain age.

Nonetheless, brain training was quickly accepted in some areas, for example, the space program where it continues to be part of astronaut development. The Defense Department also uses it, not just for the treatment of PTSD, but also for improving signal detection and cognitive performance.

What Are the Different Brain Waves?

Brain Wave Type Cycles per second Details
Delta waves 0-4 hertz Typically associated with deep sleep.
Theta waves 4-7 hertz Typically associated with light sleep or very relaxed, meditative states.
Alpha waves 7-14 hertz Relaxed wakefulness.
Beta waves 15-30 hertz Focused concentration and processing. The higher levels are associated with stress, anxiety and even obsessive rumination.
Gamma waves 32+ hertz Multi-modal sensory processing that involves processing two different sensory inputs


What is Neuroplasticity?

The old idea that the brain is fixed and doesn’t change after a certain young age has now been completely debunked. In the last decade there have been huge advances in the understanding of how the brain works. Perhaps the biggest advance is that we now know that the brain is very “plastic” or malleable. Rather than being fixed by a certain age, the brain is constantly changing, dependent on how we train it. In fact, we can continue to grow new brain cells throughout the lifespan and are constantly creating new pathways that underpin new behaviors and mental function.

There has been a lot of research on this topic. For example, musicians who play stringed instruments have motor areas of the brain responsible for fine movement that are far more developed than the rest of us. Trainee taxi drivers learning the complex geometry of London streets actually showed development of the spatial areas of their brains.

In one famous case a blind boy, Daniel Kish,  taught himself echolocation — the ability to navigate around physical space by listening to the echoes of sounds he emitted, like dolphins do. When Daniel was examined, the visual areas of  his brain had created new connections with the areas responsible for sounds, effectively enabling him to “see” sounds. Despite being blind he can ride a bike and do many things that would be unthinkable to someone who had no sight.

So, we now fully accept that not only can the brain be retrained, this is happening all the time through our own actions and behaviors.

How Does Neurofeedback Work?

The science behind neurofeedback is relatively simple. By providing feedback in one form or another, brain waves, and thus neural activity, can be trained to increase or decrease, depending on the goal of therapy. This is achieved by “reinforcing” the brain when it is producing the desired patters of activity.

For example, in neurofeedback for ADHD, one of the goals is to reduce theta wave activity, because theta waves are shown to be abnormally high in those suffering from ADHD.   At the same time, another goal is to increase beta waves, which are shown to be less frequent than normal in those with attention problems.


In practice this typically means that the user watches a video matched appropriately for age. The beautiful thing about neurofeedback is that any type of video can be used for training purposes, making the session fun and engaging for people of all ages. So, let’s assume that a 10 year old diagnosed as having ADHD is watching a fun video.

When his brain wave patterns are in the training range, in this case lower theta and higher beta, the video plays. When the child’s brain produces a different brainwave activity, the video stops playing. With repeated practice, brain activity is shaped by this training and achieves the “normal” beta/theta ratios symptomatic of normal brain function.

Is Neurofeedback Effective for ADHD and ADD?

Much of the early clinical work in neurofeedback was indeed geared towards the treatment of ADD and ADHD. Researchers have found several brain patterns characteristic of ADD and ADHD, like the high beta/theta ratio mentioned above. Some of this work has even identified which brain ADD brain patterns are most conducive to treatment with stimulant drugs, like Ritalin.

What is a Brain Map?

Neurofeedback sessions are typically preceded by a brain-map that shows the current functioning of the brain. This map is incredibly helpful for several reasons:

First, it is an objective reflection of what is going on in the brain. Many diagnoses, especially ADD and ADHD, are often very subjective and the diagnoses might not be reliable. However,  actually seeing brain patterns is incredibly helpful and fundamentally more objective. In addition, a brain-map is a wonderful visual representation of the brain, clearly showing the difference between a normal brain and one that has attention problems.

Identify Differences In Your Brainmap

Second, the ability to actually see the difference between a “normal” brain and that of a child with an issue like ADD can be crucial. More than once, I have had skeptical parents, who didn’t believe their child had an ADD problem, be completely convinced of the presence of the condition once they saw their child’s brain-map.

Benchmarking Your Cognitive Profile

Third, a brain-map is an incredibly valuable tool and resource, independent of whether you go on to have any neurofeedback sessions or not. That brain-map represents a snapshot at a particular time in your life and can be valuable down the road if you develop symptoms of cognitive decline. The initial brain map can serve as an incredibly valuable reference point.

Assist In Determining Treatment & Therapy Methods

Fourth, a brain-map can actually show whether any treatment, be that neurofeedback, medications, or other forms of therapy, is actually changing the brain for the better. Many treatments for psychological conditions are only verified by the subjective report of the client, or other observers. A brain-map is thus a much more objective assessment, again showing what is actually happening in the brain rather than how that dynamic is manifesting itself in the person.  

And because the brain-map doesn’t involve any conscious participation by the client, the brain-map can be repeated many times as there are no practice effects.

One way of looking at it is to imagine that you have a problem with your car. You take it to a mechanic, who spends the entire time asking you about your driving and the handling of the car. However, if he never looks at the engine and the actual car itself, he is only going to have a second-hand view at best of what is really going on. Neurofeedback is looking under the hood of the car and examining the engine and the working parts of the car.

Can Neurofeedback Help People With Autism?

Using variations on EEG brain mapping, researchers have identified six possible types of problem associated with autism spectrum disorders. These brain wave abnormalities probably underpin the different symptoms found in autistics.

  1. Abnormalities from several regions of the brain but most notably the left frontal lobe, an area involved in speech and language processing.
  2. Abnormalities in mirror neuron processing which effects empathy and the ability to understand how others are feeling, the so-called theory of Mind (ToM).
  3. Hypersensitivity reflected as high beta waves activity in sensory areas.  
  4. Poor coordination between different areas, with some areas being hyper coordinated and others lacking co-ordination. Hyper coherence in the frontal lobes might be responsible for obsessive rituals.
  5. Excessive delta-wave activity, which is related to poor attention and impulsiveness.
  6. Low voltage activity in many parts of the brain.

These dysfunctional areas can become the focus of neurofeedback training, with the possibility of significantly moderating autistic symptoms. Moreover, by looking at the brain in this way, research can specify the various different issues that characterize autism spectrum disorders, making it more understandable and potentially treatable.

Can Neurofeedback Treat Anxiety?

On a brain map, anxiety shows up as increased beta waves. Beta waves represent mental processing and the higher the frequency of Beta waves, the more one moves from normal processing to stress to worry to rumination to obsessiveness to delusional thinking. This matches well to our experience of stress, as our minds ramp up and thoughts start flying all over the place.

So, yes, neurofeedback can treat anxiety by training down the beta activity and training up alpha and even theta activity, which are associated with relaxed wakefulness. This highlights another  advantage of  neurofeedback: it bypasses the need for conscious effort on the part of the user. If you ask a stressed person just to relax, it’s likely that his or her brain would keep spinning. By targeting  the infrastructure of the brain directly, neurofeedback bypasses the problem of patient compliance. They don’t have to do anything, except watch the screen or even just close their eyes.

Another aspect of our training that it is valuable across the board but especially in the training of those with anxiety, is heart rate variability training (HRV). A hallmark of stress and anxiety is a high heart rate, a reflection of the activation of the fight/flight  response. On the perception of threat, the brain prepares the body for action by sending blood to large muscle groups and away from organs. It also increases  substances like cortisol and adrenaline,  as well as increasing heart rate. This is the sympathetic nervous system response to stress. The opposite process, conserving energy is a function of the parasympathetic nervous system.

When people are under stress, their heart rate goes up and shows little variability, a function of their fight/flight sympathetic nervous system arousal.

Obviously this is not healthy unless you really do need to run or fight. Heart rate variability training effectively trains the body to lower heart rate, which can help to manage stress and restore balance. In some research studies, HRV training enhances the effects of neurofeedback.

Can Neurofeedback Help Ease Depression?

Mood disorders, especially depression, are characterized by low energy levels and these can be detected on the brain-map. The goal of neurofeedback is to increase these low levels of energy and increase activation of critical parts of the brain.

Neurofeedback has also been used to treat bipolar disorders. In a manic phase, thoughts race uncontrollably as a result of a  faulty brain filter, the thalamus, which regulates sensory input. Reducing excessive processing in this area of the brain can calm the brain down and improve sensory filtering.

Can Neurofeedback Help Addiction?

Addiction is a brain disorder, involving various parts of the brain that have been hijacked by chronic  exposure to toxic substances. As a result, the relapse rate for addicts trying to quit drugs is very high.

Many centers have introduced neurofeedback into their addiction recovery programs. Neurofeedback can help balance the brain, reduce stress and reduce impulsivity, all of which can help the addict. Research shows that when added to the regular drug treatment regimen, neurofeedback can significantly enhance the chances of recovery.

Does Neurofeedback Help Dementia?

As we age a certain amount of cognitive decline is inevitable.  The question is that decline just normal aging or a sign of something more sinister? Again, looking at what is actually going on in the brain is incredibly helpful and can answer that difficult question.

Sometimes cognitive decline is not so much a result of structural issues in the brain but can also come from lack of stimulation. New pathways need to be, and can be built, leading to improved cognitive function.  This is especially helpful, as many people can be fatalistic about  dementia and cognitive decline assuming that there’s nothing they can do about it.

Nothing could be further from the truth. In fact, there is convincing evidence that lifestyle factors such as nutrition, sleep and exercise, play a major role in the development of cognitive decline and even dementia. And we know that new pathways can be built that can enhance memory, attention and cognition.

What is a Typical Neurofeedback Session Like?

The initial session is typically a diagnostic assessment, which includes the brain-map. These are now run off a standard computer. A cap, which can have anything from 12 to 19 electrodes on the inside, is fitted on the client’s head. These electrodes are strategically placed over key areas of the brain and record brain wave activity at these sites. The procedure is non-invasive and harmless. You might get  some conductive gel, used to facilitate transmission of the brain wave signal, in your hair but that’s about as bad as it gets.

Once a clear signal has been established, different areas of the brain are recorded in turn, once with eyes open and once with eyes closed. The whole procedure takes about 20-30 minutes.

Once the brain-map is available, it is explained and the implications described. The brain-map is compared to a  normative group matched for age and gender. This way, statistical abnormalities can be identified, and these then become the basis  for recommending neurofeedback. Research has been able to identify which neurofeedback protocols are most appropriate given the brain-map findings.

Analyzing Brain Signals During Neurofeedback Sessions

The neurofeedback sessions themselves again entail placing electrodes on the areas selected for training, so the computer can analyze the user’s brain signals and use them as a basis of the feedback. An appropriate and engaging video is then selected, and the user asked to simply view it.

The training parameters are then set. These could be keeping theta waves low and beta waves high, as with an ADHD user. Or it could be a low beta, high alpha protocol for someone with anxiety. The video plays but it will only continue playing while the user’s brain is showing activity within the desired parameters. If the brain signals are outside the desired parameters, the video stops playing and resumes once the brain signals show that is back in the desired ranges.

As the neurofeedback training progresses, the brain wave parameters become more specific. For example, in ADD training we start out with generally low theta and high beta parameters but these got much more specific as training progresses.

How Long Does It Take for Neurofeedback to Work?

Some people feel a difference after the first couple of sessions, for others it takes longer. It is commonly thought that an average of about thirty sessions is typical to get long lasting changes but some users have many more sessions, especially when they continue to feel and see the benefits.

It’s also beneficial to have a series of sessions at regular intervals after the initial training to consolidate learning. For example, someone with anxiety might feel benefit from 10 weeks of neurofeedback three times a week. After a break of a couple of months, they might come back for some consolidation sessions. Above all, however, brain maps can be repeated  regularly to show any differences that have occurred in brain function since the treatment has begun.

Can I do Neurofeedback and Brain Training at Home?

It is now possible to do neurofeedback from your own computer at home guided by a remote coach or monitor. These are particularly helpful for the experienced user who doesn’t need much guidance in what to do.

Neurofeedback and brain training can also be enhanced by other devices that similarly train the brain and can be used anywhere. For example, light and sound machines have been around for a long time, particularly to reduce stress and anxiety.  These have become much more sophisticated and are combined in to Audi-Visual Entrainment (AVE). 

They are easy to use and effective even in the short term. For example, when stressed, using the machine’s calming program can change your brain state quickly and be maintained for several hours. Mind Alive is run by pioneer Dave Siever, who now has developed technology that allows specific signals to be sent to the different hemispheres of the brain, thus increasing the machine’s versatility and effectiveness.

Other centers, like the NeuroCare Clinics use transcranial stimulation and neurofeedback to address anxiety based issues, insomnia, ADHD and depression.

The brain is the basis of emotions, thoughts and behavior. So it should be only natural that, when considering all sorts of behavioral and psychological issues, we should take advantage of the technology that now allows us to easily and simply see what is happening in the brain. In fact, it seems likely that neuroscience, brain mapping and brain training will all become standard parts of treatment for these conditions. As Daniel Amen, a psychiatrist and pioneer in using brain assessment for diagnosis of clinical conditions rightly says:

“98% of my colleagues are committing malpractice” when they don’t look at the patient’s brain for diagnostics. “We’re the only specialty that doesn’t look at the organ they treat,” he adds. That is about to change.