This is a page that just might answer the questions you have about neurofeedback. These questions are not unusual for people who are considering neurofeedback for themselves, a member of their family, or a friend. If you have any other questions about neurofeedback, neurofeedback therapy, or if you live near Palo Alto in the San Francisco Bay area and would like a consultation, please feel free to contact me.
What is neurofeedback?
What kinds of problems are neurofeedback used for?
Does everyone who does neurofeedback improve?
How do you decide how to treat a particular person?
How many sessions are usually needed?
How long are the sessions?
How does one learn from the feedback of the brainwaves?
How can I expect to feel after a session?
You talk about brainwave frequencies, but what does that mean?
What are the mechanisms that explain the efficacy of neurofeedback?
Is there any research showing the success of the use of neurofeedback?
Does your equipment do anything to me?
Do you decide to work with everyone who comes to you for neurofeedback?
I have always wanted to learn how to meditate, but have a lot of trouble quieting my mind enough. Would neurofeedback help?
What happens if a person is taking prescription medication, for example for attention deficit disorder or depression?
I play golf and would like to improve my game. Would neurofeedback be useful?
What does the term "Peak Performance" mean?
What is the difference between biofeedback and neurofeedback?
Are there any other terms for Neurofeedback?
Do you shave my head in order to attach the electrodes?
Since neurofeedback is a way of tuning the central nervous system, it is not surprising that it works for many other problems. Some examples are brain disorders like seizure disorder, closed head injury, stroke, and migraine. Even in a condition like multiple sclerosis the symptoms can be diminished. Another group of problems which can be alleviated are emotional conditions like depression, manic-depressive illness, and intermittent explosive disorder, in addition to chemical dependency and Post-Traumatic Stress Disorder. Sleep can often be improved, whether it is a part of depression, anxiety or a physiological, neurologically based condition. Many endocrine or immune system disorders respond well, too, for example fibromyalgia, Chronic Fatigue Syndrome and premenstrual syndrome. The list continues: Neurofeedback can also help older people who need to improve their memory. As we become older, our brains become less efficient, and tend to slow down. Neurofeedback can help to bring the brain function to a "younger" level. Another application is "peak performance", that is, performing at one's optimum level. (Back to questions.)
Analysis of the raw EEG is first undertaken to determine whether there are any signs of brain disease, which should be referred to a neurologist. The quantitative EEG helps me know which parts of the brain to pick, and what parts of the frequency band need to be retrained. In addition, I usually have the person take a computerized performance test called the TOVA (Test of Variables of Attention) or the IVA (Integrated Visual And Auditory) Continuous Performance Tests, which measure attention, impulsivity, and response time. Children may also take a battery of short tests, while I use questionnaires for adults.
I base the treatment plan on what the brainmap (QEEG) or constellation of symptoms show me, and fine-tune it by taking into account the TOVA or IVA, the results of any other tests and questionnaires, and the symptoms which the client reports. As the neurofeedback training proceeds, I repeat the various measures to monitor changes, and to develop the plan for further training. (Back to questions.)
Visually you see graphics, which change in response to your brainwave performance. Examples of graphics are spaceships, which fly faster when you produce more of a given frequency, with the competing spaceships signifying the undesired frequencies. Another example is a puzzle, which fills in as you proceed, or a bobsled or boat ride that moves faster the better you do in producing the desired frequencies.
Visual or auditory feedback is stressed depending on whether you learn better by watching the screen or by just listening while doing a mental task. In the case of chemical dependency treatment, or of meditation training, the session is done with the eyes closed, and a pleasant, lower tone is used for the auditory feedback. If we add the Roshi or pROSHI glasses, you can have either eyes closes or open, depending on the kind of glasses.
When you first begin the sessions, it is quite common that you have no idea what you need to do to get the feedback, as it takes some time to learn, but after a few sessions you will get an inner sense of what brain-state you need to go into, even though you probably are unable to verbalize it. (Back to questions.)
An arbitrary way to define brainwaves is to say that Delta is from 0 to 4 Hz, which is the brain frequency most predominant during deep sleep. From 4 to 8 Hz is called Theta and is the predominant frequency during the transition stage between wakefulness and sleep. The next frequency band along the spectrum is Alpha, which is associated with relaxation, or "idling" at 8 to 12 Hz, at least if it is measured in the posterior part of the brain. We call the brainwave of 12 to 15 Hz Sensory Motor Rhythm (SMR), and this is associated with bodily relaxation, while the next frequency band is called Beta and is predominant when one is focused. The segment of the Beta band which is trained is usually defined as being between 15 and 18 Hz. Gamma is a very high frequency at around 40 Hz and is associated with a focused state.
In general, when one is not sleeping or meditating, it is desirable to have a comparatively flat EEG, meaning that the different frequencies are relatively equal, although the slower frequencies always tend to have a higher amplitude that the faster ones. When the brain is inefficient due to genetic factors, illness, injury or age, the problem is most often one of having too much energy allocated to the slower frequency bands, i.e. Delta or Theta. Sometimes there is too much Alpha.
Depending on what we want to accomplish, the thresholds are set, so that the person gets reinforcement via graphics and a tone when he or she produces enough of the desired frequency, for example Beta above the threshold, and simultaneously produces little enough of the undesired frequency, for example Delta and/or Theta (below the inhibit setting). After a while the person gets a sense of what it feels like to be in the right "zone", and is able to reproduce that state of consciousness even when not connected to the instrumentation. It takes some time to learn it well enough so that it becomes a natural place to "hang out". The goal is to create flexibility, so that one can shift from one state to another as needed. (Back to questions.)
This alpha-theta training can bring up memories from your past, and one can sometimes require therapeutic help to process them, although in this state one usually has the ability to be a "witness" to possible traumatic memories without being re-traumatized by them. (Back to questions.)
Mind-altering medications often change the brainwave patterns, and therefore it is more difficult to rely on the brainmap for a treatment plan. Fortunately I can make allowances for the effects on the EEG of various medications, when I evaluate it, so if going off your medication for the purpose of getting an uncontaminated brainmap would cause you much discomfort, you need not do that. It is definitely possible to work with a person on medication, even though it is sometimes more complicated. (Back to questions.)
What is neurofeedback?
What kinds of problems are neurofeedback used for?
Does everyone who does neurofeedback improve?
How do you decide how to treat a particular person?
How many sessions are usually needed?
How long are the sessions?
How does one learn from the feedback of the brainwaves?
How can I expect to feel after a session?
You talk about brainwave frequencies, but what does that mean?
What are the mechanisms that explain the efficacy of neurofeedback?
Is there any research showing the success of the use of neurofeedback?
Does your equipment do anything to me?
Do you decide to work with everyone who comes to you for neurofeedback?
I have always wanted to learn how to meditate, but have a lot of trouble quieting my mind enough. Would neurofeedback help?
What happens if a person is taking prescription medication, for example for attention deficit disorder or depression?
I play golf and would like to improve my game. Would neurofeedback be useful?
What does the term "Peak Performance" mean?
What is the difference between biofeedback and neurofeedback?
Are there any other terms for Neurofeedback?
Do you shave my head in order to attach the electrodes?
What is neurofeedback?
Neurofeedback or EEG Biofeedback is a process whereby a person can learn to change his or her predominant brainwave pattern. The process begins with an electroencephalogram (or EEG, for short). An EEG is a record of the electrical activity of the brain, obtained by means of sensors attached to the surface of the scalp. These sensors pick up a wide variety of signals or brainwaves. The sensors (electrodes) are connected to an EEG biofeedback instrument, which is in turn connected to a computer. The signals are filtered and processed, and feedback is provided visually on the screen and auditorily from speakers or earphones. With this visual and auditory feedback, the person is made aware of when he or she is producing enough of the desired frequency within the brainwave frequency band. With practice, these new patterns can be trained to stay within desired limits, and the person is able to maintain the new patterns even when not in the neurofeedback situation. (Back to questions.)What kinds of problems are neurofeedback used for?
It is often used for attention problems, in disorders like Attention Deficit Disorder (with or without hyperactivity). In addition, other neurobehavioral disorders such as motor and vocal tics, obsessive compulsive behavior, Asperger's and mild autism respond well to the training.Since neurofeedback is a way of tuning the central nervous system, it is not surprising that it works for many other problems. Some examples are brain disorders like seizure disorder, closed head injury, stroke, and migraine. Even in a condition like multiple sclerosis the symptoms can be diminished. Another group of problems which can be alleviated are emotional conditions like depression, manic-depressive illness, and intermittent explosive disorder, in addition to chemical dependency and Post-Traumatic Stress Disorder. Sleep can often be improved, whether it is a part of depression, anxiety or a physiological, neurologically based condition. Many endocrine or immune system disorders respond well, too, for example fibromyalgia, Chronic Fatigue Syndrome and premenstrual syndrome. The list continues: Neurofeedback can also help older people who need to improve their memory. As we become older, our brains become less efficient, and tend to slow down. Neurofeedback can help to bring the brain function to a "younger" level. Another application is "peak performance", that is, performing at one's optimum level. (Back to questions.)
Does everyone who does neurofeedback improve?
Since almost everyone has the capacity to learn, most people benefit to some extent. Most studies show that 70 to 80 percent improve dramatically. In a research study everyone is treated according to the same plan. Since each individual's brain inefficiencies are different, we have an advantage in a clinical situation because we can individualize the treatment plan, tailoring it to the needs of the person. This usually ensures a higher rate of success. (Back to questions.)How do you decide how to treat a particular person?
I often, but not always, begin by performing a Quantitative EEG (QEEG). This is another way of saying that I obtain an EEG showing the brainwave forms at 19 sites on the head, using a cap with built-in sensors. This information is then processed by the computer, utilizing specialized software, and compared to the brainwave patterns of a database of normal brains. Several minutes of brainwaves are collected during the following conditions: with the eyes closed, with the eyes open, and during a task such as reading, listening or playing Tetris. A QEEG or brainmap is obtained for each of the above conditions.Analysis of the raw EEG is first undertaken to determine whether there are any signs of brain disease, which should be referred to a neurologist. The quantitative EEG helps me know which parts of the brain to pick, and what parts of the frequency band need to be retrained. In addition, I usually have the person take a computerized performance test called the TOVA (Test of Variables of Attention) or the IVA (Integrated Visual And Auditory) Continuous Performance Tests, which measure attention, impulsivity, and response time. Children may also take a battery of short tests, while I use questionnaires for adults.
I base the treatment plan on what the brainmap (QEEG) or constellation of symptoms show me, and fine-tune it by taking into account the TOVA or IVA, the results of any other tests and questionnaires, and the symptoms which the client reports. As the neurofeedback training proceeds, I repeat the various measures to monitor changes, and to develop the plan for further training. (Back to questions.)
How many sessions are usually needed?
Typically ADD requires about 40 sessions. Alcoholism takes 30 to 40 sessions. The number of sessions needed to achieve Peak Performance depends on your goal. Other conditions vary: for example, head injury or stroke take many more sessions to treat. If it looks as though a person will need a lot of sessions, he or she can use a home trainer (an EEG instrument), supervised by me. (Back to questions.)How long are the sessions?
With most neurofeedback training, the actual length of time spent getting feedback is half an hour, although young children may spend only 20 minutes. With chemical dependency it is usually 40 minutes and includes imagery at the beginning of the session. The time spent in the office is longer, allowing time for putting on the electrodes, and taking them off. Depending on the treatment protocol, the session lasts anywhere from 45 minutes to an hour or longer. The longer sessions are necessary for chemical dependency treatment. (Back to questions.)How does one learn from the feedback of the brainwaves?
Neurofeedback utilizes the principles of operant conditioning. One of my former clients said it is "like playing Nintendo with your brain". To set the stage for this to happen, I set a threshold, which determines how much you have to produce of a certain frequency before you get a tone. This frequency is often Beta, especially in the case of attention deficit disorder. In addition I set another threshold for the undesired frequency or frequencies, below which you need to stay in order to get the tone which means you are succeeding.Visually you see graphics, which change in response to your brainwave performance. Examples of graphics are spaceships, which fly faster when you produce more of a given frequency, with the competing spaceships signifying the undesired frequencies. Another example is a puzzle, which fills in as you proceed, or a bobsled or boat ride that moves faster the better you do in producing the desired frequencies.
Visual or auditory feedback is stressed depending on whether you learn better by watching the screen or by just listening while doing a mental task. In the case of chemical dependency treatment, or of meditation training, the session is done with the eyes closed, and a pleasant, lower tone is used for the auditory feedback. If we add the Roshi or pROSHI glasses, you can have either eyes closes or open, depending on the kind of glasses.
When you first begin the sessions, it is quite common that you have no idea what you need to do to get the feedback, as it takes some time to learn, but after a few sessions you will get an inner sense of what brain-state you need to go into, even though you probably are unable to verbalize it. (Back to questions.)
How can I expect to feel after a session?
Depending on what frequency is being trained, you may feel a little tired, as if you worked hard, or sleepy and a little spacey for a while after the session. This is natural, as you are doing the equivalent of aerobic training or weight-lifting with your brain. (Back to questions.)You talk about brainwave frequencies, but what does that mean?
Brainwaves are the manifestation of electrical impulses generated by different parts of the brain. We are interested in the frequencies of these brainwave oscillations from 0 to at least 40 cycles per second - or Hertz (Hz), as we call them for short. We usually have a mixture of frequencies at any given time, but the dominant frequency varies depending on the state of consciousness and on individual differences. The frequency bands have been named, using the Greek alphabet.An arbitrary way to define brainwaves is to say that Delta is from 0 to 4 Hz, which is the brain frequency most predominant during deep sleep. From 4 to 8 Hz is called Theta and is the predominant frequency during the transition stage between wakefulness and sleep. The next frequency band along the spectrum is Alpha, which is associated with relaxation, or "idling" at 8 to 12 Hz, at least if it is measured in the posterior part of the brain. We call the brainwave of 12 to 15 Hz Sensory Motor Rhythm (SMR), and this is associated with bodily relaxation, while the next frequency band is called Beta and is predominant when one is focused. The segment of the Beta band which is trained is usually defined as being between 15 and 18 Hz. Gamma is a very high frequency at around 40 Hz and is associated with a focused state.
In general, when one is not sleeping or meditating, it is desirable to have a comparatively flat EEG, meaning that the different frequencies are relatively equal, although the slower frequencies always tend to have a higher amplitude that the faster ones. When the brain is inefficient due to genetic factors, illness, injury or age, the problem is most often one of having too much energy allocated to the slower frequency bands, i.e. Delta or Theta. Sometimes there is too much Alpha.
Depending on what we want to accomplish, the thresholds are set, so that the person gets reinforcement via graphics and a tone when he or she produces enough of the desired frequency, for example Beta above the threshold, and simultaneously produces little enough of the undesired frequency, for example Delta and/or Theta (below the inhibit setting). After a while the person gets a sense of what it feels like to be in the right "zone", and is able to reproduce that state of consciousness even when not connected to the instrumentation. It takes some time to learn it well enough so that it becomes a natural place to "hang out". The goal is to create flexibility, so that one can shift from one state to another as needed. (Back to questions.)
What are the mechanisms that explain the efficacy of neurofeedback?
There is some evidence that increasing the faster brainwaves and decreasing the slower ones helps to activate the brain by increasing blood flow. There are also signs that the neurochemistry is altered by this method, but it is still not known exactly why it works. (Back to questions.)Is there any research showing the success of the use of neurofeedback?
The earliest research was on the use of neurofeedback for epilepsy. The prominent researcher was and still is Barry Sterman, Ph.D. One area which has been researched the most since then is that of attention deficit disorders; the pioneer in this work is Joel Lubar, Ph.D., who works with his wife Judith and have done follow-up studies up to 14 or 15 years. Another important area is alcoholism, pioneered by Eugene Peniston, Ph.D. and Paul Kulkosky, Ph.D., but research also exists on closed head injury and a variety of other disorders. For more information, visit the website of the Society for Neuronal Regulation. (Back to questions.)Does your equipment do anything to me?
No, the equipment does not send any electricity into you or in any other way do anything to you. It only picks up the tiny electrical signals from your brain through the scalp, and then feeds back to you how large the amplitude of the signal is. In other words, in a way the instrument is like a mirror, showing you how your brain is functioning, and telling you if you are on the right track. It could be said to be the ultimate form of micro-management. (Back to questions.)Do you decide to work with everyone who comes to you for neurofeedback?
I sometimes find that other problems in the family are more pressing and need to be dealt with before a child with attention deficit disorder is trained to focus with neurofeedback. For example, if one parent is an active substance abuser, or if the family has a lot of problems, which need to be worked on in counseling, these issues need to be the priority. In cases like these, I refer them out for the needed treatment and suggest that they come back when family life is less chaotic. (Back to questions.)I have always wanted to learn how to meditate, but have a lot of trouble quieting my mind enough. Would neurofeedback help?
Yes, it is an excellent tool for teaching you how to meditate. You can accomplish in a relatively short time what it would take years to do by simply practicing meditation. Usually you would learn how to produce alpha waves in the back part of your head. This is a state of quiet relaxation, which is very pleasant. If indicated, you could later be trained to produce both alpha and theta, depending on your brainwave "signature". This is a state of daydreaming, not unlike the hypnogogic state just before you fall asleep.This alpha-theta training can bring up memories from your past, and one can sometimes require therapeutic help to process them, although in this state one usually has the ability to be a "witness" to possible traumatic memories without being re-traumatized by them. (Back to questions.)
What happens if a person is taking prescription medication, for example for attention deficit disorder or depression?
The person would usually continue taking the medication until the neurofeedback has changed the brain function to a point where the medication is no longer needed. Children with ADD are often able to gradually decrease or even discontinue their medication. Adults with depression sometimes continue their medication, but have fewer symptoms, and sometimes they cut back or go off the medication. It cannot be stressed enough that you need to work with your doctor, if neurofeedback alters your need for medication, and I am always more than willing to cooperate with your doctor.Mind-altering medications often change the brainwave patterns, and therefore it is more difficult to rely on the brainmap for a treatment plan. Fortunately I can make allowances for the effects on the EEG of various medications, when I evaluate it, so if going off your medication for the purpose of getting an uncontaminated brainmap would cause you much discomfort, you need not do that. It is definitely possible to work with a person on medication, even though it is sometimes more complicated. (Back to questions.)