Navigating Neurofeedback

When I share with people that I am a neurofeedback therapist I am often met with a blank stare.  Most people have not heard of neurofeedback and if they have, they normally don’t know a lot about it.  Despite neurofeedback having been around for several decades it hasn’t become a part of mainstream culture.  This lack of awareness exists for various reasons, including the structure of health care and insurance in our society, as well as the fact that medication is often the first line of intervention for mental health.  Neurofeedback can be a powerful therapeutic resource and I would love for it to be widely accessible. How do you know where to start, if you are fortunate enough to have access to neurofeedback?  How does one navigate the field of neurofeedback?

First of all, let’s clarify what neurofeedback is and cover some of the terms.  “Neuro” means relating to the nervous system, and with neurofeedback we are working to influence brain cells called neurons.  A computer is used to read the electrical activity of these neurons, and we call this activity “brainwaves”.  Then “feedback”, or information, is shown to the brain about its own brainwave activity with the intention of making changes to how it functions.  It’s like we are presenting the brain with a mirror of what it is doing so that we can “train” the neurons to do something different.  There are many types of neurofeedback training available, but they all have the same goal – providing the brain with information about its own activity to make it more flexible.

Brain activity can get stuck in detrimental patterns for many reasons.  Sometimes connections between neurons just don’t develop as they should in childhood or they get altered due to injury or trauma. Inflexibility of these brainwave patterns can lead to mood dysregulation, attention disorders, intrusive thoughts, or other various health issues.  The goal of neurofeedback is to prompt the patterns of activity to change so that we perform better and feel better in daily life.

I want to be clear here that changing brain activity with neurofeedback isn’t necessarily a substitute for talk therapy.  It won’t alter your core beliefs or make you forget about things that happened.  Talk therapy is often an invaluable component in any healing journey.  What neurofeedback can do is provide more of a space for you on that journey.  A space between when something happens and when you respond- flexibility rather than a rigid pattern – where you can begin to choose or choose differently - and where your baseline feels more like a place of calm.

During a neurofeedback session, the clinician will use some gentle paste to attach electrodes (passive sensors) to your scalp.  These sensors pick up brainwave activity and send it to a computer program.  No electrical stimulation ever goes INTO your brain (except with the LENS approach which I will mention later).  The computer simply reads your brainwaves and then feeds back information to your brain in audio or visual form.  How this feedback happens depends on the type of neurofeedback training that you are doing. 

Great, so what kinds of neurofeedback are out there?

I mentioned there are many types of neurofeedback, and for someone starting to look into this therapy it may feel overwhelming.  It can be helpful to know a little bit about each approach so that you can decide what is best for you.  There is no right or wrong style of neurofeedback.  They each have pros and cons, and different types will work better for different people.  I think it is best to do your research, talk to different clinicians, and find which style resonates with you.  Below is a general overview of the most common approaches.

Traditional Neurofeedback – This is the type of neurofeedback that has been around the longest and is most referenced in research studies.  It is the approach of asking the brain to make changes to its electrical activity or to alter certain brainwave patterns.  For example, a person struggling with attention concerns will often have too many slow brainwaves near the front area of the brain.  During training, the clinician will set the criteria that the brain is supposed to meet – in this case decreasing the amount of slow brainwave activity.  When the brain meets these criteria and reduces the amount of slow brainwaves at the location, there will be a reward.  Often the reward is in the form of a movie or a game.  If the brain does not reduce its slow waves, the movie will be very dim or the game will stall.  If the brain can figure out how to decrease the slow waves, the movie will play clearly or the client will win the game.  The brain learns to perform what it is asked so that it can get the reward.

Typically, this type of neurofeedback begins with a qEEG, or brain map.  Brainwave activity is recorded from all over the brain and this activity is compared to a database of “normal” values.  This information guides the clinician to know where to place the electrodes and how to set the criteria for reward during training.  The goal of traditional neurofeedback is to bring the client’s brainwaves more towards the “normal” values.   

It is important to note that there isn’t always a clear course of action with every brain map.  It is a good idea to see a qualified practitioner who has experience interpreting maps or who works closely with someone who does.  The field of neurofeedback isn’t highly regulated but there is a certification program. If you want to look for a practitioner who is certified in neurofeedback you can visit the Biofeedback Certification International Alliance (BCIA).

Self-contained units – There are a wide variety of neurofeedback units on the market that require little clinician involvement. In other words, the protocols or rules for training are built into the software itself.  Sometimes these protocols are based on a brain map, such as the Brain-Trainer platform, or sometimes they are based on a symptom checklist, like the Brain Paint platform.  These types of neurofeedback systems gather information in their own way and then tell the clinician what protocol to use.  There is often little room for the clinician to adjust the training. 

There are also systems that you can buy online for home use only.  They are often geared towards a specific thing, such as the Muse Headband, which prompts a state of relaxation with one specific training protocol.  Anyone can purchase them and they are “one size fits all”.

Another common self-contained unit is NeurOptimal®, which is often done with a clinician but clients can be encouraged to rent or purchase their own at-home unit.  This particular device gives feedback in the form of music, offering the brain a mirror of its own activity so that it can adjust itself to function in an “optimal” way.  Systems such as this allow many more clinicians to practice neurofeedback without rigorous training, making neurofeedback more accessible.

LENS (Low Energy Neurofeedback System) – This is the only type of neurofeedback that actually gives a small amount of electrical stimulation to the brain.  The frequency of the stimulation is based on brainwave activity that is interpreted by the software, which is why it is considered a neurofeedback system.  The electrical stimulation feedback is very brief and the belief is that when the brain receives this small stimulation it allows it to reset itself.

Slow Frequency Training – There are a few styles of neurofeedback that train some of the slowest brainwaves produced.  Here I will focus specifically on Infraslow Fluctuation neurofeedback, or ISF, as that is the approach I use the majority of the time.  The Infraslow brainwave frequencies play an instrumental role in regulating the autonomic nervous system (ANS).  The ANS controls many functions such as heart rate, breathing, and blood pressure.  It is also responsible for our fight/flight/freeze response and our “rest and digest” state.  When our nervous system is inflexible we can find ourselves stuck in very anxious states or unable to be present in our daily lives.  Being able to target this system allows us a powerful means to regulate emotions and physiology.

During an ISF session the client relaxes and listens to a tone, which is like giving the brain a mirror of the infra-slow wave fluctuations.  This mirror is what prompts the changes, the brain is not asked to do anything specific.  My website has many more details, including links to the most recent research validating the effects of ISF neurofeedback.  I also have a brief video that shows a demonstration of a session.

Is neurofeedback right for me?

Because neurofeedback directly influences brain function it has the capacity to affect many different areas of concern.  Emotional dysregulation, attention deficits, panic, anxiety, sleep disorders, stroke, or brain injury – all of these things may be influenced by neurofeedback.  The biggest obstacle for people is often the financial and/or time commitment. Neurofeedback can take several sessions (it is impossible to say how many, most practitioners quote at least 30) as we are asking the brain to make lasting changes in how it functions.  I encourage prospective clients to compare it to talk therapy or lifestyle changes – when viewed in this way neurofeedback can make shifts in how one feels quite quickly.

I have seen neurofeedback make powerful, positive, and lasting changes. Often, when done simultaneously, neurofeedback can greatly facilitate progress in talk therapy. There is a lot of information available about the various neurofeedback systems and if you have questions please reach out to me or another licensed practitioner. Neurofeedback can be a valuable investment for your health and future.