What is Neurofeedback?

What is Neurofeedback? Who can it help? What does it look like? Does it really work?

What is Neurofeedback?

Neurofeedback, also known as EEG Biofeedback, is a brain-based therapy that uses a sophisticated brain-computer-interface (BCI) to help people change their own patterns of brain activity by training brainwaves, the tiny electrical signals produced by the brain. Neurofeedback harnesses the natural ability of the brain to change its own structure and function, a process known as ‘neuroplasticity.'

Brain training is not new. For example, people have been changing their own patterns of brain activity for thousands of years during the practice of meditation. Neurofeedback is not meditation but instead uses modern technology to help people change very specific patterns of brain activity to improve how their brain works.

Neurofeedback is suitable for people of almost all ages. People sit comfortably and relax during training whilst sensors precisely detect and measure brainwave activity. This information is analysed in real-time and presented as audio and visual feedback. This real-time feedback can be used to improve brain function, through a process known as ‘conditioning’, a type of learning.

Neurofeedback is often guided by information from special brain scans known as QEEG (Quantitative Electro-Encephalogram). The information from these scans can allow for more specific and targeted training.

History of Neurofeedback

Neurofeedback was pioneered in the late 1950s and 1960s by two researchers: Dr. Joseph Kamiya (University of Chicago, USA) and Dr. Barry Sterman (University of California, Los Angeles, USA).

Dr. Kamiya found that with neurofeedback training people could learn to increase specific brainwaves, known as “Alpha”, associated with a state of relaxation by providing simple feedback using just the sound of a bell as a reward. At around the same time Dr. Sterman found that cats could be trained to increase specific brainwaves, known as “SMR” or “Lo-Beta”, associated with a state of physical stillness and mental alertness by providing food as a reward. Several years later Dr. Sterman was working with NASA investigating whether rocket fuel could cause seizures and he used the same cats in these new experiments. He discovered that cats that had been trained to produce more “SMR” or “Lo-Beta” brainwaves were much less likely to experience seizures than cats that had not done previous brainwave training. Dr. Sterman then applied his research findings to people with epilepsy. He discovered that more than 80% of people could significantly reduce their epileptic seizures using “SMR” or “Lo-Beta” neurofeedback training.

In the 1970s, Dr. Joel Lubar (University of Tennessee, USA) first discovered that neurofeedback was an effective treatment for children, adolescents, and adults with Attention Deficit Hyperactivity Disorder (ADHD). Since then, as they say, the rest is history…

For a detailed account of the history of Neurofeedback see: ‘Neurofeedback - The First Fifty Years’.

Who can benefit from Neurofeedback?

As psychiatrist Dr. Norman Doidge describes in the internationally best-selling book ‘The Brain’s Way of Healing - Remarkable Recoveries and Discoveries from the Frontiers of Neuroplasticity’ (2015):

“Neurofeedback is a sophisticated form of biofeedback and an extremely versatile treatment. It has recently been recognised by the American Academy of Paediatrics as a treatment for removing ADD and ADHD symptoms as effectively as medications. It rarely has side effects, as it is a form of brain training. It also has been approved for the treatment of certain kinds of epilepsy and is effective for many other conditions, including certain kinds of anxiety, post-traumatic stress conditions, learning disorders, brain injuries, migraines, and sensitivities that affect the autistic spectrum, to mention a few. It is a neuroplastic treatment but is not better known because it was pioneered before neuroplasticity was widely understood.”

In summary, neurofeedback is suitable for people of almost any age, from young children to the elderly. Clinical research and expert reviews indicate that Neurofeedback is an effective treatment for conditions including ADHD, anxiety, and depression. There is also evidence indicating that neurofeedback may be helpful in the treatment of other conditions including (but not limited to) Autism, epilepsy, insomnia, memory and performance, PTSD (post-traumatic stress disorder) and TBI (traumatic brain injury).

What happens during a Neurofeedback session?

Whilst there may be some differences between clinics most neurofeedback sessions will look very similar.

Firstly, people will usually sit comfortably in a chair and the clinician will prepare the person for training by using a special non-toxic gel to gently clean the areas of the head where the electrodes will be attached. The clinician then attaches the electrodes to the head using a special non-toxic conductive paste. Care is taken to ensure that the correct “training sites” (the brain areas to be trained) are located. The electrodes are connected to a brain-computer-interface (BCI) that amplifies the brainwaves that are detected beneath the electrodes. This amplified signal is processed by a computer using specialised software that provides feedback to the person about their own patterns of brain activity.

Next the clinician will select the correct “training protocol” - This is when the clinician can select the specific brainwaves that the person will be training. For example it is common for people to train to increase “Alpha” brainwaves to promote relaxation and reduce anxiety, or to train to decrease “Theta” brainwaves and increase “Beta” brainwaves to improve attention and focus. Everyone is different and training protocols are usually determined by carefully considering information from a number of sources including QEEG Brain Scans and/or other brain imaging, published research and evidence, a person’s history and goals and their response to previous therapies, and last (but by no means least) clinical experience with past and similar cases.

Once the correct training protocol is selected, and the person is comfortable, training starts. There are some differences between Neurofeedback systems however in most instances the “feedback” is audio and/or visual. Sometimes this may be in the format of a simple bar graph display or a video game. In other systems, a person may be training whilst they watch a video where the picture and sound fade in and out. During training people may be encouraged to “keep the bar above a certain level” or “move the rocket as fast as possible” or “try and see as much of the movie as you can”. This is not a conscious process and is not always easy at first but with repeated practice, over time most people can learn to control their brainwaves and change patterns of activity in their brain.

Finally, after the training session has finished the clinician carefully removes the electrodes from the person’s head and wipes away any remaining paste. There is little to no mess.

How frequently do people usually do Neurofeedback?

Neurofeedback can be thought of as a type of learning: Your brain is learning to control itself by “strengthening” or “rewiring” specific connections or neurological pathways. This is no different in principle to a young child learning how to regulate their emotions, to a teenager learning how to drive or play a musical instrument, or an adult learning a new skill for work. As with all learning-based activities, the frequency of training sessions can make all the difference. It is exactly the same with Neurofeedback and in most cases, people will typically “train their brain” at least twice per week.

How many sessions of Neurofeedback are needed?

Some people choose neurofeedback for “peak performance”, some choose neurofeedback to improve their attention at school or work, and others choose neurofeedback to help improve their mental health. In many, but not all cases, people choose neurofeedback after all other attempts have failed. Everyone is different, however, on average it is very common for people to do at least 20 sessions of training and in many cases, people choose to continue as they pursue further gains.

Is Neurofeedback safe and are there any side effects?

Side-effects from neurofeedback are rare. There are no reported incidents of serious adverse events reported in the literature since the inception of neurofeedback in the late 1950s. The vast majority of people will feel nothing during or immediately after neurofeedback training. A few people however can experience mild reactions such as fatigue, headache or irritability. These effects are rare and usually short-lived and typically reduce after a few training sessions.

Does Neurofeedback always work?

No treatment works for everyone all the time and neurofeedback is no different. Research shows that at least 75% of people can benefit from neurofeedback. In practice the majority of people will see improvements within a few weeks, which means that most will report progress within a relatively short period of time.

How long do the effects of Neurofeedback last?

The evidence supporting the long-term benefits of neurofeedback range from individual case studies to large randomised controlled trials. These studies have followed people from 6 months to 10 years after finishing neurofeedback and demonstrated that the results and benefits are maintained long-after sessions have stopped.