This is probably the most frequently asked question on the topic of EEG neurofeedback. In my experience as a therapist and neurofeedback practitioner, I know how important your goals and your well-being are to you, and I am confident in your success.
It’s recommended that individuals complete 20-40 neurofeedback sessions to see a measurable effect on their condition. Meta analysis on the topic of neurofeedback for ADHD (Pimenta et. al., 2019), anxiety (Chao Chen et. al., 2021), depression (Fernandez-Alvarez et. al., 2022), autism spectrum disorders (van Hoogdalem et. al., 2021), obsessive-compulsive disorder (Zafarmand et. al., 2022), PTSD (Panisch et. al., 2021), traumatic brain injury (TBI) (Kim and Priefer, 2020), migraine (Walker, 2011), and epilepsy (Morales-Quezada et. al., 2019) all point to 20-40 sessions as a good number of sessions before seeing a major difference. The number of neurofeedback sessions necessary will vary from person to person, based on the severity and type of problem being addressed.
Since sessions tend to be scheduled two to three times per week, the good news is that it does not take long to see results.
Why the number of neurofeedback sessions will vary from person to person
As mentioned above, the number of neurofeedback sessions required to see improvement in a condition varies. The primary factor is the level of severity of the problem being addressed. In neurofeedback training, normative databases are used to compare the individual to a group of subjects in the same age group with no diagnoses or head injuries, and this can give an indication of how the individual’s brain activity may deviate from the average population.
When investigating the specific biomarkers for a given disorder, this comparison will give us a basis for determining how many sessions will be required. The next most critical factor is the consistency and frequency of the training. Individuals who are committed to their goals will be rewarded for their persistence by accomplishing more results in fewer sessions.
How many neurofeedback sessions before we start seeing a difference
When beginning neurofeedback brain training, the effects of training can be quite dramatic. Many individuals will report changes from the first session. Others may find that it takes multiple rounds to perceive a difference.
Principles of neuroplasticity hold that neurons that fire together wire together (see Dr. Norman Doidge’s The Brain that Changes Itself for more details). In these individuals, repetition is a necessary component of any lasting change in neuronal networks.
Tracking the results of training sessions becomes a crucial component of successful training, as the brain begins to perform differently after each round of training, and protocols are tailored to the individual to optimize performance. It is not necessary for the individual to understand complex neuroscience for it to be effective, but your experience of the training and its effects will be an invaluable element of successful neurofeedback.
Some effects of neurofeedback training may feel different to the individual initially, such as mental fatigue. These can be promising signs that the training is effective. Often, a neuronal pathway that is neglected, like a muscle, can atrophy, and protocols that challenge the trainee to use these pathways can experience tiredness after a productive session.
These initial results typically do not linger, and there is often a rebound effect where individuals report that they feel energized, or notice marked improvement in each focus area. This rebound effect may be short-lived at first, but repetition will extend the effect progressively until it becomes the default state.
As with any form of learning, neurofeedback will exhibit a learning curve or period it takes to acquire a new skill or knowledge. As with learning, the skills acquired will prove to last over time. This is similar to the principle by which we never really forget how to ride a bike, even if it is collecting dust in our garage.
In fact, studies show on post-training follow-up results improve even after training is concluded. This is because neuronal pathways, once established, continue to strengthen because cells that fire together wire together, exhibiting the brain’s built-in capacity for optimization.
How neurofeedback changes take hold
For changes to really take hold in an individual, the brain must create new connections or strengthen existing ones. While this is not an overnight process, it does occur during sleep.
Neurofeedback changes take hold during sleep. The brain, in any new learning, marks new synaptic connections with acetylcholine, a neuromodulator involved in facilitating synaptic potentials, to be constructed while we sleep (Lambert et. al., 2019). These are the same potentials measured by the EEG when an individual is training with neurofeedback. The neurons fired together, and the brain changes itself to facilitate the further development of these new neural pathways.
In an individual, this neuroplastic change means changes in mood, behavior, and cognition that translate into improvements in focus, energy, performance, sleep, emotional regulation, and clarity.
How many neurofeedback sessions before changes really take hold
For some individuals, this process may involve multiple issues that interact in complex ways, and therefore a multimodal strategy must be employed. This will mean that such an individual will first need to develop the resources to train the network that is causing the issues that they want to address, such as reducing anxiety to set the stage for reducing symptoms of PTSD.
Even though it may take around 30 sessions for changes to take hold, the individual will typically experience incremental progress from the start. Other individuals, with a single objective in mind, may find the progress is more rapid.
Training protocols are guided by the data acquired in the qEEG brain map and any additional testing indicated in the assessment phase. Your neurofeedback technician will develop a training plan in consultation with you that is designed to meet your individual needs. In all neurofeedback training, the process can be accelerated with proper recovery time, a regular exercise regimen, optimal sleep hygiene, and excellent nutrition. Individuals considering neurofeedback are encouraged to consult their healthcare professionals about protocols to achieve optimal health and address any major concerns.
How often should we schedule neurofeedback sessions?
Neurofeedback three times per week is optimal for rapid progress. This gives the brain the ideal amount of time to consolidate gains yet pushes you to improve in a rapid manner. This frequency is useful to determine what changes have occurred from the previous session, and memories fade if the time elapsed between sessions is too long. Training can be done in as little as 30 minutes, so it does not need to take up a lot of time out of your schedule.
Initial protocols may produce only temporary changes, as the brain response to training tends to be progressively greater as it continues. Your neurofeedback technician will routinely ask you about these changes and incorporate the data into your next protocol. It is truly a collaborative process, so the more you can notice the subtle changes in sleep, mood, appetite, and symptoms specifically related to your goals and communicate these results, the quicker the progress you will make.
There is another advantage to training more frequently. Much like starting an exercise regimen, the frequency with which you train will influence the results. If you started going to the gym once a week, it would certainly be better than not going at all, but your progress would be limited. Neurofeedback works the same way – the more you train the better the results.
A final consideration is your goals. Making training a priority in your life for a few months can make a major difference in your quality of life for the rest of your life. Your brain influences every aspect of your life, and neurofeedback unlocks the tools you need to influence your brain. A small sacrifice in terms of time over a short period can pay huge dividends. Adding one session per week can trim an entire month off of the total time needed to train to reach all of your goals. Isn’t that worth considering?
Conclusion
Neurofeedback is a tool that can give you the ability to master your mind. It teaches self-regulation of neuronal activity, and it can do so very quickly because it relies upon the mechanisms that your brain already uses to change itself. The difference is that you are choosing the changes your brain will make, based on your goals. With the help of this cutting-edge technology, you can change your life.
References
Chao Chen, Xiaolin Xiao, Abdelkader Nasreddine Belkacem, Lin Lu, Xin Wang, Weibo Yi, Penghai Li, Changming Wang, Sha Sha, Xixi Zhao, & Dong Ming. (2021). Efficacy Evaluation of Neurofeedback-Based Anxiety Relief. Frontiers in Neuroscience, 15. https://doi-org.lopes.idm.oclc.org/10.3389/fnins.2021.758068
Fernández-Alvarez, J., Grassi, M., Colombo, D., Botella, C., Cipresso, P., Perna, G., & Riva, G. (2022). Efficacy of bio- and neurofeedback for depression: a meta-analysis. Psychological Medicine, 52(2), 201–216. https://doi-org.lopes.idm.oclc.org/10.1017/S0033291721004396
Kim, K., & Priefer, R. (2020). Evaluation of current post-concussion protocols. Biomedicine & Pharmacotherapy, 129. https://doi-org.lopes.idm.oclc.org/10.1016/j.biopha.2020.110406
Lambert, K., Eisch, A. J., Galea, L. A. M., Kempermann, G., & Merzenich, M. (2019). Optimizing brain performance: Identifying mechanisms of adaptive neurobiological plasticity. Neuroscience and Biobehavioral Reviews, 105, 60–71. https://doi-org.lopes.idm.oclc.org/10.1016/j.neubiorev.2019.06.033
Morales-Quezada, L., Martinez, D., El-Hagrassy, M. M., Kaptchuk, T. J., Sterman, M. B., & Yeh, G. Y. (2019). Neurofeedback impacts cognition and quality of life in pediatric focal epilepsy: An exploratory randomized double-blinded sham-controlled trial. Epilepsy & Behavior, 101(Part A). https://doi-org.lopes.idm.oclc.org/10.1016/j.yebeh.2019.106570
Panisch, L. S., & Hai, A. H. (2020). The Effectiveness of Using Neurofeedback in the Treatment of Post-Traumatic Stress Disorder: A Systematic Review. Trauma, Violence & Abuse, 21(3), 541–550. https://doi-org.lopes.idm.oclc.org/10.1177/1524838018781103
Pimenta, M. G., Brown, T., Arns, M., & Enriquez-Geppert, S. (2021). Treatment Efficacy and Clinical Effectiveness of EEG Neurofeedback as a Personalized and Multimodal Treatment in ADHD: A Critical Review. Neuropsychiatric Disease & Treatment, 17, 637–648. https://doi-org.lopes.idm.oclc.org/10.2147/NDT.S251547
Van Hoogdalem, L. E., Feijs, H. M. E., Bramer, W. M., Ismail, S. Y., & van Dongen, J. D. M. (2021). The Effectiveness of Neurofeedback Therapy as an Alternative Treatment for Autism Spectrum Disorders in Children A Systematic Review. JOURNAL OF PSYCHOPHYSIOLOGY, 35(2), 102–115. https://doi-org.lopes.idm.oclc.org/10.1027/0269-8803/a000265
Walker, J. E. (2011). QEEG-guided neurofeedback for recurrent migraine headaches. Clinical EEG and Neuroscience, 42(1), 59–61. https://doi-org.lopes.idm.oclc.org/10.1177/155005941104200112
Zafarmand, M., Farahmand, Z., & Otared, N. (2022). A Systematic Literature Review and Meta-analysis on Effectiveness of Neurofeedback for Obsessive-Compulsive Disorder. Neurocase, 28(1), 29–36. https://doi-org.lopes.idm.oclc.org/10.1080/13554794.2021.2019790