What is Neurofeedback?



A futuristic image of a human brain.

Traditional psychotherapeutic offices have two main options-talk therapy or medication. An intake may only rely on self-reports and interviewing. Brain interventions are not a part of the process and there may be no ways to directly measure baseline and improvement. Medication alters but doesn’t necessarily heal the brain but they make electrochemical changes in the brain but don’t alter structures. They frequently have side effects or attenuate (Demos, 2005). Talk therapy can help make metabolic changes over time but it does not always stay consistent. Neurofeedback is a comprehensive training approach that promotes change at cellular levels. It takes science out of research facilities and into the hands of competent private healthcare institutions or practitioners. Neurofeedback is an option to change behavioral or stress-related states and can actually be used in combination with counseling, medication, or other modalities.  It does not have to be mutually exclusive of behavioral or medical medications and can be used along with talk therapy and psychiatry. Neurofeedback is the technological side of psychotherapy, cognitive rehabilitation, poor brain-related functioning, or attention and memory improvement are its focus.  

If you think about the brain, it is in fact the central control system of the body.  Issues such as PTSD, personality disorders, addictions, unresolved emotional issues, or even concerns such as migraines, sensory issues, trouble relating to others due to overstimulation, ADD, autism, reactive attachment, learning disabilities, obsessive-compulsive behaviors, addiction, even developmental trauma essentially are housed in the brain’s structures.  For years, researchers have been tracking what parts of the brain house which areas of concern.  The deep limbic system, the memory centers, or even excessive blood flow to the brain resulting in migraines can all be studied and tracked.  For decades, EEG or Electroencephalography has been recording sleep and awake cycles in human beings and animals in lab sleep studies.  Passively recording the brain’s movement into different states such as Delta, Theta, Alpha, Beta, and High Beta are specifically tracked as people fall asleep and awaken. For over 30 years, EEG has been used with seizure disorders with success as well. Cognitive decline exercises and Traumatic Brain Injury Neurotraining are more notable uses for neurofeedback that we recognize currently.  

Often, behavioral health teams are involved in many of these functions because the interface between our emotional and physical states has so much overlap. Medical clinicians do not necessarily train in behavioral health and vice versa, so the presentation of many stress-related or clinical issues can be found and observed with EEG involving the body and the mind. The use of technology to be able to track brain regulation states and be able to feedback on this information to clients could have profound effects.  The use of technology in behavioral health and stress health management is taking the world by storm.  Neurodevelopmental professionals, research facilities, physical therapists, and medical and mental health professionals are taking an interest in this modality that is thought to be useful for many persons on their journey toward mental health. 

The brain has a role in cognition, memory, personality, and emotional processing.  Even moral decision-making can be affected by events such as TBI, early developmental interruptions or trauma, or addictions.  Brain imaging has allowed the field to grow in leaps and bounds in our understanding of neuroscience.  Neurofeedback has very few ever documented negative reactions since it works as biofeedback.  For example, the brain and body would not let you alter your own heartbeat into a life-altering state by watching heart rate EEG.  Biofeedback can help “hack” or make a client aware of their own current rhythms and allow them to begin to be aware and use techniques outside of sessions and retrain brain waves within sessions. Clients can be monitored after every session to see results and get feedback about what is improving.  Few clients report no changes and even more rarely do they report a negative effect and most clients enjoy coming to appointments. Clients report feelings of emotional freedom, emotional release, a decrease in stress-related responses, changes in behaviors or memory, sleep improvements, or general functioning increases. 

Being able to quantify a client response such as “I feel calmer” with metabolic levels in the brain or EEG data is groundbreaking.  It would make sense that if we are feeling changes in the brain we may notice changes in ourselves and vice versa.  After all, the brain is the central computer of just about everything. Clients can now actually begin to help the brain be more economical, focus better, and in some cases, allow clients to reduce medications, or services to continue to address symptoms.  Our brains and bodies always want to function in the most economical fashion possible or the most coherent.  Instances, where bursts of energy and survival responses are needed, are not supposed to be “all of the time” for example.  Our brains will gladly retrain to a more easy route.  When we learn to ride a bike and our brain has gotten ahold of it, it remains an easy stable connection.  It does not wish to relearn or expend energy.  Traumatic brain injury training can work on this premise as well.  If the brain can relearn any connections that benefit survival or ease memory consolidation, it will do so.  It tends to hold this learning or relearning whenever possible. 

While we support clients that need to be on medications, some clients with the help of knowledgeable providers have been able to decrease the use of medications.  Many clients want to be on the least restrictive amount due to cost, side effects, or arduous need to remember to take medications. Neurofeedback can work alongside necessary medications and actually improve the length of stay in treatment centers and relapse rates after later surveys (Demos, 1996). Clients should always consult with providers and medical professionals and communication is important with a treatment team. 

Neurofeedback is a modality of biofeedback that can facilitate changes in brain wave patterns and regional cerebral blood flow. The brain can heal or even change itself by retraining. Biofeedback is the idea of sending information back to the client to observe and change.  Electrical charges or subliminal introduction of material is not part of neurofeedback.  Imagine if you were able to see your own heart rate and be aware of your heart beating fast and you are able to intervene and do deep breathing.  After a while, your entire pattern of breathing may change entirely.  Neurofeedback can give clients real-time readings on brainwaves and help train clients to a more functional level.  Take a client who is overfocused and hypervigilant (trauma can cause this effect) and help a client retrain to a calm state.  Brainwave activity is related to hyperfocus on hypervigilance which comes with several disorders.  While this is an extreme simplification, this is the idea of biofeedback.  Trainees can be informed of audio or graphic signals or cues when they are beginning to get into “the zone” of more desired functioning. Slowly coaching the brain into more desired states and out of less functional states results in lasting changes.  Many studies are showing neurofeedback is often given in as little as 2-6 sessions or 20-40 sessions and changes tend to stay on board.  Very few disorders require ongoing, unending training.  The changes last over time when compared to baseline measures. 

Change can be compared and quantified against verbal reports whereas the field of psychotherapy has very little ability to measure or report definitive changes.  Many a new clinician stumbles into neurofeedback lectures and says “How do we know if it works”.  It doesn’t take long to realize that we need to say the same thing about our psychotherapy sessions too, then.  As we know, however, the real proof is in how the client reports feeling in terms of their changes and if they feel more functional in their lives. 

Many times the emotional part of our brain tends to win out over the rational side.  The deepest emotional structures sit right under the executive part of our brains so there is actual reasons why we can’t always seem to access the emotional side or make changes. 

Talk therapy has some limitations but it has a completely needed space in our field.  Sometimes with our clients, talk therapy alone can only bring them so far.  The emotional or behavioral responses seem to rise up and take us back to where we started so it makes sense we may need to start with some brain-based strategies. The mind seems to have the power to heal itself but it doesn’t always have the know-how and lacks feedback or tools to do so. Neurofeedback is one such technique that is now coming into its own as clients are seeking something non-invasive, and data-based, and as they crave options for brain healing besides just the usual suspects. Thousands of studies are being conducted at universities, and research continues to discover the efficacy of this unique approach. Expect neurofeedback to be a primary modality in the next few decades to come. 

Finding that your brain is shifted in a gear that is inefficient, finding some improvement with a learning disability, or seeing where an image shows the trouble with impulse control or depression can have a sense of helping take the shame out of having a mental health or behavioral issue. Especially since many behavioral health issues are initially truly out of your control. Many things can be changed most importantly, however. Being able to see pictorial images or printouts of what is happening in your own unique processes can be really impactful.  Many of our clients have reported feeling relief just by being able to see a better picture of their “condition” which can help them get motivated to make changes.  If you walked around limping but never quite had an idea of what was causing your issue-it could lend some real insight as to what needs to happen next or get you into a frame of mind of being able to see a solution if you can start with some information. 

Recording measurements can be sent to databases with hundreds of thousands of researched maps that can give credence to what is outside of normal functioning then you can begin to get an idea of what’s happening within your own cortex or perhaps what is not functioning well (or is better than average). Using statistical comparisons known as standard deviations from normal (mean), mapping data can give us a good starting point to assess if something may really be an issue from a database perspective. 

Let’s take the example of someone who is depressed.  They may blame themselves for being weak or lazy. Their brain may actually show a common pattern where there is slowing in the anterior left hemisphere that may be genetic or has been there their whole life making things a whole lot harder every day (Davidson, 1998). They may have twice the fortitude of a regular person. Aspects such as these are often trained to be more consistent with “happy moods” or the lifting of depressive feelings in our minds. This has done wonders to reduce shame and well, have “happy outcomes”. 

Each region of the brain has a unique function.  If you are bad at math, for example, cerebral blood flow to the parietal lobe region is related to trouble with mathematical problem-solving or skills. Essentially if you can help the brain uptrain these areas, there are marked improvements in learning disability behaviors.  The client may even be able to see where the problem is since the brain’s activities can’t be seen at all. Many clients have begun changes with the relief of being able to see where the problem begins and some information about its pattern in their brain and then in their life.