"Neurofeedback should play a major therapeutic role in many difficult areas. In my opinion, if any medication had demonstrated such a wide spectrum of efficacy it would be universally accepted and widely used"
-Dr. Frank H. Duffy
Professor and Pediatric Neurologist
at Harvard Medical School
Neurofeedback therapy is technically called "EEG-Biofeedback" and is commonly referred to as "brainwave training" in layman's terms. Different neurological networks within the brain are responsible for producing specific brainwave frequencies and brainwave patterns, and neurofeedback therapy uses sophisticated equipment that can isolate these specific networks and then challenges them in a way similar to how you strengthen different muscles in the body. As these neurological networks within the brain are consistently challenged, they get stronger (just as muscles do), and the associated brainwave patterns get easier to produce. A fundamental difference between weight training and brainwave training is that the resting state of your muscles (your physique) is a reflection of the continued stress you place upon them - this is why you don't maintain muscle definition if you stop working out; brainwave training is different - if you sufficiently develop neurological networks within the brain, it can result in long lasting results. This is why you don't forget how to play a musical instrument, a foreign language or how to ride a bike.
There are healthy brainwave patterns, and there are unhealthy brainwave patterns. Some patterns make you calm, relaxed, focused, aware, mentally present, or sleep well; others can make you anxious, depressed, distracted, or sleep poorly. Additionally, more complicated "unhealthy" brainwave patterns are often correlated to learning disorders, ADHD, poor emotional regulation, migraines, brain fog (i.e., from post-Lyme, post-concussion or post-Covid) and Autism Spectrum Disorders.
People consider doing neurofeedback for a variety of reasons and motivations. Some people have clinical conditions that they suffer and are looking for a drugfree, more natural way to mitigate the symptoms that they are experiencing; others simply want to realize a greater potential, and neurofeedback can often significantly help in that regard. The most important thing to understand when learning about neurofeedback is that it very similar to physical therapy. Physical therapy uses specific equipment to isolate and stress specific muscle systems within the body to help improve the function(s) that are associated with those muscles. It can help someone recover from knee replacement, or from tennis elbow, because it is isolating different networks and strengthening them. But that same "rehab" equipment is used by professional athletes to maximize the development of those same muscles so they can operate at their highest level of physical performance. The same holds true for neurofeedback - strengthening different networks in the brain has different outcomes associated with it, and training in one region could help a child better regulate his/her emotions, and also help the professional athlete be better able to stay laser focused and in the "zone" or optimal performance.
Looking deeper into brainwave patterns.
Depending upon your mental state, your brain produces 4 distinct brainwaves. Beta waves are produced when you are alert and externally focused, Alpha waves are produced when you close your eyes and relax, Theta is produced briefly when you start to fall asleep, and Delta waves occur when you are sleeping.
Scientific research has demonstrated that, for any given circumstance, there is an accepted normal pattern of brainwave activity. A
healthy, balanced and properly regulated nervous system will produce the appropriate brain waves at the appropriate levels and at the appropriate times for any given situation. However, when the nervous system becomes tense and unbalanced as a result of subluxation, poor nutrition, stress, food sensitivities, drugs or trauma, the brain wave patterns become deregulated resulting in many different neurological symptoms and conditions.
For example, if the brain produces high magnitudes of delta or theta, the person will likely experience attention and focus issues such as those associated with ADHD, cognitive decline, learning disorders, or symptoms related to concussions. If the brain produces higher that normal magnitudes of alpha, the person will likely experience symptoms associated with fibromyalgia such as pain, irritability or depression. If the brain produces higher than normal magnitudes of beta waves, the person will likely experience symptoms associated with generalized anxiety, panic attacks, migraine/tension headaches, chronic pain, or insomnia. These are just some of the many examples of brain wave dysregulation that can be addressed with Neurofeedback Therapy.
What is Neurofeedback?
Neurofeedback Therapy is also known as EEG Biofeedback. Neurofeedback is exercise for the brain. It is actually a learning modality designed to retrain dysregulated brainwave patterns. The goal of all neurofeedback is to transform an unhealthy, dysregulated brainwave imbalance into normal, healthy organized pattern. By doing this, the brain becomes more stable and is able to operate optimally and efficiently. It is a completely noninvasive and is considered safe by the Food and Drug Administration. In fact, the FDA recognizes that neurofeedback has NEVER produced a serious side effect since it was first discovered over 40 years ago. Published scientific research has demonstrated neurofeedback's efficacy in managing many neurological conditions such as ADHD, Migraine and Tension Headache, Insomnia, Chronic Pain, Post Stroke Syndrome, Anxiety and Panic Attacks as well as many others.
THE qEEG EVALUATION - The Gateway to Brainwave Training
Neurofeedback often involves a Quantitative Electroencephalogram (qEEG) evaluation. The qEEG is an assessment tool designed to objectively and scientifically evaluate a person's brainwave patterns. The qEEG "cap" is placed on the person's head, and this cap has a number of small sensors that are specifically located where major neurological networks lie in the brain. These sensors are simply detecting, measuring and recording the electrical activity (or brainwaves) that these networks are producing. [It is important to note that these sensors do not put any electrical current into the brain-they simply record signals coming from the brain.] This evaluation statistically compares an individual's brainwave patterns to a large normative database. This begins to identify areas that are inherently different within that individual. This evaluation also provides information on how well a person can shift their brainwaves from a resting state to an alert state. How well (or not well) a person is able to shift brainwaves depending on what situation they find themselves in is critical to optimal and efficient performance. The qEEG then provides statistically driven protocols and locations that would be most beneficial for that person to "normalize" their brainwave patterns. This involves neurofeedback training, which is the crux of neurofeedback therapy. This again has similarities to physical exercise - you can have a full body assessment done to determine which muscles are the weakest, and then from that assessment, specific exercises can be recommended that can help strengthen the weakest muscles within the body. As the brainwave patterns normalize, the brain is able to operate more optimally and efficiently.
It should be noted that our office does not always use protocols that are exclusively driven by the qEEG evaluation. We have a thorough consultation process prior to the qEEG that helps us determine what we would anticipate being areas of weakness and subsequent patterns of brainwave dsyregulation. [Dr. Woodman has spent thousands of hours understanding brainwave patterns and teaches 12-18 hours seminars on functional brain development, neuroplasticity and neurofeedback to other healthcare providers.] We use the qEEG to help confirm what we would anticipate. The majority of the time, there is a high level of correlation between what we expect and what the evaluation shows, but sometimes there are discrepancies between them. We explain all this to the patient during the report of findings, and explain what our recommendations for training would be. Our office has a satisfaction rate of over 93%, and we feel that our approach to protocol selection is critical to that level of success.
Working with high level performers (elite athletes and high business executives) is another situation where we might not want to train specifically from the qEEG evaluation. Taking the elite athlete as an example, their qEEG might demonstrate brainwave "dysregulation" that is specifically why they can perform at a much higher level than others, and training specifically from the qEEG might have a negative effect on that. We have helped many athletes dramatically improve their performance, and have helped several make National Teams, Olympic Teams and even make it into professional sports.
Neurofeedback Training Sessions - How it Works
The ability to isolate specific neurological networks within the brain requires that sensors get securely and accurately located on the head itself, and then these sensors be connected to incredibly sophisticated equipment that monitor real-time brainwave activity. Finally, there needs to be "feedback" given back to the brain that rewards the brain when it is producing a more desired pattern of brainwave activity. In spite of the aforementioned information, the user experience is honestly very simple - you simply watch television while you have two sensors on your head (and 3 clips on your ears). The television you are watching will fluctuate between being brighter (and louder) and darker (and less volume) - it might seem random to your MIND, but you are not training your mind - you are training your brain. When your brain produces the right pattern of brainwave activity, your TV will be bright and loud; when you produce the wrong pattern of brainwave activity, the TV darkens and the volume cuts out. Immediately your brain will recognize that there is an optimal viewing experience, and then there is a suboptimal one, but is a short period of time, your brain will realize that it is influencing the viewing experience that you are having, and it will try to provide a brighter, louder experience. This is predicated on specific neurological networks within the brain producing specific brain frequencies, and in producing these new patterns, it challenges those networks (just like lifting weights). The result of this process is that the regions of the brain producing those frequencies will get stronger, larger and over time, those brainwave patterns become much easier to produce.
Logistics - how much training does someone need, and are these changes long lasting?
For peak performance training, or using neurofeedback to enhance a specific attribute or aspect of the already well adjusted individual, the use of neurofeedback can be incredibly gratifying. The number of sessions varies significantly. Some people who regularly meditate might do one of two sessions to help them get to a more relaxed state. But generally speaking, it would be recommended that there be 10 sessions devoted to each area that the person would like to see improvement in. The major areas of peak performance that we often work on with people include anticipatory worry, focus and concentration, emotional regulation, sleep enhancement, auditory processing, visual processing, and executive functioning. This can apply to the business executive, self-employed individual or the athlete. Some people doing peak performance training want to improve their anticipatory worry, and will do a 10 session package for that purpose. Elite athletes looking to take their game to a collegiate, national or professional level might do 20 sessions to each of the areas mentioned (usually done over 2-3 years). So the number varies based on the what the desire and motivation is. Coupled into this also the "return on investment" potential - 2% of high school athletes play in D-I sports, but most D-I sports have athletic scholarships that can save tens of thousands of dollars, if not more. So investing in this type of program could greatly improve that possible opportunity.
For those people who struggle with some condition on a clinical level, every case is different. With that said, specific clinical conditions tend to have an average number of sessions involved during the active or acute phase of training. We refer to this as the active phase because you need consistent and repeated training to sufficiently develop these networks. Once this is done, a number of scientific studies have demonstrated that it can result in very significant change that can last for an extended period of time. It is difficult for a scientific study to demonstrate how long the changes hold for (time constraints of publishing the study itself), but anecdotally, we have seen substantial changes last for many years. The first patient we had 12 years ago did only 20 sessions for a focus issue that prevented her from doing well in school (and required years of tutoring prior to doing our program). Within 6 months she was caught up to grade level, stopped tutoring within 12 months, and proceeded to make the honor roll for the first time the following year as a high school freshman. She made honor society, got an academic scholarship and graduated college with honors. She never did another session beyond her initial 20. We generally see this type of response with focus/concentration issues, but usually we recommend 20-30 sessions. While not necessary, many parents elect to do occasional "training boosters" just before school starts, before SATs, or before any activity where sustained focus is required. In those cases, the number of booster sessions usually drops off in subsequent years.
Anxiety-related issues tends to require more sessions, often due to the overactive mind that is driving the anxiety symptoms. As mentioned above, we are training the brain, not the mind, and the mind needs to let that happen. These types of cases tend to benefit from 25-35 active training sessions, and they often benefit from boosters more than the person struggling with focus issues. Often, these people recognize times, situations or circumstances where the anxiety symptoms are greater, and pre-emptive training often significantly improves their experience. This generally drops off as well, but it is not uncommon for these people to continue boosters when they find that they are beginning to worry more. This is not intended to sound discouraging - these people almost always improve, but for some they would describe themselves as now being someone that tends to overthink things, but they are not debilitated by the anxiety symptoms like they previously were.
The following is very general, but helps people get a better understanding of what to expect when they are dealing with a clinical condition.
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Peak performance - 10 sessions minimum - read above
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Focus issues - 20-30 sessions
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Anxiety issues - 25-35 sessions
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Sleep issues - 20-25 sessions
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Depressive issues - 20-50 sessions (some brainwave patterns see a much quicker resolve than others)
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Emotional regulation - 30 sessions
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Learning disorders/processing issues - 30-50 sessions
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Brain Fog (Post Lyme, Concussion or Covid) - 25-40 sessions
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ASD - depends on the function level. This can be life changing, but each case is different. Call the office
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Age-related cognitive decline - 25 sessions.
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Addiction - see below.
Using Neurofeedback to Support Addiction Recovery
Neurofeedback Therapy is an intervention that can help with various addictions. It is becoming increasingly popular within substance abuse treatment facilities, helping many people change the brainwave patterns that are often associated with anxiety, depression, and insomnia. Additionally, there are advanced neurofeedback protocols that have specifically been shown to help improve treatment outcomes for those people dealing with alcohol and other addictions.
The Evolution of Neurofeedback in Addiction-Related Conditions
In 1989, Drs. Eugene Peniston and Paul Kulkosky developed a therapeutic alpha-theta protocol for addiction recovery and prevention of its relapse. Based upon the earlier groundbreaking work of Elmer Green, Alyce Green and Dale Walters, Peniston and Kulkosky modify the original alpha-theta protocol. They created a program that included a variety of different inventions (guided imagery, constructed visualizations, and neurofeedback training -specifically Alpha Theta Training) that was used in conjunction with the 12-Step program. The protocols have also been referred to as the Peniston-Kulkosky Protocols and the Peniston Protocols. The design was based on anecdotal observations by Dale Walters. - It was the first neurofeedback study for an addictive population. The results of this study were dramatically better than using the 12-Step program by itself, and resulted in 79% abstinence for neurofeedback group 12 months after treatment (based on collateral contacts, in addition to self-report), as well as significant improvements in 5 of the 10 MMPI-2 scales (personality tests used within mental health). These outcomes were presented to the neurofeedback community in 1991, and this lead to subsequent studies that assessed the effect that neurofeedback could have on various addictions. [This study, as well other research, can be found on the Research page.]
The largest and most efficacious addiction study to date involved 121 subjects in a randomized controlled trial conducted by UCLA, which was published in a 2005 edition of The American Journal of Drug and Alcohol Abuse, titled, “Effect of an EEG Biofeedback Protocol on a Mixed Substance Abusing Population“. The results of this study has been replicated multiple times. The finding of this study showed that, "Of the experimental subjects completing the protocol, 77% were abstinent at 12 months, compared to 44% for the controls." The conclusion determined that, "This protocol enhanced treatment retention, variables of attention, and abstinence rates one year following treatment."
These protocols were reviewed in 2013 by Ross in an article entitled, "Neurofeedback: an integrative treatment of substance use disorders." It was concluded that the addition of the Peniston Alpha-Theta protocol and (and the subsequent protocols designed thereafter) with traditional Substance Use Disorders "has the potential to improve measurable parameters and significantly increase positive outcomes".
Another study from 2013 concerning neurofeedback and addiction was titled, "Neurofeedback Training for Opiate Addiction: Improvement of Mental Health and Craving" by Dehghani-Arani, Rostami and Nadali, and was carried out to examine the effectiveness of this therapeutic method for opiate dependence disorder. The specific aim was to investigate whether treatment leads to any changes in mental health and substance craving. The conclusion showed that "the experimental group achieved improvement in somatic symptoms, depression, and total score in general mental health; and in anticipation of positive outcome, desire to use opioid, and relief from withdrawal of craving in comparison with the control group. The study supports the effectiveness of neurofeedback training as a therapeutic method in opiate dependence disorder, in supplement to pharmacotherapy."
Our Approach to Addiction Related Conditions
Our goal for all our patients is to help them reach their highest potential in a safe and supportive environment. This holds especially true for this population as well. To help with this, we have created a training template that helps minimize the potential for abreactions to occur.
First, we utilize a qEEG brainwave evaluation that will help provide information about specific brainwave patterns that the person demonstrates within the major neurological networks within the brain. Using this information, we first look to train in the occipital region to restore appropriate sleep patterns and reduce rumination, then train in the frontal region to decrease anticipatory worry and increase executive function, and then look to train the temporal region to help decrease emotional over-reactions and increase social connections. Once this is done, then we look to add in the Alpha-Theta protocols outlined above. This program can range between 20 and 40 sessions.