Frequently Asked Questions

What is Neurofeedback?
How is Neurofeedback done?
What is the history of Neurofeedback?
What is CNS dysregulation?
What specific diagnoses can Neurofeedback help?
How many training sessions are required?
How do we know the positive effects are not a placebo?
What is the minimum age for Neurofeedback to be effective?
Is it safe? Are there any side effects?
What happens if medications are being taken?
How is it that Neurofeedback influences so many different areas?
What will happen at the first session?
What is a QEEG?



What is Neurofeedback?

Neurofeedback is based on more than three decades of research and is a specific form of biofeedback which involves the measurement and feedback of brainwave activity for the purpose of allowing one to increase their ability to regulate their central nervous system. It utilizes very small EEG (electroencephalogram) signals obtained from sensors on the scalp, to monitor the brainwaves and provide corresponding feedback to the brain. Neurofeedback is essentially brainwave training, a tool for the brain to directly learn flexibility, mental control and ultimately increased stability and resiliency. Improvements in attention, impulse control, mood, sleep and cognitive functioning are often observed with training.

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How is Neurofeedback Done?

During the session, the child, adolescent or adult sits in a comfortable chair, typically for about 30-45 minutes. Two or more leads or sensors are attached to the scalp with a water-soluble paste; brainwave signals are then able to be detected and sent to a computer using special software and hardware that amplifies the signals. The computer displays interesting graphics in the form of a game or a movie (visual feedback) and your brainwaves control the progress of the visual information being seen. As brain waves are generated which represent well-regulated attention and arousal levels, the visual graphics continue uninterrupted. Large excursions in optimal brain wave activity will cause the graphics to either stop or change in their quality. The brain then responds to the challenge of the feedback and moves towards more adaptive and flexible functioning. The therapist is responsible for making the necessary changes in the placement of the sensors and management of the raw EEG data being obtained.

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What is the History of Neurofeedback?

Human EEG Biofeedback was first administered in the 1960's by Joe Kamlya at the University of Chicago. Early investigations focused on operant conditioning of alpha brain waves to assist with deep relaxation.

SMR/Beta biofeedback developed from operant conditioning of cats' EEG. Barry Sterman of UCLA discovered that when cats were exposed to toxic chemicals that usually induce epileptic seizures, those that had been trained in the middle to high frequency range (12-20 hz) from a previous unrelated experiment had a higher threshold for seizure onset, than untrained cats. These results were replicated in monkeys and then humans. The results with humans were then replicated in some twelve centers, comprising some twenty studies. After treating patients for several years having intractable seizures, it was noted that the hyperactive children in particular demonstrated improved behavior and regulation. In the mid 1970's, Joel Lubar at the University of Tennessee examined the effect of Neurofeedback on hyperactive children absent of any seizure activity. To date there are many more studies showing the medical basis behind the use of this therapy. Studies have shown, especially in relationship to ADD that 80% of adults who received Neurofeedback as children showed continued positive focus results in a three, five and ten year follow-up study. Decreases in impulsivity, distractibility and hyperactivity and increase in IQ have been documented in over 50 studies. As Neurofeedback shifts the brain's arousal level, many other brain based issues including mood and behavioral concerns decrease. We have a comprehensive Neurofeedback study bibliography prepared by D. Corydon Hammond, PhD, Professor, Physical Medicine and Rehabilitation, University of Utah School of Medicine here at our office available for anyone to read. The information is organized by areas of interest or symptoms that are of concern.

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What is CNS Dysregulation?

This is a condition associated with the following:

» Difficulty in concentration
» Mood swings that seem hard to control
» Sleep disturbance
» Low mental and emotional energy
» Memory problems
» Difficulty with organization
» Problems beginning and ending projects
» Depression
» Anxiety or Panic Attacks
» Tics
» Mental fogginess or lack of clarity
» Inability to stay on track or maintain desired focus

If an individual experiences three or more of the above there is a likelihood that CNS dysregulation is present and that one would benefit from Neurofeedback.

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What Specific Diagnosis Can Neurofeedback Help?

While Neurofeedback is more concerned with symptoms than the actual diagnosis it may be easier to consider this form of therapy based upon whether the following disorders are present.

» ADD/ADHD/Conduct issues (ODD) This is an area we specialize in and use other forms of Biofeedback as well.
» Anger and Rage
» Anxiety/Panic Attacks
» Autism
» Chronic Fatigue Syndrome
» Depression
» Seizures
» Fibromyalgia
» Headaches (Migraine, Cluster and Tension) - This is an area we also specialize in and utilize other forms of Biofeedback in conjunction with EEG Neurofeedback.

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How Many Training Sessions Are Required?

Neurofeedback training is a learning process and results occur over time. Improvements in many conditions can be seen in ten sessions, though permanent changes take longer. It may not always be possible to predict how successful training may be for every individual, but a reasonable expectation of results can usually be seen early in the course of training. Initially sessions need to be regular and frequent with a minimum of two sessions a week. As the brain re-regulates to healthy patterns of brainwave activity, the frequency of the sessions can then be decreased. Many symptoms are "permanently" reduced by 30-40 sessions. However, developmental disorders such as Autism may require many more than the standard protocol due to the complexity of issues being dealt with. The amount of time depends on the type of problem, consistency of training, presence of medication in one's system and especially how well other areas of one's life are managed in terms of nutrition, activity level (ex: frequent computer and TV usage; lack of exercise) and sleep routines.

The formation of new neurons and connectors in the brain typically requires at least two months to begin to develop. Neurofeedback changes existing patterns while encouraging the development of new neuronal connections. This is why changes can be seen after a few sessions but may take longer to become permanent.

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How Do We Know the Positive Effects are Not Due to the Placebo Effect?

Neurofeedback training effect is cumulative and tends to not disappear over time as is common with placebos. Placebo effect tends to reach maximum quickly and then fall off. Also, training effects tend to be consistent with localization of function within the brain. Many clinicians will see improvements in areas of function that the child or adult were not expecting. It is common to receive reports of improved performance from independent observers who are unaware of the person's treatment, such as teachers, friends and extended family members. In addition, the initial discoveries of Neurofeedback effectiveness in eliminating seizure activity were made in connection with animal research (Sterman 1976). It is highly unlikely that feline seizure activity was resolved due to the cat's strong belief in Dr. Sterman and his research methods.

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What is the Minimum Age for Neurofeedback to be Effective?

We have worked in our office with children as young as two years of age. Often, young children are seated on their parent's lap and are so interested by the visual image on the screen in front of them that it is easy to keep them engaged. We also use specific tools related to sensory experiences within the session to further keep attention focused on children of all ages.

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Is it Safe? Are There Any Side Effects?

Neurofeedback is a safe non-invasive training technique. Unlike medication, nothing is put into the body or brain. Neurofeedback provides information to the brain in the normal way through the senses in the form of auditory, visual and at our office even tactile/proprioceptive or vibration. The process is very gentle and nothing is forced. The basis of Neurofeedback is self-regulation, teaching the brain to properly regulate itself. Training is a process of undoing limiting mental habits that are no longer useful to the brain, rather than learning a new coping strategy or technique as is often the emphasis in traditional behavioral or psychotherapy. Because nothing is being put into the body or brain, there are no side effects in the traditional sense. However, it can not be emphasized strongly enough that the experience of the therapist can in fact have an impact on the training process in the form of no changes obtained, or transient changes in regards to mood or activity level. Any negative effects of therapy do wear off but it is important that the therapist be aware of the settings that are being used as well as what areas of the brain are being trained according to the symptom profile and standardized data obtained from testing as well as information provided by the Brain Map or QEEG. By choosing a clinician who uses Neurofeedback as a primary treatment tool in their clinical practice, has years of experience, higher level training and on-going professional mentoring one can then use this as a good indicator of whether there will be success in the Neurofeedback process.

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What Happens if Medications are Being Taken?

When Neurofeedback training is successful, medications targeting the brain may no longer be needed or they may be needed at lower dosages as the brain takes over the role of regulating itself. We have seen this first hand in many of our clients although we do not advocate stopping any medication or altering the dosage without the direct supervision of the physician in charge. Those on medication should be closely monitored by their physician, as dosage changes may be indicated. Neurofeedback typically takes longer to produce changes when compared to medication but in turn it yields long-term benefits in all key areas of attention span, impulse control, academic and social behaviors. This occurs without the physiological side effects often associated with medication.

Often medications are prescribed to treat symptoms rather than causes. Both the diagnosis and the drug regime must be very precise to work effectively. As noted, drugs come with side effects, some more troubling than others with long term side effects often seen. In addition, drugs work only in the moment, while they are being taken; the effects cease after they are discontinued.

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How is it that Neurofeedback Influences So Many Different Areas?

The brain is central to all of our mental and physical processes. Functional improvements in the brain translate into similar improvements in our motor, behavioral and cognitive or learning experiences. Most importantly, the optimally functioning energy is available to reorganize and restore any physical or mental processes that are not functioning well.

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What Will Happen at the First Session?

Even before the first session, a no-charge consult is available from our Clinical or Medical Director, to explain the process involved and determine whether this therapy is a good fit for you or your child.

The first session involves an interview in regards to clinical symptoms of concern as well as a review of the health history including current and past medications. When children are involved, their input in regards to the symptoms they experience is also encouraged. We utilize an on-going symptom tracking protocol which will be explained in more detail at your first visit. An initial "hook-up" will take place at this time to provide some basic information as to brain waves and the process of Neurofeedback although it should be noted that the information obtained from visual observation of brain waves is in no way diagnostic due to the lack of a standardized data base with which to measure the brain wave tracings against. However, general inferences can be made about the predominance of particular brain wave activity. In addition, standardized testing will take place in the form of a Continuous Performance Test. Additional standardized testing involving visual perception, visual-motor integration, fine and gross motor coordination and sensory processing is also available at a separate session. A QEEG or Quantitative EEG/Brain map may be scheduled prior to the initial Neurofeedback visit in order to more specifically target areas of the brain that need to be trained in terms of Neurofeedback treatment.

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What is a QEEG?

A Quantitative Electroencephalogram (QEEG), also known as a Brain Map, is a diagnostic technique administered by a highly experienced medical professional that measures specific aspects of the human EEG. It requires that 19 or more sensors be placed on the head so that the brainwave activity can be recorded and measured. Like Neurofeedback, it is non-invasive, meaning the procedure does not involve breaking into the skin. In our office, we utilize a cap system which is more comfortable and easy to apply, especially on children. Brainwaves are recorded with eyes open while the person is passive and again while performing certain tasks. It is recorded again in the eyes closed condition. The idea is to measure how the brain's response to challenges and different conditions plays out in the EEG activity. This data is then compared to the LORETTA normative database. The data are mapped into a series of graphs which reveal the areas of the brain that are abnormal as well as the severity of abnormality. The QEEG can provide valuable information regarding determining Neurofeedback protocols in conjunction with symptom based information obtained in the initial intake session. It is also useful as a re-evaluation tool to specifically document changes taking place within the brain. Parents and adults in treatment also have expressed the desire for a QEEG as it re-affirms or validates that there are indeed issues to be addressed. The QEEG is administered by our Medical Director, who is a licensed and board certified Medical Doctor.

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