What is Neurofeedback | DrHoganPesaniello

Image 1: Neurofeedback Infographic (Hirshberg, 2014)

What is Neurofeedback?

Biofeedback has a long track-record of helping patients with relaxation. Neurofeedback is biofeedback for the brain. Neurofeedback specifically measures data (eeg or infrared energy) from the brain and works through neuroplasticity. In neurofeedback, special sensors measure how the brain is performing. When the patient’s brain is doing what it is being asked to do, the patient sees the display progress as visual or auditory feedback.

The display on a screen or auditory feedback will represent the brain’s activity (such as the amplitude of different speeds of brain waves.) The data about the brain’s activity is collected by sensors that only collect information from the brain. No electricity or stimulation is put into the brain through the sensors.

By observing the computer display (visual feedback) and/or listening (auditory feedback) (beeps or other sounds), the patient changes his/her brain’s behavior in the direction encouraged by the protocol selected. The brain notices the improved feedback and keeps responding as the clinician “coaches” the brain through the feedback.

Neurofeedback works through an unconscious process. (The patient does not have to understand HOW it works. The brain “figures it out” just by observing the feedback. The clinician will also verbally coach the patient to relax and simply notice. The more the brain practices the new brain behavior and learns to change the brain activity in the desired direction with increasing consistency and power, the patient is able to have improved natural control over targeted symptoms like mood, sleep, concentration, focus, and anxiety.

Neurofeedback works through neuroplasticity. Neuroplasticity refers to the ability of the brain to change itself, literally changing the behavior of neurons, the growth of connections that perform certain brain functions, and the changes in the brain that lead to neuronal growth and connection between neurons.

What aspect of the brain’s behavior changes in response to neurofeedback is directly related to what brain region is targeted, and which brain activity IN that region is targeted. Neurofeedback can target specific speeds of electrical activity and specific connections in the brain. That flexibility and specificity of focus is a major difference between neurofeedback and medication. Medications enter the entire bloodstream and bathe the entire brain.

The patient’s job during sessions is to maintain a relaxed state while focused on the computer display. For example, the display could be spaceships moving forward/ boxes that expand and contract, or a movie that turns off and on.

The therapist continuously coaches and evaluates the patient, sometimes changing the difficulty, sensor sites, frequency targeted, or length of sessions. The therapist is also trained in carefully evaluating the response, and considering factors other than neurofeedback that might affect usefulness or response.

What can neurofeedback help with? It can be helpful, preferably along with a comprehensive approach, in the treatment of many stress-related disorders. Neurofeedback, because it addresses brain regulation, can be helpful in issues involving mood problems or excessive reactivity, as well as symptoms of the brain being sluggish or over-activated. For example:

Difficulty with sleep (insomnia, depression, generalized anxiety, etc.)

Problems with anxiety (anxiety disorder, problems from trauma)

Need for improved physical relaxation (affective and anxiety problems, problematic pain , symptoms connected with eating disorders)

Problems with attention / focus/ concentration (ADD/ADHD, brain injury)

Problems with motivation (depression.)

Problems with mood (including depression, anxiety, and bipolar symptoms)

Problems with brain dysregulation (it can be used in the treatment of seizures and migraines, and in situations characterized by unstable mood as in the affective disorders, premenstrual problems)

Deep state eyes-closed trainings (Alpha-Theta) can improve symptoms related to trauma, existential problems, and psychological conflicts, so improving function and wellness.

So, neurofeedback can help with symptoms spanning major diagnostic categories, as is the case with many psychotropic medications and with psychotherapy. Psychiatric medications, especially antidepressants and anticonvulsants, are used for a broad array of symptoms that cross major diagnostic categories from mood and anxiety to sleep.

Are there non-clinical uses?

These would include optimum performance (reducing performance anxiety for work presentations, improved focus for competitive athletes, meditation, etc.). Deep state experiences (the focus of the eyes-closed alpha-theta protocols) can result in transformational /spiritual experiences, sometimes resolution of conflict and trauma-related feelings.

What does the evaluation involve?

This includes a psychiatric eval, with particular attention to symptoms that might affect protocol selection (mood issues, migraines, hx of head injury, attention problem. This would be performed by the licensed neurofeedback clinician. Sometimes functional tests like Qeeg or infrared imaging of the frontal lobe add to the data used by the NF practitioner.

Do patients need to be under psychiatric care?

If patients already have a primary mental health provider, they can receive neurofeedback from me as an adjunct to their care elsewhere. Patients should obtain an evaluation for medical causes of their symptoms.

Will insurance pay?

Some insurances cover biofeedback, some don’t. Check with your insurance company. When a tech provides the repeated sessions, , the cost is less.

Is it safe?

Neurofeedback is generally well tolerated, and any uncomfortable effects are likely to be mild. Because neurofeedback causes its effects to be more permanent by repeated trainings, any uncomfortable effects generally reverse quickly on their own and provide useful information for adjusting treatment. Neurofeedback is powerful, so just as with meds and medical procedures, there are some rare serious effects, and contraindications assessed by the licensed provider. This is more of a risk with seizure disorders and certain sensor placements or specific training frequencies. However, neurofeedback may actually be useful in treatment of seizure disorders. There is also the risk, as with meds, of no positive response.

How long does a training session take?

30 to 45 minutes depending on the presentation and complexity of sensor positions.

How soon do positive effects show?

We hope to see positive effects within 10 sessions or sooner with eegNF. Sometimes it takes longer. With PirHEG NF, we hope to see changes within a session or two, and within 6 we usually begin to see benefit if it is going to occur.

How long do affects last?

With eeg NF, some patients may need 40 or more sessions to see a sustained improvement. Once that has occurred, it does not take long to gradually taper sessions to see if improvement is sustained. Sometimes once one set of symptoms, like sleep is better, we decide if there are other symptoms requiring eegNF to a different site. Some will need no more after tapering, or may need periodic refresher sessions spaced weeks, months, or years apart.

References

Hirshberg, L. (2014, September 14). NIMH Funds Definitive Study of Neurofeedback for ADHD. The NeuroDevelopment Center. https://neurodevelopmentcenter.com/neurofeedback-for-adhd/

FOR MORE INFORMATION ON NEUROFEEDBACK AND BIOFEEDBACK PLEASE REVIEW THE POWERPOINT BELOW

Click below to view my presentation on neurofeedback given at TidalHealth Peninsula Regional Grand Rounds.

shared with permission from TidalHealth

Click below for more info on the usefulness of eeg in the treatment of difficult symptoms

“Here is a link to a simple presentation by a neurofeedback educator, about what neurofeedback is. Neurofeedback does not introduce any stimulation into the brain. It simply provides information that the brain responds to with learning. It trains the brain to make a strong pathway to better regulation."

MedChi Summer Summit 2024 presentation on Neurofeedback and Biofeedback in the Treatment of Stress Related Conditions