What does evaluation for neurofeedback and biofeedback involve?

     In my practice, every individual seeking biofeedback (BF) or neurofeedback (NF) will receive an initial
evaluation from me, sometimes with assistance from my technician. The initial evaluation will include a
face-to-face interview at a depth that depends on nature of the referral, the complexity of the
presentation, and the aim of the biofeedback or neurofeedback. This is personalized and can range
from a brief screening to an in-depth comprehensive psychiatric evaluation.
After that initial evaluation -- particularly for eeg neurofeedback -- there will be a more thorough
personal interview to review additional history, stressors and previous treatments to help clarify what
brain region/and brain activity that is needing improved regulation. If desired -- a comprehensive report
can be provided for collaboration with other providers involved. (Collaboration with primary therapist
or with a medication prescriber).

Clear targets for improvement will be discussed and identified, and we will determine together how
we will measure progress.  

Depending on which kind of biofeedback (HRV or hand-warming training) or neurofeedback (eeg
feedback or pirHEG feedback) is desired, a decision for additional assessment may be made that might
include psychological testing or a specialized collection of eeg for Qeeg analysis. (See more on that
elsewhere on this website.) Or we may require a discussion or agreement from your provider for
headaches, for example, or your cardiologist, if you have an arrhythmia or other condition we need to
respect as we move forward. In that case we provide written information for your medical or therapy
provider, and with your permission, will speak with your provider as necessary. Then a training
approach (protocol) is identified. This is determined by the presenting problem and what aspect of the
nervous system appears to need improved regulation. If the purpose is for demonstration, the
screening might be brief or more involved if the symptoms are complex or call for more assessment
before participatory demonstration.

More about the process of engaging in Neurofeedback (NF) training:

NF protocols are aimed at improved self-regulation through improving brain regulation. The method
and protocol selected will depend on the area of the brain that we choose to address. For example, if
the target is clearly the front of the brain (often the case in typical migraines or old concussive injuries,
or issues mainly with “executive function”,) we might start with pirHEG training, which targets this
frontal region and requires weekly trainings initially. If areas further back on the head are targeted, eeg
neurofeedback, which requires a more detailed evaluation and protocol, will generally be the method
chosen.

     Once an initial treatment protocol (region of the brain and a method and protocol) are selected,
training begins. Patients are instructed and assisted in close observation of their baseline symptoms and
their response to training. In eeg neurofeedback, some patients will respond to the first or second
protocol used. Some patients require changes in sensor location or selection of the parameters of the

eeg to train. Sometimes it is only by selecting a protocol, then assessing the brain’s response to it over
time, and adjusting the protocol according to response, that the effective protocol is discovered.

   It is reasonable to hope for early signs of response or early indications that the protocol should be
adjusted. Generally, with close observation, some response is expected within 3 to 5 to 10 sessions.
However, once a useful protocol is identified, it can take repeated sessions, at least 30 to 40 sessions or
more to see a full response / more sustained response. And this is in the most straightforward
situations. Some patients with complex symptoms in different regions of the brain may need 100 or
more sessions. For this reason I have designed the space at Willow Street Wellness, where individuals
can train with a tech or self-train with a tech, in order to reduce cost. Once a sustained response has
occurred, we generally taper sessions until they are every other week for a month or two then taper off,
and see if the response is sustained.

Other considerations in eegNF training:

     In some cases, with the eegNF it takes more time to find the right protocol, just like with
medications. And the protocol will be carefully and methodically shifted in sites and/or frequencies
targeted, in order to find the optimum and most likely effective protocol. If needed, additional tests,
such as the Qeeg, may be requested. (There is more information on Qeeg on this website.)
In some cases, the response is positive but partial. Sometimes neurofeedback will not work. It is not
unusual to see medication- resistant symptoms respond to neurofeedback. However, it is important,
particularly in chronic conditions throughout medicine, to realize that chronic conditions generally
respond best to a comprehensive approach to treatment, including nutrition, exercise, social and
spiritual aspects. So, particularly in challenging cases, it is important that treatment is thorough,
creative, and comprehensive. Other modalities may need to be optimized in addition to the
neurofeedback. (Psychotherapy, meds, group or couples work, study skills or social skills re-training).