Frequently Asked Questions
By the end of the 20th century, breakthroughs in medical understanding of the body changed much of our thinking about how the body actually operates. It was found that simply giving feedback about many body functions controlled by the autonomic (unconscious or automatic) nervous system makes it possible to deliberately regulate that system. This process is known as biofeedback and can be used to therapeutically control such body functions as temperature regulation, muscle tension, heart rate variability, bowel and bladder control and other processes.
Most interesting, from our perspective, was the discovery that it was also possible to change the brain's operation. This is accomplished through training the electrical activity of the brain or the EEG. The electrical activity of the brain is produced on the surface or cortex of the brain in the form of micro voltages. These voltages are generated in certain rhythms and frequencies and are the basis of the principal communication that occurs throughout the brain, forming thought and controlling activity. The equipment used for neurotherapy detects these micro-voltages and allows us to listen to the brain's activity as it goes about its job. By providing information about these electrical patterns in the brain, within a few thousands of a second of their occurrence, it is possible for the brain's regulatory system to modify itself on the basis of the information or reinforcement which it is receiving about its own activities. This is the ultimate form of self training since it occurs with only very modest conscious involvement and is part of the normal regulatory adjustments which the brain makes as it goes through various learning processes including operant conditioning.
Although such training requires extremely sophisticated computer software and expertise on the part of the trainer, it is, in fact, an easy and interesting process for clients. Neurotherapy can be done by almost anyone including very young children, people with brain injuries, or others with a variety of emotional and behavioral problems. It can also be done by people who have healthy brains but who are simply seeking to improve their performance athletically, artistically or cognitively.
Although there are many variations of EEG biofeedback, they can be divided into two broad approaches. The first, known as deep state or Alpha-Theta therapy, focuses on shifting the individual's state of consciousness. This approach first attracted our attention due to its effectiveness in addressing addictions and post-traumatic stress disorders. Along with a shift in consciousness, the approach emphasizes the use of the imagery and psychotherapeutic techniques to facilitate its outcome. The other broad approach is one which focuses on specific training of brainwave parameters such as frequency, timing, and variability. This approach emphasizes the development of self-regulatory activities in the brain to achieve a more consistent production of electrical brain activity so that the brain is more effective and efficient in meeting the challenges of everyday life. This long-lasting skill is acquired and mediated at levels that are typically below consciousness and can therefore be employed more automatically when the situation requires.
The actual sessions of therapy typically last between 30 and 45 minutes. The client sits in a comfortable chair and is attached to a computer through sensors which are placed on the head using electro-conductive gel. The sensors allow only the measurement of micro-electrical activity from the brain and do not allow the transmission of electrical impulses into the head. All the client is receiving is information about their performance. This information is usually provided in the form of games on a computer screen and auditory feedback such as music. The trainer, who is present in the room, has a separate computer monitor to set certain parameters and goals for training. The client's brain runs the game and no joystick or other controls are needed. This is possible because the client's brainwave activity is processed through the computer in parameters related to the goals established by the therapist. In less than a second the computer processes and provides information to the client on his or her performance by allowing the music to play and the game to run when the goals are met. Through the feedback, the brain is exercised and challenged, going through a learning process which utilizes operant conditioning. By selecting specific sites on the head, eeg frequencies, and other types of parameters, the training is specifically tailored to the individual needs of each client. Such individualization is a very complex process requiring the full expertise of the trainer. By the end of training, the brain automatically uses this capacity of improved self-regulation to meet everyday challenges such as paying better attention, maintaining better emotional stability, and performing more efficiently and flexibly. Most people find the training to be interesting and challenging and quickly note their improvements not only in the training sessions but in real life.
Neurotherapy can be conducted with clients who are on medications. Typically, we work hand-in-hand with clients' physicians with regard to their medications. As the brain experiences the benefits of training and becomes better regulated, medications are often more effective. Often, it may become possible to reduce, or even eliminate, the medication. The same is true with regard to psychotherapy or other treatments since the brain's improved self-regulation and increasing stability allow the effects of all types of therapies to be augmented and made more effective.
The number of sessions which are required for neurotherapy depend on the presenting problems and response in training. It is not uncommon to begin to see benefits from training as early as 10 sessions; however, additional training is necessary to stabilize such gains. Our experience, as well as the professional literature in the field, suggests that 30 to 40 sessions are typical for many conditions. Obviously multiple problems and more complex symptoms require longer training. Training is ideally conducted two or three times a week. Optimally, the training is done on a continuous basis until completion; however, it is possible to take breaks for vacations or other activities. We work actively with clients and their families to schedule the treatments in the most convenient way based on school, work, and family schedules.
One of the strong components of the neurotherapy field is the amount of research that has been conducted. During the last 40 years there have been more than a thousand articles written in scientific, peer-reviewed, and clinical journals. In recent years there have been reviews of the field presented in scientific journals and chapters in professional texts. Additionally a number of books have been written about this developing field. For information on this body of literature please see the Resource Section of this website. There also has been a steady accumulation of clinical results and therapeutic experience which further validate the effectiveness of neurotherapy. The principal criticism with regard to studies in the field is that there has not been large double-blind, randomized subject, control group design studies. This criticism is recently being addressed by several studies that are currently underway. However, most reviews of the field to date have identified very positive outcomes with minimal, if any, risk to the client. The consensus of research also suggests that approximately 80% of clients enjoy significant improvement following training.
There is considerable variation in the reimbursement from various insurance companies for neurotherapy. In some instances the companies will pay the full cost of a program while other companies may pay only partially or even deny reimbursement. Our clinic is a member of most insurance panels and we will provide assistance to determine the specifics of any insurance program. We are also a Nevada State Medicaid Special Clinic and are reimbursable by them for services.
To determine whether Neurotherapy is an appropriate modality for treatment, a thorough assessment is first conducted. This consists of a clinical interview in which a client's history and presenting symptoms are reviewed. Next, a series of questionnaires or psychological tests are administered. Then we may also conduct very precise testing which directly measures cognitive and brain functioning. Such testing might include a Micro-Cog Test which is an analysis of memory, reasoning, information processing, and related factors. In cases of ADD or suspected attentional problems, a Test of Variable Attention (TOVA) might be administered. The TOVA is a computerized instrument that allows very exact measurement of attentional functioning. Finally, in some instances, a Quantitative Electroencephalograph (QEEG) might be conducted.
A QEEG takes approximately two hours and is an assessment of electrical activity in the brain during which a mapping at 19 different brain sites occurs. This provides data which is compared to a number of normative databases and presents a mapping and statistical analysis of brainwave activity across a number of dimensions. The results of this test can be used for treatment planning as well as a diagnostic workup. Additionally, some physicians are now using QEEG's as part of the basis for medication decision-making in complex cases.
Not only do we assess a client's status prior to the start of training but, there is an on-going self-assessment after each session. More extensive reviews take place at regular intervals and include both questionnaires and objective measures. Particularly important is input from sources such as the client' family, school or employer. Real life measures such as grades, work evaluations, athletic or artistic performance, and other relevant behaviors are given close attention.
Because we employ several different kinds of equipment for neurotherapy and we vary our procedures according to the presenting problem, it is possible to effectively train a wide variety of conditions and behaviors:
Attentional Problems (ADD)
Obsessive Compulsive Behavior
Autism and Asperger's
Oppositional Defiant Disorder
Cognitive Dysfunction and Dementia
PMS and Menopausal Symptoms
For a more comprehensive list of conditions in which neurotherapy has been used, we suggest you visit www.eeginfo.
There are also a number of life improvement situations in which neurofeedback is frequently used:
Memory Development and Maintenance
Fisher, S., Riding the Waves, Psychotherapy Networker, Sep/Oct 2004: Vol. 28
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Baehr, E., Rosenfeld. J.P., & Baehr, R (2001). Clinical use of an alpha asymmetry neurofeedback protocol in the treatment of mood disorders: Folllow-up study one to five years post therapy. Journal of Neurotherapy 4 (4). 11-18.
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Vernon, D., Egner, T., Cooper, N. Compton, T., Neilands, C., Sheri, A., & Gruzilier, J. (2003). The effect of training distinct neurofeedback protocols on aspects of cognitive performance. International Journal of Psychophysiology, 47, 75-85.
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Fuchs T, Birbaumer N, Lutzenberger W, Gruzielier JH, Kaiser J, Neurofeedback treatment for ADHD in children: a comparison with methylphenidate, Appl Psychophys Biofeedback 2003 March 28 (1):1-12
Gruzelier, J & Engner, T. Critical validation studies of neurofeedback. Child Adolescent Psychiatric Clinics N Am 2005; 83-104.
Hammond DC., Neurofeedback with anxiety and affective disorders. Child Adolescent Psychiatr Clin N Am. 205 Jan; 14(1): 105-23, vii
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Scott, Kaiser, Othmer, Sideroff, Effects of an EEG Biofeedback Protocol on a Mixed Substance Abusing Population AJ Alcohol Drug Abuse, Volume 31, Number 3/2005 Pages 455-469
Quantitative EEG and Neurotherapy
James Evans and Andrew Abarbanel
Academic Press, 1999, 406 pp
Getting Rid of Ritalin
Robert Hill, Ph.D., Eduardo Castro, M.D.
Hampton Roads, 2005, 285 pp
Getting Started with Neurofeedback
John N. Demos, Ph.D.
Wm Norton & Company, 2004, 282 pp
A Symphony in the Brain
Grove Press, 2001, 272 pp
ADD: The 20-Hour Solution
Mark Steinberg, Ph.D. & Seigfried Othmer, Ph.D.
Robert D. Reed Publishers, 2004, 250 pp
The Neurofeedback Book
Michael Thompson, M.D.
Association for Applied Psychophysiology, 2003, 457 pp
A Users Guide to the Brain
John J. Ratey, M.D.
First Vintage Books, 2002, 404 pp
Stress Management for Dummies
Allen Elkin, Ph. D.
Wiley Publishing, 1999, 289 pp
The New Science of Breath
Stephen Elliott with Dee Edmonson, RN
Swanstone Wynot, 2005, 125 pp
Pain: The Science of Suffering
Patrick Wall, M.D.
Columbia University Press, 2000, 184 pp
The A.D.D. Book
William Sears, M.D., and Lynda Thompson, Ph.D.
Little, Brown and Company, 1998, 300 pp
The Pain Survival Guide: How to Reclaim You Life
Dennis C. Turk, Ph.D., Frits Winter, Ph.D.
American Psychological Association, 2006, 203 pp