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The Hardest Things About EEG Neurofeedback

EEG biofeedback, more recently called EEG neurofeedback or neurofeedback, is not rocket science—but it is neuroscience. It is not brain surgery—but it does change and improve people’s brains. EEG neurofeedback is a noninvasive treatment for a variety of conditions and symptoms; it is basically a regimen of exercises for the brain whereby self-regulation and neural network communication within the brain are markedly improved. In practice, it is the training of brainwaves.

Neurofeedback is administered by connecting the person to computer equipment via electrodes that monitor the EEG signal from the scalp and transmit the signal so that it can be amplified, transformed, and digitally filtered. The modified information is then selectively “offered back” to the person in the form of special effects integrated into videos and games, such that the person witnessing his own brain activity automatically modifies portions of the brainwave activity.

This treatment reliably results in many improvements in mental, emotional, and physiological functioning. Areas positively affected vary according to the individual’s physiology and deficits. A wide range of advancements occur as a result of the treatment including:

  • focusing efficiency and flexibility
  • augmented concentration
  • better organization
  • mood stability
  • improved sleep
  • greater relief from anxiety
  • lessened hyperactivity and restlessness
  • abated depression
  • reduced headaches seizures
  • enhanced learning capabilities
  • decreased anger
  • diminished overreactions
  • healing from traumay
  • improved sensory processing and more accurate perception
  • more appropriate social interaction
  • generalized overall well-being

Having successfully practiced and administered EEG neurofeedback for decades, I am still amazed not only by its efficacy, but also by the inherent challenges that it poses. Here is a summary of the most demanding and thought-provoking aspects I face in my practice as a front-line neurofeedback practitioner:

  • Explaining how and why it works

    The training of brainwaves is not something that most people understand. It is difficult to form concepts about how something works within our own brain, particularly when such knowledge is not taught routinely in school or even by most professionals with whom we consult about our health, learning and habit issues, and other matters relating to our overall well-being. While we may acquiesce to the not-so-comfortable idea that we have electricity pulsing in our head, notions of electrical rhythms controlling our thoughts and feelings are harder to wrap our minds around. It is even more challenging to grasp the idea that electrical patterns within us may be responsible for or linked to symptoms, disorders, and conditions that profoundly affect us.

    The concept of self-regulation is fundamental to neurofeedback theory and practice; yet it is not something with which people are generally familiar. Self-regulation refers to the systems within our brain and central nervous system that control and balance our “internal housekeeping”—processes endemic to our functioning that include sleep/wake regulation, alertness, concentration and attention, mood regulation, fight-or-flight responses, hormone regulation, appetite, satiety and pleasure signals, body awareness, nonverbal and interpersonal cues, perception of pain and comfort, and even the natural rhythms of cellular aging.

    Normally, we don’t have to think about these functions or “will’ them to work (just as you don’t normally have to supervise the healing of a minor skin cut—it just fixes itself in the absence of infection). However, when things don’t work and we are plagued by symptoms, there must be some intervention to get the patterns of self-regulation back on track. This is the work that neurofeedback accomplishes so consummately.

  • Explaining what it’s like to participate in neurofeedback

    When patients or prospective patients ask how neurofeedback works, it’s not always clear what type of explanation they are seeking. Some want to be apprised of the process from a logistical standpoint; some want the theory and science; and some want proofs.

    I’m reminded of the story about the 8-year-old who approached his parents and asked where he came from. The parents were certainly surprised by this relatively early request from their child about reproduction, but they decided to give their best, simplified explanation of the “birds-and-the-bees” to their precocious child. The youngster sat through a 45-minute presentation with riveted attention. Finally, the parents, sensing that they must be handling this situation adeptly, asked if he had any questions. “Well, said the child, “that’s really fascinating. But what I really wanted to know is: what hospital was I born in?”

    So it may sometimes be that in responding to queries about the neurofeedback process, the information sought is a “what do I do and what does it feel like” answer. In that case, a succinct explanation is that we attach electrodes to the scalp that sense and monitor the brain’s electrical signals outward (nothing goes into the brain directly through wires). The signal is then amplified, transformed, and filtered, whereby a portion of the filtered EEG signal is shown to the patient in the form of continuous, real-time subtle messages interwoven with and overlaid upon some video entertainment. There are video games whose actions and speed are influenced by the patient’s brainwaves, and there are movies the patient watches that are blended with special effects signifying whether the patient is “on-track” or whether his brain should do “something else.” These special effects are relative, progressive, and interactive with the patient’s neural activity. The feedback effects may include cloudiness or clarity of the images, or “curtains” that get narrower or wider according to the patient’s focus, relaxation, and the neuronal training effects we are trying to accomplish in order to get rid of symptoms and promote improved brain functioning.

    The patient “sees” his internal brain activity through a shifting, real-time experience with the feedback. The patient is essentially a witness or observer to his own neuronal networking processes. Our brains are magnificent multitasking controllers; however, we are not very adept or oriented toward looking inward at this neuronal activity, and so we need a vehicle by which to monitor it and make adjustments. In this “witness protection program,” the person gets to observe and adjust his regulatory activity without censure, verbal clues or reprimands, or even conscious reinforcement.

  • Concepts of training and generalization

    We refer to EEG neurofeedback as a training regimen. It is an exercise for your brain. Like physical exercise, it requires repetition. Your brain faces challenges, adapts to meet those challenges, and, in the process, becomes stronger, more durable, and more flexible. In contrast to physical fitness training, the neurofeedback mental fitness training does not require indefinite maintenance, since the brain retains its new learning and internal state adjustments. The brain then exercises these improved capacities in many areas of life, generalizing the effects to better levels of functioning on an enduring basis.

    We may ask the question: how does one ride a bicycle? The simple answer is that you just get on and ride, using your sense of balance to steer and move forward on the apparatus. You may remember learning to ride, or perhaps teaching your child to ride. At first it seems an overwhelming task—and then, the brain just “gets it,” and coordinates the sensory and motor systems in conjunction with gravity. You adjust to constantly changing conditions and adapt and balance in accord with the changing flow of conditions, all the while maintaining your balance, equanimity, and purposeful progress. In the same manner, with neurofeedback, the brain learns the hang of adapting internal neuronal activity to the varying demands of appropriate functioning with changing conditions, as daily life requires.

    Neurofeedback is an exercise that increasingly builds functionality in the brain. The branches and interconnections of functionality follow a developmental hierarchy. As we develop from infancy through childhood and adulthood, we must build neurologically the functions and resiliency that will enable us to deal with life’s varying conditions, challenges, adversities, and setbacks. These include self-regulatory patterns, cognition and flexibility, and the ability to emotionally “self-soothe” in the face of provocation or perceived threat.

    Effective neurofeedback not only reduces symptoms rather quickly, but it lays the developmental foundation for the brain to be flexible, able to shift, and to become more resilient to impingements and adversity, even long into the future after the neurofeedback intervention has taken place.

    Because we are building the brain’s self-regulatory functionality, symptoms subside as a consequence of the improved level of function. We may also “scaffold” training protocols to further improve functionality, once the basic stabilization and self-regulation issues are accomplished. This results in “peak performance” and resistance to symptoms returning in the future in the event that life takes a bad turn.

  • What the computers tell and don’t tell

    Patients commonly ask “what the computer says about my brainwaves,” or “how the computer says I’m doing.” In Silicon Valley, where I practice, there is a population of highly technical engineers who seek and expect precise digital and mathematical information to verify “correct operations.”

    This approach may be understandable from an engineering standpoint, but it is off the mark with regard to brain self-regulation and the generalizable process and effects of training the EEG. We are using the EEG as a vehicle to exercise the brain—much like we might use a treadmill to exercise the body. We look not to what the treadmill says, but to other parameters and measurements of improved fitness and functioning. Similarly, we are relatively unconcerned with ephemeral brainwaves, but are oriented toward the lasting and adaptive effects of exercising the brain’s abilities and habits of shifting gears at the appropriate times to the effective states and electrical rhythms suited for the demands of the moment.

    If you exercise on the Stairmaster at the gym, you are actually going nowhere. However, the cumulative effect is that you will more sprightly and effortlessly climb up and down the stairs in your daily life, less winded and less fatigued from the demands. Additionally, over time, you will accrue widespread additional benefits that sanguinely affect your physical health, outlook, emotional balance, and resiliency. Just extend this scientific truth to the powerful effects of improving your brain functioning globally.

    It is common for well-meaning and frustrated parents to inveigh me to “set the computers so he can do his science homework.” I explain that though there are hemispheric processing centers associated with certain cognitive activities, the best way to get tasks accomplished—including particular homework activities a child may struggle with—is to address disregulation and deficits in neuronal harmony in the way the individual regulates the EEG. The outcomes for varied demands will be better when the brain can more facilely attend to its own housekeeping functions and shift EEG rhythms to accommodate specific demands.

  • Brain maps and QEEGs

    There is a growing trend among some neurofeedback practitioners to rely upon “brain maps” (also called QEEGs or Quantitative EEG studies) as a guidance system and even as a prerequisite to administering effective neurofeedback. In my opinion, this is a very misguided approach. The acolytes of this movement would insist that you must pinpoint precise brain deficits in order to appropriately treat and repair them. There are several problems and fallacies with this tenet. First, the brain map provides multiple correlations of EEG activity that compare the brain being studied with controls in the population. These data show patterns of deviations from normal; however, the deviations neither correlate well with symptomatology, nor do they specifically predict what treatment protocols will offer the brain what it really needs to self-correct. QEEG-based approaches tend to be focused on disorders rather than models of functionality.

    The brain map is a relatively static picture in a short time frame. It does not portray an adequate picture of a functional or dysfunctional person over the course of recent and past history and that person’s aspirations, needs, current priorities, and symptomatology. Whereas the QEEG can and does serve as a general indicator of the brain’s state of health and the possible correlatives of disease and injury (such as strokes, tumors, drug use, etc.), it is a very poor differentiator of clinical syndromes, such as sleep issues or the relative impact of anxiety or depression. To demonstrate these limitations, I have challenged professionals to look at ten QEEG studies (of which one is severely autistic) and pick out the autistic brain. In these experiments, the failure of trained observers to reliably spot the autistic study indicates the poor predictive correlation between EEG patterns and clearly observable clinical behavior. Identification and diagnosis notwithstanding, the brain map patterns do not dictate what training protocols will be effective to remediate the presenting deficits and dysfunctions.

    So why do many practitioners insist on the tests before doing neurofeedback? I believe the answer is twofold. First, QEEG studies lend an aura of scientific credibility. After all, they are medical studies of the brain itself: hard data, taken from direct measurements and crunched by computers to produce sophisticated mathematically based interpretations. The many graphs and compelling colorful pictures of the brain are impressive, and they lead the layperson to have faith that these “scientific data” lead to a sure and indisputable course of intervention. The “scientific data” also contribute to a pool of risk management evidence, should the practitioner be challenged or the outcome be inadequate.

    Second, QEEG studies are profitable for the practitioner. They are expensive lab tests administered and billed by the elite in the field. In addition, due to some current trends in practice and professional self-justification, many practitioners believe that they need these studies to guide them in their administration and practice of neurofeedback. To me, this is like believing that you need a GPS navigation system in your car to drive to the local supermarket.

    It’s also the case that treatment goals and results do not typically reflect in significant changes in the patient’s EEG. We are not “repairing” the EEG, but rather are training the way the brain organizes and controls the various signal patterns and neurological communications. This is in keeping with the training paradigm described earlier. Accordingly, identifying deficits in the EEG does not dictate where in the brain to attach the electrodes or what protocols will be most helpful in helping a particular brain to better organize and regulate itself.

    That said, I do find value in QEEG studies, and I have been using them for over 20 years. In fact, I studied in Europe with Juri Kropotov, Russia’s top neuroscientist and the author of textbooks on QEEGs and ERPs (event-related potentials). I have testified in court numerous times, using QEEGs as evidence to highlight brain functioning and the probability of certain behaviors in petitioners and defendants. I find that QEEGs (and event-related potentials which look at real-time brain activity “lighting up” areas of the brain while the patient is performing certain tasks) can shed interesting light and potentially useful information on brain functioning and possible approaches to improving it. It can be helpful to have separate sets of objective scientific eyes reporting on the brain of patients I am treating. The data and overviews provided by brain mapping can and should be supplemental, rather than fundamental.

    I always prioritize my professional assessment and treatment approach by using my tried-and-true method of clinical and neuropsychological assessment, face-to-face interaction with the patient, and the theory and experience of neurofeedback protocol selection developed by myself and colleagues who have cumulatively administered millions of sessions to different populations over the span of several decades.

  • Clinical skills required

    The foregoing discussion of approaches to neurofeedback administration and oversight leads to a frank inquiry regarding what does it takes to provide effective clinical neurofeedback treatment?

    The good news is that neurofeedback is such a robust technique that many different approaches can work (although I would argue that some are clearly better than others). This means that with a modicum of training and the exercise of good professional care and judgment, even novice practitioners can and do obtain excellent results—often without being exactly sure of how they are doing it. After all, this is the way that most of us started in this field, if truth be told. All the education and training doesn’t sufficiently prepare one for the actual hands-on work of dealing with whole and fragmented human beings in their hardships, suffering, uneasiness, and skepticism. As patients improve, practitioners become more confident and accrue more of an experiential base for decision-making, astute intervention, and individualized case-appropriate protocol modifications.

    It is paradoxical that the work is accomplished by the interaction between the patient’s brain and the computers, and yet the neurotherapist is a critical and necessary variable in the treatment equation. When I began providing neurofeedback, it seemed unnatural to treat patients without talking as a treatment modality. It was more amazing when patients got better without the benefit of my insights or words of wisdom. Indeed, it was humbling to discover that I could successfully treat even patients who didn’t like me and avoided interacting with me. What a strange and novel tightrope to walk: supervising and caring for patients who felt uncomfortable and mistrustful of me. Yet such is the miracle of the brain’s ability to heal itself (when given adequate information about its internal regulatory mechanisms—which is what neurofeedback provides)! And the reality is that verbal interaction and insight—counter to our intuition and the beliefs and training of many mental health professionals— do not adequately address the plethora of maladies presented by suffering patients.

    Good therapists sense when to intervene and when to stay out of the way. Still, I am surprised by the way some patients insensitively dismiss the important role of the supervising therapist. I’ve had patients overtly question my relevance in their treatment and challenge me regarding my contributions (and charges). They extoll the benefits they received, yet disregard or diminish my role in producing them.

    I am okay with taking a back seat role, and I do not need the accolades or prominent credit. The point is that even when technology colludes with biology to effect good outcomes, it is the human sentient professional (not the computers or colorful printouts) who is primarily responsible. And this requires exquisite care, sensitivity, alertness, and involvement. Supervisorial professional experience, insight, and honed skills also play key roles in training the clinic staff to implement the neurofeedback procedures properly, in dealing with any problems that may arise, and in attaining successful treatment outcomes. Just as the skilled surgeon maintains the demanding professional standards and tenor of the operating room, so, too, does the skilled neuropsychologist maintain the demanding standards and tenor in the application of the highly sophisticated equipment in the neurofeedback treatment room. The neuropsychologist may not necessarily be present in the treatment room, but his or her exacting professional procedures, values, and ethics most certainly are. This benchmark is reflected in the competence of the staff.

  • Beliefs and motivations

    There is virtue in having a positive attitude. Some would ascribe to the attitude factor a significant role in the large part of the variance of success outcomes. Beliefs are very powerful motivators, and they can inspire and direct much of human behavior, faith, and fortitude. However, beliefs, motivations, and attitudes are not the principal or actual causes in much of the material world and certainly not in the arena of science. Indeed, the relationship between beliefs and outcomes is quite the opposite of what intuition might predict: it is the results that typically shape beliefs when one is willing to regard the evidence in an unbiased manner (notably the scientific method). Many people are swayed by the “power of positive thinking,” and many also ascribe to the pervasive influence of the “placebo effect.” However true these are, beliefs and expectations must yield to the factual results from cause-and-effect interventions.

    So, too, is it in the practice of neurofeedback and in the positive results obtained. This is important because of the overwhelming skepticism that still pervades this established and proven field. Critics tend to “invent” a placebo effect to account for “improvements.” Many patients ask me if successful treatment doesn’t require the patient (usually a recalcitrant child or adolescent) to believe in the treatment or to be motivated. In response, I ask if a patient must believe in an antibiotic in order for it to work. No, belief in that case doesn’t matter—either it will work or it won’t, regardless of the patient’s belief or attitude (thankfully), as long as the patient’s motivation goes as far as agreement to swallow the requisite number of pills. It is the same with neurofeedback: just sit in the chair and become a witness, repeatedly. That’s what is required (on the patient’s part) for it to work.

    Ironically, the successful effects of the neurofeedback itself are what changes and reforms attitudes and beliefs! We change the physiology, the neuronal networking patterns, and behold: attitudes, behaviors, and beliefs evolve.

  • Insurance and payment

    Patients ask if their insurance will pay for neurofeedback treatment. Unfortunately, the answer is mostly negative. Though it is disappointing and quite unfair, this is a sad reality in American health care today. It also reflects the ignorance, minimization, and dismissiveness on the part of the medical establishment toward the well-established value and scientific evidence of neurofeedback’s efficacy. Although there are many progressive physicians who understand (and some even practice) neurofeedback, most medical professionals (including many in the mental health fields) blithely ignore or dismiss this treatment. It represents an astonishing collective ignorance and denial (see below).

    Insurance companies and health care organizations—always looking to save money—seize upon the lack of physician support, and they deny neurofeedback treatment as “medically unnecessary,” “investigational,” or simply “not covered under the plan.”

    Of course, this causes chagrin, confusion, consternation, and downright anger among patients and neurofeedback professionals. The insurance industry has no monopoly on a short-sighted approach to health quality and longevity. However, they are the ones who drive most policies and practices for patients.

    The pharmaceutical industry, of course, is the powering force behind many medical policies, costs, physician training, beliefs, and outlooks regarding health care. But even a simple look at the trajectory of patient care shows how neurofeedback treatment could and does save tremendous amounts of money while promoting and preserving long-term health.

    Hundreds of millions of American routinely ingest pills daily for maladies including mood problems, sleep disorders, attention and behavior problems, headaches, and a laundry list of other syndromes resulting from brain state disregulation. For many people, pharmacology is a way of life, and it goes on for decades, if not most of their lives. The cost of this approach to solving health problems is staggering. Even at generic cost, taking medicines for decades adds up to many thousands of dollars. Newer medicines exponentially increase the prices that consumers are charged. There are very unpleasant medication side effects. Medicines taken to relieve symptoms caused by a disregulated brain often contribute to the myriad of severe health problems that people eventually develop. Taking pills for immediate relief can mask the problem and often backfire when the drugs no longer work or when unintended complications occur. And the medications do not teach or train the brain how to regulate and control itself.

    Many of these medications cause weight gain, high blood pressure, and eventual organ problems. Other medications are addictive: try getting off Ambien, Xanax, Paxil, or various opiate painkillers. The medical community is becoming more cognizant and even alarmed at these growing trends (for instance, there is a direct link between the continued use of certain antidepressants and antipsychotics leading to diabetes); however, the “solutions” seem to be more and different pills or invasive, sometimes painful, and exorbitantly expensive treatments like TMS (transcranial magnetic stimulation).

    What about neurofeedback? For a few thousand dollars, not only can symptoms be vanquished, but the patient’s brain and nervous system can be trained for a life-long better maintenance of self-regulation, so that the treatment effects endure. All without drugs!

    Not that many years ago (before the HMO revolution and the wide scale arbitrary “cutbacks” by the insurance industry), insurance carriers would typically pay 80+% of the vast majority of medical and health care procedures. Deductibles rarely exceeded $200 (whereas today, patients may typically have $5000-$10,000 deductibles, even if they work for a major corporation). Nowadays, many people have HMOs or other restricted “in-network only” plans where neurofeedback is not offered or reimbursed. Before the last decade or two, patients could receive treatment for only a few hundred dollars out-of-pocket at most; insurance would pick up the rest. But now, everything is cut back—due to “allowable amounts” for many services (including psychotherapy). Even the shrinking percentage of patients who have insurance benefits that allow them to go out-of-network (since in-network doesn’t provide or cover it) find that insurance companies pay a pittance toward mental health treatment (10-20% is common, even when the “plan” quotes 70%).

    Trying to explain this to patients is difficult. People are angry and indignant, and they feel cheated. Of course, they are being cheated, not by mental health professionals or other providers, but by a greedy and chaotic system that has run amok and lost sight of reality and compassion, as well as longer-term economics.

  • Why haven’t I heard about neurofeedback?

    It’s getting better: the word is spreading that neurofeedback is effective. More and more people are seeking out this treatment. Decades of clinical success and research, plus a swelling dissatisfaction with narrow mainstream drug treatments are contributing to a grass roots populist attraction to neurofeedback.

    Still, the “elephant in the room” phenomenon that begs to be recognized and addressed is why doctors, educators, therapists, and other responsible professionals don’t recommend, refer, or even acknowledge the viability of EEG neurofeedback for the treatment of conditions for which it has a well-established, scientifically verified track record.

    Patients and prospective patients often ask about why neurofeedback had not been recommended to them; it is a topic that I bring up routinely. It’s a hard conversation to have, since I am partly engaging in apologetics, partly “defending” the treatment protocol, partly educating, and walking a delicate line when I confront the ignorance of so many professionals. However, the curiosity and skepticism surrounding neurofeedback must be addressed. People are not stupid; they can make intelligent decisions and make better decisions with the benefit of information, much of which is seemingly withheld by those with other vested interests. Still, there is no excuse (only “explanations”) for why neurofeedback is not a first-line recommended intervention that deserves to be validated and praised for its demonstrated success by the mainstream of healthcare professionals.

  • Physician minimization and dismissal

    It is time to hold people accountable. Though I have many dear professional colleagues who are medical doctors (several even work for me) and many are progressive and enlightened, the medical community at large continues to display ignorance, denial, and irresponsibility with regard to neurofeedback. The evidence for this sweeping allegation abounds. In the communities in which I practice, there are many physicians who have practiced for decades. They know me, and I know them. Their patients come to me, but not typically by their referrals. When I ask patients if their doctors ever mentioned neurofeedback (or other interventions besides drugs), the answer is almost universally negative. How can this be? When patients do ask their physicians about neurofeedback, the answers range from tacit nods to overt criticisms. And this minimization and dismissal is certainly not based upon evidence and research. It is truly unconscionable! Were a physician not to tell a patient about a viable cancer treatment option (such as radiation instead of immediate surgery), this would be considered unethical and irresponsible. Many physicians are increasingly held accountable for writing prescriptions for medicines that are abused. One would think they would look to neurofeedback for their own risk management in addition to patient benefit.

    The pervasive denial and lack of acknowledgment is a mystery—yet ignorance and mythology abound. Here’s some advice: if you do ask a doctor or professional about neurofeedback, phrase the question this way: “What do you know about neurofeedback and how do you know it? What direct experience do you have with this method?”

    If you simply ask, “What do you think of neurofeedback?”, you are potentially inviting an uninformed and highly prejudicial opinion. Don’t be an accessory to ignorance.

  • Connecting progress with the treatment

    In my decades of practice, I have observed something uncanny in the treatment of patients and the observations of their progress. People often do not readily connect their improvements with the neurofeedback treatment they have received.

    Patients first come in skeptical, but hopeful; they are apprehensive about the cost, uncertain about the benefits, uneasy about the procedures and commitment. Gradually, they get better, both in symptom reduction and in other ways that blossom when the brain works better. Yet it is very common for patients to attribute their improvements to factors other than the neurofeedback treatment for which they’ve paid and in which they’ve participated! It is a common and classic example of what we call the “apex problem”—the mind inventing explanations for what it cannot assimilate as rational and fitting the explanations to its beliefs and concepts.

    Often with children, their handwriting will clearly improve within a month or two of treatment. Though parents may bring this up, when I highlight and explore this volunteered information, the positive change is usually attributed to “maturation.” No doubt, maturation plays a part; but when I ask, “And when did you start noticing this improvement in handwriting (and other parent-described behaviors)?”, the answer is curiously parallel to the onset of neurofeedback training. There are too many replications of this cause-and-effect phenomenon to harbor any doubts about the productive changes that neurofeedback elicits.

    Because the brain’s functions are interconnected, patients will often experience (and report, especially with skilled interviewing) positive changes that are collateral with the problems for which they first sought treatment, but failed to report during the initial intake. For example, many people come in for problems with attention, distractibility, and disorganization; these symptoms abate and improve, but they also may report the disappearance of depression—a symptom they did not indicate earlier (perhaps not expecting that neurofeedback would help with that problem).

    Or, patients may come in seeking relief for depression or anxiety. Not only are these conditions alleviated, but the patients report much improved sleep. And so on, and so forth.

    Many of my colleagues have observed these salubrious “extra” benefits repeatedly over the years with thousands of patients. In our book, ADD: The 20-Hour Solution, Dr. Siegfried Othmer and I describe:

    Patients engage in EEG biofeedback training to relieve symptoms. They enter treatment in distress, and leave in transformation. People are not reduceable to chemical formulae, response times, or neurosynaptic uptake. They are whole individuals. In the process of becoming again whole, they undergo transformations in entirety, integration, aliveness, and personal responsibility. We may change electrical settings to encourage their brains to learn more effectively, but they are active participants who are very much “in charge.”

  • Commitment, reporting, and consistency

    Collectively, we know that neurofeedback works—that it has healed and improved the lives and conditions of thousands upon thousands of people of all ages worldwide. There are continuing challenges in refining the technique and pushing the envelope of what we have already learned and established about significantly helping people.

    In daily practice, however, the main challenges involve caring for patients and guiding them through the steps that lead to successful outcomes. Explaining procedures, answering questions, being available, and even challenging some assertions and beliefs—these are all expected and necessary aspects of patient care. Holding patients accountable is another aspect of responsible care and successful treatment, and it is not always easy. I recommend that patients attend at least two neurofeedback treatments per week, gradually building up their brain’s strength, endurance, flexibility, and resilience. The treatment is robust, meaning that it yields good results even when performed in a variety of ways and on different schedules. However, like any exercise, you have to stick with it and practice, at least for a while. Interruptions are accommodated, as the brain is used to them and it rebounds and adjusts. People do get sick and take vacations, crises appear, and life throws things in our way that may interrupt or suspend the regularity of treatment participation. Though interludes of inconsistency may happen, resuming regularity and follow-through will produce the desired results.

    I encourage people to continue what they started, to fulfill their commitments, to ask questions, and to stay involved. One significant requirement on the part of patients is reporting. We ask them to fill out forms and return them, to go online several times per week to rate their progress on private “symptom trackers.” I want my patients to keep in touch with me, to rely on me, to know that I care about them and that I am there for them. I want my patients to take initiative in their treatment and in their relationship with me, so that their highest expectations may be fulfilled.

In the final analysis, the most challenging elements about EEG neurofeedback are typically getting people to buy into it and to follow-through. As these barriers are toppled with increasing frequency and with more and more patients, the evidence of neurofeedback’s irrefutable success and viability is becoming increasingly accepted, and the funding for its proliferation and availability is commensurately materializing. I’m happy to say that the prognosis for this invaluable protocol is good and getting better!