Frequently Asked Questions
What is Neurofeedback?
Neurofeedback is an applied neuroscience modality that most fundamentally is a process of relaxation, and not a goal in and of itself. It is is provided for purposes of reducing stress. Clients who participate in Neurofeedback training may present with a variety of medical, psychological, physical and mental disorders, diseases and conditions, but Neurofeedback is never used to diagnose, treat, cure or attempt to cure any of these.
How does Neurofeedback work?
Neurofeedback training sessions are relaxing and non-invasive. A few tiny sensors are placed on the scalp at sites that correspond with the chosen protocols. The sensors continuously monitor and transmit EEG brain activity. The brain signals are amplified just enough to play back the wave forms on a computer screen, where the clinician and/or technician can watch the “live” information.
These same signals activate specialized computer-based “games” that the trainee or client watches on a separate screen. Playing the game consists of interacting with a representation of your “live” brain activity and learning to relax. This is laregely an unconcious process. The games reward the brain for changing its own activity; that is, for self-regulating. Over time, a relaxation response is “learned” as the brain sustains improved self-regulation.
Is Neurofeedback covered by Insurance or Medicare?
Neurofeedback is sometimes covered by insurance, and as it becomes standardized and more evidence-based we can expect this trend to continue. The Insurance and Deductions section of this website provides more specific information on reimbursement for all of our services.
Are Neurofeedback providers required to be licensed in order to practice?
The short answer is "NO".
Consumers are well advised to be aptly informed, and at the same time, to be appropriately wary of inaccurate claims (that a measure of safety and competence in Neurofeedback practice for an unlicensed provider) suggest they must by law have an on-site licensed professional supervising them at all times. With regard to supervision hours in any licensure, for example psychology, every potential licensee has to undergo thousands of hours of supervised practice, but such supervision does not have to be on-site, and it does not require that the supervisor be available at the time of service delivery. In fact, constant on-site supervision is not a requirement of any licensure specialty, with an exception within hospital settings. As for technicians employed by licensed clinicians in any discipline, these technicians may often perform without a supervisor present. For all of these reasons, licensed oversight in any discipline, in and of itself, is not the only or most important criteria for choosing a Neurofeedback provider that is safe for you and your children.
In Virginia, Maryland, District of Columbia and most U.S. jurisdictions, there is no single law specifically regulating who can and cannot provide Neurofeedback services. This is because Neurofeedback is a truly multi-disciplinary practice. At the present time, qualified providers may have one or more original disciplinary backgrounds. Neurofeedback amounts to a variety of procedures that might fruitfully be drawn upon by many disciplines. If any statutes requiring licensed supervision for technicians exist, these may be considered erroneous, given the fact that Neurofeedback is absolutely not a practice of either medicine or of psychology. In the state of Virginia there is no requirement for an unlicensed Neurofeedback provider to maintain a licensed supervisor on-site at all times unless the technician is directly treating a medical condition, and thereby exceeding FDA sanctioned uses for Neurofeedback equipment.
Consider all of these standards for competence in choosing your provider:
In excess of a thousand hours of certified advanced Neurofeedback and peripheral Biofeedback training and continuing education, nine or more years of full time experience, hundreds of hours of experience working with populations of specific presenting conditions, BCN-EEG certification, and other relevant certifications (providers who are nationally certified in Neurofeedback have all completed the same training and national certification exams, regardless of licensure status), multiple and reputable professional affiliations, QEEG proficiency and full-time use of in practice, relevant graduate credentials if unlicensed, (a Masters or PhD in the Applied Behavioral Sciences, in Communications/Cognitive Sciences, in Biology or Psychology, etc). Where appropriate, be sure an unlicensed provider is formally supervised by a graduate-level licensed and EEG certified professional. For example, a certified BCN-EEG who is also a Mental Health Psychiatric Nurse Practitioner specializing in adult, adolescent and pediatric care is an ideal supervisor, given expertise in both general medicine and psychiatry.
Some of the oldest and most respected leaders in the field today are not medically licensed, reflecting the fact that Neurofeedback extends well beyond the concerns of a single discipline. Given its' interdisciplinary proclivities, it has been difficult to license the practice of Neurofeedback.
Dr. Donald. C. Ferguson, Ph.D., MPH, of the Department of Psychiatry at the Uniformed Services University in Bethesda, Maryland, has written an article entitled "Licensure and Biofeedback". He suggests that " licensure in a health care field does not imply...[competence]...to practice biofeedback...In order to qualify to effectively and competently practice... professionals [should] obtain specific biofeedback training as well as supervised clinical experience...after completing training in a basic health [or related] discipline...".. A health discipline can include master's or doctoral prepared individuals in related fields, including the Applied Behavioral sciences, education, psychology and biofeedback, etc. Where clinical licensure is not available a professional provider may still be trained in multiple aspects of human behavior and learning. Look at qualifications carefully.
Dr. Ferguson stresses the "value of referring problems beyond the scope of [an individual's] practice [where applicable], and the desirability of actively collaborating with physicians and other health professionals as appropriate...No single physician, medical specialty or health discipline is uniquely qualified to deal with all aspects of the 25,000 plus medical diagnoses and ailments...humans may experience, nor is any single professional ordinarily equipped to deal with all aspects of certain single or multi-problem patients.
The Neurotherapy and Biofeedback Certification Board (NBCB) certify neurofeedback specialists, as do the Biofeedback Certification International Alliance and EEG Institute.
How long are Neurofeedback training sessions?
Appointments last between 30 to 50 minutes total, depending on which technologies are applied. From 10 to 20 minutes may be devoted to a progress review, and twenty minutes to a half hour for actual Neurofeedback training.
How often must I attend Neurofeedback sessions?
It is very important to train 2 or 3 times a week (and perhaps even more often with more difficult challenges). At an absolute minimum, 1 training session a week is required, but results may be slowed by such infrequency. Generally speaking, after adequate progress has been made (this as defined by the provider and trainee relative to individually defined benchmarks for success) sessions may be titrated to once a week, and later to bi-monthly visits. Consistency is as important as frequency, especially in the earlier stages of training.
How many training sessions of Neurofeedback will I need?
Because Neurofeedback is a natural relaxation process, no exact number of sessions can be predicted for any one individual. No two people experience the same rate of relaxation in exactly the same way. Unique environmental factors influence each person’s progress toward greater stress reduction, as do individual aims. When applicable, our most current technology can often cut the number of required sessions in half. Often, though not always, a relaxation response may be noticed between the first few sessions and no later then the tenth treatment, with a minimum of 20 training sessions required for clients to experience a tangible reduction of stress levels with related functional performance improvements. In most cases 40 sessions or more may be needed to ensure long-lasting results, with the average number of sessions completed by most individuals being 40 sessions. Very serious stress-related conditions may require 60 to 80 training sessions or more. It is important to keep in mind that we are dealing with organic processes. Therefore it is helpful not to form rigid ideas about how training will progress or how many sessions one will actually undergo outside of the average expectation of twenty to forty sessions.. Booster follow-up sessions are a good idea, and individuals often schedule ‘tune-ups’ on a quarterly basis after completing more intensive training. There appears to be a cumulative benefit with the number of sessions undergone.
How long do the effects of Neurofeedback last?
Results often appear to be long lasting, with a cumulative benefit via number of sessions completed. Depending on the technology used, the effects may less likely be sustained without completing around 40 and in some cases more sessions and titrating down over time. Where applicable, and using the newest technology the alloted time may be less, with results sometimes sustained in 20 and sometimes less then 20 sessions. Occasionally, a tapering effect after cessation of training is experienced given the passage of time or trauma-induced stressors (unforeseen accidents or other environmental or emotional precipitating events). Quarterly preventative booster sessions are recommended and a new round of training in the event of a trauma-induced relapse. Some serious conditions where organic decay has occurred may require indefinite treatments, in which case it may be possible to transition to doing Neurofeedback training in the home.
Does Neurofeedback work with individuals who cannot respond to visual / auditory cues?
Neurofeedback can be administered successfully to all individuals. Alternative cueing devices are available for those who have special needs; technologies with vibrating tactile cues are used along with the standard devices.
Are there age restrictions on who can receive Neurofeedback?
Neurofeedback providers make individual choices about age groups they train. There is no conclusive evidence to suggest any particular age is or is not appropriate for receiving Neurofeedback.
Are there any known "side effects" to Neurofeedback?
The term "side effect" is well established and is useful for describing reactions in reponse to taking prescribed medications. The term is not accurate when applied to Neurofeedback, which is not a pill, and is not an allopathic process or practice. A more accurate description for responses to Neurofeedback training is "shifts in arousal levels", and these vary from person to person, are temporary and transient, and can be expected in any change process. Some individuals are comfortable with change, and others are not. This is a major difference that sets Neurofeedback apart from allopathic paradigms, where wellness is obtained from taking a prescribed pill which is not derived from within the individual. With Neurofeedback participants are much more proactively involved with their own change processes, including identifying subtle or noticable state shifts and proactively participating in their own change adjustments.
FDA has examined EEG biofeedback in great detail and finds it of very minor risk because it has failed to find well documented abreactions over a 50 year period. In fact, Neurofeedback vs placebo studies show no side effect different than placebo.Thereforethe the FDA has exempted restrictions on its' use.
Some individuals have reported experiencing subjective and temporary state shifts noted as fatigue or more energy, mood changes, sleep disruptions or improvements, and so on, either while undergoing training or shortly after. Typically these last for only a short period of time and can be easily corrected. It is similar to starting a new medication and needing to adjust the dosage or substituting one medication with another that is better tolerated. The brain has many compensatory mechanisms that become engaged as change occurs, thus non-linear progression of outcomes is expected. Another possible effect of Neurofeedback training is its impact on family dynamics. As the family member who is being trained learns to relax, other previously under addressed family issues may suddenly surface, causing temporary disruption as adjustments within the family system are made.
Can I continue to use my prescription medication?
Neurofeedback is an effective complement to medical prescriptive protocols and clients may exercise a number of options for medication use while undergoing Neurofeedback. These options should be managed with the oversight of a prescribing physician. Individual choices are based on specific needs and aims. Some trainees start their Neurofeedback while on medication and then choose to titrate off under the supervision of their prescribing physician. If timely and successful results are not forth-coming, referrals for further evaluation by a physician will be required and a medical prescriptive intervention will be called for in addition to Neurofeedback. Newly prescribed medications targeting brain function can be accommodated at any time during Neurofeedback, with the oversight of your prescribing physician.
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Is it necessary to get a qEEG before starting Neurofeedback?
Several philosophies of practice dominate the field. Some clinicians require a quantitative analysis of EEG or qEEG, with a written report and interpretation before administering Neurofeedback training, while others do not. A gold standard data-based Brain Map is a statistically valid instrument, and is recommended over those that are not compared with a normative database. Hospitals specializing in head injuries provide comprehensive EEGs but without the quantitative analysis that a qEEG offers. Conventional imaging technologies like CT, MRI and PET may not capture abnormalities that a qEEG sometimes can, but a qEEG is not a diagnostic stand-alone instrument. For a better understanding of comparative testing procedures , or for a more comprehensive description and comparison see neurological testing procedures.
Is Neurofeedback Well-Researched and Evidence-Based?
Neurofeedback research is ongoing. Levels of efficacy, gold strandard data bases, research practices and peer-reviewed journals have been established within the field. Each year more studies are funded involving larger populations using double blind controls. It is likeley a matter of time before Neurofeedback is more widely allopathically sanctioned. Please see our Learn More/Research page to learn about Neurofeedback studies and research developments.
Is Neurofeedback equipment FDA approved, and for what uses?
Not all neurofeedback equipment manufacturers register their equipment with the FDA. It is important to ask your provider if they use professional grade EEG Neurofeedback equipment that is certified by the FDA. Under FDA guidelines, these devices can be used for "stress reduction", pain reduction, and for relaxation. No other claims can be made. Licensed clinicians may choose to use Neurofeedback equipment for "off-label" purposes as long as they do not exceed their legal scope of practice as conveyed by their specialized discipline or license.
Neurofeedback primarily helps both relaxation and improves self-regulation, thus there is really no need to make other claims for the technology. The FDA may some day approve Neurofeedback for treatment of ADHD, anxiety and other conditions, but currently the cost to obtain approval for a device to treat ADHD or anxiety from the FDA is in the millions and millions of dollars. The costs are not just related to the original product. Every software change and every new feature requires documentation that is subject to FDA approval.
Why isn't Neurofeedback more widely known and recognized?
In the last eight years, the number of Neurofeedback clinicians in practice world-wide has at least doubled. Although providers in the United States tend to be clustered in the Northeast and California, almost every state has at least one or two Neurofeedback providers. Professionals from many relevant backgrounds who have entered the field bare testament to a track record of efficacy. Prominently recognized affiliated organizations of the field include:
An impressive body of Neurofeedback research has been compiled over the last 38 and counting years. Neurofeedback provides evidence-based practices on par with health care establishment demands (Gemon, Devon & Ramsey (2000), Sacket et al, (2000), where "Efficacy" determination is derived from systematic evaluation in controlled clinical trials (La Vaque et al (2002) in which investigational treatment has been shown to be statistically superior to credible placebo, pill or alternative bona fide treatment in at least two independent researcher settings.
The field can be expected to grow and become more widely accepted, particularly as media coverage has increased, and as the field becomes more research-based.
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Is it possible to do Neurofeedback in my home?
Neurofeedback for purposes of relaxation can be administered in the home by a provider who is willing to do home calls with portable equipment in cases where the client is bedridden or home-bound. Some individuals may be challenged with life-long intractable conditions, yet can improve their quality of life with indefinite Neurofeedback training. In such cases, it is highly advisable to explore arrangements for purchasing or leasing equipment to do home training. Neurofeedback equipment is available for purchase by licensed providers only.
The recommended path to home training is to complete 30 to 40 sessions with a professional Neurofeedback provider. Once the trainee is ready the provider can offer oversight with transitional consultation on a schedule to monitor progress and ensure ongoing safe and proper instruction for the efficient use of Neurofeedback technology.
Are there cases where Neurofeedback does not work?
Neurofeedback has a good record of efficacy but it is not a stand-alone panacea; positive results cannot always be guaranteed given some mitigating circumstances.
For good results, trainees should attend sessions at least twice a week in the beginning stages of training and must be willing to maintain a consistent schedule for sessions; once a week or less initially will not yield efficacious and timely results.
Clients with recalcitrant stress-related conditions who have protracted functional deficits may need to exercise patience; relaxation responses may come more slowly then hoped for. Typically, at least 20 sessions will be needed to yield a satisfactory relaxation response, and up to 40 sessions or more to make lasting reductions in stress levels. Given these "rules of thumb", there is a natural tendency to cling to preconceived notions about how many sessions will be undertaken. It is helpful to remember we are dealing with organic functional processes that may not correspond with set notions about how training will progress or how many sessions one will undergo. Doing so may prove counterproductive to the process.
Neurofeedback may not suffice in some cases as a stand-alone intervention. Psychotherapy, medication, neutraceuticals and other interventions may be required and are recommended with referrals where appropriate. Unheeded advice for supplementary care may well mean less efficacious results.
Neurofeedback training cannot replace sound life-style choices. An unstable home or work or school environment, poor nutritional practices, poor breathing habits, unstructured sleeping habits, substance abuse, improper medication titration, a lack of willingness to improve or not heeding professional advice or requirements are all factors that can make the difference between successful or mediocre results in receiving Neurofeedback.
Neurofeedback is a function-driven learning process, meaning that technicians make adjustments to ensure increased relaxation based on known functional base-lines. Sleep quality, appetite, anxiety levels, ability to concentrate, etc. are all indicators that guide providers during a course of training. Successful relaxation results are quantitatively more possible when a client can offer succinct information with regard to functional changes observed between sessions. Without adequate reporting from clients on changes observed between sessions, providers have no clear basis for making adjustments if needed. Collaboration and communication between trainee and Neurofeedback provider are of the essence.
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