Answers to the top questions about Neurofeedback.
Q17. I’m a therapist/psychiatrist. I want to offer Neurofeedback. What’s the best Neurofeedback device to buy?
A1. If it works so well, why haven’t I heard of Neurofeedback?
Neurofeedback intersects Medicine, Psychiatry and Psychology, but isn’t owned by any of these fields. So today it isn’t is taught at Medical School, Psychology faculty, or Psychiatry specialist training.
In asking ‘Why do Doctors fail’, the respected US doctor and writer Atul Gawande describes this as ineptitude – the knowledge exists but isn’t applied everywhere it could help.
Despite the evidence of the power of Neurofeedback going back 40 years, it was only in the last few years that conventional science has accepted that the brain could change – a concept now known as Neuroplasticity. Before this was accepted the idea that Neurofeedback could change the brain was officially ‘impossible’ despite the overwhelming evidence. Not only has science finally caught up with what many have known to be true for decades, the cost of bringing these treatments to you had been very high. Highly complex and large equipment cost millions to own and operate. With advances in digital technology, gaming software and processes refined over many years, Neurofeedback has now become a commercially viable treatment option.
Most importantly, the understanding of the best clinical approaches and equipment design for brain training has improved to the point where several thousand Neurofeedback Practitioners are using this technology in the USA to help clients improve their brain function. Although individual practitioners have been carrying out Neurofeedback in increasing numbers in the USA, Canada, continental Europe and Australia, it is still relatively unheard of in these countries, and not quite mainstream. In the UK, BrainTrainUK aims to raise awareness and enable thousands of people to benefit from this drug-free, natural approach.
A2. What is the brain training experience like?
Clients enjoy the Neurofeedback sessions. The brain is curious about the feedback and seems to remain interested even when some repetition is necessary to train your brain to become better at self-regulation.
Electrode sensors will be attached to your head to monitor your brain waves. This involves cleaning the scalp with an alcohol swab and attaching the sensors using a special paste, similar in consistency to Vaseline. Feedback to your brain is provided through the use of video, audio and if you choose, touch. You can choose your method of feedback from session to session, but usually people settle on a preferred method. There is a choice of video games that you ‘control’ with your brain, from very simple ‘pong’ type games to car racing and jet ski games. You can also choose from a range of documentaries, TV shows or music videos, in fact any DVD you want to bring along or YouTube videos. We are not restricted to particular movies.
The video will go faster, louder or bigger as the brain changes state. As you relax, the brain is able to ‘tune in’ to the feedback and adjust in response. This all happens subconsciously, which means you don’t consciously try to direct the brain one way or another, but just relax and allow the brain to use it’s own ability to self-regulate. See more details here.
A3.How effective is brain training, what kind of results can I expect?
Studies have repeatedly shown Neurofeeedback to be effective in a wide variety of clinical applications as well as for peak performance. In cases where Neurofeedback is an alternative to medication, Neurofeedback brain training is not only safer than medication as there are no dangerous side effects, the benefits of the treatment also remain after the programme has finished. With medication you are simply controlling the symptoms, not solving the problem.
We take the time to understand your home and work environments and help you ensure they are supportive of the treatment. But like with any form of training, Neurofeedback brain training needs you to be motivated and committed to the training programme. It doesn’t work for everyone however, and the only way to find out if it works or not is to try it.
A4. Is it safe?
Absolutely. In fact, no one has been harmed since Neurofeedback began in the 1950s. The sensors we attach to your scalp are simply there to listen to the brain; there is no stimulation or signal transmitted by the equipment. The brain does all the real work, adapting in response to the feedback.
A5. Are there any side effects to the BrainTrainUK programme?
There are no side effects in the conventional sense because the training is non-invasive and does not involve any medication whatsoever. Because everyone is different, your Neurofeedback Practitioner will carefully monitor how your symptoms react to the training. Checking, for example, your sleeping patterns to ensure you are given the ideal treatment. If, for example, you developed a headache during an early training session your Practitioner will adjust the feedback settings to modify the reward frequency, ensuring that future sessions are free from discomfort. Although clinical-grade Neurofeedback is certainly not a toy, in the hands of skilled and responsible practitioners you should be confident that any side-effects can be minimised and overcome.
A6. How soon will I feel a benefit and how many sessions will I need?
Clients often feel different after just the first session, although it will take multiple sessions for the new ways of working to be fully learned by the brain. Just as different people learn at different rates, so do different brains, and some have more to learn than others. The spiral in our logo represents how each session builds upon the previous ones to accumulate the benefits. We ask that you commit to 20 sessions; this will deliver significant, lasting improvements for most clients. If your condition is particularly serious you may wish to continue beyond 20 sessions, but this is something you would discuss with your Neurofeedback Practitioner towards the end of your first course.
A7. Is Neurofeedback beneficial for everyone?
In most cases Neurofeedback promotes a learning process and long-term improvements are expected. Neurofeedback is a learning process, so the environment needs to be supportive of learning, the brain needs to be physically fit to be able to learn, and there has to be a motivation to learn. If you attend French classes you will be successful only if you are motivated to learn.
Reasons why Neurofeedback could be less beneficial include food intolerances, dietary insufficiencies, digestive malabsorption, heavy metal toxicities or excesses in certain minerals, problems in visual processing (to receive the feedback information), deficits in blood glucose regulation (dysglycemia) affecting brain function, poor sleep or poor sleep hygiene can impact the learning process. Degenerative conditions can lead to a fading of the training effect, structural injury in the brain (i.e. stroke injury; brain tumour; arteriovenous malformations; hydrocephalus; history of meningitis, etc.) limit what can be accomplished (we can’t repair damaged areas), and cerebral under-perfusion which can be a side-effect of blood pressure medications can limit effectiveness.
Another important factor that could impact the level of improvement are environmental factors within the home or school that hinder training success: emotionally unsettled or even a traumatizing home environment; being subjected to bullying behaviour at school, etc. In these cases the brain needs to ‘survive’ and there is little room for ‘learning’. For more detailed information about factors that could impact the benefits of Neurofeedback, please click here.
A8. What are your qualifications and how up to date is your equipment ?
BrainTrainUK are the UK’s leaders in the Neurofeedback field and the first multi-modality practice. We are technically trained by the the world’s leaders in Neurofeedback for therapeutic applications, including EEG Info, Siegfried Othmer, Susan Othmer, David Kaiser and Juri Kropotov. With BrainTrainUK you can be confident that as soon as the latest upgrade is released, we will be offering it. We are UK’s only team-based, mult-discpliciniary practice, meaning you get the benefit of multiple skills and we can cover each other in holidays. We use technology from multiple sources including Bee Medic, BrainMaster, BioExplorer, Sterman-Kaiser Imaging Labs. Most importantly, we have a process based on the medical school model to teach the clinical and operational skills that are essential but cannot be learned in a classroom.
With BrainTrainUK you don’t have to choose one technology or another, just trust us to have access to whatever’s right for your case. Our founder’s expertise in engineering enables us to cut through the marketing claims, continuously review the technologies and methodologies, challenge the boundaries and ensure BrainTrainUK clients always get the best.
Whilst our technology is the most advanced and progressive in the field, we don’t forget that the most complicated part of the feedback system is the brain, and every client is different. So we believe the most important skill is the ability to take a client-centric approach to training. Our approach has been developed and refined over more than 20 years and continues to do so, led by clinical practice, making our approach the leading 21st century Neurofeedback approach based around the whole client.
We don’t train clients to be more ‘average’ based upon a scientifically flawed concept of an ‘average brain’.
We see Neurofeedback as an important part of medicine that the medical community are still learning about. We complement and augment conventional medicine, collaborate with the existing healthcare system, are members of the Royal Society of Medicine and have strong relationships with world-leading Dieticians, General Practitioners and Specialist Consultants.
Our experience at the highest levels of private and public healthcare means we lead the field in integrating Neurofeedback with your overall healthcare experience. All of our Neurofeedback Practitioner professionals have qualifications in Neurofeedback theory, equipment and practice and have attended residential training courses . We supplement these with qualifications in Psychology, Educational Psyschology, Medicine and Neuroscience. We also take part in regular supervisory calls with Susan Othmer who has been described as ‘the best Neurofeedback clinician in the World’, and any of our practitioners can schedule a personal call with Sue at any time.
With BrainTrainUK you are getting the best – delivered by the best – supported by the best – why choose anyone else ?
A9. What are the different types of Neurofeedback ?
Neurofeedback has evolved in different directions over its 40 year history and it can be difficult to choose, as every approach makes their own claims on how they are different. The good news is with BrainTrainUK you don’t need to choose one or the other as we have access to them all – we offer a ‘best of breed’ approach that we continue to develop.
Original protocols used a ‘one size fits all’ approach. Everyone received the same Neurofeedback training based upon an understanding of what protocols work on a general basis. They don’t assume that the goal should be a certain ‘average’, they focus on maximising brain activity in certain ways. Although it has been around for a long time, this approach has value and is still used by the most expensive Neurofeedback training in the world at the Biocybernaut Institute, at $15,000 for a week of intensive training.
QEEG-Guided Neurofeedback (also known as 3G or LoRETA Z-score or Deep Brain Neurofeedback)
Some Neurofeedback practices focus on the idea of using a Quantitative Electroencephalogram (QEEG) which compares your brainwaves with ‘average’ brainwaves for your age and can display ‘3D’ images that show how your brainwaves compare with the ‘average’, using an open source algorithm called ‘LoRETA’.
You can also get a written report with lots of data and diagrams that show how your brainwaves compared with the ‘average’.
The limitation with this approach is it assumes there is such a thing as an ‘average’ brain that we should all aspire to. 10 years ago neuroscience tended to use ‘average brain’ models, which is what normative Z-score Neurofeedback, all the rage 10 years ago, is based on. Modern neuroscience does not accept the scientific validity of an ‘average brain’. See The End of Average by Todd Rose for references.
The claims of ‘Deep Brain’ neurofeedback don’t stand up to scientific scrutiny either, as this 2018 study laid out.
Even if the science still stood up to scrutiny, who wants their brain to be ‘more average’?
High-performing executives, peak athletes or autistic children do not have an ‘average’ brain and our focus is not on ‘averaging’ but building on strengths and reducing limitations.
Another point to bear in mind if you are considering a normative-QEEG is what information you want to get from the report – clients often come to us with reports from other providers that have lots of data but but little if any information on what your QEEG actually means. For a full explanation of this, and how our Advanced QEEG Brain Mapping differs, see our dedicated AQBM page.
Advanced QEEG Brain Mapping
Rather than give you a report that simply compares your electrical brain activity with the theoretical ‘average’, we give you an interpretative report that puts your QEEG into context, that you will find far more useful, and can be an input into your individualised Neurofeedback Plan. See our dedicated AQBM page for more information.
We don’t need a QEEG to deliver endogenous Neurofeedback (see below), but if we do a QEEG this approach (AQBM) is the one used by BrainTrainUK uniquely in the UK.
Endogenous (Infra Low Frequency) Neurofeedback
2 generations on from QEEG-Guided Neurofeedback, we have the capability to train at Infra Low Frequencies, where we are training the core control networks of the nervous system, using the nervous systems’ inherent ability to self-regulate to maximise performance.
We don’t ‘tell’ the brain how to change based upon 20 year-old databases as with QEEG-Guided, we use the much more powerful approach of using the brains’ own ability to learn through neuroplasticity. Some of the key differences between Infra-Low Frequency Neurofeedback and QEEG-Guided Neurofeedback:
|QEEG-Guided NF aka 3D or LoRETA Neurofeedback aka Deep Brain||Infra-Low Frequency NF|
|Focus||Brainwave averaging||Symptom improvement and performance maximisation|
|Objective||Average brain performance||Maximum brain performance|
|Mechanism||Operant Conditioning discovered 50 years ago – tell the brain how it should change to become ‘average’||Endogenous Neuromodulation first available in 2012 – give the brain information to enable the brain’s natural ability to self-regulate and change itself through neuroplasticity|
|Reference database||20 years old||Not applicable – assumes that every brain is unique|
|Reward frequencies||Traditional frequency bands Alpha, Beta, Gamma, Delta, Theta||Infra-Low Frequencies, the core control networks of the nervous system that control the traditional frequency bands|
The questions you need to ask yourself when making a decision about which approach to Neurofeedback is best for you are:-
- Do I want to be ‘average’ OR the best I can be ?
- What do I really care about ? Making my brain waves average ? OR maximising performance and relief from symptoms ?
- Would I rather use a computer database to ‘tell’ my brain how to change OR use my brain’s natural ability to self-regulate to change itself through neuroplasticity ?
- Often children with learning difficulties have specific talents that are far from average – do you want your children to be ‘average’ or to make the most of their talents ?
- What would a QEEG-based approach make of the brains of Richard Branson, Albert Einstein, Steve Jobs or Bill Gates ? Would they be average or would the QEEG suggest their brains were ‘abnormal’ ?
The questions you need to ask Neurofeedback practitioners when making a decision about which approach to Neurofeedback is best for you are:-
- How did you choose your particular approach ?
- Do you have evidence for any specific claims that your approach is better than others ?
BTUK Leading-Edge Approach to Neurofeedback
Our latest approach combines QEEG-Informed NF and Infra Low Frequency NF and is unique to BrainTrainUK. We find them useful where there are psychological issues and particularly with a history of trauma.
We use $20,000 worth of equipment and software to conduct a ‘Brain Map’. Brain Maps cost an additional £449, including written report and telephone de-brief. Full details of our Advanced QEEG Brain Mapping here
A10. What’s different about Infra-Low Frequency (ILF) Neurofeedback ?
Leading-edge research in the world of Neurofeedback is investigating the possibility of using functional magnetic resonance imaging (fMRI) to provide real-time feedback. The exciting thing about fMRI research is that by presenting live images of their own brain activity to participants and challenging them to change the activity level in certain brain regions, they can restructure brain patterns in a single session.
fMRI Neurofeedback is so powerful because it is working on the primary regulatory networks or resting-state networks, the core control networks of the nervous system. However, the practical application of fMRI-based neurofeedback is handicapped by the fact fMRI scanners cost £millions and weigh tons. But thanks to the work done with fMRI neurofeedback and the identification of the resting-state networks in the EEG, this same mechanism is now available through EEG neurofeedback, in the form of Infra-Low Frequency (ILF) Neurofeedback.
ILF is the latest generation of Neurofeedback and takes the capability of Neurofeedback beyond the so-called ‘deep-brain training’ of LoRETA. The term ‘Infra-Low’ comes from the fact that the frequencies being rewarded are below 0.1Hz, well below the traditional Neurofeedback reward frequencies. Before these frequencies were identified through fMRI experiments they were not identified in the EEG, and are ignored by most current forms of Neurofeedback. Only available commercially since 2012, ILF is a modality of neurofeedback in the category of ‘endogenous neuromodulation’, which means that any changes are solely due to information being provided to the brain on its own state. In other words, the training doesn’t encourage the brain to shift itself in any particular direction, it just gives information back to the brain, an analogy is showing the brain itself in a ‘mirror’, often for the first time. We are using the most complex structure in the universe, the human brain, to decide what to do with the information.
ILF Neurofeedback reaches deep into the hierarchy of nervous system regulation, providing feedback on the brain’s primary regulatory networks or resting state-networks, the core control networks of the nervous system. Initially the brain recognises its connection with the feedback signal, and then the signal becomes the object of control by the brain. A feedback loop has been established that allows the brain to enhance its own capacity for self-regulation. The brain’s natural development depends on similar feedback loops being established within the brain.
ILF Neurofeedback gives the brain more information, more directly, accelerating the learning process. By targeting we can focus on particular functions or competencies we would like to improve.
A11. How much does it cost ?
Please visit our price page.
A12. Where can I do it ?
Full details are on our Locations page.
A.13 What does the NHS say about Neurofeedback?
Not much, although it is positive. There is a ‘chicken and the egg’ effect that means whilst the NHS do not pay for Neurofeedback, it is not widely practised. Whilst it is not widely practiced, the people who review the guidelines don’t understand it, so they sit on the fence.
For example, the 2009 full guidelines on ADHD were published by NICE (National Institute for Health and Care Excellence)( full guidelines (646 pages) can be found here.) They don’t say much about Neurofeedback, but what they do say is objective and non-critical, though a little out of date with research references. A key sentence is “Biofeedback has been employed as a non-invasive treatment for children with ADHD since the 1970s but is probably not used as a significant intervention in UK clinical practice.” We reproduce the text on Page 202 of the Guidelines here:-
“Biofeedback has been employed as a non-invasive treatment for children with ADHD since the 1970s but is probably not used as a significant intervention in UK clinical practice. A wide range of feedback presentations that are suitable for children are available and its rationale lies in theories of brain plasticity and cortical self-regulation that suggest it may be possible to countermand deficits of cortical activation (see Heinrich et al., 2006). The use of electro-encephalography (EEG) biofeedback derived from the initial hypothesis of Satterfield and colleagues (Satterfield & Dawson, 1971; Satterfield et al., 1973) that attentional deficits result from dysfunction of the central nervous system and that children with ADHD exhibit behaviours consistent with ‘low arousal’. It is assumed that variations in alertness and behavioural control are directly related to specific thalamocortical generator mechanisms and that such variations are evident in distinctive EEG frequency rhythms that emerge over specific topographic regions of the brain (Sterman, 1996).
It is proposed that ADHD neuropathology could alter these rhythms and that EEG biofeedback training directed at normalising these rhythms might therefore yield sustained clinical benefits. Biofeedback techniques thus involve training individuals to exercise a certain amount of control over their brainwaves (as recorded by EEG) through bioelectrical neuroregulation. The mechanism by which it is proposed that this can be achieved is based on the assumption that the central nervous system can regulate a series of phys-iological functions in addition to its own activity.
Intentional modulation of cortical self-regulation is achieved through a process of operant learning through the provision of training aimed to decrease excessive theta or slow wave activity (which is associated with feeling drowsy) and increase beta activity (which is associated with ‘alertness’ and attentional and memory processes). Biofeedback training involves the clinician setting desired thresholds on the biofeedback equipment. These thresholds are based on treatment goals, for example to decrease theta rhythm and increase beta rhythm.
As the individual’s physiological changes approach and surpass the set thresholds, the equipment provides either auditory or visual feedback, which serves as positive reinforcement for the desired changes. Thus, as an individual decreases theta and increases beta waves during EEG biofeedback, reinforcement is provided to encourage them to become more aware of what they are doing to achieve this desired state and to continue in the same manner. In children a focus has been on the training of slow cortical potentials as well as theta and beta waves, and the use of a computer- based delivery seems to assist with the acceptability of the method.”
NICE reviewed the guidelines for ADHD in 2016-18. They did consider Neurofeedback, but they sat on the fence once again.
We have raised concerns about the operation and independence of NICE with the UK Government.
A14. Is there any research going on in the UK on Neurofeedback ?
Yes. In fact there is so much research going on that it is too hard to keep this section up to date. We will instead refer to key research via the News page or the Facebook page.
For example, BrainTrainUK are involved in a doctorate study at Bournemouth.
A15. Is it possible to complete the brain training program from home?
Provided you are confident using a PC, and are able to attend several in-person sessions initially, it is possible for you to deliver the balance of the training program at home by borrowing the equipment. This allows a potentially more frequent training program without the need to travel. We would have to be confident that you were able to master the skills necessary, would set a time limit on the loan, and would require regular updates of symptoms and regular progress calls with your Practitioner. Please contact us if this would be of interest.
A16. How many electrodes do you use?
This question is like asking a train company how many horses they use – it comes from an outdated mindset.
The idea that by collecting information from 19 electrodes and providing feedback simultaneously is superior to a focused bipolar montage using 4 electrodes is like suggesting you can train all your muscles simultaneously!
The reality is that all Neurofeedback training information is simple. In the old days this was a red light or a green light. These days the feedback information is still very simple but is presented in more sophisticated ways.
If you are tempted by the implication that 19-channel feedback is fundamentally different then we suggest you read this first.
A17. I’m a therapist/psychiatrist. I want to offer Neurofeedback. What’s the best Neurofeedback device to buy?
This question is like asking which is the best stethoscope to buy as you wish to become a medical doctor.
Neurofeedback is a clinical process that uses technology. It’s not a technical process that anyone can use clinically.