How NF works

Neurofeedback is a painless, non-invasive procedure. The method involves quantifying and training brain activity. The brain activity involved in the thoughts, sensations, actions and emotions is detectable in the form of brainwaves (electrical impulses generated by brain activity). During NF sessions, one or more electrode sensors are placed across the scalp and one to each ear, to detect these brainwaves and enable practitioners to view an individual’s brain activity.

Brain waves are monitored by an amplifier and a computer based instrument that processes the signal and provides feedback. This is displayed to the patient through a video game or another video display along with audio signals. The patient is then asked to either “make the game go” or “play the movie” with his or her brain. As activity in a desirable frequency band increases, the video game either moves faster, or the movie continues playing. When activity in an adverse band increases, the visual display is inhibited. During this process, the brain activity of the patient is compared to a goal on the computer. The sounds and images act as rewards, telling the patient immediately when their brain reaches the goal – as they are activating or suppressing the target brain area. Gradually, the brain responds to the cues it is given and a “learning” of new brain wave patterns takes place.



Baseline assessment

Before you begin your NF training, an initial interview will be used to obtain a description of symptoms, and to gather your health and family history. Some cognitive tests may also be done (e.g., neuropsychological/cognitive) if neurofeedback is being conducted for the purposes of trying to improve cognitive performance. Having a good baseline of cognitive ability and being able to quantify a persons cognitive strengths and weaknesses is very valuable. Whilst many practitioners give a single attention test, it is well understood that attention is not a unitary construct, hence a thorough attention battery is recommended at a minimum testing both auditory and visual attention (a single test is not enough as the attention weakness may be in the other modality). Working memory and processing speed should also be assessed as these two skills are often associated with functional deficits in attention, hence may also need to be monitored. Executive functioning (i.e.. planning and organisation) should either be assessed formally with neuropsychological tests or alternatively screened with a questionnaire like the Behaviour Rating Inventory of Executive Functioning (which has both child and adult versions). In an ideal scenario anyone with cognitive issues should have a full neuropsychological test battery, however most neurofeedback practitioners are not neuropsychologists, hence more simple test batteries are often used. If the neurofeedback is being conducted for more emotional issues, a proper standardised questionnaire should be completed as to ascrertain the severity of the issue as a means of gaining a baseline to monitor improvements. As part of baseline it is also recommended for all clients that  a routine quantitative electroencephalogram [QEEG]  is conducted to gain and overview of the entire brain and areas of dysregulation, in order to guide the actual training.

Potential neuropsychological tests for patients with cognitive issues:

Cognitive Areas Common tests  When to use
Intellectual functioning (IQ) Wechsler  Scales If queries of intellectual issues it is important to do an IQ test. If an intellectual deficit is present it is recommended that the families are informed that results of NF will be limited as NF has not been shown to improve intellect.
Processing speed Wechsler Scales or SDMT If a patient is slow to answer questions or generally slow to process information. NF can be targeted at improving coherence in the brain or generally through activating the brain some improvements in processing speed may occur. Note: If the patient is only slow visually it is worthwhile having their basic acuity and functional visual skills assessed, as visual issues may be underlying this slowness which will not be improved with NF.
Working Memory From Wechsler Scales or WRAML If a patient is struggling to retain instructions, or when given multiple instructions quickly forgets them. May also present as issues getting through a morning routine or struggling to recall information that is read. A good baseline is important in NF as improving working memory may be dependent on the area trained. Front lobes are found to be more associated with working memory.
Memory WRAML, WMS, CMS If a patient is very forgetful it could be worthwhile assessing both visual and verbal memory, as well as short-term and long-term memory in order to objectively monitor benefits.
Attention skills Continuous performance tests such as: Conners CPT, CATA, IVA, TOVA, TEA-Ch, TEA, MOXO Comprehensive attention testing is vital in any patients with diagnosed ADHD or has complaints of attention problems. Without a doubt formal objective attention assessment is one of the most under-utilised tests for ADHD, which makes it the only diagnosed disorder that relies upon people opinions rather than an actual test of the patient. One of the most puzzling phenomenon that the medical profession has created.
Executive functioning BRIEF, CEFI, BADS, TMT, Verbal fluency, Category Test Important to have a baseline of planning and organisation especially in people with ADHD or complaints of executive dysfunction.


Actual NF sessions

Following this, each standard NF feedback session will last for approximately 45 minutes: usually around half an hour of training, and around 15 minutes to prepare the equipment and clean up at the end. Standard NF training usually involves 30-40 sessions. Consistency is extremely important for training to yield enduring benefits. It is recommended that patients attend at least 2 NF sessions per week.

There are many types of neurofeedback and it is important to understand which type of NF your practitioner is providing so that you understand the scientific evidence behind each type of NF and what issues they have each been shown to treat. More information can be found on the different types of NF on our website and under each disorder different efficacies of different modes are discussed. The most common type of training in frequency training, which is the oldest and most established type of training, with the greatest body of research and some of the widest applications. Other training like Slow Cortical Potential training has more limited applications because only a single site is trained, it great contrast to the very new and exciting Z-score training that can train numerous sites simultaneously (although has weaker research due to its more recent invention).

Typically most people will require between 30 or 40 sessions of neurofeedback to access long-term benefits of the training. Practitioners of Z-score training claim that this number of sessions can be cut dramatically with this new technology. Results can be seen as early as the first few sessions, but most people will require sustained sessions to maintain the results long-term. Every individual is different, so a qualified practitioner should be able to outline a training schedule to suit your specific needs and ensure lasting results.