What is EEG Biofeedback?
EEG Biofeedback is a learning strategy that enables persons to alter their brain waves. When information about a person’s own brain wave characteristics is made available to him, he can learn to change them. You can think of it as exercise for the brain.

How is it done?
An initial interview is done to obtain a description of symptoms, and to get a picture of the health history and family history. Some testing may be done as well. And the person does the first EEG training session, at which time we get a look at the EEG. This all may take about two hours. (The details may differ among the various affiliate offices. In some offices a full brain map, or quantitative EEG, is routinely obtained, which may require a separate office visit. Or more extensive testing may be done.) Subsequent training sessions last about 40 minutes to an hour, and are conducted from one to five times per week. Some improvement is generally seen within ten sessions. Once learning is consolidated, the benefit appears to be permanent in most cases.

The EEG biofeedback training is a painless, non-invasive procedure. One or more sensors are placed on the scalp, and one to each ear. The brain waves are monitored by means of an amplifier and a computer-based instrument that processes the signal and provides the proper feedback. This is displayed to the trainee by means of a video game or other video display, along with audio signals. The trainee is asked to make the video game go with his brain. As activity in a desirable frequency band increases, the video game moves faster, or some other reward is given. As activity in an adverse band increases, the video game is inhibited. Gradually, the brain responds to the cues that it is being given, and a “learning” of new brain wave patterns takes place. The new pattern is one which is closer to what is normally observed in individuals without such disabilities.

What Therapeutic Applications have clinical evidence?
There are clinical reports or case histories concerning the effectiveness of neurofeedback for the following therapeutic applications. See also Therapeutic Applications of Neurofeedback.

Addiction Anxiety
Attachment Disorder Attention Deficit Disorder
Autoimmune Dysfunctions Chronic Fatigue Syndrome (CFS)
Chronic Pain Conduct Disorder
Depression Epilepsy
Sleep Disorders Stroke/TBI
Tourettes Syndrome

Can a successful outcome be predicted?
It is not possible to predict with certainty that training will be successful for a particular condition. But for the more common conditions we see, a reasonable prediction of outcome is usually possible. More important, however, the effectiveness of the training can usually be assessed early in the course of training. For most conditions, there are no known adverse side effects of the training, provided that it is conducted under professional guidance.

Why does this training procedure work?
The brain is amazingly adaptable, and capable of learning. It can also learn to improve its own performance, if only it is given cues about what to change. By making information available to the brain about how it is functioning, and asking it to make adjustments, it can do so. When the mature brain is doing a good job of regulating itself, and the person is alert and attentive, the brain waves (EEG) show a particular pattern. We challenge the person to maintain this “high-performance”, alert and attentive state. Gradually, the brain learns, just like it learns anything else. And like with other learning, the brain tends to retain the new skill.

We observe that if the EEG is not well-behaved under these circumstances, there may be adverse impacts on learning ability, on moods, on sleep, and on behavior. With training, these may be gradually brought under control, along with normalization of the EEG.

How long does training normally take?
EEG training is a learning process, and therefore results are seen gradually over time. For most conditions, initial progress can be seen within about ten sessions. Initial training goals may be met by twenty sessions, at which time the initial retests are usually performed. In the case of hyperactivity and attention deficit disorder, training is expected to take about forty sessions, or even more in severe cases. Teeth grinding usually responds in twenty sessions. Some symptoms of head injury often respond in less than twenty sessions (quality of sleep; fatigue; chronic pain), whereas others may require longer training before they show an initial response (memory function, for example).

How frequent should the training sessions be?
In the initial stages of learning, the sessions should be regular and frequent, at two, three, or even more sessions per week. After learning begins to consolidate, the pace can be reduced. Daily sessions can be very beneficial as well.

Is EEG Biofeedback covered by insurance?
Many medical and psychological insurance plans now cover biofeedback for various conditions. Some require co-payments. Other plans have annual caps. A prescription for the training, along with a diagnosis, may be required from a physician under the medical part of the plan, or from a licensed psychologist under the mental health services part of the plan. Medicare pays for EEG biofeedback for some conditions.

My doctor is skeptical about EEG Biofeedback. What can I do?
Your doctor may not know of this specific type of biofeedback. He or she will maintain a healthy skepticism about any new approach claiming numerous benefits. If your doctor is familiar with EEG biofeedback in general, he may still be thinking in terms of the more common early experiments with alpha wave training, rather than with the training we are dealing with here. Ask your doctor to examine the recent research on the effectiveness of EEG biofeedback in treating various disorders such as attention deficit disorder and epilepsy. The following references are a place where he or she can start:

  • Duffy FH (2000). The state of EEG biofeedback therapy (EEG operant conditioning) in 2000: an editor’s opinion Clinical Electroencephalography, 31, v-vii.
  • Egner T, & Gruzelier JH (2004). The temporal dynamics of electroencephalographic responses to alpha/theta neurofeedback training in healthy subjects. Journal of Neurotherapy, 8, 43-57.
  • Fernández T et al (2003). EEG and behavioral changes following neurofeedback treatment in learning disabled children Clinical Electroencephalography, 34, 145-52
  • Hirshberg LM (2005). Emerging brain-based interventions for children and adolescents: overview and clinical perspective. Child and Adolescent Psychiatric Clinics of North America, 14, 1-19
  • Lubar JF & Lubar JO (1999). Neurofeedback assessment and treatment for attention deficit/hyperactivity disorders (pp. 103-143). In JR Evans & A Abarbanel (Eds), Introduction to quantitative EEG and neurofeedback. San Diego: Academic Press.
  • Rossiter T. (2004). The effectiveness of neurofeedback and stimulant drugs in treating AD/HD: Part I. Review of methodological issues. Applied Psychophysiology and Biofeedback, 29, 95-112; Part II, Replication. 29, 233-43.
  • Sterman, M.B. (1996). Physiological origins and functional correlates of EEG rhythmic activities: Implications for self-regulation. Biofeedback and Self-Regulation, 21, 3-33.
  • Trudeau DL (2005). Applicability of brain wave biofeedback to substance use disorder in adolescents. Child and Adolescent Psychiatric Clinics of North America, 14, 125-36

How much does the training cost?
The cost of the training differs among offices depending on location, the professional status of the person delivering the service, and on supplementary services offered. Typically, individual sessions run from $50 to $125. Discounts are often available for payment in advance.

What does EEG Biofeedback look like?

The therapist computer is usually positioned behind the patient. This enables the therapist to monitor the patient’s EEG at any time during the session without disturbing the biofeedback.

A single electrode is placed on the scalp (above the motor strip, typically) using gel or paste and two other electrodes are attached to the earlobes. Most patients recline during training.

The game computer is placed a few feet away, directly in front of the patient. The patient interacts (only using his EEG) with the game computer for the next 30 minutes.

Each display contains six EEG data streams (below each stream are text and average data values). The top 2 lines, slightly squiggly, are the person’s entire EEG recorded from the scalp by the electrodes. The wavy lines below show activity in separate EEG frequency bands or rhythms — here, theta, SMR, and high beta bands. The patient’s goal is to increase certain EEG frequency bands (e.g., SMR) while decreasing others (e.g., theta & high beta). The patient monitors their EEG frequency band activity NOT as wavy lines on the therapist machine, but as elements of a game on the game computer, in this case Islands. Each frequency band appears as a colored rectangle which grows larger or smaller in response to the brain wave activity.

With his brainwaves he is playing the game called "Islands." Frequency band activity is displayed at the bottom of the screen — two square “inhibit” boxes on either side on a large "enhance" rectangle. At this instant, he is doing quite well, inhibiting or reducing the activity of the bands represented by purple & yellow (at the moment, mere dots in each corner of the screen). He has increased his SMR activity to a point where it overflows the middle (green) rectangle. As long as he keeps this up, he is rewarded in the game with visual and auditory stimuli. During the 30 minute session, he will work to keep purple and yellow small and make green large as long as possible. Hundreds of times he may need to alter his brain activity in order to achieve a brain state which scores the most points. For every half second that his brainwaves stay in the desired state or “zone”, he scores another point, an additional seagull appears in the sky (top of screen, barely visible), a new stripe segment is drawn on the highway (middle of screen), and a beep sounds to announce it all. If or when he attains 500 points, the volcano (middle right) will erupt!

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