Frequently Asked Neurofeedback Questions for Beginners and Clients

We have written this frequently asked questions post as a resource for staff training and your clinic website. Please use it as a starting point rather than the final word on these topics.

1. What is Neurofeedback?

Neurofeedback, sometimes called EEG Biofeedback, is a non-invasive training method designed to help individuals improve their brain function through self-regulation. It operates on the principle of neuroplasticity – the brain's natural ability to change and adapt. By providing real-time information about brainwave activity, it teaches the brain to function more efficiently, stably, and resiliently. It is a form of brain training, distinct from brain stimulation techniques that introduce external currents. Because the brain is so closely involved with what we think, feel and do, the point of neurofeedback is to train the brain to change its activity so that our thinking, emotions, actions, and bodily functioning work better for living successfully in the world.

2. How does Neurofeedback work?

The process involves placing small sensors on the scalp to detect the brain's electrical signals (EEG or brainwaves). These signals are instantly processed by computer software and presented back to the individual through auditory, visual, or sometimes tactile feedback (like sounds, music, video displays, or games). When the brain produces more desirable and regulated patterns (e.g., related to focus or calmness), positive feedback is given. This acts as a reward, reinforcing those healthier patterns through operant conditioning, gradually teaching the brain to maintain these states more consistently on its own. A trained clinician guides this process, setting appropriate protocols based on assessment.

3. What is the role of assessment, including qEEG Brain Mapping?

A thorough assessment is essential before starting neurofeedback to ensure it's appropriate and to personalize the training. This typically includes a detailed clinical interview about symptoms, history, and goals. Many practitioners also utilize Quantitative EEG (qEEG), or "brain mapping." This involves recording EEG activity from multiple scalp locations (often 19+) during resting states, then comparing this data to age-matched normative databases. The resulting "map" highlights specific patterns of brain activity (e.g., areas of over- or under-activity, communication issues between regions) that can guide the clinician in designing highly targeted and effective neurofeedback protocols.

4. What are the different types of Neurofeedback?

Neurofeedback encompasses various approaches, each utilizing unique methods to influence brain function. Traditional neurofeedback commonly involves one, two, or multiple-channel power training, which targets specific brain wave amplitudes to promote desirable changes in brain activity. Z-Score neurofeedback compares an individual's brain activity to normative databases, guiding brain function toward statistically defined norms. Connectivity and coherence training specifically addresses the synchronization between different brain regions, enhancing efficient communication across neural networks. Infra-Low neurofeedback targets extremely slow-frequency brainwaves, often below 0.1 Hz, to influence deeper regulatory processes, while Infra-Slow neurofeedback similarly focuses on slightly faster yet still very slow frequencies to promote brain stability.

Beyond EEG-based methods, Functional Magnetic Resonance Imaging (fMRI) neurofeedback provides real-time feedback based on blood-oxygen-level-dependent (BOLD) signals, allowing direct visualization and modulation of activity in targeted brain regions. Hemoencephalography (HEG) neurofeedback utilizes feedback on cerebral blood flow dynamics, typically measured from the forehead, to enhance frontal cortical activity linked to attention, executive function, and emotional regulation.

5. What conditions or issues can Neurofeedback help with?

Neurofeedback addresses issues related to brain dysregulation and is used for a wide range of conditions, including Attention-Deficit/Hyperactivity Disorder (ADHD), anxiety disorders, PTSD and developmental trauma, attachment issues, sleep disorders (insomnia), Traumatic Brain Injury (TBI) / Post-Concussion Syndrome, stroke recovery support, migraines, learning disabilities, and mood disorders like depression. It may also be used supportively in integrative approaches for conditions like Lyme disease or PANS/PANDAS. Additionally, it's used for peak performance training to enhance cognitive function, focus, and stress resilience in athletes, artists, and professionals. There is substantial scientific evidence that supports many applications of neurofeedback.

6. How does Neurofeedback relate to Psychotherapy or Functional Medicine?

Neurofeedback can be highly complementary to other therapies. For individuals with trauma histories, it can help stabilize the nervous system and improve emotional regulation, making them more able to engage effectively in psychotherapy. The therapeutic relationship itself remains crucial in these contexts. Within functional or integrative medicine, neurofeedback can work alongside nutritional strategies, lifestyle changes, and other modalities to support overall brain health and address underlying physiological factors contributing to brain dysregulation.

7. Is Neurofeedback safe? Are there side effects?

Neurofeedback is generally considered very safe and non-invasive when administered by a qualified and properly trained professional. Since it is a learning process for the brain, side effects are uncommon and typically mild and temporary. They might include brief fatigue, mild headache, or feeling slightly "spacey" or "wired." These effects usually indicate that the training protocol needs minor adjustment and typically resolve quickly. Reporting any such experiences to the provider is important for optimizing the training.

8. Who is qualified to provide Neurofeedback?

Neurofeedback should be provided by licensed healthcare professionals (e.g., psychologists, physicians, clinical social workers, licensed professional counselors, marriage and family therapists) who have also completed extensive, specialized training specifically in neurofeedback principles and practice. Certification in neurofeedback, such as Board Certification (BCN) from the Biofeedback Certification International Alliance (BCIA), indicates a recognized level of competence and adherence to professional standards. 

9. How important is the therapist-client relationship?

The quality of the therapeutic relationship plays a critical role in the success of biofeedback training. Research has consistently shown that rapport, warmth, and encouragement from the therapist significantly enhance outcomes. In one classic study, participants trained by a friendly therapist had a hand-warming success rate of over 90%, compared to only 9% among those trained by a less personable clinician. Because neurofeedback involves technical equipment and structured protocols, it is easy to overlook the human dimension. However, clients are more likely to engage, persist, and benefit from the process when they feel understood, supported, and positively reinforced throughout training.

10. What is the role of client motivation and buy-in?

Client motivation and belief in the legitimacy of neurofeedback are essential to its effectiveness. Clients who understand how the therapy works and why it was recommended are more likely to engage fully and benefit from the process. Therapists should explain the physiological mechanisms behind the presenting problem and show how neurofeedback interventions can address them. This process, often referred to as building treatment credibility, has been shown to enhance adherence and outcomes in multiple studies. Clear rationales, realistic expectations, and a collaborative approach all contribute to stronger buy-in and better results.

11. How is home practice incorporated?

Home practice is a fundamental part of neurofeedback training, as it helps consolidate skills learned in the clinic. Neurofeedback benefits can be boosted by home practice, for instance, of mindfulness meditation, relaxation, or heart rate variability biofeedback. Home practice may also include neurofeedback itself. Therapists work with clients to set realistic goals for practice frequency and duration, typically adjusting initial expectations downward to accommodate daily life. Clients are encouraged to log their practice sessions and track symptoms to reinforce learning and identify progress. Consistent home practice strengthens self-regulation and supports the generalization of biofeedback skills to daily situations where stress, pain, or emotional challenges may arise.

12. How many sessions are needed, and how long does training take?

The number of sessions required varies significantly based on the individual's brain, the conditions being addressed, training goals, consistency, and overall health. While some benefits might be noticed earlier, a typical course often ranges from 20 to 40 sessions. More complex or long-standing issues, such as severe trauma, may require 60 or more sessions for optimal, lasting results. Sessions are usually scheduled 1-3 times per week. Each appointment might last 45-60 minutes, including setup and discussion, with the actual brain training feedback period often lasting around 30 minutes.

13. Is Neurofeedback a replacement for medication?

Neurofeedback is generally not considered a direct replacement for medication, but rather a different approach focusing on retraining brain function rather than chemically managing symptoms. Some individuals find that as their brain regulation improves with neurofeedback, they can work with their prescribing physician to reduce or potentially eliminate certain medications. However, neurofeedback can often be used effectively alongside medications, and any changes to medication should always be managed by the prescribing doctor.

14. Is insurance likely to cover Neurofeedback? What about cost?

Insurance coverage for neurofeedback varies greatly depending on the specific plan, state regulations, diagnostic codes used, and the provider's credentials. It's best to contact your insurance company directly to inquire about coverage for "biofeedback" or "neurofeedback." Many providers operate on a private pay basis but may provide clients with a "superbill" (a detailed receipt with diagnostic and procedure codes) to submit for potential out-of-network reimbursement. Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) can typically be used for neurofeedback expenses.

15. Can Neurofeedback be done remotely or at home?

Yes, supervised home-based neurofeedback training is an increasingly available option. These systems typically require an initial assessment (often including an in-office qEEG) and rely on technology that allows a qualified professional to remotely set protocols, monitor progress, and provide guidance. While offering convenience, successful home training requires client commitment, a suitable environment, and consistent communication with the supervising provider to ensure safety and effectiveness.

Glossary

attention-deficit/hyperactivity disorder (ADHD): a neurodevelopmental disorder characterized by patterns of inattention, hyperactivity, and impulsivity that interfere with functioning or development.

attachment issues: difficulties in forming secure emotional bonds with caregivers, often stemming from early relational trauma or neglect.

biofeedback: a technique that uses electronic monitoring to convey information about physiological processes, allowing voluntary control over bodily functions.

brain mapping (qEEG): a technique that records electrical activity from multiple scalp sites and compares it to normative databases to guide individualized treatment planning.

brain stimulation techniques: methods that apply external currents or magnetic fields to influence brain activity, distinct from neurofeedback's internal training.

cerebral blood flow dynamics: the movement of blood through the brain’s vascular system, important for delivering oxygen and nutrients and measured in haemoencephalography.

connectivity training: a neurofeedback approach aimed at improving communication between different brain regions by training their synchronization.

depression: a mood disorder marked by persistent feelings of sadness, hopelessness, and loss of interest or pleasure in activities.

developmental trauma: psychological trauma resulting from early adverse experiences that disrupt healthy emotional and neurological development.

emotional regulation: the ability to monitor, evaluate, and modify emotional reactions in adaptive ways.

executive function: higher-order cognitive processes such as planning, working memory, attention, and problem-solving.

functional magnetic resonance imaging (fMRI) neurofeedback: a technique that provides real-time feedback about brain activity based on blood-oxygen-level-dependent (BOLD) signals.

functional medicine: a holistic approach to healthcare that addresses the root causes of disease through personalized treatment plans including nutrition, lifestyle, and integrative therapies.

hemoencephalography (HEG) neurofeedback: a form of neurofeedback that measures and trains blood flow in the brain, typically targeting the frontal cortex.

heart rate variability (HRV) biofeedback: a biofeedback method that trains individuals to regulate heart rate variability to enhance autonomic nervous system balance.

home-based neurofeedback: supervised neurofeedback training conducted at home using remote technology and clinician oversight.

infra-low neurofeedback: a technique targeting extremely slow brainwave frequencies, often below 0.1 Hz, to regulate deep brain activity.

infra-slow neurofeedback: training that focuses on very slow brainwave frequencies slightly faster than those targeted in infra-low neurofeedback.

insomnia: a sleep disorder characterized by persistent difficulty falling asleep, staying asleep, or waking too early.

learning disabilities: neurological disorders that affect the brain’s ability to receive, process, store, and respond to information.

licensed healthcare professional: a person legally authorized to provide medical or psychological services, such as a psychologist, physician, or counselor.

migraines: recurring headaches often accompanied by nausea, light sensitivity, and neurological disturbances.

mood disorders: psychiatric conditions characterized by disturbances in emotional state, including depression and bipolar disorder.

neurofeedback: a non-invasive brain training method that provides real-time feedback about brainwave activity to promote self-regulation and improve brain function.

neuroplasticity: the brain’s capacity to reorganize itself by forming new neural connections throughout life.

normative databases: collections of standardized data used as benchmarks to assess individual brain activity patterns.

operant conditioning: a learning process through which behaviors are influenced by their consequences, such as rewards or punishments.

peak performance training: the use of neurofeedback and related techniques to optimize cognitive, emotional, and physical functioning in high-performing individuals.

post-concussion syndrome: a complex disorder with symptoms like headaches and dizziness that persist after a concussion.

post-traumatic stress disorder (PTSD): a psychiatric disorder that can occur after experiencing or witnessing a traumatic event.

psychotherapy: a therapeutic process in which a trained professional helps a client address emotional, behavioral, and psychological challenges.

quantitative electroencephalography (qEEG): a quantitative analysis of EEG data, often used for brain mapping and guiding neurofeedback protocols.

rapport: a harmonious relationship characterized by mutual trust and understanding, critical for therapeutic success.

self-regulation: the ability to control one's behavior, emotions, and thoughts in the pursuit of long-term goals.

sleep disorders: medical conditions that disrupt normal sleep patterns, impacting overall health and well-being.

stroke recovery: rehabilitation efforts aimed at regaining physical, cognitive, and emotional abilities after a stroke.

superbill: an itemized receipt provided to clients for insurance reimbursement purposes, listing services rendered and diagnostic codes.

therapeutic relationship: the professional bond between therapist and client that fosters trust, engagement, and effective treatment.

traumatic brain injury (TBI): damage to the brain caused by an external mechanical force, potentially resulting in cognitive, emotional, and physical impairments.

z-score neurofeedback: a type of neurofeedback that compares an individual’s brainwave activity to normative data and trains deviations toward statistical norms.

Sources

We are indebted to the Houston Brain Center, ISNR FAQ page, and Sebern Fisher.

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