What is Neurofeedback?

Understanding the fundamentals of neurofeedback can help patients talk with their providers about this treatment option. 

What exactly is Neurofeedback (NFB)? Simply put, NFB is a technology that allows us to perceive the activity of our brainwaves. NFB is non-invasive and non-pharmacological. NFB equipment reads electrical activity of the brain through sensors placed on the head; it does not add electrical currents to the brain from the device.  

The surface sensors, called electrodes, measure electrical output using electroencephalogram (EEG), a technology that measures electrical activity in the brain. The interpreted brainwave data is called quantitative EEG, or qEEG, as it is translated into measurement modes using various quantitative mathematical applications. These subtle qEEQ readings are converted into visible or otherwise perceivable forms such as graphs, charts, amplitude readings, colors, animated images, sounds and so forth.  

Using these technologies, NFB simultaneously measures, monitors, and records brainwaves. The qEEG data is then used to create feedback loops that train the brain towards brainwave states that result in reduction of symptoms and/or improvement in well-being.  

The feedback loops ultimately enable patients’ brains to modulate their own brainwaves towards healthier or target frequency levels by offering rewards to the brain in the form of images, sounds, or other stimuli.  

A typical NFB session would include the patient sitting in a chair or otherwise in a resting, relaxed pose with four or more sensors connected to their head and ears. Depending on the treatment protocol determined by the practitioner, the patient might use a visual feedback system, like watching a movie or sequence on a screen, or use audio cues such as listening to a song. When the brain is experiencing the intended brainwave, the visual or audio feedback system runs smoothly; and when an unintended brainwave occurs, there may be a visual interruption on the screen or a volume change or skip in the song. These changes give the brain continuous real-time feedback to help it self-correct towards target brainwaves. 

The changes either positively or negatively reward the brain for shifting states/brainwaves, which creates a learning experience for the brain that over time trends toward healthier brainwave states. The patient is not consciously redirecting brainwaves; this is an automatic action in the brain, much in the same way desiring to pick up a cup causes the arm to reach out and clasp it.  

EEG is an instant measure of brain activity; there is no time delay for confirmation indicators. Therefore, when participants’ brains are successful at modulating brainwaves towards a goal, they promptly get a reward in the form of a visual or auditory stimulus. This “cookie for the brain” gives a hit of dopamine,11 a win not unlike “winning” a video game or hitting the bull’s-eye with a dart. The brain likes this form of reward, and the whole system—the participants, their intentions, the neurological and neurochemical brain activity—is incentivized and trained to repeat the effort in anticipation of another reward. Over time, and with practitioner adjustments based not only on quantitative brainwave data but also qualitative participant self-reports, the brain is conditioned into a new state. Repeated modulation towards the goal produces lasting changes in brain fitness and function, which, in turn, lead to lasting improvements in mental and behavioral states.  

 During a typical NFB session, this measure-loop-modulate process continues for approximately 20 to 40 minutes. A trained NFB mental health or medical practitioner monitors the session, sets the protocol, interprets activity, and gets feedback from the patient, which is used to adjust future sessions toward more effective outcomes. Repeated NFB sessions produce lasting changes in brain function and fitness, and consequently lasting improvements indicated by remission or reduction of symptoms in mental and behavioral health disorders. 

Learn more about the evidence behind NFB for treating ADHD and anxiety, or read the full report for more information.

[1] Sulzer, J., Sitaram, R., Blefari, M. L., Kollias, S., Birbaumer, N., Stephan, K. E., Luft, A., & Gassert, R. (2013). Neurofeedback-mediated self-regulation of the dopaminergic midbrain. NeuroImage, 83, 817–825. https://doi.org/10.1016/j.neuroimage.2013.05.115