The single most important factor is observing very carefully after each session to see what changes there may be and reporting those to us consistently after very session using our online reports. Other than that, the general factors that have been associated with brain health are helpful. Get enough sleep. Eat a balanced diet with whole rather than highly processed foods. Make sure you get enough Omega 3 fatty acids, through your diet or with supplements. Get regular aerobic exercise. Avoid excessive screen time and engage in a wide variety of activities that stimulate.
The definition of evidence based practice in psychology accepted by the American Psychological Association is: “Evidence based practice in psychology is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.” The National Institutes of Health Institute of Medicine define it in this way: “Evidence based practice is the integration of best research evidence with clinical expertise and patient values.” At the NeurodevelopmentCenter, we will talk with you about all forms of treatment you have tried and the degree of evidence for each, and we will encourage you to pursue any or all treatment for your area of concern that has more or stronger research support than neurofeedback. We will summarize for you the research that is available on neurofeedback for your target symptoms and note the strengths and weaknesses of this research. Then we will discuss your preferences and values and think together about whether or not neurofeedback makes sense for you given all this information. That is evidence based practice.
No. In fact, we will not begin neurofeedback with our clients until they feel that they are more or less stable on the medication they are on, at least for the short term. We do not want there to be medication changes early on in the training process while we are first observing the effects of the neurofeedback. If two factors (medication and neurofeedback) are changing at the same time, we do not know how to interpret any changes you observe or experience. Were those changes due to the medication or to the neurofeedback? After an initial period of neurofeedback, it may be possible to reduce a medication dose or eliminate a medication. That is a decision you make together with the prescribing medical professional, although we are happy to discuss this with your doctor if you prefer. It is our experience, and that of many other neurofeedback providers, that neurofeedback often seems to make trainees more sensitive to the effects of medication.
No. Neurofeedback is a way to retrain the brain to function better. It is not a matter of learning strategies to consciously apply, and then using those strategies in everyday life. What is important is that when it is effective, it results in brain change. And it is that changed brain that goes about the business of helping you adapt successfully in life.
You can think of it as like working out in a gym. You get stronger, more flexible, more fit. But you don’t have to think what you were thinking when you worked out in the gym in order to be strong, flexible, and fit during your daily life. Your retrained body takes care of that naturally, as does your retrained brain.
No. Studies have shown that neurofeedback can alter brain function in cats, rats, and monkeys. What is most important is that a reward or signal is given when the desired brain response is shown. The cats, rats, and monkeys were not trying to change their brains. They just liked it when they got rewards. However, we always want the person who is training to understand as best he/she can and to want to reach the goals or outcomes for training that have been established. The whole process makes much more sense if you understand that you can do better in life if you improve the brain function in the part of the brain involved in those functions. For example, “I want to be able to pay better attention when I play baseball. The front part of my brain helps me pay attention. So I want to make that part of my brain stronger so my attention is better.”
The neurofeedback trainee sits in a chair. Three areas on the head and earlobes are wiped with alcohol and a mildly abrasive paste that removes skin oils and dead skin cells that reduce transmission of the electrical signal from the brain. Then three silver disk sensors are placed on these spots, held by thick salty conductive paste. The electrical signal is amplified and sent to the computer to be processed. No electricity is put into the brain. The sensors just pick up the electricity like a microphone picks up sound. The feedback is provided by a computer screen and sounds. Every half second the EEG is compared to the targets or goals. The feedback displays are varied, but in each display good things happen on the screen when your EEG is meeting the targets, and they stop happening when your EEG is not. For example, pacman turns bright yellow and gobbles up dots when your brain meets the targets and stops gobbling and turns black when it does not. Or, every half second that your brain is meeting the targets, a small piece of a picture is revealed, like a puzzle piece being added, while nothing further is revealed when you brain does not meet the target. Here is an example of another videogame-like feedback format.
Healthy skepticism is an important part of taking a scientific approach to health care. Your doctor wants to be sure there is scientific support for the effectiveness of neurofeedback. He or she probably believes that there is little research proving the effectiveness of neurofeedback. This is fair enough, since until fairly recently, there was relatively little solid research on neurofeedback, and it was not published in commonly read journals.
In the last five years or so, there is much more and better research. But these studies are primarily published in neuroscience journals, not in the kind of journals that most practitioners regularly read. And even now, the field is still lacking in the kind of large, randomized, carefully controlled studies that allow for the highest level of confidence. Neurofeedback research is incredibly expensive and time consuming. Still there is more research on neurofeedback than on many interventions that are widely used today in medical and psychological practice.
In fact, the American Academy of Pediatrics has recently ranked neurofeedback as having “Best Support” for the treatment of ADHD.
To provide our medical and mental health colleagues with additional evidence of the effectiveness of neurofeedback in actual practice, we engage in systematic measurement of treatment outcome using well established psychological measures. You and your doctor will be able to see your improvement with hard data.
Your job when doing neurofeedback is simply to pay attention to the feedback and be pleased when you are successful and patient when you are not. You want to allow your brain to learn. Your thoughts will wander from time to time. You want to bring your attention back to focus on the feedback.
It takes a while to learn. This is not easy. So you need to be patient with yourself. Remember, your brain learns from the moments when it is successful and when it is not. You learn what to do and what not to do. Both types of hints give information to your brain.
Many people want to find strategies to get the EEG to change, things like thinking positively or using imagery, and so on. Our experience has been that this seems to get in the way of brain change rather than make it easier to change. A recent study done in a university lab in Austria confirmed this experience. In their study, those who tried to use strategies to get their brain to change in neurofeedback were not able to change their EEG, while those who just attended to the feedback and allowed their brain to learn were able to change the EEG.
Until recently, the research into neurofeedback has been published in very specialized journals. Even now, studies are often published in neuroscience journals which most practicing medical and psychological professionals do not read. Except for a few universities in the US and abroad, neurofeedback is not taught in training programs.
There have been multiple follow-up studies to answer this question. Follow-up research has been done on neurofeedback for ADHD, autism spectrum disorders, and PTSD. The period of follow-up has ranged from six months to three years. All of them show that the gains from neurofeedback last over the period of follow-up. Several studies showed continued improvement after the training ended. However, much more follow-up research needs to be done, and over longer periods of time.
Please remember though that these results are averages. If on average the gains last, still there may be individuals within the group whose gains do not last. In practice, we have found that for some individuals, the benefits from neurofeedback have lasted. Others need occasional booster sessions, say three or four times a year. Some though have required ongoing training at home to maintain their improvement. This is usually with more severe and more chronic problems.
There can be short lived negative effects after sessions. For example, it may be hard to fall asleep on the night of the session. Some clients feel a little tired after sessions. Occasionally, trainees have a headache after the session. These effects usually are gone the next day. Usually we are able to change the training so that these negative effects no longer occur.
We are not aware of any lasting adverse effects. The reason is simple: neurofeedback is a form of training. It takes lots of repetition to result in neuroplastic change so that a neurofeedback effect endures. Of course this includes negative effects. As long as you do not repeat multiple times a way of training that results in negative effects, the adverse effects fade. That is why we have developed our online system for getting your observations about the effects of each neurofeedback session. We have very clear information about any side effects and take them very seriously. We are almost always able to find a way to adjust the training so that the adverse effects stop. Many studies of neurofeedback have been completed with no reports in them of lasting adverse effects.
Many studies of neurofeedback have been done and no adverse effects have been reported in these studies.
So neurofeedback is safe. This is less surprising if you think of what it is: it is just learning.
It’s easy. Just contact us to schedule your first visit.
We have different ways to provide the feedback. Some formats are like videogames, where you make progress in the game when you meet training targets. Good things happen in the game when your brain is headed in the right direction, and stop when your brain is not. You can see this in action by clicking here. Another form of feedback uses images in a puzzle format. Each half second that training targets are achieved, a piece of the puzzle is revealed. We can also use any video as the feedback. You pick the video or movie from our large collection. The movie plays when brain training goals are met and stops when they are not. Similarly, we can provide feedback so that music plays when goals are met and stops when they are not.
The most important thing is that good things happen when the targets are met and do not when the targets are not met.
No. We have worked with all ages, from 3 to 73. With younger kids, the limiting factor is their ability to sit still enough and long enough. With young children, we choose the feedback screens to maintain their interest and engagement in the process. Younger kids will often sit in a parents lap. We have also used edible rewards to keep younger kids engaged – a potato chip after every maze is done. There does not seem to be an upper age limit. As long as you can sit and pay attention to the feedback, it is possible to train.
Two or three times weekly. Neurofeedback is a form of training, and like all training must be repeated consistently to be effective. We recommend twice weekly sessions whenever this is possible. Although progress does seem to be more rapid with twice weekly visits, many of our clients have made good progress with weekly visits.
Training sessions typically take about 45 minutes, with actual feedback time varying based on what is best tolerated and most effective. Some individuals do best with short sessions – ten to fifteen minutes. Others seem to progress faster with longer sessions. This is always individualized to optimize benefit.
Neurofeedback sessions can be scheduled with our office manager. We provide neurofeedback services on Tuesday and Friday afternoons, from 1:00 to 5:30. There are multiple training stations in our brain training center so that you are usually able to find an open time that is convenient.
Unfortunately, there is simply no way to predict how many sessions will be needed to attain the goals our clients specify in advance. We ask all those considering neurofeedback to commit themselves to a minimum of 20 sessions. Some of our clients are able to attain their goals within this time frame.
Roughly speaking, there seems to be a relationship between the severity of the problem and the length of training required. Less severe difficulties (with attention, mood, anxiety, for example) can sometimes be resolved within 20 sessions. More severe difficulties may require a longer period of training. For some types of difficulty (for example, autistic spectrum disorders) regular ongoing training may be best. In these instances, we recommend that the individual carries out the training at home under our supervision and coaching.
Please contact us to request a current schedule of fees.
You may be eligible for insurance reimbursement for the assessment and neurofeedback training services we provide.
Dr. Hirshberg serves as a participating provider for and Blue Cross Blue Shield of RI (not Mass) and United Healthcare. Blue Cross and Blue Shield of RI and Mass do not cover either the quantitative EEG or neurofeedback. If you are a BCBS subscribers, you will need to pay all fees out of pocket at the time of your visit or use a package plan. United Healthcare covers for some policies only. For all United subscribers, our office will check to determine if there may be coverage. Please remember that you are responsible for all fees in the event that your insurer denies a submitted claim.
For those with insurance from other carriers, we require that you pay all fees at the time of service. You may be able to obtain reimbursement for your payments from your insurance carrier, although we do not guarantee such reimbursement. We will provide you with a statement to submit to your carrier.
If you are covered by plans other than United Healthcare and Blue Cross Blue Shield of RI, the only way to know if your carrier will cover neurofeedback is to contact them directly and inquire. Please be sure to confirm coverage from them yourself. To assist you in obtaining a record of information concerning your insurance coverage for QEEG and neurofeedback for plans other than BCBS or United, we have designed an Insurance Worksheet. If you are covered by a plan other than United Healthcare and Blue Cross Blue Shield of RI, you will need to pay out of pocket at the time of the visit and apply for reimbursement from your carrier.
For the qEEG, your insurance carrier may require an indication of medical necessity, which would be provided by your primary care physician. QEEG is often used to rule out any medical contribution to your symptom pattern, such as epilepsy or some form of encephalopathy. Dr. Hirshberg can speak to your physician should he/she wish. The interpretation of the EEG is done by a board certified neurologist, which should satisfy the requirement your insurance company may have that the assessment be done by a qualified medical professional.
The procedures we use for psychological assessment for neurofeedback may also be covered by your insurance.