Since the birth of Neurofeedback in the 1960s, the field has expanded to include many different styles, and the advancement of technology has paralleled the advancement of clinical knowledge to expand the horizons of what is possible.
To someone looking to start neurofeedback therapy, however, the different options can be confusing. Which neurofeedback system or way of training is best? What’s the difference between different types of neurofeedback? Which neurofeedback system should I choose? What’s the difference between neurofeedback devices for home use and neurofeedback in a clinic?
There are actually several different ways we could approach describing the differences between types and styles, but I think it’s helpful to start by considering the underlying goals in each technique. Most can be described in 3 broad categories:
Teaching the brain to increase or decrease certain brainwave frequencies according to a pre-set protocol.
Encouraging the brain to become more similar to a ‘normal’ brain in its brainwave patterns
Simply showing the brain information on its brainwave activity, and allowing the brain to make changes to its own activity by a process of associative learning.
Let’s look at each of these approaches with some examples, to explain them further:
Number 1: Teaching the brain to increase or decrease certain brainwave frequencies according to a pre-set protocol.
“Let’s persuade your brain to make more of this, and make less of that”
The earliest pioneers of neurofeedback followed this approach. The birth of neurofeedback as a technique was from the discovery by Barry Sterman in the 1960’s that increasing levels of a certain brain frequency (12-15Hz or ‘SMR’) on the sensorimotor strip of the scalp was able to reduce the frequency of seizures. This was actually discovered entirely by accident. As neurofeedback practitioners started to experiment with training different brain frequencies, they found patterns that certain frequencies in certain locations on the scalp seemed to help with certain symptoms. They then developed protocols based on these findings that seemed to help many people.
For example, encouraging a person’s brain to increase beta waves and reduce theta waves on the left side often helped with ADHD symptoms. Increasing alpha waves at the back of the head and reducing high-beta waves helped some people with anxiety. In this form of training, the brain is actively encouraged to produce more of a certain frequency and less of another (this might be, for example, by the computer software making a car in a video game go faster when you make more of the target frequency, and making the car go slower if you make too much of the frequency that the practitioner is aiming to reduce).
This form of neurofeedback has been around the longest and it is simple to understand and implement. Technology has now advanced enough that a version of this style is now accessible to individuals at home via a mobile app and a headband, which is the approach used by Myndlift. The downside of it is that whilst some people get very good results with it, it may not help other groups of people as much, and results can take many sessions to appear. Also, the brain is a highly complex system, and we cannot assume that certain protocols are always beneficial and won’t have a downside. We know that increasing alpha waves helps many with anxiety, but could we have any unexpected effects by persuading the brain to increase alpha waves at a certain frequency that we have chosen? There is a level of inbuilt arrogance to this approach, because we are acting as if ‘we know best’ for the brain what it should be doing.
Number 2: Encouraging the brain to become more similar to a ‘normal’ brain in its brainwave patterns.
“Let’s encourage your brainwaves into more normal patterns”
As technology and computing power evolved over the years, it became possible to measure many parameters of brainwaves at multiple sites on the scalp, as well as quantifying aspects such as connectivity and coordination between different areas of the brain. If you take these measurements from a random sample of human beings, then you can start to gather data on the ‘normal’ readings for each of these parameters. Databases of these normal readings are now available. You can then compare (with computer software) any given person’s reading to the average, and put a number on how much that person’s reading is different from the average. The way that we describe how different a reading is from average is known as a ‘Z score’. So as an example, we might have a client with anxiety, and when we measure their alpha brainwaves in the back of their head, they are much lower than average. Maybe their z-score for this parameter (alpha amplitude) is -1.8 (a negative Z-score means that parameter is below average, and a positive z-score means that parameter is above average). Electrodes placed all over the scalp and the computer software used to analyse the readings can measure and compare to average tens or even hundreds of different parameters. The principle behind this style of neurofeedback, then, would be to encourage the brain to get closer to ‘average’ by encouraging the brain to modify its activity so that the z-score for certain parameters becomes closer to zero. The aim is not to get every z-score to zero, of course, but mainly to encourage the parameters with the most extreme z-score (high or low) to be less extreme. Again, this can be done via audio-visual feedback – for example the movie you are watching become clearer when the brain waves are moving in the desired direction, or more blurry when the brainwaves are showing more extreme activity.
This type of training is fairly easy to understand and the computer software is able to measure multiple parameters and target normalisation of several parameters at once, which can be viewed as an advantage. Once again, many people have found a lot of benefit from neurofeedback with this technique. But you may be able to already think of some downsides to this approach. Are the ‘average’ brain parameters in our current population necessarily the optimum levels that we would want to encourage everyone towards? Not all significant variation from normal is problematic, for example some highly talented people may have brain parameters that look very far from ‘normal’ but may not benefit at all from having them ‘normalised’. It’s possible again for us to have unintended consequences as we try to ‘push’ the brain towards acting more ‘normally’.
Number 3: Simply showing the brain information on its brainwave activity, and allowing the brain to make changes to its own activity by a process of associative learning.
“Let’s show your brain what its doing, and see how your brain feels about that”
This final approach is the one that is used in the Othmer method, the technique that we use at Neurointegra. In this technique, we simply show the brain it’s own activity within a certain frequency range, and we let it react to that however it will. We do not try and ‘push’ it in one direction or another. A metaphor that is sometimes used is ‘holding a mirror up to the brain’. Imagine a dancer practicing their moves in front of a mirror….being able to see their movement and posture in the mirror allows them to continually improve their technique. The brain seems to work in much the same way – when it can see its own activity, it can regulate itself better, which in turn leads to a more calm and stable nervous system. Each individuals brain seems to find the most benefit from being able to observe brainwave activity at a particular frequency, which can be quite specific, and unique to that individual. In the Othmer method we call this the Optimal Training Frequency (OTF). Much of the fine tuning of settings in the first few neurofeedback sessions in this method is designed to find the OTF for that client, where they feel the most relaxed and focused. The activity of the brainwaves at the frequency chosen is represented on the audio-visual feedback screen – for example the window in which a movie is playing gradually gets larger or smaller as the brainwave activity changes. The feedback also informs the brain of any sudden changes in brainwaves over the whole frequency spectrum, for example with a change in the volume of the music when a sudden change is detected. Again, the aim here is not to persuade the brain to move in any particular direction. Instead we are giving information to the brain, and letting the brain make of it what it will. This process happens beneath conscious awareness, and so there is no need for the client to ‘try’ and do anything. Essentially, this approach is a ‘brain-led’ technique, that trusts the innate wisdom of the brain as a fundamentally intelligent and self-regulating organ, capable of significant reorganisation and self-healing when given the opportunity. Despite this method being less directive than the previous two approaches, many practitioners have found it to be the most effective, often giving rapid results and able to help even people with extensive past trauma or instabilities. The Neurofeedback Advocacy Project has had significant success using this method with very complex clients- you can read more about their work here: https://www.frontiersin.org/articles/10.3389/fnhum.2022.921491/full .
Some downsides to this method, is that is requires a trained and experienced practitioner to select electrode placements most likely to help the clients symptoms, and fine tune the frequency to find the OTF based on the clients symptom report within and between sessions. In the Othmer method specifically, due to the use of very low frequencies, specialised equipment is also necessary to pick up and measure the brainwaves of interest.
So hopefully that gives you a bit more of an idea about the philosophy and theory behind the most common approaches to neurofeedback that are offered at present. There are many other differences as well between styles and systems, and we can look further at some of these in a future blog post.
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