Neurofeedback uses real-time EEG technology to measure electrical activity of the brain and present this information in a form that enables the individual to perceive changes in the state of the brain and learn to modify abnormal EEG patterns.

Neurofeedback "meets the American Academy of Child and Adolescent Psychiatry ‘Clinical Guidelines’ for treatment of ADHD, seizure disorders, anxiety (eg, obsessive-compulsive disorder, generalized anxiety disorder, posttraumatic stress disorder, phobias), depression, reading disabilities, and addictive disorders. This finding suggests that (neurofeedback) always should be considered as an intervention for these disorders by the clinician….Specific recommendations based on the body of empirical evidence currently available suggest that (neurofeedback) be considered by clinicians and parents as a first line treatment of ADHD when parents prefer not to use medication and as an empirically supported treatment choice when significant side effects or insufficient improvement occurs with medication.

Hershberg, et al. (2005) Emerging brain-based interventions for children and adolescents: Overview and clinical perspective. Child and Adolescent Psychiatric Clinics of North America, Vol. 14, pp.1-19.

What is EEG Neurotherapy?

The brain sends and receives messages to and from the body through electrical impulses transmitted through the central nervous system. When the brain is physically injured or psychologically traumatized, these electrical impulses, or brain waves, are disturbed creating abnormal rhythmic patterns of activity and imbalances in the chemistry of the brain itself. Moreover, when the brain continues to transmit these abnormal patterns, imbalances are created in the delicate neurochemical, hormonal and immunological systems and the complex motor and sensory systems of the body.

Such dysregulation can result in numerous physiological problems and unpleasant symptoms. Just as somatic biofeedback therapy can be used to assist dysregulated body functions to return to their proper balance, so neurotherapy can assist the brain in regaining normal balance and function.

Neurotherapy (NT) refers to the application of a number of related brain wave modification technologies to the amelioration of various psychological and physiological disorders that appear to be related to changes in central nervous system functioning.

The various types of neurotherapy currently available provide drug-free alternative treatments for many brain-related disorders such as anxiety disorders, attention-deficit disorder, autistic spectrum disorders, cerebral palsy, cognitive dysfunction following mild-moderate brain injury, depression, hyperactivity, learning disabilities, movement disorders, obsessive-compulsive disorder, and seizure disorders, to name a few. Neurotherapies can also be used to increase peak performance in academics, atheletes, executives, etc.

Four basic technologies are currently in use under the general term “neurotherapy”...

1) EEG Biofeedback
2) EEG-Driven Stimulation (EDS)
3) Audio-Visual Entrainment (AVE) devices
4) Cranial Electro-Stimulation (CES) devices

Although not as well-researched at this point as EEG biofeedback, other forms of EEG neurotherapy have also been found clinically effective in the treatment of many brain-based disorders.

Dr. Horst Mueller has access to a number of different EEG neurotherapy systems— including EEG biofeedback, EEG-Driven Stimulation, Audio-Visual Entrainment, and Cranial Electrotherapy Stimulation— that can be effectively used to train individuals to better control their brain wave patterns and reduce or ameliorate brain dysfunction.

EEG Biofeedback

The term “biofeedback” refers to a type of skills training in which persons learn to increase their ability to control biological responses, such as blood pressure, muscle tension, heart rate, or skin temperature, etc. Sophisticated and highly sensitive electronic instruments are commonly used in biofeedback therapy to measure and amplify physiological signals from the body and convert these signals— usually through a computer— to a form that is meaningful to both the therapist and the patient and which can be used to show moment-to-moment changes in the biological response. Biofeedback of muscle tension (electromyogram or EMG) has been successfully used to treat chronic muscle pain, TMJ, and tension headache. Biofeedback of blood pressure has been used to treat hypertension. Biofeedback of heart rate has been used to treat panic attack and anxiety disorders. Biofeedback of skin temperature has been used to treat migraine headache.

EEG biofeedback simply uses specialized electronic equipment to measure the electrical activity of the brain cortex (electroencephalogram or EEG) from electrodes placed on the scalp and convert this raw data into a display that the therapist and patient can easily understand and which shows moment-to-moment changes in EEG. With the proper feedback of moment-to-moment brain wave activity it is possible to learn to alter and control brain electrical activity or brain wave patterns to a significant degree.

Sometimes also called "neurofeedback", EEG biofeedback is a training strategy that enables individuals to learn to alter their brain waves. It is a type of operant conditioning.

EEG biofeedback was first used clinically by Dr. Barry Sterman in the early 1970s to successfully treat persons with epilepsy. Dr. Sterman discovered that increasing the amount of 14 Hz activity as recorded from the sensorimotor cortex of the brain had the effect of inhibiting seizure activity. In a similar vein, Dr. Joel Lubar in the late 1970s discovered that many persons with attention deficit disorder show too much brain wave activity in the 7-9 Hz range (NOTE: Hz = Hertz = cycles per second or frequency) from the frontal lobes of the brain and EEG biofeedback could be used to train a shift in brain wave activity to the higher frequencies associated with more focused attention. Through the 1980s and 1990s, numerous well-designed controlled scientific studies have demonstrated the efficacy of EEG biofeedback in the treatment of both seizure disorders and attention deficit disorder.

There is now good scientific evidence from both controlled research and clinical studies as well as long-term follow-up that EEG biofeedback can be an effective treatment for seizure disorders and attention deficit disorder when compared to both common drug treatments and placebo, and that treatment affects are long-lasting. There is growing scientific and clinical evidence supporting the effectiveness of EEG biofeedback in the treatment of the following conditions: addictions, alcoholism, anxiety disorders, autism, chronic pain, depression, insomnia, migraine and tension type headaches, motion sickness, PTSD, and Raynaud’s disease. There are also increasing numbers of clinical reports suggesting that EEG biofeedback may be useful in ameliorating some of the symptoms and dysfunctions associated with such conditions as brain injury, chronic fatigue syndrome, fibromyalgia, movement disorders, multiple sclerosis, Parkinson’s disease, and senile dementia.

Currently, there are well over 2000 practitioners in the United States and Canada offering some form of EEG biofeedback or other neurotherapy treatment for one or more of the above listed disorders and tens of thousands of children and adults have been treated over the last 25 years.

EEG-Driven Stimulation

Whereas EEG biofeedback trains the person to alter brain wave activity, the Flexyx EEG-Driven Stimulation (EDS) system directly trains the brain itself. First developed in 1990 by Dr. Len Ochs at the University of California in Los Angeles (now owner of Flexyx LLC & Ochs Labs, Walnut Creek, California), the Flexyx EDS system uses photic (or light) stimulation to directly effect the brain waves through a process called “EEG entrainment”.

EEG entrainment refers to the well-known observation that brain waves tend to follow rhythms or frequencies in approximately the range of 1-30 Hz. That is, the brain will tend to produce an increase in EEG voltage or amplitude at the same frequency at which it is stimulated. For example, listening to a metronome steadily beating at 4 beats per second (a frequency of 4 Hz) will tend to cause an increase in brain wave activity at approximately 4 Hz frequency, whereas listening to a metronome at 10 beats per second (10 Hz) will cause an increase in faster 10 Hz brain waves. Similarly, looking at a light that is flashing at a certain rate or frequency will tend to increase brain wave activity at that same frequency— speed up or slow down the flash rate of the light and the brain waves will tend to follow.

Just as in EEG biofeedback, the EDS system measures brain wave activity from electrodes placed on the scalp and sends this raw data to a computer for analysis. By means of special proprietary software developed by Flexyx LLC, the brain wave data is analyzed to determine the single frequency from 1-40 Hz that is the most powerful at any given moment— that is, the dominant EEG frequency. This calculated dominant frequency is then used to control the frequency of a set of flashing LED lights built into a set of eyeglasses worn by the patient. The flashing lights can be set by the therapist to lead or lag the EEG dominant frequency by some amount. The therapist can also change the brightness of the flashing lights.

With EDS there is a complex interaction between the patient’s brain waves and the flashing lights in the eyeglasses. This is because the frequency of the flashing light stimulus changes with the EEG dominant frequency— as the dominant moves to a faster frequency, the light stimulus flashes faster; as the dominant moves to a lower frequency, the light stimulus flashes slower—  but the frequency of the flashing lights also tends to control the frequency of the EEG dominant through the process of entrainment. When the therapist sets the flashing lights to lead the EEG dominant by some fixed amount— say 5 Hz— the lights will always flash at 5 Hz faster than the EEG dominant frequency and this will tend to move the EEG dominant into a higher frequency range. Similarly, when the therapist sets the flashing lights to lag the EEG dominant by some fixed amount— say 3 Hz— the lights will always flash at 3 Hz slower than the EEG dominant and tend to move the dominant into a lower frequency range.

The Flexyx EDS system has been clinically demonstrated to be a very effective technique for treating problems that appear to be associated with brain wave patterns that are more or less stuck in one part of the total EEG spectrum. For example, clinical evidence suggests that most patients with fibromyalgia or chronic fatigue show excessive amounts of lower frequency delta (0-4 Hz) and theta (4-8 Hz) brain wave activity with measured EEG dominant activity that infrequently moves above alpha (8-12 Hz) into the beta (12-30 Hz) range of the total EEG spectrum (e.g., Chaudhuri, Holden, & Donaldson, 1996; Donaldson, Sella, & Mueller, 1998; Mueller, Donaldson, Nelson, & Layman, 2001).

How Does EDS Differ From AVE and EEG Biofeedback?

EDS differs from EEG biofeedback in that EDS does not require the patient to understand the meaning of, or consciously attend to, the feedback signals in order to control them and, thereby, benefit from treatment. No attentional, discrimination, or conscious learning demands are placed on the EDS patient. The feedback goes directly to the brain by way of the optic nerve and the occipital cortex and its connections with the rest of the brain. The pattern of photic stimulation is processed by the brain and facilitates adjustment of ongoing background brain activity without the patient’s conscious awareness.

EEG biofeedback involves learning through operant conditioning; whereas EDS is a form of Pavlovian or classical conditioning.

EDS also differs from commercially available AVE devices in that the light strobing frequency is directly controlled by the patient’s own EEG activity. The stimulation frequency of the consumer AVE systems is pre-programmed and changes in ways that are unrelated to the user’s own brain wave activity. With these commercial AVE devices the user may be able to select from a variety of pre-set programs designed to entrain brain waves in some particular manner to enhance relaxation, or meditation, or deep sleep, or mental energy and creativity, etc. but the program cannot adjust itself to ensure that the user becomes entrained. EDS customizes the stimulation from moment-to-moment on the basis of the patient’s own changing EEG. AVE devices are not biofeedback devices.

Audio-Visual Entrainment (AVE)

Also known as light and sound stimulation, AVE systems use flashing lights (usually small lights set inside eyeglasses, similar to EDS) and sound (usually through a pair of earphones) to entrain the EEG. Various forms of AVE devices have been in use both clinically and commercially since the mid-1970s and currently there are a number of different manufacturers (mostly American) who make this type of equipment and sell these machines to the public (e.g., Comptronic Devices Ltd. [the only Canadian manufacturer], Microfirm Ltd., Mind Gear Devices Ltd., Synectics Systems Inc, Zygon Inc., etc.).

Basically, all commercially-available AVE devices are relatively small and portable electronic devices which will stimulate the user with flashing light through a special set of eyeglasses and with sound through earphones. Like the EDS system, the light stimulation from AVS devices is given by means of a set of special eyeglasses with small lights built into the back of the lenses. The sound stimulation usually consists of simple beats or pulses of sound generated for the user through a set of earphones. Generally, the light and sound stimulation are designed to be syncopated so as to increase the EEG entrainment effect.

Unlike EEG biofeedback systems or the EDS system, commercial AVE devices do not record the user’s brain waves or show the user what is happening to the EEG while the device is being used. Also, unlike the EDS system, AVE devices are not interactive— that is, the stimulation coming from the AVE device does not change with changes in the user’s EEG. AVE devices are usually preprogrammed to run some number of different stimulation sessions, each varying in the pattern of frequency changes of the lights and sounds over the course of the session.

In most cases, commercial AVE devices include some limited number of different stimulation sessions pre-programmed into the device memory chip. Usually each of the different sessions are designed to entrain the user’s EEG to some specific segment of the total EEG spectrum so as to achieve some specific mind state. For example, most of these devices include programs that are designed to entrain the EEG into the alpha frequency range (8-12 Hz) which is generally associated with feelings of awake relaxation or reverie, or into the delta frequency range (1-4 Hz) which is generally associated with deep, restorative sleep, or into the beta frequency range (above 12 Hz, but usually 16-24 Hz stimulation) which is generally associated with alert wakefulness and focused attention.

Published scientific and clinical studies have reported AVE to be effective in inducing relaxation, reducing stress, reducing blood pressure, relieving tension headache, managing chronic pain, relieving insomnia, and reducing the discomfort of premenstrual syndrome. There is also some evidence of effectiveness in treating Attention-Deficit Disorder (ADD), mild depression and Seasonal Affective Disorder Syndrome (SADS).

Dr. Mueller frequently uses AVE for prescribed in-home therapy in conjunction with in-clinic EDS or EEG biofeedback sessions. 

Cranial Electro-Stimulation (CES)

CES devices apply pulses of very low power electricity to the brain through the scalp or, more commonly, the ear lobes as another means to alter the user’s brain wave patterns through EEG entrainment. Some CES devices can be used alone for entrainment to electrical impulses, others can be used in conjunction with an AVE device in such a manner that the user can obtain syncopated stimulation in three sensory domains simultaneously— light, sound, and electrostimulation.

In general, commercially-available CES devices are sold to the public as a means to enhance relaxation and relieve stress, and the majority of these devices are geared toward increasing EEG power in the alpha band (8-12 Hz) of the EEG but some devices may be adjustable to entrain any desired frequency band, including Delta for deep sleep and Beta for increased attention/concentration.

When using CES devices, the user sets the device so that he/she feels only a very mild electric pulse or tingling from the electrodes. Treatment sessions generally last about 20-30 minutes but can run as long as an hour if necessary. While many CES-users prefer to simply lie back in a comfortable easy chair for their treatment sessions, is not unusual for people to work on their computers, watch television, or read during CES treatment sessions. Following CES treatment, most people report feeling less anxious, less distressed, and more focused on mental tasks.

CES is safe to use in children (as young as 3 years) and adults and appears to be equally effective for both men and women. There have been no reports of enduring adverse effects.

In the treatment of anxiety or depressed mood, most patients use the CES device for 30-60 minutes once a day for a period of 3-5 weeks, followed by another couple of weeks of treatments every other day or as necessary. Patients with positive outcomes generally sleep better and report improved concentration, increased learning abilities, enhanced recall, and a heightened state of well-being after one or a series of CES treatments.

The over 150 research studies of CES that been published to date reveal significant changes associated with relaxation responses such as reduced muscle tension, positive changes in brain wave activity, increased vasodilation, reductions in gastric acid output, and reductions in blood pressure, pulse, respiration, and heart rate. CES research has also shown significant reductions in clinical depression (Gilula & Kirsch, 2005) and anxiety (Klawansky, et al., 1995).

More than 25 clinical research studies examining the efficacy of CES for the treatment of depression have been published, with over 80% of these studies reporting significant clinical improvements in the symptoms of depression (Gilula & Kirsch, 2005).

A recent meta-analysis of 22 placebo-controlled CES research studies involving a total of 1075 patients found that the average treatment effect beyond that attributable to placebo was 57% (Gilula & Kirsch, 2005). This compares very favourably with the often claimed 40-60% average treatment effects beyond placebo for antidepressant medications.

Using Neurotherapy to Normalize Brain Wave Activity

There is a growing body of clinical and scientific evidence that many of the clinical problems commonly experienced by people are associated with changes in the pattern of brain waves as seen in EEG recordings. For example, a number of clinical disorders are associated with “EEG slowing” or an excess of slow wave Delta (1-4Hz) or Theta (4-8Hz) or slow Alpha (8-10Hz) brain wave activity during the waking state when compared to normals. These conditions all appear to involve symptoms of reduced mental clarity, reduced mental and physical energy, irritable and depressed mood, and increased pain sensitivity. Large amounts of Delta and Theta activity are commonly seen in the normal brain during sleep but not while awake. Fibromyalgia and Chronic Fatigue Syndrome are two disorders that appear to be associated with EEG slowing, especially slowing in the sensorimotor cortex and frontal cortex.

Other common clinical problems appear to be associated with too much fast wave activity— especially high Beta (24+ Hz) activity— and relatively too little normal Alpha (8-12Hz) activity during the relaxed waking state. These conditions are associated with hypervigilance and high anxiety, an inability to relax, and irritability. Again, it is normal to see increases in Beta (12-32Hz) activity when a person is actively focusing their attention and processing information. Relaxation and meditation, on the other hand, are associated with an increase in normal Alpha (8-12Hz) activity and a decrease in Beta activity. In contrast, persons with attention deficit disorder tend to show too much high Theta and low Alpha (6-9Hz) and too little low Beta activity (14-18Hz) when they are awake and trying to concentrate on some mental task.

A increasing number of clinical research reports show that persons who have sustained traumatic brain injuries may frequently benefit from neurotherapy with improvements in a host of problems, including headaches, dizziness, fatigue, poor concentration and emory, irritability, mood swings, slurred speech, anxiety, and depression.

With respect to seizure disorders, there is good research evidence supporting the use of neurotherapy to train individuals to increase the amount of 14-16Hz EEG activity over the sensorimotor cortex to reduce the frequency and severity of seizures. This 14-16Hz EEG rhythm over the sensorimotor cortex has been termed the “sensorimotor rhythm” or SMR. 

Some recent research suggests that persons with alcohol or drug addictions frequently show a pattern of excessive high Beta activity and too little Alpha activity and, since alcohol and many sedative type drugs slow the EEG,  these persons’ substance abuse may actually be an attempt at “self-medication” to normalize the EEG and how they feel. A number of clinical outcome studies have shown good results in reducing the craving for alcohol and drugs with neurotherapy focused on reducing high Beta activity and increasing Alpha activity to more normal levels. Many of these studies have reported a 70-80% success rate with less than 20% recidivism over 5 years.

Other disorders appear to be more associated with imbalances in brain wave activity between the right side of the brain and the left side. For example, there is some evidence pointing to depression being associated with the right brain being chronically more active than the left.

Neurotherapy has been clinically demonstrated to improve functions such as focused attention, concentration, short-term memory, speech, motor skills, sleep and relaxation, mental and physical energy, stress coping, and emotional balance. As well, neurotherapy has been shown to moderate the brain’s perception of pain. The results of neurotherapy appear to be permanent unless another trauma or injury occurs. Experience to date suggests that once the brain’s normal rhythmic patterns have been restored, continued neurotherapy is no longer necessary.

Important Concluding Statement

Many published clinical studies have demonstrated the effectiveness of various forms of EEG neurotherapy, particularly EEG biofeedback training, for treating various problems. Some EEG neurotherapy interventions have extensive published support and others have little or none. As such, some health insurance company personnel and professionals like physicians, psychologists and other health care professionals are not aware of or familiar with the latest published research or may consider the support for the specific EEG intervention being proposed for treating a particular problem to be insufficient to consider this intervention valid and efficacious. There are also many health care practitioners who are convinced of the efficacy of EEG neurotherapy.

References and Selected Sources
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 “In my experience with EEG biofeedback and ADD, many people are able to improve their reading skills and decrease their need for medication. Also, EEG biofeedback has helped to decrease impulsivity and aggressiveness. It is a powerful tool, in part because the patient becomes part of the treatment process by taking control over his own physiological processes.” —Dr. Daniel Amen, MD, Change Your Brain, Change Your Life.

“It improves seizures, depression, low self-esteem or congenital head injuries, and it helps the ‘craziness that often comes with these’... Patients report that they sleep better, feel better, they don’t have seizures, they are more in control, and that they get more work done. It helps with closed head injury patients. It helps with chronic neurological disease, where there is no active injury but there are problems with normal functioning. We’ve had success with multiple sclerosis, with toxic encephalopathy, with chronic pain, migraines and fibromyalgia. And, of course, we get very good results with ADD.” —Dr. Jonathan Walker, MD, neurologist, Dallas, Texas.

“Among the newer approaches to managing ADD, the most exciting is a learning process call neurofeedback. It empowers a person to shift the way he pays attention. After more than 25 years of research in university labs, neurofeedback has become widely available. This is a pleasing development, because neurofeedback has no negative side-effects.” —Dr. William Sears, MD, The ADD Book.