Neurofeedback FAQs

In this section you will find some answers to frequently asked questions about Neurofeedback. Furthermore, basic and technical terms of Neurofeedback are explained.
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Neurofeedback is an EEG-based therapy that can treat the symptoms of disease-related defective regulation in the brain.

Neurofeedback is a specialty of biofeedback and is based on the measurement of brain activity by evaluating EEG signals. The electrical brain activity is measured, evaluated in real time, broken down into its frequency components and visualized for the patient on a screen. Since states of consciousness, concentration and attention are dependent on these frequency components, states that are normally imperceptible can be visualized and used for therapeutic purposes. Finally, by visualizing their own brain wave pattern, patients learn to control symptoms of diseases that are due to incorrect regulation in the brain.

1. Attaching the electrodes

Neurofeedback is based on measuring the electrical activity of the brain. Therefore electrodes are placed on the patient’s head at the beginning of the session in order to be able to derive the EEG signals. The application of the electrodes, like the entire treatment, is absolutely painless when used properly by a trained doctor or therapist. Any residues of conductive pastes that are necessary to attach the electrodes can be easily removed from the hair after the treatment.

2. Derivation of EEG signals

The EEG signals measured via the electrodes are directly transmitted to a computer via a special amplifier. Using software, the EEG signals are evaluated and broken down into their individual wavebands and frequency bands. This allows the individual characteristics of brain activity to be made visible and used to improve the brain’s ability to regulate itself.

3. Visualization of brain activity

The visualization of the wavebands and the individual frequency bands is now carried out through two monitors. The therapist follows the spontaneous EEG on a screen, broken down into the individual wavebands.

At the same time, the patient sees an age-specific graphic on his own monitor – this can be an animation, a computer game or a short film – which also moves according to brain activity.

If the desired change – depending on the intensification or reduction of certain activity patterns – is achieved, the patient receives direct feedback via the monitor. Thus, the animation moves towards a target or the image becomes clearer and sharper. An acoustic signal usually supplements this feedback. Thus, a positive reinforcement of the desired behavior takes place.

Patients should schedule at least 30 Neurofeedback sessions. This corresponds to the average number of sessions that are also used in Neurofeedback studies.

However, this is a very general guideline. No general statements can be made about the actual duration of treatment. Rather, the duration depends on the type of disease and the individual situation of the patient. In any case, a thorough medical history and diagnosis is the prerequisite for starting therapy. On this basis, it can be clarified in which context Neurofeedback should take place by a trained doctor or therapist. If the patient reacts to Neurofeedback, the first successes are achieved very quickly.

Including all necessary preparations, a session lasts approximately 45 to 60 minutes.

Treatment with Neurofeedback must be done at regular intervals, usually once or twice a week. In the advanced course of therapy, the intervals between the individual sessions can also be extended. However, it is also important to differentiate between different areas of application and to adapt the therapy to the individual needs of the patient.

Neurofeedback can basically be used alongside other procedures and also during medication. In this context, please also note the information given under the point “Is Neurofeedback suitable for everyone?”

Since neurologically related diseases are very complex and need to be treated comprehensively, Neurofeedback is usually part of multimodal therapy and is used in addition to other interventions such as behavioral therapy or drug therapy. Treatment with Neurofeedback also (in most cases) aims to supplement medication and reduce drug doses. Treatment with Neurofeedback must, in any case, be preceded by a guide-line based diagnosis and a thorough anamnesis. A trained doctor or therapist with appropriate experience will adapt the therapy to the individual needs of the patient.

Basically, Neurofeedback is not tied to any particular requirements on the part of the patient. In any case, however, please inform your doctor or therapist about previous illnesses, your state of health and any medication you are taking.

Basically, Neurofeedback can be used from primary school age to old age. The treatment is not tied to any specific requirements, but you should always inform your doctor or therapist about current or chronic complaints, previous illnesses, or pregnancy. You should also talk to them about your general state of health and your current life situation. For example, are you under pressure to perform or do you often have headaches? A good Neurofeedback therapist will also inquire about your state of health before starting therapy.

Neurofeedback is currently considered to be an IGeL, i.e. Individual Health Service. However, in some cases, the costs will be reimbursed on an individual request. The costs will also be reimbursed if the procedure is offered as part of a therapy that the health insurance company pays, e.g. for occupational therapists and psychotherapists with health insurance.

Currently, the costs of Neurofeedback treatment are not easily covered by the statutory health insurance. Legally insured patients are usually offered Neurofeedback as an IGeL service against payment. However, it is advisable – before starting treatment with Neurofeedback – to contact the insurance provider and clarify which insurance benefits you can expect. In some areas of application, such as ADHD or migraines, the costs are accepted on individual request. Private health insurances offer different tariffs or contracts. Your doctor or therapist will assist you in assuming the costs.

Neurofeedback is offered by doctors, psychiatrists, occupational and psychotherapists and psychologists.

Basically, treatment with Neurofeedback is preceded by a diagnosis and a thorough medical history examination. Your doctor or therapist will then inform you about possible treatment methods and recommend suitable therapists if necessary. There are also some hospitals and therapy centers that work with Neurofeedback and specialize in individual areas of application.

  • Does the doctor or therapist offer you a non-binding initial consultation? The doctor or therapist should give you the opportunity to get to know him (and vice versa). After all, Neurofeedback also requires the patient’s own initiative to regularly follow the therapy. In addition, the therapist should take the time to explain the training procedure to you and to collect initial values ​​at the beginning of the treatment. In addition, the doctor or therapist should clarify the costs of the Neurofeedback treatment in a non-binding initial consultation.
  • The doctor or therapist should have qualified training as a “Neurofeedback therapist” or “Neurofeedback trainer”. You can also inquire, for example, where the training was completed and how many courses were attended or whether continuous training is taking place.
  • The doctor or therapist should have experience in using Neurofeedback in your clinical picture (at least one year) and specialize in certain areas of application.
  • The doctor or therapist should be willing to check the success of the treatment quantitatively and to adjust the training plan to your needs.

Neurofeedback systems are medical devices that should only be found in the hands of medical specialists – a trained doctor or therapist who has also completed appropriate training education. The Neurofeedback network therefore expressly distances itself from those who recommend or promote home use. Rather, our network is working to further establish Neurofeedback as a medical application.

There are several reasons against home application: First, treatment at home cannot guarantee whether the correct settings are used, whether the electrodes are correctly attached, or whether EEG signals or only artifacts are actually measured during treatment. On the other hand, Neurofeedback is a treatment method that is largely free of side effects. In rare cases, however, side effects such as headache, nausea or rapid heartbeat can occur. This is called an inappropriate adaptation. Such effects are usually of very short duration and are regulated by the therapy – unless incorrect training is continued over a longer period of time. Improper training can increase the symptoms instead of alleviating them. Therefore, it should only be carried out by appropriately trained professionals in Neurofeedback in order to adapt the training protocols in case of side effects.

Neurofeedback is a form of therapy that must be individually adapted to the patient. Therefore, Neurofeedback should not be used without the specific expertise, neuropsycho- and neurophysiological knowledge of an expert.

Anamnesis is a systematic survey to comprehensively determine the state of health of a person. This is usually done by the doctor. Not only current complaints are taken into account, but also previous medical history and chronic diseases. Also included are predispositions such as allergies or genetic risks. So it is also considered whether certain diseases have already occurred in the family.

An Amplitude is measured in volts (V) and is used to describe vibrations. It describes the maximum fluctuation of a mostly sinusoidal wave. The amplitude is directly related to the frequency. The slower the amplitude, the lower the frequency.

Biofeedback is the feedback of physical signals. As a result of the biofeedback methods, bodily functions can be made perceptible, that we normally have no conscious awareness of.

We can learn to change everything we get feedback about. Thus, for example: heartbeat, blood circulation, muscle tension, sweat gland activity, breathing or also brain activity (= Neurofeedback or EEG biofeedback).

The term originates from the Greek word for brain (encephalon) and writing (gráphein) and is used to record the sum of electrical brain currents by measuring the electrical signals on the outer layer of the brain – called cerebral cortex – by means of electrodes. These brainwaves are generated due to the activity of numerous large nerve cell assemblies. Electroencephalography is used in medical diagnostics to check whether the brain has epilepsy, in neurological research and in Neurofeedback.

The electroencephalogram – also abbreviated EEG – is the graphic representation of electroencephalography. This is the typical brain wave pattern on a sheet of paper or on a monitor – usually several waves among themselves, as all those who have already had a neurologist’s examination know.

An electrode is an electrically conductive part and is used in Neurofeedback to measure the electrical activity in the cortex. This always requires a counter-electrode in order to measure electrical currents between the two electrodes. Such electrodes are attached to the surface of the head during Neurofeedback – just as for a normal EEG. The electrodes are usually called adhesive electrodes, which are “stuck” to the head with a conductive paste. Attaching the electrodes and measuring the brain’s EEG signals is completely painless. Removal of the electrodes from the scalp is easily possible after a Neurofeedback session. Also, the remains of the conductive paste can be removed with a cloth.

A frequency is measured in Hertz (Hz). This is the number of vibrations in a fixed unit of time -usually per second. The form of the oscillation is insignificant, but the frequency is directly related to the amplitude: the lower the frequency, the slower the amplitude.

Frequency bands (or EEG bands) include several frequencies, these are the frequency ranges. The classification of common frequency bands is mainly due to historical reasons and is considered to be partly obsolete.

IGeL stands for Individual Health Services. This includes all services that are not paid for by the statutory health insurance.

In Neurofeedback, the therapeutic challenge is to determine the frequency ranges. It is necessary to determine both the areas where a “reward” is given via the monitor and those where none is given. The reward is given on the screen, for example by making the graphic faster or the picture sharper. This can stimulate the brain to improve self-regulation. Inhibition is understood to mean those frequency thresholds from which no reward is given.

The term parameter can also be referred to as a transfer value in German. Especially in computer science, parameter is a common term. In relation to Neurofeedback, this refers to certain values that are set at the beginning of a session, such as the reward frequency, i.e. the frequency at which a reward occurs. This particular setting is then taken into account by the software when processing the measured EEG signals and ultimately influences the animation on the screen. To stay with the example of the reward frequency: The animation on the screen will only take place if this reward frequency is reached. Ultimately, parameters are used to determine which data should be processed by the software and how.

The therapeutic challenge with Neurofeedback is to determine the frequency ranges at which a “reward” is given via the monitor, for example by making a graphic faster or the image sharper; as well as the area where there is no reward. The brain can thus be stimulated to improve self-regulation. Rewards are therefore frequency thresholds from which reward is given.