Usually, I can tell when someone wants to ask me why they haven’t heard of neurofeedback before or why, although they have heard of it, they haven’t heard more. People get a funny look on their faces, as if trying to find the right way to ask the question without sounding accusatory or rude.  After all, the question makes it sound a bit like they suspect some kind of snake oil promotion is afoot.

Obviously, I cannot answer why any one individual does not know more about neurofeedback, but I understand the point behind the question. Neurofeedback has been around since the late 1960s, and it works, so why isn’t it the most popular tool in town?  Those of us who use neurofeedback discuss this from time to time, and these are some of the answers we have for ourselves, in no particular order.

It’s a Tool, Not a Field. Most people have heard of occupations like chiropractor, acupuncturist, psychologist, or teacher.  Occupations usually have some professional, guild-like organizations behind them that promote interest in the field and increase awareness.  Neurofeedback, however, is not an occupation, it’s a tool.  And, the people who use neurofeedback span many occupational categories, including tutors, coaches, occupational/physical therapists, chiropractors, spiritual guides, doctors, mental health care providers, and enthusiasts with no related occupation at all.  The result of this broad usage means that because neurofeedback doesn’t belong to any one field, it doesn’t have any one champion.  Most people end up hearing about neurofeedback from a friend who’s had a good experience.

Infighting. Sadly, a subset of neurofeedback practitioners fight among themselves over who “owns” the right to use and practice neurofeedback.  Some, especially in the mental health care professions, even go after each other legally, accusing each other of practicing medicine or psychology without a license and dragging various professional licensing boards unwittingly into the fray.  It’s unseemly, ego- and money-driven, and this sort of infighting does nothing to improve the image of those who use neurofeedback.  It also does the opposite of what these people are hoping to achieve, undermining instead of improving the reputation of the tool.

Research. Neurofeedback is a gentle teaching tool for the brain, but many skeptics treat it like it’s a pharmaceutical and argue that because there aren’t “enough” double-blind, placebo-controlled studies, it must not be a valid tool.  One of the problems researchers run into when trying to create this gold standard type of study, though, is that many trainees can tell when their neurofeedback is sham training, so an approach more like doctors use with surgical techniques is probably more useful.  Moreover, when someone is trying to use neurofeedback for mental health reasons, they often run into the problem that the brain does not subscribe to the committee-created diagnoses contained within the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).  So, researchers who are studying people with, say, depression, may not be looking at study participants with similar-looking brainwave patterns at all.

All that said, there are many well-done studies on neurofeedback showing that it works for people. The bigger problem is not the issue of how to design double-blind studies, it’s determining what is “enough.”  Someone who has a bias against neurofeedback will never accept its validity no matter how many studies get published in peer-reviewed journals, and someone who is gullible may not care even to ask the question.  Add this to what appears to be a concerted effort from the pharmaceutical industry to undermine the reputation of neurofeedback, and it is enough to keep some people dubious about whether neurofeedback works.

It Does Too Much.  In theory, neurofeedback can affect anything the autonomic nervous system covers.  In reality, neurofeedback’s impact is less than that, though still quite broad.  Researchers have shown that it works on a wide variety of training goals, and practitioners around the country use it for a long list of goals:  migraines; traumatic brain injuries including stroke and concussion; seizures/epilepsy; mental health diagnoses such as ADHD, anxiety, depression, and bipolar disorder, among others; personal performance improvement, especially with educational/school goals, sports, and musical performance; spiritual development; personal growth and awareness; serenity and calm; and still others that I may not even have heard of yet.  With so many potential uses and applications, it’s no wonder that the field ends up spread thin and not well known.

People Want Privacy. Some people like to share broadly about their experiences with neurofeedback (I’d have no practice if this weren’t the case.), but many others like to keep their training to themselves, almost as if it’s a secret weapon.  Neurofeedback is popular among professional and elite amateur athletes, and sometimes, you’ll hear about them in the media, as with the Canadian Olympic team prior to the Vancouver Olympic games.  More often, though, athletes seek confidentiality.  This means that, although it’s being used effectively, the public never knows that neurofeedback helped someone.

Technological Improvements. In the early days of neurofeedback, the equipment was large and expensive, meaning that very few had the means to use or apply neurofeedback tools.  Even though it existed as a tool, it was only for people with the passion and money to make it happen.

The advent of personal computers and, especially, the development and rise of laptop computing meant that the speed of everyday computers was enough to provide the brain with fast enough feedback. Plus, the cost of purchasing laptops and the gear required to do neurofeedback has fallen over the past 15 years, making it affordable for more and more people.  I suspect that as the technology improves, a greatly expanded number of people will know about and be able to apply neurofeedback in their lives.

Despite improvements in technology and decreasing costs, we’re still hamstrung to a large degree in bringing this into private homes. Professionals now find it affordable if they shop well, but the technology is costly enough that only people with powerful motivation are investing in and learning to do neurofeedback on their own.  And, despite burgeoning efforts to make free apps for anyone to use some aspects of neurofeedback/brain training, they are no match at all to seeing a professional practitioner.  However, even toy and game makers are interested in how to bring neurofeedback profitably to the masses, and if they succeed, the field of personal growth and development will expand dramatically.

The bottom line is not to let the absence of major, positive media coverage of neurofeedback stop you from considering whether to use neurofeedback on yourself or a loved one. If you do your homework, you’ll find that neurofeedback is safe, effective, and powerful—so powerful that it’s used for dozens of reasons by people from all walks of life—and the future looks bright.

Neurofeedback is a rewards-based system. The idea of rewarding the brain for making changes in the direction a person wants it to go can be a tough concept to grasp, but in practice, it’s pretty simple.

Our brains are designed to detect novelty in our environment. It’s a primitive survival mechanism, because we humans need to notices changes in the world that might endanger our lives—think of noticing the movement of a venomous snake or the driver who suddenly decides to cross four lanes of traffic to make a turn.  It’s a part of our daily lives, and when it comes to noticing sound, I like to use the example of an ambulance siren.  There is a fire station not too far from my office, and emergency vehicles drive down the street in front of my building every day.  If I’m with a client, they continue to pay attention to our conversation or work, but a part of them notices the siren with an internal monologue that goes something along the lines of “Hey, what’s that?  Oh, I bet it’s an ambulance.  I wonder if there was a car accident?  I hope everyone’s okay.”

Neurofeedback is a bit like the ambulance siren. We believe that the brain notices the reward tones that the computer sends the same way it notices the siren:  as a novel change in the environment.

At the same time, we believe neurofeedback works much like the process of teaching a dog to sit. A puppy receives a reward in the form of a bit of tasty food every time its hind quarters go anywhere remotely in the right direction of a sitting position.  Eventually, the dog doesn’t need the treat to be able to associate the command with sitting.  Similarly, the brain gets the reward of novelty any time the sophisticated computer software determines that the brain is going anywhere remotely in the right direction of the electrical energy pattern the trainee hopes to achieve.  Like the puppy, eventually the person doing brain training no longer needs the tones as a reward for going the right direction, and the brain can use that new pattern when appropriate.

I use the expression “we believe” because neuroscience researchers have not yet proven the theory that neurofeedback is education for the brain, but in real life, the explanation seems to fit: a person comes for training with goals to achieve, the computer rewards the brain for learning the pattern associated with the goal, and the brain eventually can do it on its own without rewards.  It’s exciting every time I watch this pattern unfold, because it means that people are using technology to regulate their bodies by teaching themselves, all in a non-invasive and generally pleasurable way.

Name That Tune was a television game show from the 1950s in which contestants competed to see who could identify pieces of music in the shortest time possible. A catchphrase from the show was “I can name that tune in X notes,” and the best among them would attempt to name a song in just three or four notes.

Sometimes, it feels like some neurofeedback practitioners are engaged in their own version of Name That Tune, only instead of playing with songs, they claim they can Cure That Disorder in X sessions. The result of this rather absurd game is that some people start to believe that neurofeedback normally only takes as few as, say, six sessions.  Another reaction is that people who hear these stories begin to think that the field of neurofeedback is full of snake oil salesmen who peddle in false promises.

Neither is true. What may occur during a controlled experiment may, indeed, be faster than what happens in the real world, but the truth is that for most of us who live outside the research world, making significant and long-lasting changes to our bodies takes time and doesn’t involve curing anything.  And, despite sometimes too-good-to-be-true claims, most neurofeedback practitioners who do not engage in invasive techniques agree that anywhere between 20 and 60 sessions is a reasonable number.

The goal for most of us is not to play Name That Tune and go with the least number of sessions possible. Taking that path is likely to result in disappointment. It is far better to find a practitioner who can come close to finding the sweet spot that lies between doing too few sessions, which can result in backsliding, and too many sessions, which is just a waste of time and money.  It takes an experienced and intuitive practitioner to find that balance, but it can be done.