I’ve recently spent some time looking at what the internet has to say about neurofeedback, and wow, what an eye-opener that has been. The marketing claims and misinformation are pretty amazing.

Let’s start to set the record straight, because as with most things, the truth is nuanced.

1.   Claim: Some kinds of neurofeedback are more cutting-edge than others.

Reality: Not exactly. When I started learning to do neurofeedback in the early 2000s, one of my excellent instructors had been doing neurofeedback as part of his psychology practice since the late 1970s. His equipment mostly original from the 1970s and was as big and bulky as you can imagine early technology to be. Despite that, he used his tool as one plays a fine musical instrument and got great results. He showed fellow students and me handwriting samples of some children whose ability to form letters transitioned from the large, clunky scrawl of someone just learning to write to legible penmanship of a typical elementary-school-aged person. It was amazing. He also introduced us to a middle-schooler who had improved his gait to the point that he was able to go from using a wheelchair to using a walker. Please understand that this remarkable achievement is NOT TYPICAL and almost no one in the field would make claims to help children walk or walk better.  I use it as an example to show that even very old, standard neurofeedback equipment operates on the same basic principle of measuring electrical brainwave activity and rewarding the brain for shifting itself.

I would argue that cutting-edge is more of a marketing term than a sign of better equipment. I have found that some start-up companies that make incredible claims about their cutting-edge technology, and it turns out to be based on faulty premises or feels ineffective.

That said, I think newer techniques and approaches to training are beneficial and important. Some of our older techniques are tried, true, reliable, and effective. Some of our newer techniques are based on new learning and are also reliable and effective. Sometimes, though, people can get stuck in old ways and fail to see that newer ways to train (called protocols) are faster and better in terms of results. This is where keeping up with colleagues and their findings is important.

In my practice, I use newer gear that is stable and reliable, and I rely on continuing my education to help know when, how, and where to conduct training sessions. Combining the proven and stable with the new and exciting seems to me to be a reasonable way to conduct brain training.

2. Claim: Neurofeedback is over-priced.

Reality: Again, not exactly. I AM aware of places that charge $20,000 for a week of spa-like services that include neurofeedback. I also know of a few places that charge around $700 per session. If there are people willing to pay those prices, great. I know I would not, and I bet that if you’re reading my blog, you would never do that either. Rest assured that those places are nowhere near the norm.

There is another side to the coin where instead of charging exorbitant fees, practitioners offer bargain rates. They could be training multiple people at once, so the service is not personal–and for neurofeedback, someone observing the session is usually important. Or, it could be that the practitioner is using a “plug and play” device that is more of a one-size fits all or an alleged brain-hacking device. Although the technology is moving closer and closer to the time when headbands and a power button are enough, I have not seen any device to date that I would consider the equivalent of plain old EEG neurofeedback. You really are getting what you pay for, and I don’t recommend going with cheap or one-size-fits-all brain training.

In between the exorbitant and the bargain is where most practitioners place themselves. Neurofeedback is a specialized skill and takes time to learn to do and use properly. Most people who offer neurofeedback as the main part of their work have spent years honing their craft or, if new, are working under the mentorship of a skilled practitioner. It is also a costly tool. Practitioners spend thousands on training, thousands on their devices, and countless hours in mentoring and keeping up with the latest trends. Like most fields, the learning never ends. It is reasonable to expect to pay for this expertise.

If you are interested in neurofeedback training but are concerned about the cost, please know that I am willing to work out interest-free payment plans. I also offer a 10% discount to active-duty members of the military or active-duty first-responders.

3. Claim: Neurofeedback can be done quickly.

Reality: That depends on what you want. Some practitioners operate under the model of doing as few sessions as possible, then expecting their clients to come back periodically for what they call tune-ups. I think they do this to try and accommodate the fact that most people are very busy and don’t want to dedicate much time to training their brains. The truth is that sometimes, such an approach requires more time, money, and effort in the long run.

Some people offer a few sessions because there are many published studies that attempt to show a shift or change, and the changes they find definitely happens in fewer than 20 sessions. Demonstrating efficacy is not the same as having changes stick over the long term.

I operate based on research done that shows more sessions lead to solid and long-lasting results. If you work with me or anyone who operates under my philosophy, you will—with a few exceptions that we can talk about during a consultation—do one round of neurofeedback training and be done, no tune-ups needed. I tell my clients to plan on 40 sessions, but like everything else I offer, the exact number of sessions depends upon the person sitting in the training chair. Some people can be done in as few as 20-25 sessions, most do take around 40 sessions, and a few require 50-60 sessions. In special circumstances, there are people who may need hundreds of sessions due to having truly stuck electrical brain patterns.

In general, I advise people to plan on 40 twice-weekly sessions, but my goal is never to more sessions than a person needs or less than is needed to avoid doing so-called tune-ups.

4. Claim: Neurofeedback is covered by insurance.

Reality: Most insurers do not see neurofeedback as a health or mental health tool and thus do not cover it. Some practitioners, trying to be helpful, will mis-code their sessions so that their clients can get coverage. This is well-meaning, but it is also insurance fraud. However, some insurance companies, in some states, have begun to provide some limited coverage for neurofeedback. This coverage is usually quite restricted in the number of sessions and is usually for specific diagnoses. I am aware that here in Virginia, a couple of companies cover some sessions if there is an autism diagnosis, and a few others will cover some sessions for ADHD. If you think you have one of those golden plans that will help you pay for sessions, it is your responsibility to communicate with your insurance company.

I do not accept insurance, and insurance does not cover my services. My philosophy is not to use neurofeedback as a medical or mental health treatment.

5. Claim: Only MY way of doing neurofeedback works well.

Reality: Nope. Not true. My approach to neurofeedback training includes what I think of as the best of all world: collecting objective data for optimal brain performance along with subjective information about your life and what you’d like to train. The reality is, though, that some practitioners only ask about symptoms or problems, then surmise where to train based on that interview, with no measurements of what’s actually happening in the brain. This approach can work just fine. In fact, I use this with young children who are not yet ready to sit still for a full Trainers’ QEEG that measures 20 locations on the scalp to create a brain map. Other practitioners measure 19 spots on the scalp and compare that to normative databases that show how many standard deviations away from “normal” any one person’s brain might be. As much as I am opposed to the idea of a normal brain and trying to train to make everyone more normal, I agree that this approach can work, too.

If you are working with an experienced and skilled clinician who has invested the time and energy to learn to do neurofeedback well; who customizes your training to your brain and needs; and who works with you one-on-one rather than hiring staff who slap on electrodes, then leave, you are likely to get good results from your neurofeedback training.

Anyone who says that only their approach works is dissembling.

These are some of the key myths that I stumbled across in my browsing. I may write more on this subject another, but if in the meantime you have questions or ran across another piece of information that puzzles you, please feel free to contact me.