What Is Neurofeedback: History And Protocols

Updated September 6, 2022 by BetterHelp Editorial Team

Have Questions About Neurofeedback?

Neurofeedback (also known as EEG biofeedback) and its applications are classed under psychophysiology, which, according to the online dictionary, is "the study of the relationship between physiology and psychological phenomena." To understand neurofeedback, one needs to glance back at the history of its origins.

What Is Neurofeedback?

In vertebrates, the nervous system comprises two parts - the central nervous system (CNS), which consists of the brain and the spinal cord. The other part, the peripheral nervous system (PNS), is subdivided into three separate systems, of which one is the Autonomic Nervous System (ANS). The ANS regulates functions such as digestion, heartbeat, circulation, etc. Neurofeedback therapy is a therapeutic tool in clinical neurophysiology that primarily focuses on healing the central nervous system, as many of the conditions it treats are related to the brain and mental health.

According to a review done by Basic And Clinical Neuroscience, neurofeedback is a form of biofeedback that teaches its subjects self-regulation of brain functions. It might sound like a concept from a video game or movie, but it really does work! It does this by measuring brainwave activity for abnormalities or irregularities and then providing helpful brain signals in return.  By providing these brain signals, neurofeedback therapy helps restore normal brain patterns, which gives the patient more cognitive control.

Since cognitive control affects emotions, thoughts, and actions, neurofeedback services help patients with their mental health conditions, regulate their emotions, and act more appropriately in social situations. Depending on the issue the patient is dealing with, neurofeedback services target EEG signals to specific brain regions (such as the motor cortex or cerebral cortex) depending on their brain function. Some conditions will require targeting specific neural substrates of cognitive control while other conditions will need to focus on other types of brainwave activity for treatment.

The Birth Of Biofeedback

For most of the 20th century, it was believed that a person could consciously control only the central nervous system. In contrast, the ANS was observed to function automatically and beyond possible conscious control or awareness. Only the central nervous system was thought responsive to EEG operant conditioning, which, essentially, is the use of stimulants, such as punishment and reinforcement, to change or modify behavior. The famous experiments conducted on dogs by Ivan Pavlov in the 1800s is probably one of the best examples of operant conditioning.

For obvious reasons, there was strong resistance to experimentation with instrumental control of ANS responses. However, numerous studies eventually showed that humans and animals could control certain ANS responses through instrumental training and real-time feedback. In practical terms, it means that, through instruments that provide information on the brainwave activity of a system in the body, a person can self-regulate these systems. Patients learn how to control their own biofeedback and create the desired improvements they want, with how many sessions it can take to get there. This could be called the birth of biofeedback as we know it today. Biofeedback therapy is done with the purpose of improving health and performance, and, according to the Association of Applied Psychophysiology and Biofeedback, these changes are lasting. It could even mean that continued use of an instrument eventually becomes unnecessary.

Neurofeedback is a form of biofeedback that allows for self-regulation of brain function through stimulation and mental strategies. The therapeutic aim is to increase brain efficacy and treat specific disorders.

Neurofeedback specialist and researcher Siegfried Othmer, Ph.D., says: "Our intellectual abilities and emotional resources can be considerably enhanced with neurofeedback training."

Types of Neurofeedback Therapy

Traditional or EEG Neurofeedback has been in use since the 1970s. Electrodes that record brain regions are placed on the person's scalp, and then stimulated with various treatment protocols.

There are seven types of EEG neurofeedback therapies that work well for the treatment of various disorders such as anxiety, schizophrenia, and depression. Traditionally, two brain sensors, two ear sensors, and the ground is used. The treatment can be tailored to the individual in training surface brain activity, except in the case of LORE-TA and fMRI neurofeedback. These types of psychotherapy sessions allow for whole and deep brain stimulation to specific brainwaves.

EEG Neurofeedback is versatile in its application but requires great expertise to administer.

  • Frequency/Power Neurofeedback:
    • This is the most frequently-used neurofeedback, also called 'surface neurofeedback.' Two to four electrodes are used to change the amplitude or speed of specific brain waves in particular areas of the brain. Frequency Neurofeedback is used, in particular, to treat attention deficit hyperactivity disorder (ADHD) and anxiety disorders.
    • This type of neurofeedback results in cortical activation which changes the amount of slow cortical potentials in brainwave activity. This type of neurofeedback is used to treat epilepsy, attention deficit disorder (ADD), ADHD and migraines.
  • Low-Energy Neurofeedback System:
    • This delivers a weak electromagnetic signal to change the person's brain waves while they are motionless with their eyes closed. It is known to treat traumatic brain injury, ADHD, insomnia, restless leg syndrome, fibromyalgia, anxiety, and depression.
  • Hemoencephalographic (HEG) neurofeedback:
    • This gives feedback on cerebral blood flow and is used for treating migraines.
  • Live Z-score neurofeedback:
    • This is used to treat insomnia.
  • Low-resolution electromagnetic tomography (LORE-TA):
    • This is a neurofeedback technique that involves the use of 19 electrodes. This allows for simultaneous neuro-training in multiple areas of the brain, as opposed to single areas with the more common two-sensor neurofeedback. It is used to treat addictions, depression, and obsessive-compulsive disorder.
  • Functional magnetic resonance imaging (fMRI):
    • This is a new type of neurofeedback that "regulates brain activity based on the brainwave activity feedback from deep subcortical areas of the brain." It helps improve voluntary control of activity in the targeted brain region. fMRI neurofeedback is used for treating ADHD, ADD, depression, anxiety, Parkinson's disease, behavior disorders, and even phobias.

Have Questions About Neurofeedback?

'Brand name neurofeedback systems' refers to brain training systems that 'stimulate and encourage' the brain to 'reset' and self-correct. A number of these 'packaged brain training systems' are available on the market.

The above most often involves a dual-sensor neurofeedback system and a variety of pre-programmed brain training protocols. A device is used to record a person's brain wave activity through electrode readings. These results are then processed through specialized computer software. The therapeutic aim is for the person to promote some frequencies and diminish others by using mental strategies. With a video and audio interface, the person plays a game with only their brain signals to train various frequencies that allow for specific physiological outcomes.

Treatment Protocols And Details

The following are brain wave protocols used to stimulate targeted areas of the brain. The list is not exhaustive.

Alpha Waves And Alpha Protocol

Alpha waves in a brain are associated with calm and relaxed, yet alert and focused brain functioning. They relax muscles and eventually lead to sleep. Research has shown that meditation increases alpha waves. Therefore alpha training in neurofeedback therapy has the following benefits:

  • Pain relief
  • Stress and anxiety reduction
  • Improves mental performance
  • Improves memory
  • Treats brain injury.
  • Deep muscle relaxation
  • Decreases heart rate and regulates breathing

Beta Protocol

Beta waves are indicated for improving mental performance and are also associated with problem-solving and focus. As you may guess, beta protocol is primarily useful in treating patients with ADHD. ADHD patients on average have slower brain wave activity than normal, and often have less beta activity than typically recorded.

This protocol in neurofeedback therapy may include sensorimotor rhythm frequency bands as they are sometimes described as lower beta waves. Sensorimotor rhythm waves are associated with mental alertness and physical relaxation.

Therefore, beta protocol of neurofeedback treatment helps with the following:

  • Induces focus and attention
  • Improves reading ability and computational performance
  • Reduces worries, OCD, and over-thinking
  • Treating ADHD, ADD, and similar mental health conditions
  • Treats alcoholism and insomnia
  • Reduces anxiety, epilepsy, anger, and stress

Alpha/Theta Protocol

This protocol is one of the most popular forms of training for stress-reduction.

Alpha/theta protocol of neurofeedback treatment helps with the following:

  • Improves severe depression, alcohol or drug addiction, and anxiety
  • Increases creativity, relaxation, and musical performance
  • Helps with healing of trauma

Delta Protocol

These are the slowest brain waves and associated with deep sleep. Therefore, people with sleep disorders may get neurofeedback therapy in the form of slow wave EEG to induce sleep.

Delta protocol of neurofeedback treatment helps with the following:

  • Pain reduction
  • Improves insomnia by reducing concerns
  • Alleviates traumatic brain injury, severe headaches, and learning disorders

Gamma Protocol

The gamma brain waves are associated with cognitive processing and memory. As they speed up, memory recalling is faster.

Gamma protocol of neurofeedback treatment helps with the following:

  • Promotes cognition, mental sharpness, and problem-solving tasks
  • Improves poor calculation and brain organizing
  • Increases information processing
  • Improves short-term memory
  • Reduces migraine attacks

Theta Protocol

Theta brain waves are involved in brain activities such as memory, emotion, creativity, meditation, sleep, and hypnosis. It is also observable during the first phase of sleep when sleep is light.

Theta protocol of neurofeedback treatment helps with the following:

  • Reduces anxiety, depression, and distractibility
  • Curbs daydreaming
  • Treats ADHD symptoms and emotional disorders.

Who Is Qualified To Give Neurofeedback Therapy?

Traditional EEG Neurofeedback is a highly specialized therapeutic modality that requires great expertise and continuous training. Practitioners are usually qualified, doctors or psychiatrists. Learning how to use software with pre-packed treatment protocols, on the other hand, doesn't require rigorous training. In most cases, it is simply a matter of learning the software and how to work with the interface.

Who Should Avoid Neurofeedback Therapy?

Persons going through epilepsy should only consult with neurofeedback therapists who are also qualified, doctors or psychiatrists. This therapy has demonstrated efficacy in the treatment of epileptic seizures, but it should be administered with great care and skill. Important to note - the fact that a patient has epilepsy should never be concealed from a medical practitioner before embarking on any form of therapy. Neurofeedback systems with preloaded protocols should be avoided as there is evidence that they can induce seizures.

It is also contraindicated for persons going through severe psychiatric disorders. Symptoms should first be stabilized before treatment is started, and then only under supervision by a qualified mental health practitioner.

What Are the Side Effects?

Unfortunately, neurofeedback therapy has been associated with adverse side-effects such as increased anxiety and agitation, mania, nausea, fatigue, hypersomnia, panic attacks, seizures, mood swings and increased depression, to name but a few. These were due to operator incompetence or mistakes, which further underscores the need to insist on treatment only by qualified practitioners. Neurofeedback doctors should also be vigilant in watching for side effects.

Is it Safe for Children?

Neurofeedback therapy has been very successfully employed to help children and adolescents with the following:

  • ADD, ADHD,OCD, and other behavior disorders
  • Developmental, speech and learning disorders
  • Autism Spectrum Disorder, autism, Asperger's
  • Chronic pain and physical disabilities
  • Self-control
  • Post-traumatic stress disorders, anxiety disorders, sleep problems and brain injuries

It has shown improvement in cortical function and teaches self-regulation and healthier patterns. It can also help with sustained attention span. Again, neurofeedback therapists should be chosen with care. Neurofeedback treatment should also be administered cautiously for children with severe behavioral problems.


Neurofeedback therapy has immense value, with promising prospects for even more applications. However, there is no silver bullet that can fix everything. Often, neurofeedback therapy is paired with counseling or talk therapy because, as someone put it, neurofeedback therapy can fix the brain, while talk therapy can fix the mind.

Both are invaluable in any holistic healing journey towards improved mental health. Supplements and medications are a necessary and effective way to address many problems; yet, termination of these are likely to result in recurring symptoms. Targeted professional counseling and neurofeedback therapy could achieve permanent or long-lasting results.

For adjunct talk therapy or counseling, or for whatever psychological assistance you may need, BetterHelp could be the ideal online place to start. Find a therapist or counselor picked for your specific needs and receive the help you need in the comfort of your home.

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