Frequently Asked Neurofeedback Questions for Beginners and Clients

Dr. John Davis wrote this frequently asked questions post as a resource for staff training and your clinic website. Please use it as a starting point rather than the final word on these topics.

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1. What is Neurofeedback?

Neurofeedback, sometimes called EEG Biofeedback, is a non-invasive training method designed to help individuals improve their brain function through self-regulation. It operates on the principle of neuroplasticity – the brain's natural ability to change and adapt. By providing immediate, real-time information about brainwave activity, Neurofeedback teaches the brain to function more efficiently, stably, and resiliently. It is a form of brain training, distinct from brain stimulation techniques that introduce external currents. Because the brain is so closely involved with what we think, feel and do, the point of Neurofeedback is to train the brain to change its activity so that our thinking, emotions, actions, and bodily functioning work better for living successfully in the world.

2. What happens during a Neurofeedback session?

One or more small metal electrodes are placed on the scalp and on one or both ears. Water-soluble paste attaches the electrodes and conducts the brainwave electrical signal (EEG) to an amplifier. No electricity goes into your brain. The amplifier is connected to a computer that uses software to process the brainwaves instantly. Based on whether the signal is in a desirable range or not, the computer presents feedback in the form of sound, video, numbers or graphs, or vibration to tell you when your brain is performing in a stronger, healthier range.

An initial assessment helps pick brainwave patterns and ranges, or thresholds that must be met for feedback to occur. That is, when the computer detects your brain performing in the desired range, better than the threshold setting, it activates changes you see on the computer monitor or hear on speakers. Feedback goes on, or off, depending on whether brain activity meets the threshold setting. The feedback acts as a reward to reinforce healthier brainwave patterns, in that way gradually teaching the brain to maintain healthier or more effective brainwave patterns on its own. Usually, about 30 minutes of training is provided in a session, often in 3-minute segments with the trainer/therapist guiding and talking with you about the feedback and your experience between segments.

After the training, the electrodes and paste are removed, and the places where they were are easily cleaned up. The trainer/therapist then reviews the results of the session and discusses what to do before the next session to strengthen the benefits. At the following session, home practice (see below) is reviewed along with overall results that have developed from session to session.

3. How does Neurofeedback work?

The immediate presentation of feedback rewards the brain for producing more desirable brainwave patterns. The change in brainwave patterns happens due to the learning process of operant conditioning. Changes in brainwave patterns may be long-lasting because of changes in microscopic brain structures and brain function, as shown in some scientific research. Because the changes in brainwaves help to support changes in performance that lead to real-life successes, those improvements in action may also help sustain changes in the brain and the brainwaves it produces.

4. Does Neurofeedback always work?

Neurofeedback usually results in benefits. The degree of benefit varies depending on the condition and the client. As with most other approaches to influencing thinking, emotion, and action, some clients experience little or no gains, though the majority enjoy noticeable improvements.

5. What conditions or issues can Neurofeedback help with?

Neurofeedback addresses issues related to brain dysregulation and is used for a wide range of conditions, including Attention-Deficit/Hyperactivity Disorder (ADHD), autism, anxiety disorders, PTSD and developmental trauma, depression, attachment issues, sleep disorders (insomnia), epilepsy, Traumatic Brain Injury (TBI) / Post-Concussion Syndrome, stroke recovery support, migraines, and learning disabilities. Because these conditions often show particular EEG brainwave patterns, Neurofeedback can be used to identify and change these patterns and influence the condition. Neurofeedback may also be used supportively for conditions like Lyme disease or PANS/PANDAS (childhood autoimmune disorders that affect mental health) in an integrative therapy approach that tailors combinations of therapeutic methods to a person’s individual needs. Additionally, Neurofeedback is used for peak performance training to enhance thinking, focus, and stress resilience in a variety of athletes, artists, and professionals. There is substantial scientific evidence that supports many applications of Neurofeedback.

6. Can my therapist tell what I’m thinking or feeling from my brainwaves?

No, it is not possible for the trainer/therapist to read a person’s mind. Neurofeedback's measurements only show how much different parts of the brain are active or communicating with each other. However, brain waves do show the degree of arousal a person might feel, from very sleepy to calm to extremely alert.

7. Is Neurofeedback training difficult to do?

Different people may have somewhat different experiences of learning to work with Neurofeedback. Sometimes it is helpful to practice with relaxation or biofeedback as a first step, for instance, using heart rate variability or muscle tension Biofeedback to get a feel for how Neurofeedback works. The process of learning to work with Neurofeedback may develop from simple, calm observation of the feedback, and how it changes with one’s internal experience, to more actively reproducing mental/physical states that one has learned help make the feedback go. This is somewhat like learning to get into the right “groove” for getting the most points from a video game.

8. Is Neurofeedback safe? Are there side effects?

Neurofeedback is generally considered very safe and non-invasive when administered by a qualified and properly trained professional. Since it is a learning process for the brain, side effects are uncommon and typically mild and temporary. They might include brief fatigue, mild headache, or feeling slightly "spacey" or "wired." These effects usually indicate that the training protocol needs minor adjustment and typically resolve quickly. Reporting any such experiences to the provider is important for optimizing the training.

9. When should I avoid Neurofeedback?

It may be wise to wait to begin Neurofeedback until a major new illness or disruptive life change has subsided. On the other hand, Neurofeedback may be helpful to prepare for such developments.

10. What are the different types of Neurofeedback?

Neurofeedback encompasses various approaches, each utilizing unique methods to influence brain function. Traditional Neurofeedback commonly involves one, two, or multiple locations for training to increase or decrease the activation (voltage, power) beneath the electrodes. This type of Neurofeedback targets specific brain wave amplitudes and ranges (slow, medium, fast speed) to promote desirable changes in brain activity.

Z-Score Neurofeedback compares an individual's brain activity to normative databases in real time, to guide brain function toward statistically defined normal range. LORETA (Low Resolution Electromagnetic Tomographic Analysis) Neurofeedback provides feedback for activity located more deeply within the skull.

Connectivity and coherence training specifically addresses the synchronization between different brain regions, enhancing efficient communication across neural networks.

Infra-Low Neurofeedback targets extremely slow-frequency brainwaves, often below 0.1 Hz (cycle per second), to influence deeper regulatory processes, while Infra-Slow Neurofeedback similarly focuses on slightly faster yet still very slow frequencies to promote brain stability. Slow Cortical Potential Neurofeedback trains the client to control slow shifts in brain excitability that occur at a frequency of less than 1 Hz.

Beyond EEG-based methods, Magnetoencephalography (MEG) Neurofeedback provides feedback for electromagnetic changes in brain function, closely related to EEG Neurofeedback. Functional Magnetic Resonance Imaging (fMRI) Neurofeedback provides real-time feedback based on blood-oxygen-level-dependent (BOLD) signals, allowing direct visualization and modulation of activity in targeted brain regions. Hemoencephalography (HEG) Neurofeedback utilizes feedback related to cerebral blood flow dynamics, typically measured from the forehead, to enhance frontal cortical activity linked to attention, executive function, problem-solving and emotional regulation.

11. What is the role of assessment, including qEEG Brain Mapping?

A thorough assessment is essential before starting Neurofeedback to ensure it's appropriate and to personalize the training. This typically includes a detailed clinical interview about symptoms, history, and goals. New clients may complete standardized questionnaires or test of cognitive performance. Usually, one or more sites on the scalp are used to sample EEG activity above locations that are relevant to the client’s presenting issue.

Many practitioners also utilize Quantitative EEG (qEEG), or "brain mapping." This involves recording EEG activity from multiple scalp locations (often 19) during resting states with eyes open and closed, then comparing this data to age-matched normative databases. The resulting "map" highlights specific patterns of brain activity (e.g., areas of over- or under-activity, communication issues between regions) that can guide the clinician in designing highly targeted and effective Neurofeedback protocols. EEG or qEEG assessment results are integrated by the trainer/therapist to identify Neurofeedback methods that will help the client achieve their goals. The findings and methods are then discussed with the client to answer questions and agree on a plan.

12. How does Neurofeedback relate to Psychotherapy or Functional Medicine?

Neurofeedback can be useful in a manner complementary to other therapies. Functional medicine and integrative therapy aim to use multiple treatment methods together to address complex health problems that may not respond to a single form of care. The aim is to gain a holistic understanding of the root causes of such problems and work on changing those, rather than only the symptoms. in this way, complementary and alternative therapy methods may be combined with conventional treatment.

For individuals with trauma histories, Neurofeedback can help stabilize the nervous system and improve emotional regulation, helping clients to be more able to engage effectively in psychotherapy. The therapeutic relationship itself remains crucial in these contexts. Within functional or integrative medicine, Neurofeedback can work alongside nutritional strategies, lifestyle changes, medicine, and other modalities to support overall brain health and address underlying physiological factors contributing to brain dysregulation.

13. Why use Neurofeedback when other training/treatment methods are available?

For instance, mindfulness meditation has effects on brain function and helps improve outcomes for treatments of anxiety and depression. Medication reduces symptoms of ADHD and epilepsy. Applied behavior analysis can change environmental contingencies to improve on-task behavior in school.

It is helpful to look at this question through two lenses: biopsychosocial models of health and evidence-based practice.

The biopsychosocial model of health is a lens that considers that health or illness is the product of the interaction of biology (anatomy, physiology, genes), psychology (behavior, thinking, mood, and emotion), and the social environment (actions of others in concrete situations). The implication is that changing any one of these three components may be less likely to have an optimal and long-lasting effect than changing all three. Neurofeedback provides a validated method for influencing a client’s biological condition and can make a significant contribution when a therapist or trainer is working with someone to change their behavior, thinking, and the social/physical environment in which they aim to reach their goals.

The model of evidence-based practice used to make health care decisions is a second lens that has four pillars: the client’s condition/circumstances, scientific evidence for/against treatments of that condition, clinician expertise, and client preference. When treating conditions like depression, PTSD, addiction, and ADHD, for instance, various methods have shown benefit, such as medication, prolonged exposure, and mindfulness-based cognitive-behavioral therapy, each of which aims to reduce barriers to the client doing things that matter in the right situations. Some of these methods (e.g., prolonged exposure, conventional addiction treatment, medication) sometimes have unwanted side effects or high drop-out rates. Neurofeedback is a method that can reduce drop-out, has very few side-effects, is easily integrated with psychological and pharmacological methods, is well-supported by research evidence, and may be a highly acceptable option for clients. With sufficient clinician expertise, Neurofeedback can provide incremental healthcare benefits.

An additional consideration is complexity. Whereas some conditions in the right circumstances respond well to a single type of treatment, some clients who present themselves for care have had the experience of failure when trying a single approach to their problem, whether it has been medication, psychological intervention, or environmental change alone. Neurofeedback can be helpfully integrated with psychological and environmental change approaches to address complex conditions that are not optimally responsive to changing one element in a biopsychosocial understanding of the condition.

Further, the availability of Neurofeedback for use by non-physicians provides clients with more access to a method that can change the biological underpinning of their condition at the same time as other treatments improve the psychological and environmental factors that lead to problems.

An aspect of Neurofeedback that is sometimes overlooked when selecting methods for improving health and performance is its concrete nature. Not only is feedback immediate and quantitative, but it also provides sensory evidence that directly demonstrates real improvements. Clients may be more able to work with such concrete visual and auditory evidence than with abstract verbal information that requires introspection or necessitates interoception. And, the concrete nature of Neurofeedback may be a productive road to travel for making headway with the abstract understanding, introspective skill, and bodily self-awareness that underlie lasting change.

Which brings us to Neurofeedback’s durability. Whereas the benefits of medication often subside after the drug is discontinued, the benefits of Neurofeedback are long-lived, perhaps because of the effort-induced neuroplasticity that results in brain changes from Neurofeedback training.

14. Who is qualified to provide Neurofeedback?

Neurofeedback for diagnosed health conditions should be provided by licensed healthcare professionals (e.g., psychologists, physicians, clinical social workers, licensed professional counselors, marriage and family therapists, nurses, occupational therapists) who are qualified to care for such conditions, and have also completed extensive, specialized training specifically in Neurofeedback principles and practice. Certification such as Board Certification in Neurofeedback (BCN) from the Biofeedback Certification International Alliance (BCIA) indicates a recognized level of competence and adherence to professional standards.

Other providers, such as personal training professionals or personal coaches, may provide Neurofeedback for peak performance training and conditions such as stress or improving concentration that are not associated with a formal diagnosis. Potential clients are cautioned to ask specific questions about the provider’s professional qualifications, and their training and experience with Neurofeedback applied to the condition for which they seek help.

15. How important is the therapist-client relationship?

The quality of the therapeutic relationship plays a critical role in the success of Neurofeedback training, as it does in all healthcare. Research has consistently shown that rapport, warmth, empathy, and encouragement from the therapist significantly enhance outcomes. In one classic study, participants trained by a friendly therapist had a success rate of over 90%, compared to only 9% among those trained by a less personable clinician.

Because Neurofeedback involves technical equipment and structured protocols, it is easy to overlook the human dimension. However, clients are more likely to engage, hear, and communicate details of their experience that help guide Neurofeedback, persist, and benefit from the process when they feel understood, supported, and positively reinforced throughout training.

16. What is the role of client motivation and buy-in?

Client motivation and belief in the credibility of Neurofeedback are essential to its effectiveness. Clients who understand how the therapy works and why it was recommended are more likely to engage fully and benefit more from the process. Therapists should explain the physiological mechanisms behind the presenting problem and show how Neurofeedback interventions can address them. This process, often referred to as building treatment credibility, has been shown to enhance adherence and outcomes in multiple studies. Clear rationales, realistic expectations, and a collaborative approach all contribute to stronger buy-in and better results.

17. How long does training take?

The number of sessions required varies significantly based on the individual's brain, the conditions being addressed, training goals, consistency, and overall health. While some benefits might be noticed earlier, a typical training course often ranges from 20 to 40 sessions. More complex or long-standing issues, such as severe trauma, may require 60 or more sessions for optimal, lasting results. Sessions are usually scheduled 1-3 times per week. Each appointment might last 45-60 minutes, with the actual brain training feedback period often lasting around 30 minutes. Additional time is used for reviewing progress, setting up, cleaning up, and planning exercises for the client before the next session.

18. Are improvements permanent?

The effects of Neurofeedback are usually long-lasting, continuing for months or years after training has concluded. In some cases, follow-up booster sessions may be helpful.

19. Can Neurofeedback replace medication?

Neurofeedback is generally not considered a direct replacement for medication, but rather a different approach focusing on retraining brain function rather than chemically managing symptoms. Some individuals find that as their brain regulation improves with Neurofeedback, they can work with their prescribing physician to reduce or potentially eliminate certain medications.

Many people taking psychoactive medications experience less-than-optimal effects or unwanted side effects. In such cases, Neurofeedback can often be used effectively alongside medications to supplement the medication or modify its dosage and improve the outcome. The client should always consult the physician who prescribes the medication before any changes are made, and involvement of the Neurofeedback trainer/therapist can be helpful in this regard.

20. Is insurance likely to cover Neurofeedback? What about cost?

Neurofeedback insurance coverage varies greatly depending on the specific plan, state regulations, diagnostic codes used, and the provider's credentials. It's best to contact your insurance company directly to inquire about coverage for Biofeedback or Neurofeedback.

Many providers operate on a private pay basis but may provide clients with a "superbill" (a detailed receipt with diagnostic and procedure codes) to submit for potential out-of-network reimbursement. Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) can typically be used for Neurofeedback expenses. Session fees may differ between providers, in part based on profession (medical doctor or counselor) and length of practice/experience.

21. Can Neurofeedback be done remotely or at home?

Yes, supervised home-based Neurofeedback training is an increasingly available option. This typically requires an initial assessment (often including an in-office qEEG) and relies on technology that allows a qualified professional to set protocols remotely, monitor progress, and provide guidance. Healthcare professionals, however, must respect the limits of their practice jurisdiction as defined by their licensing organization.

The client must also first learn how to apply electrodes and operate the Neurofeedback hardware and software. While offering convenience and possibly reducing cost, successful home training requires client commitment, a suitable environment, and consistent communication with the supervising provider to ensure safety and effectiveness.

22. How is home practice incorporated?

Home practice is a fundamental part of Neurofeedback training as it helps consolidate skills learned in the clinic. Neurofeedback benefits can be boosted by home practice, such as mindfulness meditation, relaxation, or heart rate variability biofeedback. Home practice may also include Neurofeedback itself.

Therapists work with clients to set realistic goals for practice difficulty, frequency, and duration, typically adjusting initial expectations to accommodate daily life. Clients are encouraged to log their practice sessions and track symptoms to reinforce learning and identify progress. Consistent home practice strengthens self-regulation and supports the generalization of skills learned in Neurofeedback to daily situations where stress, pain, or emotional challenges may arise.

23. How can I find out more about Neurofeedback, and whether it’s for me?

More information about Neurofeedback can be found at the website of the International Society for Neurofeedback and Research (https://isnr.org/). Providers of Neurofeedback can be at the website of the Biofeedback Certification International Alliance (https://www.bcia.org/). Providers can also answer questions about Neurofeedback during an initial consultation.

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About the Author

Dr. John Raymond Davis is an adjunct lecturer in the Department of Psychiatry and Behavioural Neurosciences at McMaster University's Faculty of Health Sciences. His scholarly contributions include research on EEG changes in major depression and case studies on neurological conditions. ​

Glossary

attention-deficit/hyperactivity disorder (ADHD): a neurodevelopmental disorder characterized by patterns of inattention, hyperactivity, and impulsivity that interfere with functioning or development.

attachment issues: difficulties in forming secure emotional bonds with caregivers, often stemming from early relational trauma or neglect.

biofeedback: a technique that uses electronic monitoring to convey information about physiological processes, allowing voluntary control over bodily functions.

blood-oxygen-level-dependent (BOLD) signals: the BOLD signal reflects local changes in blood oxygenation resulting from neural activity, detected through functional magnetic resonance imaging (fMRI).

brain mapping (qEEG): a technique that records electrical activity from multiple scalp sites and compares it to normative databases to guide individualized treatment planning.

brain stimulation techniques: methods that apply external currents or magnetic fields to influence brain activity, distinct from neurofeedback's internal training.

cerebral blood flow dynamics: the movement of blood through the brain’s vascular system, important for delivering oxygen and nutrients and measured in hemoencephalography.

connectivity training: a neurofeedback approach aimed at improving communication between different brain regions by training their synchronization.

depression: a mood disorder marked by persistent feelings of sadness, hopelessness, and loss of interest or pleasure in activities.

developmental trauma: psychological trauma resulting from early adverse experiences that disrupt healthy emotional and neurological development.

emotional regulation: the ability to monitor, evaluate, and modify emotional reactions in adaptive ways.

executive function: higher-order cognitive processes such as planning, working memory, attention, and problem-solving.

functional magnetic resonance imaging (fMRI) neurofeedback: a technique that provides real-time feedback about brain activity based on blood-oxygen-level-dependent (BOLD) signals.

functional medicine: a holistic approach to healthcare that addresses the root causes of disease through personalized treatment plans including nutrition, lifestyle, and integrative therapies.

hemoencephalography (HEG) neurofeedback: a form of neurofeedback that measures and trains blood flow in the brain, typically targeting the frontal cortex.

heart rate variability (HRV) biofeedback: a biofeedback method that trains individuals to regulate heart rate variability to enhance autonomic nervous system balance.

home-based neurofeedback: supervised neurofeedback training conducted at home using remote technology and clinician oversight.

infra-low neurofeedback: a technique targeting extremely slow brainwave frequencies, often below 0.1 Hz, to regulate deep brain activity.

infra-slow neurofeedback: training that focuses on very slow brainwave frequencies slightly faster than those targeted in infra-low neurofeedback.

insomnia: a sleep disorder characterized by persistent difficulty falling asleep, staying asleep, or waking too early.

learning disabilities: neurological disorders that affect the brain’s ability to receive, process, store, and respond to information.

licensed healthcare professional: a person legally authorized to provide medical or psychological services, such as a psychologist, physician, or counselor.

magnetoencephalography (MEG) neurofeedback: a neurofeedback modality that uses magnetoencephalography to measure the brain’s magnetic fields generated by synchronized neuronal activity, particularly from pyramidal neurons in the cortex.

migraines: recurring headaches often accompanied by nausea, light sensitivity, and neurological disturbances.

mood disorders: psychiatric conditions characterized by disturbances in emotional state, including depression and bipolar disorder.

neurofeedback: a non-invasive brain training method that provides real-time feedback about brainwave activity to promote self-regulation and improve brain function.

neuroplasticity: the brain’s capacity to reorganize itself by forming new neural connections throughout life.

normative databases: collections of standardized data used as benchmarks to assess individual brain activity patterns.

operant conditioning: a learning process through which behaviors are influenced by their consequences, such as rewards or punishments.

peak performance training: the use of neurofeedback and related techniques to optimize cognitive, emotional, and physical functioning in high-performing individuals.

post-concussion syndrome: a complex disorder with symptoms like headaches and dizziness that persist after a concussion.

post-traumatic stress disorder (PTSD): a psychiatric disorder that can occur after experiencing or witnessing a traumatic event.

psychotherapy: a therapeutic process in which a trained professional helps a client address emotional, behavioral, and psychological challenges.

quantitative electroencephalography (qEEG): a quantitative analysis of EEG data, often used for brain mapping and guiding neurofeedback protocols.

rapport: a harmonious relationship characterized by mutual trust and understanding, critical for therapeutic success.

self-regulation: the ability to control one's behavior, emotions, and thoughts in the pursuit of long-term goals.

sleep disorders: medical conditions that disrupt normal sleep patterns, impacting overall health and well-being.

stroke recovery: rehabilitation efforts aimed at regaining physical, cognitive, and emotional abilities after a stroke.

superbill: an itemized receipt provided to clients for insurance reimbursement purposes, listing services rendered and diagnostic codes.

therapeutic relationship: the professional bond between therapist and client that fosters trust, engagement, and effective treatment.

traumatic brain injury (TBI): damage to the brain caused by an external mechanical force, potentially resulting in cognitive, emotional, and physical impairments.

z-score neurofeedback: a type of neurofeedback that compares an individual’s brainwave activity to normative data and trains deviations toward statistical norms.

Sources

We are indebted to the Houston Brain Center, ISNR FAQ page, and Sebern Fisher.

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