Frequently Asked Questions

• A licensed clinician
  If you are seeking help for a mental health issue, you want to seek treatment from a licensed mental health clinician who is trained in and has a deep understanding your diagnosis/symptoms, and whose work is governed by an ethics board. In other words, would you go to a teacher to get foot surgery? There are similar concerns with seeing an unlicensed or non-medical or mental health provider for brain training. The brain is a sensitive organ, and you want to choose a practitioner who has a complex understanding of neurobiology and psychology. Seeing a licensed provider means that if you have a complaint about their work, a board of their peers can review your concerns and sanction them if necessary. It offers more protection for you as a client.

• A board certified provider

  The most prominently known medical fields, such as medical, mental health, and nursing, require board certification before a clinician can practice in their field. Neurofeedback is a rapidly changing field that is still considered experimental by medical standards, despite thousands of studies showing its efficacy. Thus, board certification in neurofeedback is a choice, not a necessity. Working with a board-certified provider guarantees that they have a minimal level of competency in the neurofeedback field. This means a provider has been rigorously trained, has received mentoring and supervision of their work, is deemed competent by their colleagues to create protocols and conduct neurofeedback sessions, and is bound to follow ethical and professional rules. It ensures that providers receive ongoing continuing education in neurofeedback, and that a client will receive the highest level of quality care possible. 

• An experienced provider

  Ideally, your provider has several years of experience. This is especially true for clients with complex presentations. Neurofeedback is not a “plug and play”, one-sized-fits-all intervention. Protocols are highly nuanced, and side effects can occur, especially if you see a provider with very little experience.

• Use of FDA approved equipment

  It is important to ask whether a neurofeedback provider is using an amplifier that is FDA approved to treat mental health or brain difficulties. There are amplifiers out there, such as Neuroptimal, that are used for neurofeedback but only FDA approved for “wellness.” This means that they are not approved by a government regulatory board to treat mental health disorders. At Neuroscapes, we only use FDA approved equipment. Choosing a non-FDA approved amplifier to treat depression or other conditions can be dangerous and is unethical.

The way we do QEEG’s

We interpret QEEG’s in a qualitative fashion. Many providers who do brain mapping record an EEG and receive a computer-generated report that gives them a protocol to use with clients. This format for interpreting EEG’s compares your brainwaves to what is “normal” for your age and specific issue, and then trains the client towards “normal” brainwave functioning. However, in this landscape of ever-widening neurodiversity, we find that approach to be potentially short-sighted and dangerous. We want you to be your best self, not to just be like everyone else. Why would we take away your ability to hyperfocus if it is what makes you great at your job? Instead, we might design a protocol to help you be more flexible and able to shift your mindset when you need to, if this is what you are wanting.

The solely quantitative EEG approach also misses specific and important features in the raw EEG. For example, a computer generated report does not identify whether your symptoms might be from an undiagnosed seizure disorder, but reading the raw EEG with the help of a neurologist can.

At Neuroscapes. we categorize your symptoms with research-based phenotypes, and we create treatment plans that are highly individualized and specific to you and your goals.

We offer multiple types of Neurofeedback

Most practitioners use one type of neurofeedback, which is like a therapist offering only one specific type of therapy. This can limit your outcomes greatly, especially because not everyone responds to every type of neurofeedback. As such, we offer traditional amplitude training as well as infralow frequency neurofeedback, or a hybrid approach, depending on your specific brainwave patterns and goals.

A multimodal approach to treatment

We combine our approach with referrals to functional medicine and other specialty providers who can help you optimize your brain and body health. The healthier you are, the healthier your brain is, and the more apt it is to learn new patterns. We look for red flags in your history and EEG that could deter treatment success and ensure you find the right care from the right providers in order to become your best self. In the EEG, we can see markers for inflammation, sleep disorders, or seizure activity that could affect how well you train, and how long your brain will hold the effects of neurofeedback. We want to do everything we can to ensure that neurofeedback lasts, not just that you feel better for a short while.

Sessions take anywhere from 20-40 minutes, depending on your individualized protocol. We schedule them for an hour, as we need to check in with you each time about your symptoms, place electrodes on you, move them around during the session, and remove them at the end of the session.

When you come in for a session, we place electrodes on your head. Nothing comes through the electrodes; they just read your brain’s electrical activity, which we watch in real time during your session. When you are hooked up to electrodes, you look at a screen that is attached to an amplifier. We program the amplifier to make the screen brighter, or have you hear more beeps, every time your brain produces brainwaves that move at a speed that is more associated with healthy functioning and less associated with symptoms. This auditory and visual feedback is what solidifies the new learning pattern in your brain. Our screen is configured for you to watch your favorite Netflix and Disney shows while your brain does all the work for you.

Some people feel symptoms shifting during the session, while other people notice them afterwards. The first 24 hours after a session are most important for noticing changes. We ask clients to document changes and report what they are noticing when we see them next, as we will adjust protocols as we go for maximum positive effect.

Side effects are possible from neurofeedback, as is true with any intervention. Sometimes, if we don’t have your protocol right, or your brain is extremely sensitive, neurofeedback can cause more of what you are struggling with (more anxiety, difficulty with sleep, or worse headaches). Usually, these effects are short-term, and they can be reversed. Major side effects are very uncommon, as neurofeedback side effects are typically gentler than taking an over-the-counter medication.

The most common reported side effect is fatigue, especially after the first session. This is because your brain works very hard during sessions, and also because you may relax to a deeper level than you have in years.

We work very hard to minimize any negative effects and to catch and reverse them immediately after sessions.

Every client’s brain is different, so everyone has their own perfect number of how many sessions they need. Each type of neurofeedback comes with an ideal minimum number of sessions in order for use to create lasting change in your brain. We can make you feel better for a few days with a session, but our goal is to create long-term, lasting changes in your brain. Our goal is to work ourselves out of a job so that your brain does the work for you.

ILF neurofeedback requires a minimum of 20 sessions, and amplitude training requires a minimum of 30 sessions, to ensure that results will be long-term. Often, people with more complex issues such as brain injury or complex mental health or cognitive difficulties, will need more sessions. Additional factors can influence whether neurofeedback sticks in the long-run - most notably, anything depriving your brain of oxygen (such as sleep apnea), long-term or heavy drug or alcohol abuse, or other systemic medical issues.

Neurofeedback training is like marathon training – you wouldn’t get up off the couch and be able run 26 miles. You need to train regularly in order to reach your end goal. This is why we see people 2-3 times a week for training, as we want the new brainwave pattern to become the dominant, lasting one.

Neurofeedback is not an intervention that requires you to wait until the end to see if it worked. You will see change as you go, sometimes as soon as the first session. By 2-3 weeks in, you should notice changes.

We do require you to be an active self-reporter so we know how you feel during and after sessions. This allows us to adjust your protocol as needed and to ensure minimal to no side effects. It is important to note that neurofeedback does not work for everyone. A small handful of people may not respond to this intervention. This is another reason why trying multiple types of neurofeedback and seeing a practitioner who can individualize your interventions is extremely helpful.

We see people of all ages. We have worked with kids as young as 19 months old to adults in their late 70’s. Recent research has confirmed that the brain can generate new patterns well into the 7th decade of life.

We use much gentler methods with younger kids and are very flexible in our approach.

Brain mapping is not diagnostic - it won’t give you a label, or match up perfectly with a DSM-5 label. In fact, research shows that there is only a 6% overlap between DSM-5 diagnoses and what is ACTUALLY happening in your EEG. This is one reason why Dr. Neff prefers EEG to psychological testing - it is based on what is actually happening in your brain vs. how you performed on a test or how you interpret what is happening for you. For example, a psychiatrist might diagnose you with bipolar disorder when the EEG actually shows tendencies towards hyperactivity and impulsivity, which might suggest ADHD instead.

The EEG is prognostic rather than diagnostic. This means that it shows your brain’s tendencies and patterns, some of which manifest as symptoms. These patterns have been linked to known biomarkers. Dr. Neff utilizes Jay Gunkelman’s phenotype research, which can suggest which medications are/are not a good fit for you, and which neurofeedback protocols may be a good fit. The EEG is not focused on labels. It shows patterns and can point to research-based solutions.

The EEG can be an important data point to rule in or rule out complex diagnoses. For example, the EEG might point to whether autism is a better fitting label than ADHD because of specific patterns in your brainwaves.

The most common conditions that interfere with success are medication changes that occur during the neurofeedback process, untreated sleep apnea (the brain can’t readily learn new patterns when it is deprived of oxygen), and heavy substance use. Hormonal changes can also change your brain, and neurofeedback does not address them as well as other interventions (such as HRT for perimenopausal women). All of these issues can radically change your brainwaves.

Most insurance companies still see neurofeedback as being “experimental” or “preventative.” It is difficult for researchers to prove the efficacy of neurofeedback for specific conditions because it is nearly impossible to conduct randomized controlled trials. In such experiments, there needs to be a “sham” condition that seems like neurofeedback, but is not. It is almost always obvious to participants in the sham condition that they are not receiving treatment, and this can negatively influence the authenticity of the study and its results. In addition, there are not many neurofeedback providers who have time to lobby insurance companies and to sit down with them to discuss appropriate reimbursement rates. Thus, in the rate cases when neurofeedback is covered by insurance, reimbursement rates are often extremely low and do not cover our operating and staffing costs.

While there are insurance codes for neurofeedback, they are often very restrictive and limited in terms of what is reimbursable. Insurance companies often limit the amount of sessions needed, or only reimburse the use of neurofeedback for specific issues (such as epilepsy). When insurance carriers limit the number of sessions, this results in care that is incomplete. Incomplete care can be dangerous and unethical, as we are shifting brainwaves as part of a long-term process of change. Stopping halfway through could lead to more problems or ineffective outcomes.

We are a private pay clinic. We accept cash, checks, HSA/FSA cards, and credit cards. We are registered with two credit card companies that offer 0% long-term financing for mental health treatments (Advance Care and Care Credit). We are not set up to bill insurance, but if your insurance happens to cover neurofeedback, we can provide you with a superbill so they can reimburse you.

Yes, although certain medications may affect how well your results hold in the long-term. For example, opiates and benzodiazepines have much stronger effects than neurofeedback, so your results may not hold as well if you take these medications on a daily basis. You will still make progress, but it will likely be slower and may require more sessions than is typical.

Many of our clients start treatment while also taking psychiatric medications, such as stimulants or SSRI’s. These medications are fine to take during neurofeedback. It is important to note, however, that as neurofeedback starts to address the root cause reason for why you are taking medication, and may lead to you not need as much medication over time. Neurofeedback can also make the effects of your medication feel more potent, so this is something you will need to watch and discuss with us as you notice changes. We can be in touch with your doctor in case medication doses need to be adjusted over time.