Neurofeedback vs. EMDR

When I began working in the mental health field in 2011 the primary tools we had were a variety of talk therapy theories/skills and, if needed, a referral to a psychiatrist or hospital care. There were other tools available, but they were not what new clinicians were being handed. Since that time the field has begun to talk a LOT more about the concept of trauma, how our nervous system plays into both trauma and mental health states, and how to expand the toolbox for clients–this has been a great development and enabled a focus on what is called “trauma resolution” for clients.

With this expanded toolbox, you may wonder how to identify what is best to support you or your client. For this post, we will focus on the differences and overlaps between EMDR and Neurofeedback, and why I would recommend one direction or the other. For full disclosure, I am a certified Neurofeedback provider and utilize that approach in my work with clients when beneficial.

EMDR or Eye Movement Desensitization and Reprocessing Therapy is “a psychotherapy treatment that was originally designed to alleviate the distress associated with traumatic memories (Shapiro, 1989a, 1989b).” In EMDR, clients recall a traumatic or distressing memory while also focusing on external stimuli, typically lateral eye movements, though other forms of stimuli may be used. The theory being that this allows the brain to access necessary pathways to reprocess the trauma in a way that it can be hopefully properly resolved, new associations can be made, and the individual can move forward. More detailed information on EMDR theory can be found here. In general, EMDR is a shorter-term approach, sometimes just 3-6 sessions may be provided to see results, and it can provide a much faster movement towards therapy goals than talk therapy alone for the appropriate client.

Neurofeedback or EEG Biofeedback is a brain-based biofeedback intervention, in which information about the electrical activity in different locations in the brain is collected via electrodes placed on the scalp, and fed back to the client by watching a movie or other audio-visual input. There are several different theories of why this works, but what we observe is that the brain takes this information and auto-corrects to new ways of functioning. Neurofeedback is used for trauma, but is a whole brain intervention, and can be applied to many types of brain-based diagnoses including anxiety, ADHD, autism, depression, sleep disorders, migraine, epilepsy, dementia, and so forth. The general goal is to stabilize and calm the nervous system, which supports healthy brain function. Like EMDR, there is also an aspect where Neurofeedback can be used for trauma resolution and moving therapy forward, but there is also an overall expectation of what I call “moving the baseline” i.e. are the client’s symptoms becoming better managed in a way that moves to a new and healthier level of daily functioning. Neurofeedback is a longer form intervention, typically 20-30 sessions (sometimes more if needed), and nearly all clients are appropriate. For more information on Neurofeedback, you can check out my previous post here.

So, how do you consider what is right for you? I like to think about this in terms of

1) Individual System Readiness 2) What is being resolved

  1. Individual System Readiness
    • How well do you handle triggers of your trauma? Are you able to use skills to calm yourself after difficult emotions arise?
  2. What is being resolved
    • Concrete traumatic events?
    • Complex trauma?
    • Nervous system instabilities such as migraines/headaches, panic attacks, chronic pain?
    • General mental heath?
    • Sleep disorders?

If you are seeking to do specific trauma work and have the ability to recall your traumatic events and manage the emotional impact of that experience, then EMDR can be an excellent tool to support and speed your therapy. If you struggle to manage that emotional impact, or are needing an approach that will pull in more areas of the brain, Neurofeedback will appropriately support your work. EMDR does have applications outside of trauma treatment, but its scope is more focused than Neurofeedback. If you would like to learn more about either approach, click here set up a consultation for Neurofeedback or to be connected with one of my colleagues who provide EMDR!

What is Neurofeedback, and is it right for me?

I first heard about Neurofeedback circa 2012 and barely understood what it was! Since being given the opportunity to train as a practitioner in 2017 I have had many conversations with friends and clients who are wondering what it is and how it works.  This is a compilation of what I know, what I don’t, and what you might want to know if you, your loved one, or (perhaps) your client is interested in a brain-based approach to managing mental health symptoms.

Please note—I am a licensed therapist, NOT a medical doctor!  Any content presented here is for informational purposes only and is not intended to provide medical advice or treatment.  

Biofeedback, Neurofeedback, EMDR, Yoga, Meditation, Massage, Therapy—there are myriad options emerging for individuals and families to take alternative routes to manage symptoms related to various mental health and physical health diagnoses, so how do you sort out what is best for you?

This post will focus on Neurofeedback and hopefully help you start to answer that question for yourself!

What is Neurofeedback?

  Neurofeedback is a therapy that uses EEG (electroencephalogram) technology to provide nearly real-time information to the brain about what it is doing to enable the brain to increase self-regulation.  The process typically uses electrodes placed on the head to collect information on the brain activity and then this is transmitted via audio-visual and/or tactile (physically experienced) feedback, often in the form of watching a movie or images on a screen. It is not presented as a cure, but as an adjunct tool to help that particular brain perform at its best and often with a goal of assisting in symptom management.  It has many applications, but was first used in humans with epilepsy with effective results (p. 44, 46-47; A Symphony in the Brain) and then spread into other diagnoses.  My clients typically seek Neurofeedback to help manage mental health diagnoses such as Anxiety, ADHD/ADD, PTSD, Depression, addiction, and Autism Spectrum Disorder. Providers also use Neurofeedback to treat issues as broad as sleep disorders, physical pain, bed-wetting in children, Parkinson’s, dementias, to improve peak performance in athletes, and many, many other conditions.

It should be noted, Neurofeedback is not represented as appropriate to be used in lieu of necessary medical treatment.  Medications and/or other treatments should not be stopped or changed except as advised by your medical doctor.

How does it work in the brain?

At present, we are not precisely sure how Neurofeedback has an impact. There are various theories ranging from it being a process that teaches the brain to increase/decrease certain types of brainwaves to the results having to do with how the brain sends signals, but as of yet we do not have a clear answer.

Is Neurofeedback just a placebo effect?

Even though we don’t fully understand HOW it works, there are reasons to believe that it is more than just placebo.  The first reason is that it works in animals as well as in people.  While humans have reasons to want their goals to happen, animals do not share that drive and yet have demonstrated the ability to show changes in types of brain waves they are producing based on the feedback (p.43, A Symphony in the Brain).  Secondly, not all results of Neurofeedback are in line with the client’s goals.  A client may have symptoms return if settings are wrong, may get too energized or too slowed down, etc.  If it was only a placebo, we would expect to see similar results regardless of what we did.  That being said, double blind studies are difficult with this modality and so the research has been done via different types of studies. 

What will my provider do in a session?

While there are several different approaches, all will use some combination of the following aspects.  Electrodes are placed on the scalp and forehead to capture brain wave activity, a way to show that to the brain (often through watching a video or playing a video game), a knowledgable provider to assess the client’s needs and develop a plan, and ways to assess and re-assess for progress.  An electrode is a small receptor attached to a wire which transmits back to a machine.  These are electrodes like those used in sleep studies and for EEG (electroencephalogram) readings that are done by medical doctors and can be medical grade.  While not necessarily all are, in general the equipment used in Neurofeedback is FDA regulated.  During a session you will likely be sitting or reclining comfortably in a chair that faces the feedback via a tv or computer screen.  Your provider may or may not be in the room depending on the approach. 

If you are working with me, you will be the only client in the room.  Our sessions will involve checking-in on how you have been since the last session, discussing any observed symptom changes, placing the electrodes, and then 30 minutes of training. 

Initial sessions take about an hour to complete all tasks, over time they shorten to about 45 minutes.

What will I experience in a session?

Neurofeedback is an individual experience because all brains are unique.  The approach I use is symptoms-based, which means we will adjust based on what you are experiencing in and after the sessions. You may experience a variety of physical sensations (calming/tensing, emotional changes, changes in energy level) during a session but not everyone does.  I talk to you about what you might expect based on your symptom profile, but there is not a “right” response to Neurofeedback in my world!  If you have a highly sensitive nervous system, then I do expect that we will need to work a little more slowly and precisely.  

Does everyone use the same settings?

During the initial 7-12 (approximately) sessions we will be working to identify your ideal settings, which is called a protocol.  Settings have to do with where we place the electrodes and what types of brain waves that will best benefit you (this is also called your optimal frequency).  Your brain’s ideal setting is where you are able to feel simultaneously calm, relaxed, and alert.  This may be seen in session or in changes over the next few days.  Some may notice changes in sleep, differences in intensity or frequency of emotional reactions, a lasting sense of calm, and other changes.  From your assessment we will be tracking a handful of symptoms to help us hone in your personal settings (called a protocol).  As we see (or do not see) progress towards your goals we will adjust as needed. 

There are no true “side effects” of Neurofeedback, but during the process of protocol development you may experience an increase of the symptoms you are seeking to better manage. If this happens, it shows us that 1) your brain is aware and responding to what we are doing and 2) guides us towards better settings. Communication is key! Always tell your provider promptly if you are seeing an increase in unwanted symptoms so that adjustments can be made and those symptoms can be addressed.

How often will I do Neurofeedback?

In the beginning, an ideal session frequency is 2-3 times a week.  The effects of a session will last around 24-48 hours and over time you should see a longer lasting impact.  Once the session impact is longer, sessions can be spaced out until the client has achieved their goals.  At this point, a client may choose to end sessions or move to being seen only when symptoms flare up.

Who can Neurofeedback help?

Because of the passive nature of Neurofeedback it can be effectively utilized with people of all ages, in some cases it has even been used with infants!  The majority of those who utilize Neurofeedback are children of school age up to adults.  The method can also effectively be adapted to benefit individuals with auditory and visual impairments. 

Can MY kid do Neurofeedback?

You may wonder if your energetic, wiggly, or perhaps anxious/overly cautious child will be able to handle having electrodes put on their head and sitting still for a half an hour.  As each child is unique there is a bit of trial and error, but in general children become engaged with the feedback and are able to stay still enough to benefit.  If there is a tendency to touch the electrodes or otherwise fidget the child can be given a small toy to play with to engage their hands, the child can stand during the session, or we will get creative and find what works!  Many children end up enjoying the sessions even if initially cautious.

Is it ok to do Neurofeedback and…?

There are no hard and fast reasons a person can’t do Neurofeedback, however, there are times when the timing is not right or other factors need to be ruled out prior to starting.  In general, you should not start multiple forms of therapy at the same time, regardless of what is being addressed.  If you are starting a new medication or other therapy, then ideally that will begin before trying Neurofeedback or after you know how Neurofeedback impacts your brain.  For each of these tools to work their best, your providers need to be able to clearly see their individual impact on you.

If there is a question of an unresolved medical issue, that should be explored first.  Outside of these considerations, Neurofeedback can be effectively used at the same time as medication, therapy, occupational therapy, chiropractic, and even other related approaches such as sound therapy.   

Who provides Neurofeedback?

Neurofeedback is provided by individuals trained in the method who may be considered practitioners themselves or who are operating under the license of a trained professional such as a medical doctor.  Each Neurofeedback approach will have its own way of deciding who can provide the services.  Commonly though, it is provided by licensed professionals such as Professional Counselors, Nurses, Chiropractors, and Medical Doctors.  

Is there Certification for Neurofeedback?

Yes, there are certifications but at present practitioners are not required to obtain one.  I am certified in the Othmer Method, a process that requires self-led learning, 400 hours of experience, 10 hours of coaching, 3 in-person courses, and a minimum of 30 hours of personal Neurofeedback.  Another common certification is via the Biofeedback Certification International Alliance.  Their requirements also include coursework, a test, personal experimental hours, 100 client hours, and 25 supervisory hours. 

Is Neurofeedback permanent?

Neurofeedback is not represented as a cure for any issue, but typically clients see goal progress around 20 sessions and some aspects of the training may become permanent at this point. This does not mean the symptoms you struggle with never return, but rather the goal is that over time the symptoms are some combination of less severe, more infrequent, or when they appear the you are better able to manage them. 

EEG info’s website additionally explains some of the nuances of this by noting that for general disregulation issues in the brain (anxiety, sleep disorders), there is a certain permanence but for degenerative conditions (Parkinson’s, dementias) ongoing training will likely be necessary.

What is a Neurofeedback Intensive?

For some clients it is difficult to do weekly sessions due to travel and time commitments.  This modality can be done as often as 3 sessions daily, though practitioners rarely do more than 2.  If a fit for the client, providers may offer an intensive approach where the client can complete multiple sessions daily for a set period of time.  The sessions are evenly spaced throughout the day to allow time to see the session impact and make any needed adjustments.  If you are interested in this type of approach, please note this when you fill out the contact form and I will be happy to discuss if this is a fit for you.

Should my therapist and I discuss adding Neurofeedback?

  As a therapist, there are periodically times that I have to consider if something else needs to be added to my client’s work.  Neurofeedback typically comes up if you are struggling to make progress or have stagnated with your therapy work while still needing healing.  For some individuals there is a need to work through trauma but it is too hard to do so via the therapy process, for others there have been years of therapy but there is a stuck point in the progress.  In the same way that there comes a time to discuss an intervention like a medication for anxiety or depression, this is another tool that can be added. 

How do I find a provider?

Well, you’ve found me! If you are interested in a discussion about your specific situation, please reach out via my contact page and set up a free consultation. If my location, services, etc. are not a good fit for you, you can often identify providers via services such as Psychology Today. In Georgia, the Biofeedback and Clinical Neuroscience Association has a listing of practitioners here.