Targeted Neurofeedback Protocols
Updated: Apr 27, 2021
Neurofeedback as a Therapy
Neurofeedback training has been offered in the clinical setting for decades for many different purposes. Neurofeedback is a form of biofeedback which uses EEG technology to read the patient's brain waves in real time and show visual or auditory feedback based on protocols determined by the neurofeedback provider. The training, or feedback, is done using games or videos, and over time the brain learns to control itself. For more information on the fundamentals of neurofeedback see here.
One common use of neurofeedback is as a therapy to treat brain disorders. The effectiveness of neurofeedback training on some disorders have been more thoroughly researched than others, but, in general, neurofeedback training has been found to be beneficial in treating a variety of different neurological disorders, together with medication or as a stand-alone treatment. Some disorders that are commonly treated using neurofeedback include: ADHD, epilepsy, anxiety, PTSD, autism, and depression. It is also used to treat general symptoms not related to a specific disorder, such as memory problems, sleep problems, poor coordination and motor skills, and excessive stress.
Healthy individuals such as artists, athletes, musicians, and executives also use neurofeedback to improve their performance and "stay on top of their game". It has been shown to improve memory, promote better sleeping habits, reduce stress, and improve motor skills in healthy populations. This form of neurofeedback is known as peak performance training.
The theory behind neurofeedback is that by training certain brain waves (also referred to as frequencies, or bandwidths), you can improve the brain’s functioning - such as thoughts, moods, and the ability to relax, or concentrate. To read more about how brain waves work, see here. Research has shown that specific neurological disorders correspond to too much or too little activity, measured using EEG, in certain areas of the brain.
In order to determine which brain waves need to be trained (to increase or decrease their activity) and in which area of the brain, a quantitative EEG assessment (qEEG) is often used. This assessment uses sensors on specific scalp locations to measure a person’s EEG activity and compares the results to a large database of other individuals in their age range. After identifying the brain waves and locations that are over- and under-stimulated, neurofeedback can be used to reduce or increase the specific brain waves. The instructions for neurofeedback training (which brain waves and locations to train) are called protocols.
Neurofeedback protocols are determined by trained professionals according to patient symptom reports and/or by performing a qEEG assessment. In this post, we will explore some common neurofeedback protocols and their uses. The locations referenced are based on the international 10-20 system of mapping the scalp.
Inhibit: Theta and High Beta
Reward: Lo-Beta (SMR)
Location: Cz or C4
Sensori-motor Rhythm (SMR) training was one of the first forms of neurofeedback training which was discovered. Dr. Barry Sterman at UCLA discovered that he could train cats to increase the amplitude of a specific frequency (12.5-15 Hz) by rewarding them with food every time they successfully reached the threshold. During a later experiment, it was found that the cats which had increased their SMR activity were more resistant to rocket fuel seizures. For more on the history of neurofeedback see here.
SMR training is a common protocol used to improve attention and focus. The SMR frequency band (12-15Hz) is associated with an alert, attentive state coupled with calm or silent motor activities. SMR training improves focus and attention by decreasing drowsy, mind-wandering Theta waves and anxious or racing High Beta waves, while increasing the calm, focused SMR waves. SMR training also improves motoric precision and balance and the ability to relax.
Inhibit: Theta and High Beta
Alpha training was also one of the first types of neurofeedback training, made popular in the late 1950’s and early ‘60s by Dr. Joe Kamiya at the University of Chicago. Alpha waves are associated with being in a relaxed, calm, meditative, mindful state. Most people can naturally increase their alpha waves simply by closing their eyes for a few minutes.
Alpha training is good for improving sleep quality and relaxation. This form of training is usually done with the eyes closed, using only auditory feedback.
Inhibit: Alpha and High Beta
The frontal stabilization protocol is often used to reduce anxiety and stabilize moods. Studies have shown that patients with major depressive disorder (MDD) often have more left than right alpha (8-13 Hz) activity in prefrontal locations. This is known as Alpha-asymmetry. Neurofeedback training which lowers the Alpha activity in the prefrontal regions and increases Mid-Beta can be used to stabilize this asymmetry.