My informed consent form for neurofeedback

My office conducts EEG brainwave biofeedback, also known as neurofeedback. Depending on your situation and needs, a 2 Channel EEG Assessment may be recommended. This is performed with the intent of collecting data on sum amplitude, asymmetry, imbalances, dominant brain wave frequency, theta/beta ratio, and alpha peak frequency. Conducting this evaluation may help the practitioner customize sensor placement, frequency targets, and reward patterns.

Sensors are placed on the scalp, amplified, and sent into computer software that displays brainwaves on a screen. Brainwaves occur at various frequencies. Some are fast and some are very slow. The EEG bands are called delta, theta, alpha, and beta.

Delta brainwaves (1-4cps) are the slowest frequencies and have the highest amplitude. We normally find these when we are asleep and they originate in the brain stem. If they are too abundant in the waking state, it is often a sign of head injury.

Theta (4-9cps) brainwaves are characteristic on the twilight state of consciousness between wakefulness and sleep. Thoughts are loose and random. Originating in the hippocampus, too much of it in the waking state is associated with poor attention and distractibility.

Alpha brainwaves (8-13cps) are abundant when we have our eyes close and are relaxed. It represents the brain shifting into idling gear. Alpha should predominate in the back of the head, with less and less showing up on the EEG the closer we get to the frontal lobes. Too much alpha in the waking state in the frontal lobe, especially in the left frontal is associated with depression.

Beta brainwaves (15-21cps) are associated with being alert, focused and attentive. It should be the dominant frequency when performing tasks. Too much of it in the right frontal lobe is associated with anxiety. Too much of it in the back of the head is associated with insomnia.

All brainwaves are present in every person’s brain every hour of the day. It’s the percentage of the total and the ratios that make a difference in states of consciousness. As an example, when very high frequency of beta is dominant, we typically experience anxiety and tension.

Once training goals have been determined, the practitioner will place 4-5 sensors on the head. You will be asked to put a special pair of glasses on, the color depending on the nature of your presenting issue. You will then be given feedback that is designed to train the brain towards a balance. The feedback may be in the form of a DVD movie, CD music, audio tones, or a computer animation. These training sessions are designed to teach your brain to gradually change your brainwave pattern. Each person will have different goals. Some will focus on downtraining certain amplitude frequencies while others will uptrain. Its similar to going to a gym to exercise. The brain gets a workout. The outcome is a brain with greater resiliency and flexibility. Neurofeedback training usually requires 20-25 high frequency trainings of about 45 minutes in length. Some people need up to 50 sessions.

Low frequency training (also known as alpha-theta or altered states training) has a different goal than high frequency. This type of training increases low frequencies in the back of the head for the purpose of improving psychological or emotional functioning. Alpha-theta training usually requires 20-24 sessions of about 45-60 minutes in length each.

Neurofeedback has been shown to help a variety of conditions. Attention deficit/hyperactivity disorder (ADD/ADHD) respond well to this approach. Research has indicated that not only do the presenting symptoms improve (80%), IQ scores increase ranging from 10-23 points. Chronic alcoholics tend to have lower levels of alpha and theta waves. Neurofeedback training can achieve up to 80% success in creating long term abstinence. Using alpha-theta training, studies have shown that people who have Posttraumatic Stress Disorder (PTSD) have significant reductions in symptoms as well as a reduction in medication. Neurofeedback has been found to be helpful with all kinds of epilepsy, on average producing a 70% reduction in seizures.

Neurofeedback training has also demonstrated usefulness in reducing symptoms of anxiety, depression, head injuries and strokes, chronic fatigue syndrome, fibromyalgia, sleep disorders, Tourette's, obsessive-compulsive disorder, imbalance, incontinence, and PMS. Neurofeedback is also being used in peak performance training for athletes, executives, and musicians.

Only rarely have significant side effects from neurofeedback training been noted. However, occasionally someone may feel tired, spacey, anxious, experience a headache, have difficulty falling asleep, or feel agitated or irritable. Many of these feelings pass within a short time of a training session. If they do not, you should inform Dr. Staso in your next session of any negative side effects so that a modification can be made in the training protocol.

While neurofeedback has been demonstrated to produce beneficial and lasting change, some people may show little, if any response. This could be from having too much damage to the brain or from having an undiagnosed medical condition.

Despite all the research in the area of neurofeedback, it must be regarded as experimental given the absence of large, carefully controlled studies. I encourage clients to have 10-20 sessions to evaluate progress. It is the client’s personal responsibility to monitor subjective effects of training and to continue training as long as they see benefit.

You should be aware that many insurance companies, and even some professionals who are not aware of the latest published research and may regard all EEG neurofeedback as experimental. Some insurance companies still insist on defining all biofeedback as experimental and may not reimburse for these services.

If you are taking prescription medication, it is important to remain in close communication with your physician. In many cases, the need for some or all of these medications may decrease after a series of neurofeedback sessions. In some cases, a person will experience increased side effects of the medications unless they reduce the dosage. I advise you stay in contact with your prescribing physician and not make any changes without seeking medical advice.