Neurofeedback: One Method Does Not Fit All

Part of a blog series on Neurofeedback, this blog discusses the various methods.

Posted Dec 15, 2014

Since I have been writing this series of blogs about Neurofeedback for Psychology Today, there have been recurring questions about which method of neurofeedback is best for a specific symptom, such as headache, fatigue, memory, stress, or sleep problems.  Many have also wondered about which method would be most beneficial for those coping with brain related issues, such as concussion, stroke, MS, and Parkinson’s Disease.

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I have a neurofeedback patient who recently asked me about LENS (Low Energy Neurofeedback System), because she heard that it is suppose to be the most effective method of neurofeedback, and wanted to know why I wasn’t using it on her. I thanked her for the question and told her that she had inspired me to write this blog about neurofeedback. My answer to her, and my reason for writing this blog, is because one method doesn’t fit all, even if two patients have the same symptoms or brain related issues. It really depends on the person and their whole background.

Various Neurotherapy Methods can be used to treat the same symptoms.
In prior blogs, I explain that biofeedback is the overall term for various methods that uses information gained by monitoring the brain or body to promote control over what would normally be an involuntary process, such as your body temperature, blood pressure, heart rate or brain waves. The term biofeedback is similar that in the same way that all fruits are similar; apples and bananas are two different types of fruit, but they are both fruit nonetheless. Just like different pieces of fruit, there are different methods of biofeedback.

Various Neurotherapy Methods can be used to treat the same symptoms.

The four major groups as mentioned above are thermal, heart rate, muscular and brain. Thermal helps to control your body temperature, while heart rate variability (HRV) helps you to relax and reduce the fight/flight reaction of Post Concussion Syndrome and Post Traumatic Stress Disorder.  The basic method of training your brain is very similar regardless of equipment or method you use.  HRV is one of the core methods for teaching people internal or self control over your involuntary nervous system. In previous blogs, I noted that I emphasized about internal (self) control verses external methods of training such as various use of equipment, medication, herbs, aroma, and even food.

Muscular biofeedback called electromyography (EMG) is a technique for evaluating and recording your muscular activity in your body and provides feedback to retrain the injured or paralyzed muscles. This method is extremely effective with patients who are paralyzed due to a stroke or back injury.  When I had my 60 mile-an-hour head-on auto accident, I injured three cervical, four thoracic, and three lumbar discs.  Also, from my stroke, I had hemiparesis, which means I was not paralyzed, yet experienced weakness on one side.  I was in chronic pain for almost seven years.  EMG biofeedback truly was a life-saver allowing me to regain my physical ability and movement again, along with the Burdenko Water therapy.

Hemoencephalography (HEG) measures brain blood oxygenation and facilitates training to provide greater blood flow to the frontal lobes, thereby enhancing concentration, memory, and emotional control. It is also extremely effective for headache pain.  Even in this category, there are two methods.  One method is near-infrared (nIR) spectroscopy and the other is passive infrared (pIR).  While both types measure cerebral blood oxygenation, they vary in the way they are done.

The last major category under biofeedback is neurofeedback, which is also known as electroencephalography (EEG) biofeedback, also known as neurotherapy.  In this category, or subdivision of biofeedback, there are a wide variety of methods with subdivisions and protocols under each method. 

With neurofeedback, there are a wide variety of methods that do a wide variety of ways of helping your brain to become regulated and to function better.  The ten subcategories are:

  • Traditional neurofeedback
  • Z-score training
  • LENS (Low Energy Neurofeedback System)
  • Low frequency training
  • Loretta training
  • pEMF training
  • pRoshi
  • NeurOptimal training
  • CES (cranial electrotherapy stimulation and self-controlled energy neuro adaptive regulation (Scenar)

Of this list, the CES and pRoshi do NOT have specific protocols.  The CES machine is an FDA approved medical device for depression, insomnia and anxiety. NeurOptimal training and pRoshi methods are based on the brain's ability to return to self-regulation. Neither of these methods have specific protocols for a specific symptom or brain related issue. Each of the other seven areas has a wide variety of protocols for specific symptoms or brain related dysfunction or for enhancing specific functions, such as the ability to boost memory.

Providers and Training

The average clinician spends many hours in training to learn a specific method. Training includes positioning electrodes, learning what frequency effects specific symptoms - such as sleep issues - and how to enhance certain areas, such as increasing one's ability to recall or helping to enhance athletic performance. 

Most clinicians have learned one method, and when they have achieved a specified amount of training, they are listed as a provider for that specific method.  Some clinicians have taken specific training and education to obtain a BCIA board certification. Others have their Doctorate in Neuroantomony and are trained in a specific method.  Lastly, there are a vast number of neurofeedback providers who have been trained in many methods and have learned a wide variety of protocols from each.

I personally do not believe that there is one method that provides everything to every person, because I believe each person is unique and each symptom and brain related issue is just as unique and the individual.  I decide what method or approach I’m using based on my 5 Prong approach and where the patient is at physically and emotionally on the specific day I'm treating them.

This past week, a patient of mine, who is paralyzed on the left side from a stroke, was experiencing severe pain.  In the past weeks, I’ve been using low frequency training to help provide him with some mobility. Prior to his working with me, he had not been able to move his arm or leg in three years, even with physical and occupational therapy. The low frequency training has been very successful for him, and he now has sensation in both his arm and leg. He is even able to move his leg and briefly stand on it. During his appointment this week, he complained of experiencing pain in the back of his left leg. Hearing this, I switched my procedure to match his complaint and used a pEMF equipment with a Nogier protocol which indicated he was having gastrointestinal problems. When I shared this information with the patient and his wife, they both laughed and said he was up all night the prior night with severe stomach pain from the Italian food he had eaten. They had failed to mention this when they arrived. We all laughed about this and at the end of the treatment. He left relieved from both stomach and leg pain. If I had continued with the prior low frequency treatment, more than likely he would have left my office still in pain.

It is this type of flexibility that is often needed when deciding how to treat patients, yet for some issues and symptoms, one method does work perfectly well.  In next week’s blog, I will present the various methods as they apply to various symptoms, such as sleep and memory problems and brain related issues, such as stroke, concussion, ADHD

Hopefully with this information, you can be an educated consumer and find the appropriate clinician and methods for your specific needs.  For more of neurofeedback, please visit my website at

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Copyright © 2014 Dr. Diane Roberts Stoler, Ed.D.