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Evolution of Neurofeedback Therapy

Multiple Methods

Since Sterman’s discovery, the field of Neurotherapy has evolved. The original discovery was a text-book example of serendipitous discovery that cannot have had a placebo effect at play.

Commentators on the field often observe that interim studies have varied in quality, as assessed by study size, control arms and placebo controls. Whilst there are thousands of peer-reviewed studies, and many randomised controlled trials, often submitted to journals by neurofeedback clinicians, most academic researchers and medical practitioners have been dismissive of neurofeedback until recently. 

Studies have demonstrated the physiological effects of neurofeedback, in terms of increasing grey-matter volume and white-matter tracts pathways34:

The field has developed from the beginnings where ‘one size fits all’ directive approaches were the standard, where all subjects presented the same way and all those in the experimental group were subject to the same experimental design.

Non-directive methods have emerged that target hubs of the brain’s primary regulatory networks, focused on very low frequencies that have shown training effects in a single session in functional MRI [fMRI]-based neurofeedback studies35,36

Unlike the early animal research, the senses of taste and smell are not commonly used, but 3 external feedback loops are commonly established using:

  1. Vision (typically a computer monitor with variable speed or size as feedback)
  2. Hearing (variation in feedback volume level)
  3. Touch (using vibro-tactile feedback37 using a vibrating cushion or soft toy)

Neuro-Sequential Model

BrainTrainUK uses multiple methods or modalities of neurofeedback therapy and has treated 100s of clients since establishment in 2013. Our approach to neurofeedback therapy is unique in following Bruce Perry’s “Neuro-Sequential Model of Therapeutics”39 by using staged modalities that replicate the normal sequential process of development.

We start with modalities that target the lowest (in the brain) undeveloped/abnormally functioning set of problems, and move sequentially up the brain as improvements are seen.

Neurofeedback therapy can be thought of as a physiological intervention that can build the scaffolding for traditional psychological interventions. We start with a focus on physiological regulation (mid-brain, limbic brain) then move onto psychological regulation (cortex), as illustrated below:


Critical Success Factors

With individualised approaches to neurofeedback, it is critical that clients/parents/carers engage in the intake assessment and planning process, and provide feedback on an ongoing basis throughout the programme. Because neurofeedback is a learning process, regularity of sessions is also critical. Although every brain is different, the rule of thumb is at least once a week, preferably more frequent, 2-3 times per week is desirable.

Another important factor that can impact the level of improvement are environmental factors within the home or school that hinder training success: an emotionally unsettled or traumatising home environment; being subjected to bullying behaviour at school, etc. In these cases the brain needs to ‘survive’ and there is little room for ‘learning’.

Research and clinical practice tells us that there is an average 10-15% subset of the population who do not respond. For Developmental Trauma our clinical experience suggests a higher success rate, 90-95%, and studies . The reason for this is unknown, though there is speculation that dietary issues, deficits in blood glucose regulation (dysglycemia) affecting brain function, poor sleep or poor sleep hygiene can impact the learning process.

There is more information on the possible factors that influence success here.

There are no current methods to predict or test responsivity in advance. Clinical experience tells us that if there is no response after approximately 6-7 sessions then it is unlikely that further sessions will result in a response.

With contracts for 25+ client programmes, it is possible to spread the risk of non-responders and provide a guarantee of positive outcomes. More information on our service model for government or agencies here.

→Continue reading about the BrainTrainUK Programme for Developmental Trauma


34Ghaziri, Jimmy, et al. “Neurofeedback training induces changes in white and gray matter.” Clinical EEG and neuroscience 44.4 (2013): 265-272.

35Ros T, Theberge J, Frewen PA, et al: Mind over chatter: Plastic up- regulation of the fMRI salience network directly after EEG neuro- feedback. Neuroimage 65:324-335, 2013

36Zhang G, Zhang H, Li X, et al: Functional alteration of the DMN by learned regulation of the PCC using real-time fMRI. IEEE Trans Neural Syst Rehabil Eng 21:595-606, 2013

37Cincotti, F., Kauhanen, L., Aloise, F., Palomäki, T., Caporusso, N., Jylänki, P., … & Marciani, M. G. (2007). Vibrotactile feedback for brain-computer interface operation. Computational intelligence and neuroscience, 2007.

38Othmer, S., Othmer, S. F., Kaiser, D. A., & Putman, J. (2013, December). Endogenous neuromodulation at infralow frequencies. Seminars in pediatric neurology (Vol. 20, No. 4, pp. 246-257). WB Saunders.

39Perry, B. D. (2009). Examining child maltreatment through a neurodevelopmental lens: Clinical application of the Neurosequential Model of Therapeutics. Journal of Loss and Trauma, 14, 240–255.



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If you would like to learn more about the benefits of neurofeedback for treating trauma please call BrainTrain UK. We offer a free initial telephone consultation, will answer any questions you have and explain the treatment to you. There is no obligation to get treatment after the consultation if you decide it isn’t for you.