FREQUENTLY ASKED QUESTIONS
All neuro/biofeedback providers are not equivalent. It is not uncommon to discover people going into practice who are not licensed, or who are licensed but inadequately trained. When deciding with whom to work, be certain that the individual overseeing the training is a licensed mental health provider or physician, and has had adequate training in the field of neurofeedback.
At BiofeedbackWORKS in Virginia, our clinicians and technicians provide a diversity of education and experience that is unmatched. We offer an extensive variety of neurofeedback modalities such as EEG, HEG, and LENS neurofeedback and sometimes use more than one of these modalities in a single session. We have the latest equipment in the field such as a VieLight and Freedom 24D that is not available at many other clinics. In addition, we are one of the few clinics that offers general biofeedback as well as neurofeedback and counseling. We look at the whole person and choose the modalities that will produce the greatest positive change for the client.
Simply because someone owns equipment does not mean they are well qualified to use it. Be sure to ask prospective providers for their educational backgrounds and for which licenses they currently hold. Check that they have been certified by the Biofeedback Certification International Alliance (website: www.bcia.org), the longest existing and only reputable biofeedback certifying body. Ask about the nature of their training and how long they have been in practice.
Neurofeedback practitioners have varying levels of education and training. Many states do not regulate biofeedback. There are only a few institutions of higher learning in the United States that offer courses in this field. Don’t hesitate to ask your prospective provider for a list of credentials.
It was first discovered in the 1960’s that people could control their brainwave patterns. Because the field was in its infancy, research was conducted at very few institutions. Results were published in highly specialized scientific journals with which health care providers were largely unfamiliar. For these reasons, the possibilities of this powerful tool have not become well known among physicians or the general public. This is now changing. Advances in computer technology have enabled neurofeedback to emerge from the laboratory to become a useful clinical tool in the offices of mental health providers.
Some medical and psychological insurance plans now cover neurofeedback and/or biofeedback for various conditions. Reimbursement to the client varies by carrier and by plan. Check with your insurance company about coverage for biofeedback. Neurofeedback is a form of biofeedback, and is billed as biofeedback.
- Be sure you understand what your insurance policy will cover, and for which diagnoses.
- Important: If you are told that biofeedback is covered, be certain to document the name of the insurance representative, with whom you spoke, the date and time of your conversation. This information will be needed in the event of any misunderstandings regarding coverage or any reimbursement refusals by your insurance carrier. We have experienced instances when a representative had assured a client that biofeedback would be covered, but later the insurance company refused to reimburse the client. If you have documented your conversation, you are more likely to win an appeal.
You may ask your insurance carrier about coverage for specific CPT (Current Procedure Terminology) codes. We use the following codes:
INITIAL CONSULTATION: 90837 or 90832
Some insurance companies reimburse one code preferentially. This code is used for counseling sessions as well.
QEEG (BRAIN MAP): 95816, 95957, and 96132
95816 refers to the qEEG recording, 95957 refers to the digital analysis of the recording (eliminating artifact and comparing to the database), and 96132 refers to the evaluation of the recording and accompanying report by a neurologist.
IVA+PLUS CONTINUOUS PERFORMANCE TEST: 96146
This is a computerized test of focus and attention.
INTAKE INTERVIEW: 90791
This session includes an in-depth verbal review of the qEEG results and treatment planning.
BIOFEEDBACK AND NEUROFEEDBACK: 90901 or 96152
- 90901 is used for psychological disorders, such as: Anxiety, Depression, Post Traumatic Stress Disorder and Attention Deficit Disorder
- 96152 Health/ Behavioral Intervention, is used only for medical diagnoses such as:
- F51.01 – Primary Insomnia
- G44.209 – Tension Type Headache
- G43.911 – Migraine
- F07.81 – Post Concussion Syndrome
- G44.329 – Chronic post traumatic headache
- S06.0X0A – Concussion w/o loss of consciousness
- I73.00 – Raynaud’s
- K59.00 – Constipation
- H93.1 -Tinnitus
- K58.9 – Irritable Bowel Syndrome
Other questions you might ask your health insurance company:
Is biofeedback a covered benefit under my insurance policy? _______
– If the answer is yes, then:
- Is it covered under a. Medical Services? ____ b. Psychological Services? ____
- For which diagnosis is it covered? __________
- Under which code is it covered? a. 90901 ____ b. 96152 ____
- Do I need a prescription or letter from my medical doctor to say that it is medically necessary?
- Do I need a referral from my primary care physician? ____
- Will I need preauthorization? _____ If so, what is the preauthorization code? ____
- How many sessions are allowed? ____ a. Per week? ____ b. Per year?____ c. Is there a dollar amount limit? ____
- Is there a deductible? a. If so, what is it? ____ b. If so, how much of the deductible has been met? ______
- Is there a co pay? _______ If so, what is it? _____
- If biofeedback is covered, can counseling (90837, 90834 or 90832) be billed on the same day?
- Is there a limit to the total amount the insurance company will reimburse each year? Is there an annual benefits cap that could affect the amount of my reimbursement?
To become a client at BiofeedbackWORKS, please call our office or complete a Contact Us form. A staff member will be happy to discuss with you and answer any questions you may have. First, we schedule an hour-long Initial Consult with a therapist. During this appointment your symptoms are reviewed, your questions are answered, and a determination is made as to which of our services will be most helpful for you. If it is decided that counseling or general biofeedback alone is the best option for you, no further evaluation is necessary. If the decision is to begin neurofeedback training or a combination of neurofeedback and other services, the next step is to schedule a Quantitative Electroencephalograph (QEEG), IVA +Plus computer test of attention (if appropriate), and an Intake Interview.
The QEEG (described further below) is a recording of your brainwave (EEG) activity at 19 locations simultaneously. Afterwards, the data is edited and then compared in detail to a large database of high-functioning individuals matched to your age.
At the Intake Interview, an in-depth discussion of your symptoms takes place, and a therapist reviews your QEEG results with you. They identify EEG abnormalities and brain regions showing sub-optimal functioning correlated with the symptoms causing you difficulty. Specific treatment goals are identified, and an individualized treatment plan is developed based on your symptoms, your goals, and your specific brain function as seen in the QEEG. Please view Our Process for a more in depth explanation of each appointment.
While a QEEG does add to the cost of the overall treatment, it generally averages out with money being saved. It reveals quite specific information about the client’s brain function so that a more effective and efficient treatment plan can be developed. Without a map, the practitioner must use his or her training, intuition, and judgment to choose training sites and to make adjustments over the course of training based on the client’s reported response. We feel that the in-depth, detailed information provided by a QEEG permits the practitioner to determine in advance the most optimal training protocols and to avoid those that might be contraindicated. As a result, training is more efficient and effective.
A Quantitative EEG (QEEG), also referred to as a brain map, functions as a road map for the neurofeedback practitioner. As one Practitioner said, “If you need to fix your car, it’s kind of nice to look under the hood first.” A brain map helps neurofeedback providers “look under your hood.”
We first make a recording of brainwave activity. An elastic cap with 19 sensors is placed on the head. Electrical activity is recorded simultaneously at all 19 sites, first with eyes closed and then with eyes open. If deemed necessary, a third recording may be made while the client is given a task. The recording session itself takes between 1 and 1 1/2 hours.
After this, the recorded raw data is carefully edited to remove artifacts, which are signals not generated by actual brainwaves (such as those produced by muscle twitches, muscle tension, eye blinks, coughs, etc.). The data is then subjected to various quantitative analyses using sophisticated software dedicated to this purpose and compared to a database of age-matched high-functioning individuals free of difficulties, injury and disease. The result is a map of how the client’s brain function differs from this high-functioning population.
To complete the QEEG process, we send the raw EEG recording to a neurologist who examines it for any organic abnormalities. The EEG recording might show evidence of subclinical seizures (seizures which happen without a person’s awareness or outward symptoms), tumors or lesions which could be causing the client’s symptoms. Only a neurologist who is versed in EEG is able to make such a determination, and it is important to rule out these causes before commencing neurofeedback treatment.
Neurofeedback and Biofeedback
General biofeedback trains a person to obtain greater control over certain involuntary body responses such as heart rate, breathing, body temperature, sweat gland activity, and muscle tension. By learning to control these physiological responses, an individual can exert control over mental and physical health problems.
Unlike neurofeedback, where the brain responds to feedback at an unconscious level, biofeedback requires an individual’s conscious participation in the process. The client may be learning to change breathing patterns, control muscle tension and/or lower blood pressure or heart rate. When a video progresses or music plays, the client makes internal adjustments to alter the signal. Over time the client will learn to either increase the feedback (in the case of someone trying to make a muscle become stronger) or decrease the signal (in the case of someone trying to make a muscle relax.) It is like holding a mirror to your physiology.
At BiofeedbackWORKS our primary focus with general biofeedback is targeting health problems and mental conditions that are stress-related. Stress and anxiety manifest physiologically in our bodies in a variety of ways. With our state-of-the-art equipment, we bring your physiological responses to your awareness. With this increased awareness you can alter these responses and thus reduce your body’s stress. Some forms of biofeedback require little or no equipment, and are simple enough that clients can practice between sessions.
Biofeedback is often used in addition to neurofeedback to optimize training. Temperature training (in which a person holds a thermometer and concentrates on either raising or lowering their temperature) and breathing technique are two biofeedback techniques commonly used in conjunction with neurofeedback.
NEUROFEEDBACK is a specialized form of BIOFEEDBACK.
NEUROFEEDBACK is a painless, non-invasive technique used to train the brain to improve its functioning. An individual receives instantaneous information (feedback) about whether the brain is moving towards or away from optimal function. It may be thought of as a kind of exercise for the brain: a retraining of the way the brain organizes itself.
When the brain is out of balance, people can experience a wide range of problems that affect learning, mood, sleep, concentration, and behavior. Neurofeedback training brings these problems gradually under control.
BIOFEEDBACK is a non-invasive technique by which people learn to use signals from their own bodies to improve their health. Various instruments (from sophisticated machines to simple hand-held thermometers) are used to provide information to individuals on the state of bodily processes about which they are normally unaware. They are then trained to adjust these states to ease a wide range of symptoms.
During a training session, measurements of a relevant physiological process (for instance, skin temperature, muscle tightness, or brainwave pattern) are continuously made. At the same time information (that is, feedback) is given to the individual about whether the measurements indicate optimal functioning, or are in a range that is indicative of symptoms they wish to relieve. The individual receives this feedback in the form of a musical tone, a computer graphic, or the continued playing of a movie.
We have had success working with clients with brain injuries and those suffering from many types of disabilities. Neurofeedback helps the brain become more efficient so that it works at its best capacity, whatever that capacity might be. If someone’s brain has been injured by a stroke or through surgery, the brain learns to “reroute” signals to create new neuronal pathways.
Neurofeedback works with learning disabilities as well. Brain regions and networks involved with learning (such as word recognition, reading comprehension, expressive language, etc.) can be strengthened, thus improving performance.
Studies have shown that I.Q. scores generally raise 10 to 20 points after training. This is not because neurofeedback makes people smarter; it simply helps their brains become more efficient and flexible.
Perhaps an example will be helpful. A three-year-old boy suffering from Fetal Alcohol Effect was brought in for training by his grandmother. His mother had been drinking throughout her pregnancy with him. The grandmother reported that the child would have fits of rage during which he would bang his head on the floor until he became unconscious. Other symptoms he exhibited included repetitive hand movements, fascination with anything that moved in a circle, and delayed speech.
Training parameters were determined and neurofeedback began. The grandmother sat with the boy on her lap, distracting him with toys and books while sensors were placed on his head. A pillow that could vibrate was placed between the grandmother’s lap and the boy’s back, giving him a pleasing sensation each time his brain produced the proper brainwaves.
The first session lasted four minutes before the boy ripped the sensors off his head, ran into an adjoining office, and began banging his head on the floor.
Six minutes into the second session on the very next day, the child again tore off the sensors and began to bang his head.
Session three, on the third day, lasted eight minutes. The boy ripped the sensors off his head, ran into the adjoining office, threw himself down on the floor—but simply laid there. No head banging. A minute went by before he picked himself up, went over to some toys, and began playing. Subsequent sessions averaged 15 minutes. He completed 20 sessions in all. His grandmother reported he never returned to head banging after that third session; his speech and interaction with other family members were greatly improved.
Absolutely. Feedback for those who have vision problems is provided through auditory or tactile cues.
We have had success working with children as young as four years old and adults as old as 78. There is no upper age limitation for neurofeedback treatment.
Neurofeedback training does not change underlying personality. It may be seen, however, that when some adverse behavior problems are remediated, the intrinsic innate personality will be more in evidence. For example, in the beginning it may be difficult to dissociate irritability, hot-headedness, or cruelty from a child’s personality. After that behavior disappears, it is easy to understand that it was never a part of the child’s intrinsic personality.
When neurofeedback is used for those suffering from Alzheimer’s or dementia, it is called “brain brightening.” Neurofeedback cannot improve the physical degeneration of the brain. What it can do is help the brain access areas of itself that have not yet been affected by the condition, which can slow symptom progression and thereby improve quality of life.
For most conditions, there are no adverse side effects due to the training when conducted by a competent professional. If an occasional negative reaction to training does occur it tends to wear off quickly, or it can be trained away by the clinician, or both. Interestingly, our clients often note positive side effects. Someone undergoing training to treat migraines, for example, may report improved sleep, concentration, or mood.
It is not possible to predict with certainty that training will be successful for a particular condition. For common conditions, however, a reasonable prediction of outcomes is usually possible. Fortunately the effectiveness of training can usually be assessed early in the course of training.
In most instances, once the brain has learned how to perform at its optimum level it retains this functioning. Think about learning to ride a bicycle. Remember how difficult that was? Did you fall? And then, after a while, you didn’t even have to think about balancing anymore? At a subconscious level, your brain was sending messages to your muscles to do what they needed to do to keep you upright. Even if you haven’t ridden a bicycle in years, if you were to get on one today your brain would quickly remember what it is supposed to do to help you remain balanced.
This is what happens through neurofeedback training. We train your brain to work in a way that will help keep you “balanced.” You will not need to concentrate consciously on what you need to do to “stay relaxed” (for example). Your brain will simply function the way it needs to, in order for you to be comfortable.
There are a few instances when we have observed that several “booster” sessions might be needed:
- If the client has been involved in a long-term traumatic situation (for example, an abusive relationship or a family member suffering from a prolonged and difficult illness).
- If the client has undergone long-term medical help (such as chemotherapy).
- If the client has experienced a head trauma after training is completed (such as an automobile or skiing accident involving brain trauma).
- If the client’s main presenting problem is depression. Often people who receive neurofeedback for depression will benefit from one to three booster sessions a few times per year.
- If the client is still growing. Young children will often have to return for booster sessions as their brain and body develop.
The brain is amazingly adaptable. It is capable of making adjustments to improve its own performance if given cues about what to change. When the brain is regulating itself well and is alert and attentive, brainwaves (EEG) show particular patterns. We challenge the brain to maintain this “high-performance” alert and active state. Gradually, after 20 or more training sessions, the brain learns to stay at this high-performance state for longer periods of time and to retain these new skills.
Successful outcomes, not limited to those listed below, have been reported by Neurofeedback Practitioners for:
- Chronic Fatigue Syndrome
- Chronic pain
- Closed head injuries
- Fetal Alcohol Syndrome/Effect
- Headaches and Migraines
- Learning Disorders
- Obsessive Compulsive Disorder (OCD)
- Oppositional Defiant Disorder (ODD)
- Pain management
- Premenstrual Syndrome (PMS)
- Reactive Attachment Disorder
- Reading skills
- Seizure Disorders
- Sleep Disorders
- Tourette Syndrome
Neurofeedback has also proven effective when used for Peak Performance Training, such as developing memory skills, focusing abilities, and increasing concentration. One Peak Performance client said “I’ve taken four strokes off my golf game since doing neurofeedback training. I hope none of my buddies find out about this stuff!”
Neurofeedback Training Sessions
Each session takes between 45 and 60 minutes. The actual training period lasts a maximum of 30 minutes. Additional time is needed beforehand for sensor placement and adjustment. We also speak with our clients briefly before and after each training session to monitor how things are progressing. We reserve 60 minutes for each client to ensure that no one is rushed and that there will be time to discuss the results you are experiencing.
When starting neurofeedback training, it is optimal that sessions be regular and frequent at two or three (or more) sessions per week. It is possible to do more than one sessions in a day or to have sessions on two or three consecutive days. As learning begins to consolidate, the pace can be reduced. If it is not possible to accommodate two or three sessions per week neurofeedback will still be just as beneficial, though it may be a longer period of time before lasting improvement is achieved.
Results from neurofeedback training are seen gradually, over time. Initial progress can be seen within 15 sessions for most conditions. A typical treatment program consists of between 20 and 60 sessions depending upon the conditions being addressed with the average being 40 sessions. The current understanding among neurofeedback researchers is that it takes a minimum of 20 sessions for learning to be consolidated so the client can maintain the gains that have been made.
At a training session, sensors are placed on your head. The sensors pick up information on your brain’s activity at very specific locations. (No electricity enters your brain. The sensors merely read information from the brain and relay it to the Practitioner’s computer.)
You then sit back in a comfortable chair as you watch a computer monitor that displays a computer game, a movie, a bar graph, or simply colors that change as your brainwaves change. The Practitioner monitors your brainwaves and sets training parameters which are based upon information obtained during your comprehensive intake process.
The most common method of receiving feedback is via a dimmer on the monitor display while you watch a movie or a Netflix show. When your brain produces favorable brainwaves, musical tones will sound and the screen will become brighter. On the other hand, when your brain produces brainwave patterns that are unfavorable, the monitor will become dimmer.
This process gives your brain instantaneous feedback about its performance during the training session. On a subconscious level it begins to learn what it needs to do to make your computer screen bright. It then begins to produce more of the helpful type of brainwave patterns and less of those that are correlated with the symptoms you wish to address. With practice, your brain adapts new patterns. Desirable neuronal pathways are strengthened and new pathways may be created.
As your brain learns what it needs to do to make your computer screen active, the Practitioner gradually makes the goals a bit more difficult in order to challenge your brain to do even “better.” This is analogous to weight training workouts: as your muscles become accustomed to one weight, a little more is added until over time you build new muscle. With neurofeedback training, gradually your brain learns how to work at a more optimal level.
Neurofeedback is not “anti-medication.” We see the two methodologies working together, not against each other. Medication helps support brain function while the brain is learning what it needs to adjust. We tell clients to stay in close contact with their physicians and watch for symptoms of overmedication.
When working with hyperactive children, for example, a parent might report after the tenth session that their child is having trouble sleeping and is irritable (symptoms of stimulant side effects). We would suggest that the child’s doctor be consulted about reducing the child’s medication to see if the problems are remediated. In most cases, this proves to be the solution. As the brain becomes more efficient, it needs less pharmacological help to work optimally.
There may be a time when we might suggest—with your physician’s approval—that you temporarily not take some types of medication. This generally occurs before we administer an attention/cognition test (so we can get a baseline score) or before a brain map is done. We never suggest that a person stop any medication taken for physical conditions such as heart problems, seizure disorders, or blood pressure. Any changes in your medical regime must be made under your medical doctor’s supervision.
Initially, neurofeedback usually supports medication dosages and clients tend to feel better while on their current doses. As training progresses and brain function improves, some clients may actually begin to experience symptoms of overmedication. At this point the client is referred to their physician, who would oversee any medication changes. Many of our clients have reported either that they no longer need their medications or that they are able to reduce the amounts needed after completion of neurofeedback training. However, if the goal is to stop taking medications, you should plan on a larger number of neurofeedback sessions.