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Summary
Neurofeedback integration combines real-time EEG monitoring of brain activity with other therapeutic approaches like CBT, EMDR, and biofeedback to help clients self-regulate their brainwaves and improve mental health outcomes.
Conditions that respond to neurofeedback include ADHD, anxiety disorders, PTSD, depression, and substance use disorders, with research showing strong potential for symptom reduction and improved self-regulation.
Certification involves completing BCIA-accredited programs with foundational coursework, supervised practicum hours, and mentorship, though specific requirements vary by state and licensure.
Equipment needed includes EEG sensors, an amplifier, and specialized software to display brainwave activity, with various devices and price points available from reputable vendors.
Brain training therapy through neurofeedback can help therapists diversify their services, enhance treatment outcomes, and better serve clients whose progress has plateaued with traditional talk therapy alone.
Neurofeedback integration, a type of brain training therapy, is a non-invasive therapeutic approach that uses real-time monitoring of brain activity (via electroencephalography, or EEG) combined with other therapies like psychotherapy and biofeedback to address a client's health holistically.
As a therapist, integrating neurofeedback into your practice has the potential to completely change the way clients relate to themselves and their brains—and how they show up to and participate in therapy.
But how, exactly, does neurofeedback integration work?
And, what do you need to know (and do) to determine if it’s the right fit for your practice?
Finally, you may be wondering how you can actually get started in providing neurofeedback integration or brain training therapy services—and integrating it into your current treatment approach.
What is neurofeedback—and how does it work?
Before we dive into how to integrate neurofeedback into your practice, it’s important to understand the basics of what neurofeedback is and how it works.
“Neurofeedback is a form of biofeedback that helps clients train their brains to function more efficiently,” says psychotherapist Tameka Brewington, MS, LMHC, founder of Real Talk Counseling in Charlotte, NC and host of the Elevate Your Mindset podcast.
Research has shown neurofeedback integration has strong potential as a treatment for a variety of psychological issues and conditions, including ADHD, anxiety disorders, PTSD, depression, and substance use disorders.
Next, let’s explore how neurofeedback works.
It all starts with brain activity. There are five main types of brain waves—delta, theta, alpha, beta, and gamma.
“Each wave runs at different frequencies and magnitudes—and is responsible for certain states of relaxation from deep sleep to deep concentration,” says Maggie Bagley, LCSW, and neurofeedback specialist at Washington Wellness Center.
During a neurofeedback session, small sensors are placed on the scalp to measure brainwave activity.
That information is then sent to a computer program, which provides real-time visual or auditory feedback designed to reinforce more desirable brain states. For example, the neurofeedback program might play an uplifting, enjoyable video when your brain produces healthy, desirable patterns—and stop playing when your brain shifts to a less desirable state.
Over the course of multiple sessions, neurofeedback can help clients learn how to self-regulate their brain activity. This is why neurofeedback is considered a type of brain training therapy.
“By using EEG sensors to monitor brainwave activity, clients receive real-time feedback that allows them to regulate their mental and emotional states,” says Brewington—with the end goal being that “over time the brain learns to stay in the desired state—even when not training.”
What is neurofeedback integration?
Neurofeedback integration refers to a broad approach that combines neurofeedback training with other therapies, technologies, or interventions to potentially enhance outcomes.
Examples of integration
Neurofeedback and cognitive behavioral therapy (CBT): A person might use neurofeedback while engaging in a virtual reality exposure therapy for phobias, with the neurofeedback helping to lower anxiety as they move up the exposure hierarchy.
Neurofeedback and trauma therapy (like EMDR): Neurofeedback can help stabilize the nervous system and reduce hyperarousal, allowing for safer and more effective processing of traumatic memories.
Neurofeedback and other biofeedback methods: Neurofeedback can be combined with other biofeedback techniques, such as heart-brain rhythm coherence or photobiomodulation, to promote a more holistic approach to well-being.
What are the benefits of incorporating neurofeedback into your therapy practice?
Incorporating brain training therapy into your practice, like neurofeedback, can offer several benefits.
First, neurofeedback integration is versatile. It has the potential to produce results for a variety of clients in a variety of situations—which allows you to provide better care (and increased efficacy) for more clients.
“For instance, a client managing post-traumatic stress disorder (PTSD) found that neurofeedback helped quiet the hypervigilance that kept them on edge, allowing them to feel safer in their own body,” says Brewington. “Similarly, clients dealing with depression often notice improved motivation and mental clarity.”
According to Bagley, another major draw is that neurofeedback is non-invasive and typically has no side effects.. Bagley says neurofeedback “is also quite relaxing and enjoyable, as patients are often watching a calming screen or listening to calming music.” Due to its relaxing, enjoyable nature, it can be easier to get clients onboard with neurofeedback.
Arguably the most substantial benefit of neurofeedback integration is the impact on the client.
“Neurofeedback [can] help reduce anxiety, improve focus, enhance sleep, and stabilize mood,” says Brewington. And when a client feels less anxious, more focused, better rested, and more stable, they’re better able to participate in other forms of therapy—allowing them to reap those benefits as well.
For example, if a client is overwhelmed with anxiety, there’s a good chance they won’t feel present and/or grounded enough to fully engage in a talk therapy session, which can hinder results.
But, if you can leverage neurofeedback as a tool to help them identify when their anxiety is ramping up and effectively self-regulate, they’ll be better equipped to ground themselves if and when anxiety starts to overwhelm them.
How to get started with neurofeedback integration in your practice
Are you considering integrating neurofeedback into your current therapeutic offerings?
Here’s how to get started.
Get certified
If you’re wondering how to get certified, according to Bagley, when it comes to neurofeedback certification, rules vary by state.
At the very least, Bagley says, in order to offer neurofeedback to clients you need to be a licensed therapist who is trained in neurofeedback and staying within your scope of practice.But, even if you aren’t required to go through a neurofeedback certification program, it’s something to strongly consider.
“For therapists who work with clients struggling with trauma, anxiety, or ADHD…certification provides a valuable addition to traditional therapy methods,” says Brewington. “I often recommend it to clinicians looking to expand their toolbox for treating clients whose progress has plateaued using talk therapy alone.”
While there are a number of neurofeedback certification programs to choose from, one of the most popular and well-respected is from the Biofeedback Certification International Alliance (BCIA).
The BCIA neurofeedback certification program “involves completing foundational coursework, supervised practicum hours, and mentorship to ensure clinical competence,” says Brewington—all designed to lay the foundation for successful, effective neurofeedback integration.
Get your equipment setup
In addition to getting certified, you’ll also need to determine what equipment is needed and invest in the equipment you’ll need for your neurofeedback sessions.
“Neurofeedback requires EEG sensors, an amplifier, and specialized software that displays the client’s brainwave activity,” says Brewington.
There is a wide variety of neurofeedback devices and software on the market—and a huge variety of retailers that sell them.
Before you invest, make sure to do your research to find a reputable vendor that offers equipment that makes sense for your therapeutic needs, clients, and budget.
Create an integration plan
Once you’ve gone through the certification process and secured your neurofeedback equipment, it’s time to create a plan to roll out neurofeedback in your practice.
Before you begin offering neurofeedback integration, it’s important to determine:
Which conditions you’re planning to use neurofeedback to treat
How you’re going to introduce neurofeedback to your clients
How you’re going to structure your sessions
How—and how much—you’re going to charge (per session price, package price, etc.)
How you’re going to integrate neurofeedback into your overall therapeutic approach
How you’re going to incorporate qualitative data in your neurofeedback analysis (for example, asking clients to track their symptom reduction over time)
How to measure outcomes and how you’re going to incorporate quantitative data in your neurofeedback analysis (for example, Bagley does “full remaps to see how the brain is globally responding after each 20 sessions”)
How you’re going to use neurofeedback as a way to support your other therapy offerings and create more comprehensive treatment plans
Getting clear on these details before you integrate neurofeedback into your practice can help lay the foundation for a successful rollout.
What about insurance billing?
Understanding the ins and outs of insurance billing for neurofeedback is crucial for practice sustainability and client accessibility.
While some insurance plans offer coverage for neurofeedback, it's often tied to specific medical conditions and/or treatment plans (for example, stroke recovery).
Therefore, getting coverage for your clients isn't necessarily guaranteed.
Insurance coverage considerations
Medical necessity criteria: Some insurers require documentation that neurofeedback is medically necessary for the diagnosed condition.
Approved conditions: Coverage is more likely for certain conditions like ADHD, traumatic brain injury, or seizure disorders than for general mental health concerns.
Prior authorization: Many plans require pre-approval before beginning neurofeedback treatment.
CPT coding: Understanding appropriate billing codes for neurofeedback services is essential for reimbursement.
Alternative payment options
Do your research to see if a particular insurance payer offers any sort of neurofeedback coverage, what it might cover, and what alternatives you can offer if your clients are unable to get their treatments covered or reimbursed.
Cash pay options: Many neurofeedback providers operate on a cash-pay basis, offering package deals for multiple sessions.
Superbills: Provide detailed receipts that clients can submit to insurance for potential out-of-network reimbursement.
Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs): These accounts can often be used for neurofeedback services.
Sliding scale or payment plans: Making neurofeedback more accessible through flexible payment arrangements.
Use neurofeedback integration to better serve your clients—and your practice
From a client perspective, neurofeedback integration can help them get better results from therapy, as “neurofeedback helps restore optimal brain function, allowing clients to experience better focus, mood stability,” says Brewington.
And, from a practice perspective, brain training therapy can help you diversify your services, offer more comprehensive treatment plans, and drive better results for your clients.
Now that you understand the ins and outs of neurofeedback integration, you can determine whether neurofeedback is something you want to explore in your practice. Finally, if you decide that it is, you can take the steps to begin integrating brain training therapy into your practice.
Sources
Pigott HE, Cannon R. (2014). Neurofeedback is the Best Available First-Line Treatment for ADHD: What is the Evidence for this Claim? Neuroregulation.
Micoulaud-Franchi JA, Jeunet C, Pelissolo A, Ros T. (2021). EEG Neurofeedback for Anxiety Disorders and Post-Traumatic Stress Disorders: A Blueprint for a Promising Brain-Based Therapy. Curr Psychiatry Rep.
Lima KHM, Gomes JS, Tucci AM. (2022). Electroencephalographic neurofeedback as a tool for reducing harm and risk associated with alcohol use disorder: A critical review. Drug Alcohol Rev.
Fleischman MJ, Kaiser HM, Meulemans D. (2021). Neurofeedback: A Complement to Talk Therapy and Medication, National Alliance on Mental Illness.
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