How do clinicians determine how to train the client?
There ae several approaches, but here's a common one. Many clinicians do a comprehensive assessment of reported symptoms, looking for neurophysiological rather than psychological clues. This is often combined with standardized testing. Over 30 years, models have been developed that correlate symptoms, testing data and often EEG data with brain function and arousal patterns. This information can be used to target sites and training frequencies (often called protocols). (There's a good course for teaching this).
Information from a brain map (example, a quantitative EEG or a SPECT) may be useful in helping target EEG training. There are disagreements in the field as to whether a brain map is necessary (click for a discussion of this question). Many solid experienced clinicians feel it can be additional useful information. It's like when a doctor does a blood test - he may not always need to do it, but it can rule out a lot of issues and point out things that would not be obvious through a clinical intake. In making decisions about training a client, more information is often useful.
A qEEG brain map starts with a comprehensive clinical EEG. An in-depth computer analysis compares the EEG with a large normalized database, and identifies deviations from the norm in brain function. This can help target the training. The clinician determines the training goals (What is a qEEG - click here). .
Most clinicians feel other modalities also be included with neurofeedback. This includes psychotherapy, cognitive behavioral therapy, medications, stress reduction, nutrition, etc. Neurofeedback training may have an effect on it's own. But its much more effective as part of a comprehensive program. Interestingly, other modalities or programs tend to work better when the client is doing neurofeedback. .
A thorough assessment gives the clinician a basis for the training decision. There is no set formula for training protocols. Different people respond differently to training - just as they do to medications. Experience, clinical judgment and training all play a role in how a clinician decides on the specific training.
The therapist tracks client outcome and makes training adjustments accordingly. Training effects do not require conscious effort by the client. The training tends to have a generalized effect. That means the client doesn’t “think about” the training to get the effect. Their more regulated brain responds better in a demanding situation. The goal - to produce key symptom reduction. Monitoring key symptoms closely is necessary to make adjustments to the training.
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