It often takes time for even the best doctors to figure out what medications might work best for a patient. Rarely does the first medication and dosage work. Response is very individualized. You can’t predict a response until after the patient has tried the medication. Neurofeedback is quite similar. Many adjustments in training may be needed based on the person’s response to training. Fortunately, there are some tried-and-true models that are good starting points for many common symptoms.

Occasionally, it takes a while to start making progress with neurofeedback training. Many patients notice some change within the first 3 to 5 sessions, or at least that something is happening. A much smaller number, perhaps 10-15%, see little or no change in the first 5 to 10 sessions. If brain training doesn’t work quickly, that doesn’t mean it won’t work. It might mean a different part of the brain should be trained, or a different frequency. Even when the clinician has a lot of information, there’s no way to be sure what is the best training spot or frequency for a given brain.  Clinician usually start with sites that typically produce noticeable effects for a particular problem and adjust from there. If a clinician doesn’t have experience with a set of symptoms, they may want to mentor on a case of refer the client to a more experienced clinician.

If the client doesn’t respond to more “tried and true” training protocols, there are many options. Does the therapist train the parietal, frontal, or prefrontal lobe? Do they radically change frequencies? There is usually a logic to why different sites should be tried, but this critical point can be the time clients may drop out of training.

Not seeing results quickly enough is the most common problem for people who say neurofeedback doesn’t work for them. It’s rare to see someone who doesn’t respond eventually to training. It’s probably under 5%, based on current reported experience by clinicians. Unfortunately, many people will quit within ten sessions if they aren’t seeing change.

Skill of the clinician

Skilled therapists have learned how to get faster responses. Skill and talent for neurofeedback count. Do the wrong training, and nothing may happen. A less experienced or talented clinician may simply have success less often. That doesn’t mean neurofeedback doesn’t work. If you’re training the wrong site or the wrong frequency for a brain, you’re not as likely to have good success.

It’s fortunate that roughly 75% of brains have a robust response to neurofeedback training. Even those clinicians who are fairly new, but invest in good education and mentoring, often get very good results using tried and true training protocols.

Other Factors

Lack of consistency by the client in training often will cause treatment failures. Remember that neurofeedback is learning. If you come once a week or less, it’s much harder to learn.

There are many sites to train on the brain and many different frequencies to choose from. Training each can have a different effect on the client. Choosing the right site and frequency, like choosing the right medication, can require a mix of skill, knowledge, and patience to identify responsiveness. For some clients, it can take a while to figure out what really works.

Therapists also report that doing neurofeedback without addressing underlying family system problems can reduce the effectiveness of neurofeedback.

Defining “success” is also a challenge. Is partial symptom resolution a success? It’s important to set expectations with clients before they start training, and discuss the expectations on an ongoing basis. Some clients may perceive failure if complete remediation is not achieved, even with reduced symptoms. Some clients are impatient and may stop training if dramatic improvements aren’t seen quickly. Some clients are poor self-reporters and don’t identify changes when they do occur.

A good clinician combines neurofeedback with therapy and/or medications when necessary.  The combination makes for maximum effectiveness.