FAQs

WHAT IS BIOFEEDBACK?

Biofeedback is a non-invasive, non-medical technique in which people learn to use their own body's signals to improve their health. Biofeedback uses a wide range of instruments…… from complicated machines to simple hand-held thermometers…..to provide feedback concerning bodily processes about which individuals are normally unaware. During training, clients are given information about physiological conditions in their bodies, such as the temperature of their skin, the tightness of their muscles or the patterns of their brainwaves. By having this information, many people are able to train themselves to regulate their physiological state, thus improving their health.

At BiofeedbackWorks in Virginia, we offer many forms of both general biofeedback and neurofeedback.

WHAT IS NEUROFEEDBACK TRAINING?

Neurofeedback is a specialized form of biofeedback. It is a painless, non-invasive procedure. The focus is training the brain to help people improve their brain function. The individual receives instantaneous information (feedback) about whether the brain is moving towards or away from optimal function. Think of it as exercise for the brain or retraining the way the brain organizes itself.

When the brain is out of balance, people can experience a wide range of problems effecting learning, moods, sleep, concentration, and behavior. Neurofeedback training brings these problems gradually under control.

At BiofeedbackWorks in Virginia, we offer EEG neurofeedback, LENS neurofeedback and 2 forms of HEG neurofeedback

HOW IS GENERAL BIOFEEDBACK DIFFERENT FROM NEUROFEEDBACK?

General biofeedback allows 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 body responses, an individual can gain control of mental and physical health problems. General biofeedback is essentially using your mind to control your body.

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. With general biofeedback some kind of feedback (signal)……visual and/or auditory…..is presented when the client attempts to perform a task. When a light flashes or a buzzer buzzes, the client makes internal adjustments to alter the signal. Over time he/she 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 in Virginia, our primary focus with general biofeedback is to target health problems and mental conditions that are stress related. Stress and anxiety manifest in our body in a variety of physiological ways. With our state of the art equipment, we bring your physiological responses to your awareness. With this increased awareness (or feedback) you can change those body responses and thus reduce your body's stress.

Biofeedback is often used in conjunction with neurofeedback to optimize training. Since learning how to do biofeedback can be simple and requires little or no equipment, it is something that clients can practice between sessions. Temperature training (where a person holds a thermometer and concentrates on either raising or lowering their temperature) and breathing techniques are two of the more commonly used biofeedback techniques employed in conjunction with neurofeedback.

HOW IS NEUROFEEDBACK TRAINING DONE?

After an extensive intake process and optimum training parameters are determined, sensors will be placed on your head. These sensors will give the Neurofeedback Practitioner the information he/she needs concerning your brain activity at very specific locations. (No electricity goes into the brain. The sensors are only relaying information FROM the brain to the Practitioner’s computer.)

You will be watching a computer monitor that is showing you either a computer game, a movie, a bar graph… or perhaps just colors that change as your brainwaves change.

The Practitioner will be watching your brainwaves, and setting parameters for acceptable brain activity.
As you watch your computer screen, your brain is receiving feedback from the equipment. When your brain produces brainwaves that will help remediate your problem(s), the game or movie will play…or the bar graph will move up or down....and/or music might be produced. When your brain produces the brainwaves that are contributing to your problem(s), everything on your computer screen either stops or darkens.

Your brain is receiving instantaneous feedback about its performance. At a subconscious level, it will begin to “work out” what it needs to do to make your computer screen “active.” It will therefore begin to produce more of the brainwaves that will be helpful to you and less of those that are interfering with your life. Over time, your brain learns new brain wave patterns. New neuronal pathways can also be created.

As your brain begins to learn what it needs to do to make your computer screen active, the Practitioner makes the goals slightly more difficult, challenging your brain to do even “better.” (Sometimes this is referred to as “shaping.”) It’s kind of like working out with weights. As you muscles become accustomed to one weight, a little more is added until gradually, over time, you have built new muscle.

With neurofeedback training gradually, over time, your brain will learn how to work at its more optimum level.

WHY DOES NEUROFEEDBACK WORK?

The brain is amazingly adaptable and capable of learning. The brain can learn to improve its own performance if it is given cues about what to change. By making information available to the brain about how it is functioning, it can make adjustments to improve functioning. When the brain is doing a good job regulating itself, 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.

HOW LONG DO THE RESULTS LAST?

In most instances, once the brain has learned how to perform at its optimum level, it stays there. No further sessions are needed. If you are an adult, think of when you learned how to ride a bike. Do you remember how difficult it was? Do you remember falling over? Do you remember that after a while you didn’t have to even 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. Well, even if you haven’t been on a bike for a number of 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.

That’s what happens through neurofeedback training. We are training your brain to work in a way that will help keep you balanced. You won’t have to concentrate consciously on what you need to do to “stay relaxed” (for example). Your brain will simply be functioning the way it needs to, in order for you to be comfortable.

There are only four instances when we have observed that one or more “booster” sessions might be needed:

1. If the client has been involved in a long-term traumatic situation (an abusive relationship or a family member suffering from a prolonged, difficult illness for example).
2. If the client has undergone long-term medical help (chemotherapy for example).
3. If the client has experienced a head trauma after training is completed (for example, been involved in an automobile/skiing accident where brain trauma has occurred).
4. 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.

HOW MANY SESSIONS WILL I NEED?

Results from neurofeedback training are seen gradually, over time. For most conditions initial progress can be seen within 15 sessions. A typical treatment programs is from 20 to 60 sessions, depending upon the conditions being addressed. The average number of sessions is around 40. The current understanding among neurofeedback providers is that it takes a minimum of 20 neurofeedback sessions for learning to be consolidated so the client can maintain the gains which have made. Sometimes a client will complete 20 sessions and take a year off, then come back and complete the training process.

HOW FREQUENT SHOULD THE TRAINING SESSIONS BE?

In the initial stages of learning, the sessions should be regular and frequent at two, three, or even more sessions per week. As learning begins to consolidate, the pace can be reduced.

HOW LONG DO NEUROFEEDBACK SESSIONS TAKE?

You can plan on 45 minutes per session. While the actual training takes only 30 minutes, you need to allow time for the sensors to be placed and adjustments to be made. We also talk to our clients briefly before and after each session to see how things are progressing. We block out 60 minutes for each client to insure that no one is rushed, and that we have plenty of time to discuss the results you are experiencing.

HOW DO I GET STARTED?

It begins with your Initial Consultation with Joan Ordmandy. During the Initial Consultation your symptoms will be reviewed, your questions will be answered and it will be determined if you are a good candidate for neurofeedback. If the decision is that neurofeedback training is for you, the next step is to schedule a Quantitative Electroencephalograph (QEEG) and Intake Interview.

The QEEG is a recording of brainwave (EEG) activity at 19 locations simultaneously. This recording is then edited and compared to a database of high functioning individuals. It will take about 1 ½ to 2 hours to complete. The next step is the Intake Interview at which time a more in-depth discussion of symptoms will take place. In addition, a complete health and family history will be obtained. During the Intake Interview, Ms Ordmandy will review your QEEG and identify EEG abnormalities and brain regions that are not functioning optimally that correlate with the symptoms that are causing you difficulty. During this interview, specific treatment goals will be identified. This Intake Interview takes about 1 ½ hours. An individualized treatment plan will then be developed based on your symptoms, your goals and your specific brain function as seen in the QEEG.

WHAT IS A QEEG (BRAINMAP)?

A Quantitative EEG (QEEG), also referred to as a brainmap, functions like a road map for the Neurofeedback Practitioner. As one person 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.”

The first step is to record the electrical activity of the brain. This is done by placing an elastic cap on the head which has 19 sensors. The electrical activity at each of the 19 sites is recorded simultaneously, first with eyes closed and then with eyes open. Prior to the quantitative analysis of the brainwave recording, the date is edited to remove any artifact. Once the recording is "cleaned up" it is put through a number of analyses by the computer and compared to a database of 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.

In some cases, Joan Ordmandy may suggest that the client's EEG be reviewed by a neurologist. Sometimes subclinical seizures (those seizures about which a person is unaware and can have without showing any outward symptom), tumors or lesions can be the cause of client's symptoms. Ms. Ordmandy is not a medical doctor; it is always wise to have an MD review the EEG to rule out medical conditions.

OTHER PRACTIONERS SAY THEY DO NOT USE QEEG, WHY SHOULD I GO WITH THIS EXTRA EXPENSE?

While a QEEG does add to the cost of the overall treatment, it generally averages out with money being saved by giving the Practitioner information about the client's brain function so a more effective and efficient treatment plan can be developed. Without a map, the Practitioner must use his/her training and judgment to choose the best training sites, and make adjustments over the course of the training based on the client's response. The QEEG provides in depth information about the client's brain patterns so the Practitioner is able to determine, in advance, the most optimal training protocols and to avoid protocols that might be contraindicated. As a result, training goes smoother with less unwanted side effects.

IS BIOFEEDBACK/NEUROFEEDBACK COVERED BY INSURANCE?

Some medical and psychological insurance plans now cover neurofeedback and/or biofeedback for various conditions. Some require co-payments. Other plans have annual caps. A prescription for the training, along with a diagnosis, may be required from a physician under the medical part of a plan. Check with your insurance carrier. Note: When checking with your insurance carrier it is best to ask if biofeedback is covered. Neurofeedback is a form of biofeedback and is billed as such.

*****Warning: If you are told that biofeedback is covered, make sure you document the name of the insurance representative with whom you spoke and the day and time of the conversation. We have had a number of occasions where a representative has said biofeedback is covered but, upon submission of the claim, the insurance company has refused to pay. If you have documented your conversation, you are more likely to win an appeal.

Questions to Ask Your Health Insurance Company

1. Is biofeedback a covered benefit under my insurance policy? _________
2. If yes, is it covered under
   a. Medical Services? ____
   b. Psychological Services? ____
3. If yes, for which diagnosis is it covered? _________
4. If yes, under which code is it covered?
   a. 90901 ____
   b. 90876 ____
5. Do I need a prescription or letter from my MD to say that it is medically necessary?
6. 5. Do I need a referral from my primary care physician? ____
7. Will I need preauthorization?
   a. If yes, what is the preauthorization code? _______
8. How many sessions are allowed? ____
   a. Per week? ____
   b. Per year? ____
   c. Is there a dollar amount limit? ____
9. Is there a deductable?
   a. If yes, what is it? ____
   b. If yes, how much of the deductable has been met? ____
10. Is there a co pay?
    a. If yes, what is it? ___
11. If biofeedback is allowed can counseling, 90806, be billed on the same day?
12. Is there a limit to the total amount paid out each year? (i.e., caps out at $1500 each year)

CAN A SUCCESSFUL OUTCOME ALWAYS BE PREDICTED?

It is not possible to predict with certainty that training will be successful for a particular condition. But for more common conditions, a reasonable prediction of outcomes is usually possible. More importantly, the effectiveness of training can usually be assessed early in the course of training.

ARE THERE SIDE EFFECTS ASSOCIATED WITH NEUROFEEDBACK TRAINING?

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 wears off quickly and/or can be trained away by the clinician. However, POSITIVE side effects are often noted by our clients. Someone going through training for migraines, for example, may report improved sleep, or improved concentration, or improved moods.

WHAT CONDITIONS ARE HELPED BY NEUROFEEDBACK TRAINING?

Successful outcomes have been reported by neurofeedback Practitioners for the following conditions:

AD/HD
Addictions
Anger
Anxiety
Autism
Bulimia
Chronic Fatigue Syndrome
Chronic pain
Closed head injuries
Concentration
Depression
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
Stroke
Tourettes Syndrome

Neurofeedback has also proven to be equally 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!”

HAS NEUROFEEDBACK BEEN USED TO TREAT ALZHEMIER’S OR DEMENTIA?

When neurofeedback is used for those suffering with Alzheimer’s or dementia, it is called “brightening.” Neurofeedback cannot help with 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, thus slowing the progress of the symptoms.

ARE PERSONALITIES CHANGED BY THE TRAINING?

NO. Neurofeedback training does not change underlying personality. However, once adverse behavior problems, such as hyperactivity, are remediated the intrinsic 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, however, it is easy to believe that it was never a part of the child’s intrinsic personality.

IS THERE A MINIMUM AGE REQUIRED FOR TRAINING?

We have had success working with children as young as 3-years old (for autism) and as old as 78 (for recovering speech after a stroke).

CAN THOSE WHO ARE BLIND PARTICIPATE IN NEUROFEEDBACK?

Absolutely. Feedback for those who have vision problems is provided through audio cues.

HOW DOES NEUROFEEDBACK WORK FOR A SMALL CHILD WHO DOESN’T UNDERSTAND WHAT A VIDEO GAME IS…..OR WHO CAN’T SIT STILL?

Perhaps an illustration would work best here. A 3-year old boy who suffered from Fetal Alcohol Effect was brought in for training by his grandmother. His mother had been drinking throughout her pregnancy with him. His grandmother reported that the child would have fits of rage during which he would bang his head on the floor until he was unconscious. He also exhibited other symptoms such as repetitive hand movements, fascination with anything that moved in a circle, and delayed speech.

Training locations were determined, and the grandmother sat with the boy on her lap, distracting him with toys and/or books while sensors were placed on his head. A pillow that would vibrate each time the child’s brain responded in an optimal way was placed between the grandmother’s lap and the boy’s back. (This caused a pleasant stimulation each time the brain was producing the proper brainwaves).
The first session lasted only 4 minutes. The boy ripped the sensors off his head and ran into the adjoining office and began banging his head on the floor.

About 6 minutes into the session (the next day) the boy tore the sensors off and began head banging.
Session three (again, the following day) lasted 8 minutes. The boy ripped the sensors off his head, ran into the adjoining office, threw himself down on the floor, and simply laid there. There was no head banging. About a minute went by before he picked himself up, went over to some toys, and began playing. Subsequent sessions averaged about 15 minutes. He completed 20 sessions. His grandmother reported he never returned to head banging after session 3; his speech was much improved, as was his interaction with other members of the family.

DOES NEUROFEEDBACK IMPROVE I.Q.?

Studies have shown that I.Q. scores generally raise 10 to 20 points. This is not because neurofeedback makes people smarter. It simply helps their brains become more efficient and work up to their capacity.

CAN NEUROFEEDBACK HELP WITH MENTAL HANDICAPS?

We have had success working with brain injuries and many levels of mental handicaps. Neurofeedback helps the brain become more efficient and work up to capacity….whatever that might be. If someone’s brain has been injured by a stroke or through surgery, the brain learns to “reroute” signals…creating new neuronal pathways.

HOW CAN NEUROFEEDBACK BE SO EFFECTIVE FOR SO MANY PROBLEMS?

Think of neurofeedback as a giant pharmacy. Just as there are many different drugs to treat hundreds of different ailments, there are many training sites on the brain from which a Practitioner can choose to train. Neurofeedback is NOT “One Size Fits all.” Each training session is developed specifically for each client to address his/her needs exactly.

WILL I BE ABLE TO QUIT MY MEDICATIONS?

Almost all of our clients have reported either no longer needing medications, or being able to take reduced amounts of their meds once neurofeedback training is completed. Initially neurofeedback will usually support the current dose of medication; the client will feel better on their current dose. As training progresses and brain function improves, many clients will no longer need as much medication and will begin to experience symptoms of over medication. At this point the client is referred to their physician who will oversee any changes in medications.

DO I HAVE TO QUIT TAKING MEDICATION WHILE DOING NEUROFEEDBACK TRAINING?

There may be a time when we might suggest, with your physicians approval that you temporarily not to take some types of medication. This generally occurs before we administer an attention/cognitive test (so we can get a baseline score) or before a brain map is done. We NEVER suggest that a person stop ANY medications they are taking for a heart conditions, seizure disorders, and/or blood pressure…to name only a few. Any changes in your medical regime should be made with your doctor’s consent.

HOW WILL I KNOW WHEN TO CUT BACK OR STOP MY MEDICATION?

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 over medication.

When working with hyperactive children, for example, a parent might report after session 10 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, that’s the answer. As the brain becomes more efficient, it needs less pharmacological help to work optimally.

IF NEUROFEEDBACK IS SO GOOD, WHY DON’T MORE PEOPLE KNOW ABOUT IT?

It was first discovered in the 1960's that people could control their brainwave patterns. The equipment needed to do neurofeedback was expensive, large and not easily available so the research on and application of neurofeedback was done in just a few universities. In addition, this research was published in highly specialized journal which are not read by most educators and health care providers. As a result, the possibilities of this powerful tool have not been well known among physicians, other health care providers, educators and the population in general. Now, however, advances in computer technology have taken neurofeedback out of the lab and transformed it into a useful clinical tool that can be used in the offices of mental health providers.

HOW DO I PICK A REPUTABLE NEUROFEEDBACK CLINICIAN?

Just because someone owns equipment does NOT mean they are well qualified to use it. Ask the prospective provider for their educational background and what licenses they hold. See if they are certified by the Biofeedback Certification Institute of America, (www.bcia.org) the longest existing and only reputable biofeedback certifying body. Ask what their training has been and how long they have been in practice.

Neurofeedback Practitioners have varied 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 be afraid to ask your prospective provider for a list of credentials.

WHY SHOULD I CHOOSE BIOFEEDBACKWORKS IN VIRGINIA IF I CAN GET WHAT APPEARS TO BE THE SAME SERVICE AT ANOTHER CLINIC FOR A LOWER RATE?

All neurofeedback/biofeedback providers are not equivalent. It is not uncommon for some people to go into practice who are not licensed and/or who are licensed but not adequately trained. When making your decision about where to go, make sure the person who is overseeing your training or your child's training is a license mental health provider or licensed physician and has had adequate training in the field of neurofeedback.

At BiofeedbackWorks in Virginia, the Clinical Director, Joan Ordmandy, has been practicing biofeedback and neurofeedback since 1996. She is a Fellow with BCIA and is one of only 4 clinicians in Virginia who carry dual certification (both in general biofeedback and neurofeedback). She has been using QEEG since 2000 and has extensive background in interpreting and applying them to formulate a more effective neurofeedback intervention. In addition, at BiofeedbackWorks in Virginia a variety of neurofeedback modalities are available such as EEG, HEG, and LENS neurofeedback. At BiofeedbackWorks in Virginia, we look at the whole person and choose the modality that will produce the greatest positive change for the client. In addition, we offer mental health and nutritional counseling on site when needed.