When Discussing Neurofeedback, Does Modality Matter?

  • Genomary Krigbaum Grand Canyon University. Phoenix, Arizona
  • Nancy L. Wigton Grand Canyon University. Phoenix, Arizona and Applied Neurotherapy Center, LLC. Scottsdale, Arizona
Keywords: neurofeedback, traditional NF, slow cortical potential NF, QEEG-guided NF, z-score NF


Over the years, several new models and variations of neurofeedback (NF) have been developed. As such, NF has grown from traditional amplitude based modalities to now include slow cortical potential NF, as well as various approaches grounded in QEEG technology, including z-score NF models. These differing modalities have important implications in terms of outcomes, the number of sessions required, and treatment specificity. This, in turn, impacts clinical practice, research, and marketing considerations. In an effort to gain some perspective for where the field is today, a comparative review is presented to illustrate the importance of noting what particular modality is being referenced when discussing NF.


American Academy of Pediatrics (AAP). (2012). Evidence-based child and adolescent psychosocial interventions. [chart from: Addressing Mental Health Concerns in Primary Care: A Clinician’s Toolkit]. Elk Grove Village, IL: American Academy of Pediatrics.

Arns, M., de Ridder, S., Strehl, U., Breteler, M., & Coenen. A. (2009). Efficacy of neurofeedback treatment in ADHD: The effects on inattention, impulsivity and hyperactivity: A meta-analysis. Clinical EEG and Neuroscience, 40(3), 180-189. http://dx.doi.org/10.1177/155005940904000311

Arns, M., Drinkenburg, W., & Kenemans, J. L. (2012). The effects of QEEG-informed neurofeedback in ADHD: An open-label pilot study. Applied Psychophysiology and Biofeedback, 37, 171-180. http://dx.doi.org/10.1007/s10484-012-9191-4

Arns M., Heinrich H., & Strehl U. (2014). Evaluation of neurofeedback in ADHD: the long and winding road. Biological Psychology, 95, 108-15. http://dx.doi.org/10.1016/j.biopsycho.2013.11.013

Baehr, E., Rosenfeld, J. P., & Baehr, R. (1997). The clinical use of an alpha asymmetry protocol in the neurofeedback treatment of depression: Two case studies. Journal of Neurotherapy, 2(3), 10-23. http://dx.doi.org/10.1300/J184v02n03_02

Beauregard, M., & Levesque, J. (2006). Functional magnetic resonance imaging investigation of

the effects of neurofeedback training on neural bases of selective attention and response

inhibition in children with attention-deficit/hyperactivity disorder. Applied Psychophysiology and Biofeedback, 31(1), 3–20. http://dx.doi.org/10.1007/s10484-006-9001-y

Brandeis, D. (2011). Neurofeedback training in ADHD: More news on specificity. Clinical Neurophysiology, 122, 856-857. http://dx.doi.org/10.1016/j.clinph.2010.08.011

Breteler, M. H. M., Arns, M., Peters, S., Giepmans, I., & Verhoeven, L. (2010). Improvements in spelling after QEEG-based neurofeedback in dyslexia: A randomized controlled treatment study. Applied Psychophysiology and Biofeedback, 35, 5–11.


Budzynski, T. H. (1999). From EEG to neurofeedback. In J. R. Evans & A. Abarbanel (Eds.), Introduction to quantitative EEG and neurofeedback (pp. 65-79). San Diego, CA: Academic Press.

Cannon, R., Baldwin, D. R., Diloreto, D. J., Phillips, S. T., Shaw, T. L., & Levy, J. J. (2014). LORETA neurofeedback in the precuneus: Operant conditioning in basic mechanisms of self-regulation. Clinical EEG and Neuroscience, (Epub ahead of print, March 3, 2014).

Cannon, R., Congedo, M., Lubar, J., & Hutchens, T. (2009). Differentiating a network of executive attention: LORETA neurofeedback in anterior cingulate and dorsolateral prefrontal cortices. International Journal of Neuroscience, 119(3), 404-441.


Cannon, R., Lubar, J. F., Sokhaze, E., Baldwin, D. (2008). LORETA neurofeedback for addiction and the possible neurophysiology of psychological processes influenced: A case study and region of interest analysis of LORETA neurofeedback in right anterior cingulate cortex. Journal of Neurotherapy, 12(4), 227-241.


Coben, R. & Myers, T. E. (2010). The relative efficacy of connectivity guided and symptom based EEG biofeedback for autistic disorders. Applied Psychophysiology and Biofeedback, 35, 13–23. http://dx.doi.org/10.1007/s10484-009-9102-5

Collura, T. F. (2008a). Neuronal dynamics in relation to normative electroencephalography assessment and training. Biofeedback, 36(4), 134-139.


Collura, T. F. (2008b). Whole-head normalization using live Z-scores for connectivity training, Part 1. NeuroConnections Newsletter, April, 12, 15, 18-19.


Collura, T. F. (2014). Technical foundations of neurofeedback. New York, NY: Routledge.

Collura, T. F., Guan, J. G., Tarrant, J., Bailey, J., & Starr, F. (2010). EEG biofeedback case studies using live z-score training and a normative database. Journal of Neurotherapy, 14(1), 22-46. http://dx.doi.org/10.1080/10874200903543963

Collura, T. F., Thatcher, R. W., Smith, M. L., Lambos, W. A., & Stark, C. R. (2009). EEG Biofeedback training using live z-scores and a normative database. In T. H. Budzynski, H. K. Budzynski, J. R. Evans & A. Abarbanel (Eds.), Introduction to quantitative EEG and neurofeedback: Advanced theory and applications (2nd ed., pp. 29-59). Burlington, MA: Elsevier.

Evans, R. J., & Abarbanel, A. (Eds.), (1999). Introduction to quantitative EEG and neurofeedback. San Diego, CA: Academic Press.

Genardi, D. (2012). BrainAvatar: Flexible individualization for treating Autism, a complex disorder. Neuroconnections, Winter, 13, 15-17, 19, 33.


Gevensleben, H., Holl, B., Albrecht, B., Vogel, C., Schlamp, D., Kratz, O., … Heinrich, H. (2009). Is neurofeedback an efficacious treatment for ADHD?: A randomized controlled clinical trial. Journal of Child Psychology and Psychiatry, 50, 780–789.


Gevensleben, H., Rothenberger, A., Moll, G. H., & Heinrich, H. (2012). Neurofeedback in children with ADHD: Validation and challenges. Expert Reviews of Neurotherapeutics, 12(4), 447–460. http://dx.doi.org/10.1586/ERN.12.22

Hallman, D. W. (2012). 19-Channel neurofeedback in an adolescent with FASD. Journal of Neurotherapy, 16(2), 150-154. http://dx.doi.org/10.1080/10874208.2012.677646

Hammer, B., Colbert, A., Brown, K., & Ilioi, E. (2011). Neurofeedback for insomnia: A pilot study of z-score SMR and individualized protocols. Applied Psychophysiology and Biofeedback, 36(4), 251-64. http://dx.doi.org/10.1007/s10484-011-9165-y

Hammond, C. D. (2010). The need for individualization in neurofeedback: Heterogeneity in QEEG patterns associated with diagnoses and symptoms. Applied Psychophysiology and Biofeedback, 35(31–36). http://dx.doi.org/10.1007/s10484-009-9106-1

Huang-Storms, L., Bodenhamer-Davis, E., Davis, R., & Dunn, J. (2006). QEEG-guided neurofeedback for children with histories of abuse and neglect: Neurodevelopmental rationale and pilot study. Journal of Neurotherapy, 10(4), 3-16. http://dx.doi.org/10.1300/J184v10n04_02

Kamiya, J. (1968). Conscious control of brainwaves. Psychology Today, 1, 56-60.

Koberda, J. L. (2012). Autistic spectrum disorder (ASD) as a potential target of z-score LORETA neurofeedback. Neuroconnections, Winter, 24–25.


Koberda, J. L., Hillier, D. S., Jones, B., Moses, A., & Koberda, L. (2012). Application of neurofeedback in general neurology practice. Journal of Neurotherapy, 16(3), 231-234. http://dx.doi.org/10.1080/10874208.2012.705770

Koberda, J. L., Koberda, P., Bienkiewicz, A. A., Moses, A. & Koberda, L. (2013). Pain management using 19-electrode z-score loreta neurofeedback, Journal of Neurotherapy, 17(3), 179-190, http://dx.doi.org/10.1080/10874208.2013.813204

Koberda, J. L., Moses, A., Koberda, P., & Koberda, L. (2012a, September). Comparison of the effectiveness of z-score surface/LORETA 19-electrodes neurofeedback to standard 1-electrode neurofeedback. Oral Presentation at the 20th Annual Conference of the International Society for Neurofeedback and Research, Orlando, FL.

Koberda, J. L., Moses, A., Koberda, L., & Koberda, P. (2012b). Cognitive enhancement using 19-electrode z-score neurofeedback. Journal of Neurotherapy, 16(3), 224-230. http://dx.doi.org/10.1080/10874208.2012.705770

Levesque, J., Beauregard, M., & Mensour, B. (2006). Effect of neurofeedback training on the neural substrates of selective attention in children with attention deficit/hyperactivity disorder: A functional magnetic resonance imaging study. Neuroscience Letters, 394, 216–221. http://dx.doi.org/10.1016/j.neulet.2005.10.100

Lofthouse, N., Arnold, L. E., Hersch, S., Hurt, E., & DeBeus, R. (2012). A review of neurofeedback treatment for pediatric ADHD. Journal of Attention Disorders, 16, 351-372. http://dx.doi.org/10.1177/1087054711427530

Lubar, J. F., & Shouse, M. N. (1976). EEG and behavioral changes in a hyperactive child concurrent with training of the sensorimotor rhythm (SMR): A preliminary report. Biofeedback & Self-Regulation, 1, 293–306.

Mayer, K., Wyckoff, S. N., & Strehl, U. (2013). One size fits all? Slow cortical potentials neurofeedback: A review. Journal of Attention Disorders, 17(5), 393-409. http://dx.doi.org/10.1177/1087054712468053

Niv, S. (2013). Clinical efficacy and potential mechanisms of neurofeedback. Personality and Individual Differences, 54, 676-686. http://dx.doi.org/10.1016/j.paid.2012.11.037

Orgim, G. & Kestad, K. A. (2013). Effects of neurofeedback versus stimulant medication in attention-deficit/hyperactivity disorder: A randomized pilot study. Journal of Child and Adolescent Psychopharmacology, 23(7), 448-57. http://dx.doi.org/10.1089/cap.2012.0090

Othmer, S., Othmer, S. F., & Kaiser, D. A. (1999). EEG biofeedback: An emerging model for its global efficacy. In J. R. Evans & A. Abarbanel (Eds.), Introduction to quantitative EEG and neurofeedback (pp. 243-310). San Diego, CA: Academic Press.

Peniston, E. G., & Kullkosky, P. J. (1990). Alcoholic personality and alpha-theta brainwave training. Medical Psychotherapy, 3, 37-55.

Peniston, E. G., & Kullkosky, P. J. (1991). Alpha-theta brainwave neuro-feedback therapy for Vientam veterans with combat-related post-traumatic-stress disorder. Medical Psychotherapy, 4, 47-60.

Pigott, H. E., De Biase, L., Bodenhamer-Davis, E., & Davis, R. E. (2013). The evidence-base for neurofeedback as a reimbursable healthcare service to treat attention deficit/hyperactivity disorder. Retrieved from International Society for Neurofeedback and Research website: http://www.isnr.org/uploads/nfb-adhd.pdf

PracticeWise. (2012, October 01). RE: PracticeWise Fall 2012 Update [electronic mail from Support@PracticeWise.com].

Robbins, J. (2000). A Symphony in the brain. New York, NY: Grove Press.

Roberts, L., Rockstroh. B., Lutzenberger. W., Elbert, T. and Birbaumer, N. (1989). Self-reports during feedback regulation of slow cortical potentials, Psychophvsiology, 26, 392-403.

Rockstroh, B., Birbaumer, N., Elbert, T., & Lutzenberger, W. (1984). Operant control of EEG, event-related and slow potentials. Biofeedback and Self-Regulation, 9, 139-160.

Rockstroh, B., Elbert, T., Birbaumer, N., Wolf, P., Düchting-Röth, A., Reker, M., & … Dichgans, J. (1993). Cortical self-regulation in patients with epilepsies. Epilepsy Research, 14(1), 63-72. http://www.ub.uni-konstanz.de/kops/volltexte/2008/6404/

Rutter, P. (2011, September). Potential clinical applications for 19 channel live z-score training using Percent ZOK and ZPlus protocols. Oral Presentation at the 19th Annual Conference of the International Society for Neurofeedback and Research, Carefree, AZ.

Sherlin, L. H., Arns, M., Lubar, J., Heinrich, H., Kerson, C., Strehl, U., & Sterman, M. B. (2011). Neurofeedback and basic learning theory: Implications for research and practice, Journal of Neurotherapy, 15(4), 292-304.


Sterman, M. B., & Friar, L. (1972). Suppression of seizures in an epileptic following sensorimotor EEG feedback training. Electroencephalography and Clinical Neurophysiology, 33(1), 89-95.

Surmeli, T., & Ertem, A. (2007). EEG neurofeedback treatment of patients with Down syndrome, Journal of Neurotherapy, 11(1), 63-68. http://dx.doi.org/10.1300/J184v11n01_07

Surmeli, T., & Ertem, A. (2009). QEEG guided neurofeedback therapy in personality disorders: 13 case studies. Clinical EEG and Neuroscience, 40, 5-10. http://dx.doi.org/10.1177/155005940904000107

Surmeli, T., & Ertem, A. (2010). Post WISC-R and TOVA improvement with QEEG guided neurofeedback training in mentally retarded: A clinical case series of behavioral problems. Clinical EEG and Neuroscience, 41(1), 32-41. http://dx.doi.org/10.1177/155005941004100108

Surmeli, T., & Ertem, A. (2011). Obsessive compulsive disorder and the efficacy of qEEG-Guided neurofeedback treatment: A case series. Clinical EEG and Neuroscience, 42(3), 195-201. http://dx.doi.org/10.1177/155005941104200310

Surmeli, T., Ertem, A., Eralp, E., & Kos, I. H. (2012). Schizophrenia and the efficacy of qEEG guided neurofeedback treatment: A clinical case series. Clinical EEG and Neuroscience, 43, 133-144. http://dx.doi.org/10.1177/1550059411429531

Thatcher, R. W. (2008). Z-score EEG biofeedback: Conceptual foundations. NeuroConnections Newsletter , April, 9, 11, 20. San Rafael, CA: International Society for Neurofeedback and Research. http://www.isnr.net/uploads/NeuroConnections/2008/NCApril08.pdf

Thatcher, R. W. (2012). Handbook of quantitative electroencephalography and EEG biofeedback. St. Petersburg, Florida: Anipublishing.

Thatcher, R. W. (2013). Latest developments in live z-score training: Symptom check list, phase reset, and LORETA z-score biofeedback. Journal of Neurotherapy, 17(1), 69-87. http://dx.doi.org/10.1080/10874208.2013.759032

Thatcher, R. W., & Lubar, J. E. (2009). History of the scientific standards of QEEG normative databases. In T. H. Budzynski, H. K. Budzynski, J. R. Evans & A. Abarbanel (Eds.), Introduction to quantitative EEG and neurofeedback: Advanced theory and applications (2nd ed., pp. 29-59). Burlington, MA: Elsevier.

Walker, J. E. (2009). Anxiety associated with post traumatic stress disorder: The role of quantitative electroencephalograph in diagnosis and in guiding neurofeedback training to remediate the anxiety. Biofeedback, 37, 67-70.


Walker, J. E. (2010a). Recent advances in quantitative EEG as an aid to diagnosis and as a guide to neurofeedback training for cortical hypofunctions, hyperfunctions, disconnections, and hyperconnections: Improving efficacy in complicated neurological and psychological disorders. Applied Psychophysiology and Biofeedback, 35, 25–27.


Walker, J. E. (2010b). Using QEEG-guided neurofeedback for epilepsy versus standardized protocols: Enhanced effectiveness? Applied Psychophysiology and Biofeedback, 35, 29–30. http://dx.doi.org/10.1007/s10484-009-9123-0

Walker, J. E. (2011). QEEG-guided neurofeedback for recurrent migraine headaches. Clinical EEG and Neuroscience, 42(1), 59-61. http://dx.doi.org/10.1177/155005941104200112

Walker, J. E. (2012a). Remediation of enuresis using QEEG-guided neurofeedback training. Biofeedback, 40(3), 109-112. http://dx.doi.org/10.5298/1081-5937-40.3.04

Walker, J. E. (2012b). QEEG-guided neurofeedback for remediation of dysgraphia. Biofeedback 40(3), 113–114. http://dx.doi.org/10.5298/1081-5937-40.3.03

Walker, J. E. (2013). QEEG-guided neurofeedback for anger/anger control disorder, Journal of Neurotherapy, 17(1), 88-92. http://dx.doi.org/10.1080/10874208.2012.705767

Wigton, N. L. (2010, September). Laplacian z-score neurofeedback: A unique option in the realm of multi-channel z-score neurofeedback. Plenary Session Oral Presentation at the 18th Annual Conference of the International Society for Neurofeedback and Research, Denver, CO.

Wigton, N. L. (2013). Clinical perspectives of 19-channel z-score neurofeedback: Benefits and limitations. Journal of Neurotherapy, 17(4), 259-264. http://dx.doi.org/10.1080/10874208.2013.847142

Special Features