Introduction to Z-Score Neurofeedback
Z-Score Neurofeedback trains multiple areas of the brain at the same time. Also, Z-score Neurofeedback compares your brain to other people your age and gender to guide the process. It is a way to train the brain to be more relaxed, calm, alert, and focused. Sensors are placed on the scalp and they record brainwave activity. This information is transferred to the computer. When the software recognizes the client becoming more relaxed, calm, alert, and focused, the software plays video and sound. As soon as the client loses focus or becomes anxious, the video and sound stop playing. The client practices how to be more focused, calm and relaxed during the sessions.
The Neuros Centre in Barcelona has a great introduction video to Neurofeedback:
For a more detailed and technical explanation, please read the sections below.
WHAT IS Z-SCORE NEUROFEEDBACK?
A healthy brain is one that is flexible and dynamic. When it needs to accomplish a task, a healthy brain can recruit resources from other areas or networks in the brain, accomplish the task, and release those resources. Sometimes the brain struggles to recruit resources and other times the brain has a tough timing relaxing after a task. When this happens, symptoms may develop leaving brain function and efficiency potentially compromised.
Complex symptoms require a more complex brain assessment called a Quantitative Electroencephalogram (QEEG) assessment, or brain mapping. With the use of 19 electrodes placed on the scalp, we can look at the brain’s electrical activity in three dimensions. This assessment allows for an in-depth, objective understanding of what is going on in the brain and helps to guide neurofeedback training. Electrical activity across the brain is recorded, analyzed, and compared to age-normed (averages based on age) databases. This information is used to evaluate brain function, performance, understand where client’s symptoms may be coming from, and how to make an optimal change. We need to define what is considered “optimal” and train the brain towards that. This is where Z-scores come in.
HOW DOES Z-SCORE NEUROFEEDBACK WORK?
Z-Scores are statistical data used to compare to what is considered optimal or balanced; in this case, how the brain performs. A normative database is created from thousands of QEEGs thought to have “normal” functioning that are arranged by age and gender. A Z-score = 0 does not mean “normal” in terms of intelligence or abilities. A Z-score = 0 reflects when the brain is most dynamic and displays its greatest flexibility. It’s evident that there would be variation among individuals, which is accounted for by standard deviation (SD). Optimal brain wave activity falls between one SD above or below Z = 0. Brain wave activity that is less than normal falls between two SDs above or below Z = 0. Generally, any activity that falls more than 2 SDs above or below Z = 0 is considered abnormal brain wave activity and may be linked to the client’s symptoms.
When your QEEG assessment is compared to a normative database, this tells us which areas in the brain are optimal, too high, or too low and in what brainwave frequencies when compared to the norm. Your brain is then trained towards this optimal/balanced in multiple dimensions (communication, speed of information transfer, activation processes, etc.). Thousands of Z-scores are monitored in real time and when these Z-scores enter the "optimal" range, the client is rewarded with audio and visual feedback. The more of these Z-scores enter the optimal range, the greater the amount reward. Over time, the brain is trained to be more efficient, which may result in the reduction of symptoms.
WHO IS A GOOD CANDIDATE FOR Z-SCORE NEUROFEEDBACK?
Z-Score Neurofeedback can be helpful for those who are struggling with multiple symptoms at the same time. Examples of complex symptoms include struggling with struggling with focus, concentration, changes in mood, poor quality sleep, high levels of stress, panic attacks, issues with memory, etc. Z-score training can be used for children as young as 12 years of age and does require the client to be seated for about 45-60 minutes during training. Populations who are struggling with more than one condition such as ADHD and a Mood Disorder or Anxiety as well as a sleep issue can benefit from Z-Score Neurofeedback Training. Below is a list where Z-score Neurofeedback Training may be helpful:
Attention Deficit (ADD) and Hyperactivity (ADHD) Disorder
Concussion, TBI, and Post Concussive Syndrome
Post-Traumatic Stress Disorder (PTSD)
Frequently Asked Questions (F.A.Q)
1) Does Z-Score Neurofeedback work?
Z-Score Neurofeedback has demonstrated efficacy for multiple conditions. An increasing amount of research is being published for Neurofeedback in the treatment of Anxiety, Depression, Concussions and Traumatic Brain Injury (TBI), Post-Traumatic Stress Disorder (PTSD) and Trauma, and Optimal Performance clients. See the Research section for more information.
2) Will this treatment work for me?
It depends on your current situation, diagnosis, and training goals. After a detailed assessment and clinical interview, we can decide if you are a good candidate for training. We would then move forward and design a personalized program to help you achieve your training goals. Z-score Neurofeedback training may be a great option for people who are not responding to medication, have reached their maximum dose but are still struggling with their symptoms, or prefer non-pharmacological approaches to treatment other than traditional psychotherapy.
3) How many sessions will it take for changes to occur?
Z-Score Neurofeedback training targets and trains multiple areas at once. This means that changes usually occur faster than regular Neurofeedback training. Changes usually occur within 4 to 8 sessions.
4) How many sessions must I complete in total?
Clients usually complete 24-32 sessions though more may be required depending on their training goals. Certain optimal performance clients (executives, athletes, and students without a diagnosis) may meet their goals at the end of 20 sessions. More complex cases may take more than 40 sessions of training.
5) Can I continue to take medication while completing Neurofeedback training?
Yes. We only ask that the trainee stops taking medication during assessments as it does affect their EEG recordings. As the client progresses through the training, the dosage of medication may need to be reduced.
6) Is Neurofeedback training covered by insurance or extended health care benefits?
Psychological assessments and reassessments are covered by most insurance companies. Biofeedback and Neurofeedback training may be covered by certain insurance companies for certain conditions. Insurance companies may cover treatments plans approved by a clinical psychologist. Please inquire with your extended health care benefits company and we will do our best to work with them.
7) If Neurofeedback training works so well, why haven’t I heard of it?
The most common form of intervention for mental health conditions is medication. The pharmaceutical industry has the money and power to advertise where Neurofeedback does not. This is changing as more research is being published to advocate for the efficacy of Neurofeedback. See http://www.isnr.org/ and http://www.aapb.org/ for more information.
8) Are there an risks/side effects associated with training?
Neurofeedback is a non-invasive treatment modality that focuses on teaching individuals to regulate their electrical brainwave activity. No research to date has reported any negative side-effects from Neurofeedback training. Neurofeedback training programs are designed so that only positive, optimal brainwave patterns are reinforced. No negative or unwanted brainwave patterns can be created in this way. As the training progresses, the trainee may notice that the side-effects of their medication are becoming more prevalent (if they are on medications). This indicates that their brain functioning is becoming optimal.
9) Can Neurofeedback training help me if I don’t have a diagnosed condition?
Neurofeedback and Biofeedback techniques are also used in Peak Performance settings to help improve an individual’s level of calm, focus, relax, and alert. Z-Score Neurofeedback training can also be used for athletes, executives, and students who aim to achieve greater success in their respective disciplines.
10) What age ranges are the best candidates for Neurofeedback Training?
Neurofeedback relies on concept of neuroplasticity, which states that the brain can alter its function and reorganize itself in response to learning and other events. Neuroplasticity tends to decrease as you age, so younger clients tend to progress the quickest. This is why it is easier to learn a language or skill early in life as opposed to when you are older. The most common age ranges for training are 8-24 years old. Older clients (55 years of age and over) may need a few more sessions to achieve certain training goals.
11) Why not use medication?
Initially, drug therapies may be necessary as a short-term solution to reduce the severity of symptoms. Medication may not be a viable long-term solution for some. If medication is discontinued, symptoms reappear because no learning has occurred. Due to the numerous side-effects associated with the medication, non-pharmacological options may be a better option. As training progresses and symptomatology improves, medication may need to be reduced or removed completely.
12) Are the results from Neurofeedback Training permanent?
Follow-up studies have been conducted for children who received Neurofeedback training and they indicate that their training progress was sustained years after training was completed in most cases. Please visit our Research Section for more information.
13) Does Neurofeedback training hurt?
Neurofeedback training is a non-invasive treatment modality and does not hurt. Electrodes are placed on to the head and ears in a comfortable manner. Clients may feel fatigued at the end of a session because Neurofeedback is essentially a workout for your brain. The trainee is practicing self-regulation, and they may feel tired after a session.
14) What does a client do during a Neurofeedback training session?
Each of our clients is paired with a Neurofeedback mentor who works with the client on a one-on-one basis. After a baseline recording of the trainee’s brainwave patterns is taken, the client begins training their focus and concentration. Complex Neurofeedback software is used to give the client feedback when they are relaxed, alert, and focused. The client gets multiple chances to practice achieving this state. After each round, the mentor gives the client feedback and explains their scores related to their brainwave patterns. This is reviewed at the end of the session with the parents as well. The clients also complete tasks related to their training goals during the session. This can take the form educational games, puzzles, reading comprehension, or other metacognitive strategies to test the client and help them grow.
Please note that services are not covered under OHIP, but may be covered by insurance or extended health care benefits.