Neurofeedback can produce a positive effect relatively rapidly. For example, one could sleep better or feel more alert or calm in a few sessions – or even from the first session. Is it reasonable that something this powerful could sometimes make symptoms worse?

No clinician has reported symptoms getting worse over the long-term using neurofeedback. When you train the brain, the brain seems to work towards homeostasis. This tends to move symptoms towards normality, regardless of the training effect.

But in the short term, if you can train someone to fall asleep faster, it’s possible to train them so it takes longer to fall asleep. If “calming” training makes someone calmer, “activating” training could make them slightly less calm. Learning how the brain responds is part of the training process. The vast majority of training effects are positive. But the brain is adapting to new exercise. Just as you may notice an effect from doing an exercise that works muscles you’re not used to using, a similar pattern can take place when training the brain.

Most clinicians monitor feedback from the client about the response to training. Adjustments can be made as needed. Often, adjustments are made because no training effect is noticed, and a stronger effect is desired. Also, the more training you do with someone, the more subtle the training effects become.

If there are short-term effects, the brain may adapt on its own. Often, the brain is just exercising in a way it’s not used to, so there needs to be time to let the brain adjust to the exercise. Clinicians can make rapid adjustments if needed to reverse any training effects. This is a clinical judgment. An experienced clinician should be able to identify when a training adjustment is needed, or when the brain is simply needing to adapt. But just like adjusting medications, these judgments are part of the art and science of neurofeedback. There are some clinicians who don’t adjust the training much. They use a model that says the brain will adapt to the training. Other clinicians use a model that adjusts feedback more often.

By far, most changes reported by clients are positive. However, when any change is noticed, it tells you that the person is responding to training. That’s a very good thing. The most difficult clients are ones who report no change at all. Reported changes help provide important clues as to how to adjust the training for an individual, no matter what kind of change.

Often, the changes a client reports aren’t related to the neurofeedback training at all. The clinician can help sort this out, but at times that is challenging, since not all clients are good at reporting. Some brains are more sensitive than others to training. Most clinicians explain to clients that if the client notices any changes that are out of the ordinary within 24-28 hours after training, to please report it. Client feedback can be very helpful for clinicians to determine if you’re making progress.