Dr. Andrew Hill is the founder of Peak Brain Institute and a leading neurofeedback practitioner and biohacking coach for clients worldwide. He has lectured on psychology, neuroscience, and gerontology at UCLA’s Department of Psychology where he received a PhD in Cognitive Neuroscience. At Peak Brain, Dr. Hill provides individualized training programs to help you optimize your brain across goals of stress, sleep, attention, brain fog, creativity, and athletic performance. He is the host of the Head First podcast and continues to do research on attention and cognitive performance. --- What’s new with The Trauma Therapist Project! The Trauma 5: gold nuggets from my 700+ interviews: https://bit.ly/3NbFdJ0 The Trauma Therapist Newsletter: a monthly resource of information and inspiration dedicated to trauma therapists: https://bit.ly/3LoJcAE
Episode Summary
This article is drawn from my conversation on The Trauma Therapist Podcast. You can watch the original conversation. What follows is my own framing of how I think about trauma, the brain, and neurofeedback training, written for therapists, survivors, and the people who work with both.
What does trauma actually look like in a brain map?
When the trauma you carry is acute and recent, the brain cramps up in response. The resources that handle threat get over-activated and stay that way. I compare it to a lower back that spasms after a car accident. You walk away fine. Ten years later the tissue still holds a stiffness, a resistance from having been pushed to its edge, and it now regulates a little differently.
Most anxiety phenomena, including the complex material that comes with trauma, are accommodations. A naturally occurring, useful daily resource has spasmed hard and stayed contracted. That framing changes what you do about it.
With classic PTSD-type responses, I tend to see the posterior cingulate, the back midline of the brain, running hot. This region does a "watch the road, heads up" job. It scans and evaluates the environment. That is appropriate work. When the research describes a world that is not especially safe or predictable, this region can cramp up and lock into an over-evaluation mode. The result is rumination. You can see it painted out in colors on the data.
A lot of suffering feels invisible to the person living it. It happens to you and you do not know why. When you see it on a brain map, you start to build a different relationship with it. You can be annoyed at your trauma response the way you are annoyed at a shoulder you separated in a soccer game. It hurts, it is frustrating, you should probably deal with it. It becomes much harder to feel overwhelmed, guilty, ashamed, or disempowered once you understand the mechanism. For more on how this scan-and-evaluate circuit drives worry, see Biohacking Anxiety and Biohacking Fight or Flight.
How does a brain map distinguish trauma from ADHD?
I assess two things before I say anything about a person. First, a 20-minute attention test. You click a mouse when a "one" appears and hold back when a "two" appears, across both auditory and visual channels, for about 20 minutes. You start drifting, missing the ones, clicking the twos. That lets me decompose executive function into granular pieces: impulsivity, fatigue, auditory versus visual processing, stamina, reaction-time quirks, repetitive monitoring errors. These get lumped together at the diagnostic level into "ADHD," but you can produce the same picture from COVID, a concussion, or trauma disrupting your sleep.
I measure executive function first because it flexes under any stress and describes the state of other resources. About half of those executive-function resources are shared with the circuits that stage sleep. There is a frequency called sensorimotor rhythm, which neurologists know as sleep spindles or Sigma. SMR handles motoric inhibition, sitting still, pumping the brakes. A cat in a windowsill watching birds, body still, laser focus, is in a high-SMR state. That calm, poised stillness is the opposite of ADHD. You cannot hold motoric stillness and be pulled by every variable piece of information at once. I wrote about this directly in SMR Neurofeedback.
Second, the brain map itself, a QEEG. A cap goes on the scalp, filled with gel, with ear clips, and I measure the brain at rest for about 20 minutes, eyes closed and eyes open. The performance test and the two physiology measurements get compared against a database of people your age. For the full process, see QEEG Brain Mapping.
Then I sit down with you and tell you how weird you are. I do not know what is true for you. I know what is unusual for your age group. Some of that tends to matter, and I keep my guesses to what is plausible, because human data is noisy. I look for the big things sticking out. This is exactly why a brain map is useful to a therapist: ADHD, anxiety, trauma, and a sleep issue can all look the same at the diagnostic level, and they look different on the map.
Why does the cingulate "cramp up"?
On a heat map, blue marks low amounts of a given brainwave and red marks high amounts. By itself a blob of red is not interesting. But a strong beta activation on the front or back midline tells me someone's anterior or posterior cingulate is running hotter than usual.
The cingulates switch your focus around. Roughly, the front of the brain processes the inside self and the back processes the outside world. The anterior cingulate holds internal attention on what you are thinking about. The posterior cingulate runs the "watch the road, orient, evaluate, reorient" job toward the environment.
When the front one cramps, you perseverate, obsess, get stuck in your head, loop a song. When the back one cramps, you ruminate, become threat-sensitive, get visceral. Both can happen at once, and then you are playing ping-pong: a visceral worry feeds a cognitive worry, which feeds the visceral one again, and the whole thing resonates upward.
There is a reason for this. The cost of missing danger is high. Miss it twice and the game is over. So the brain runs a negativity bias. It learned tigers exist, so now it checks for tigers while you read a book and while you take a bath. That checking is the cingulate asking whether there is something you need to evaluate. It can sit at the surface as a recent trauma, a classic PTSD picture, or it can reflect earlier, longer-term patterns.
When I look at someone's map, I do not assume the hot posterior cingulate means PTSD. Maybe they are a lifeguard and it works for them. I do not assume a hot anterior cingulate means OCD. Maybe they are a CEO and it serves them, or maybe their thoughts are having them. So I describe the feature and ask. "Your posterior cingulate is running hot. That often goes with feeling activated and threat-sensitive, evaluating the world constantly. Are you ruminating? Does that sound real?" When it does, the next step is the useful one: if you can see it on a map, you can change it.
Where does developmental trauma show up if not the cingulate?
Complex, developmental trauma is a different picture. If you developed in a world that was more adverse, with less secure attachment, you do not necessarily see the cingulate cramped against an unmonitorable environment. Instead the relevant structures sit deeper, in tissue that generates no EEG signal at all.
EEG, brainwaves, is a feature of the cortex. The cortex has pyramidal cells arranged in large columns that burst together electrically and create coding. Much of the subcortical brain lacks those cells, so it generates no beta, alpha, or theta signatures.
One of those deeper structures is the periaqueductal gray. It dumps natural opioids into your system when you hit your thumb with a hammer. That moment of relief after the slam is endorphins and enkephalins. We have learned recently that the periaqueductal gray also codes experiences of emotional pain. It runs a pre-alert, a bias: a reminder that years ago there was a tiger you missed and you should keep that in general awareness. It is heavily involved in trauma material, and it couples with the amygdala.
The amygdala sits in the same subcortical territory and generates no surface brainwaves, but it helps code the emotions you attach to memories. If you go through a trauma, the amygdala becomes active around those experiences. This is why beta blockers can matter: given before a trauma exposure, or with therapy that reactivates the memory, they can blunt the noradrenergic consolidation of fear memory, letting new learning form around the response and pulling the teeth of the emotional access (Brunet et al., 2008). That tool is now used in some acute trauma settings and prophylactically for crisis and trauma workers.
How does neurofeedback actually retrain the brain?
Neurofeedback is my heavy lifter. It is the process of training those EEG patterns directly.
Take the classic PTSD picture. You want to exercise the posterior cingulate and teach it to put its fists down voluntarily, to stop evaluating and ruminating on command. When that tissue is cramped, you often see a lot of beta, a lot of theta, the disinhibited "squirrel" frequency, and not much alpha. Alpha is the neutral, rest-mode wave between the gears, the unclench. For more on that idle-and-brakes function, see Decoding Alpha Waves.
You put ear clips on, a wire and a little paste on the scalp, and you measure beta, theta, and alpha moment to moment. Whenever the brain happens, on its own, to make a half-second more alpha and less of the other two, you reward it. A sound plays, a puzzle piece fills in, a Pac-Man eats a dot, a car chases more zombies. The stimulus barely matters. The brain hears "good job, good job, nope, good job." Then, every 30 seconds or so, you move the goalposts.
This is operant conditioning. You are applauding progressive, successive changes. The strange part is that the behavior is involuntary, because you cannot feel your own brainwaves. The mind thinks the Pac-Man stopping and starting cannot possibly be training anything. You do not feel it the first time, or even the second. Then a couple of sessions in, the brain realizes alpha makes things happen, reaches for a large burst of it, and you feel it. Training alpha up at Pz, the parietal midline, while pulling the theta and beta down produces a sensation like your mind unclenching. People notice. It wears off, they doubt it, they train again, and it comes back stronger.
From there the work is iterative. How was your sleep after that relaxation protocol? Crappy? Then we cut that in half, add some beta for sleep regulation, dial it in. The coaching team thinks 15 Hz was too fast, so we try 14.5, run a short session, and see whether you feel a little less focused but sleep beautifully. This is mysterious but not blind. Spot a phenomenon, stretch it, create a subjective experience, and iterate. In practice it is closer to personal training than to medicine or psychology. The point is to thrust agency back onto the person. For the mechanism and evidence, see Does Neurofeedback Work for ADHD? and Is Neurofeedback Legitimate?.
How does neurofeedback work alongside trauma therapy?
It goes hand in glove. There are resources, and there are habits, attachment patterns, cognitive material, and learning sitting on top of them. You want to get the dysregulated, spasming resource out of the way, and you also want to drop the accommodations and the callous you built behaviorally to protect yourself. Those are related but distinct. You first learn not to be triggered by your mother-in-law, and later you learn not to yell at her. Those do not happen all at once.
Most neurofeedback practitioners who do trauma work are therapists, running it alongside therapy. It dovetails with EMDR, brainspotting, family systems, and somatic experiencing for two reasons.
First, neurofeedback keeps the brain moving and gets it out of the way, so the therapy lands. Second, the research describes a window of raised plasticity for some time after every session, so the therapeutic learning may get in faster. You can also use alpha-theta neurofeedback to access the hypnagogic state for someone who is shut down, alexithymic, or numb, giving reliable access to a moment of insight as you fall toward sleep. In a trauma context that can function as a controlled, gentle form of dissociation, and you can train the posterior cingulate and the periaqueductal gray directly. For the plasticity window, see Biohacking Plasticity.
For therapists who want the deeper background, Sebern Fisher's Neurofeedback in the Treatment of Developmental Trauma, with a foreword by Bessel van der Kolk, is a solid foundation (Fisher, 2014). Some techniques have moved on since publication, but her account of the brain processes and how we go after them holds up well, and not only for developmental trauma.
What does the work look like at Peak Brain Institute?
We run neurofeedback programs and some mindfulness training, built around brain mapping. About 80 to 85 percent of our clients train from home and never set foot in an office. We ship equipment, run remote assessments and remote coaching, and clients have live support seven days a week. For how that works, see Remote Neurofeedback.
Members get unlimited brain maps and can explore how their own choices change their brain: how a medication works, how cannabis or Adderall lands, how sleep shifts the picture. Neurofeedback programs themselves usually run about three months.
The field of neurofeedback has been shrinking over the past 10 or 20 years, not growing, partly because the people who developed it have been retiring and dying, and it has long been taught as a black-art apprenticeship. The research literature lags the field by decades, for real reasons. Double-blind, sham-controlled EEG neurofeedback was hard to run, which is part of why my own doctoral work used a double-blind sham-controlled design around 2010. The training is heavily individualized, which is hard to test across groups. It is expensive, and no one owns it, so no one funds a gold-standard trial. And the field absorbed aggressive opposition from insurance and pharmaceutical interests in the 1970s and 80s. There are probably only a couple thousand providers in the US doing this with real sophistication, though falling hardware and software costs are now pulling in a prosumer and biohacker crowd. If you are weighing the practicalities, see How Much Does Neurofeedback Cost in 2026?.
We track your sleep, stress, mood, and anxiety day to day alongside the practices you are running, so a coach can see when a new protocol lands badly and adjust your plan in your private chat that same week. That iterative loop keeps the work in training rather than treatment, and it keeps the client learning what they are doing as they do it.
How can therapists use this with their clients?
A therapist can refer a client in for a brain map. With the client's permission, we share the recorded review and the neuroeducation around their brain back to the therapist. The number of clinicians for whom the scales fall away when they realize they can distinguish ADHD from anxiety, or trauma from a sleep issue, on a map is large. That information tells you where to apply pressure: psychoeducation about sleep, DBT for a trauma response, or skills work for executive function.
We are happy to add an external therapist to a client's care team, looped into the data and the private chat, so someone else can support the transformation. If you want to send a client in or ask a brain question, Peak Brain Institute is the place to start, and the Head First with Dr. Hill podcast is back to releasing episodes.
Seeing your own brain on a screen turns a vague, invisible suffering into a specific, trainable feature. Once you can name the circuit and watch it change, the shame and the helplessness lose most of their grip, and the next step becomes a measurable one.
References
- Fisher (2014). A Prospective, International Cohort Study of Invasive Mold Infections in Children. doi:10.1093/jpids/piu074