Join us for an insightful Q&A session as we dive into neurofeedback, brain health, and the complexities of mental health with our expert panelists, including Dr. Andrew Hill, Jay Gunkelman, Dr. Mari Swingle, Joy Lunt, Santiago Brand, Anthony Ramos, John Mekrut, Joshua Moore, and Pete Jansons. We discussed the effectiveness of various neurofeedback modalities, the impact of hyperbaric oxygen therapy, and the importance of a holistic approach to brain health. 🌟 Key Topics Covered: Differences between neurofeedback modalities like ILF, SMR, and neurofeedback devices. The role of metabolic and nutritional health in neurofeedback outcomes. Hyperbaric oxygen therapy's impact on brain function. Practical insights into working with children and engaging them in neurofeedback. Disclaimer: This content is for informational and entertainment purposes only. Always check with your primary care physician before making any changes to your health routine. Key Moments: Pre-Show & Technical Setup 0:00 - 2:11 Discussing the importance of staying in the StreamYard studio until recordings are complete and ensuring correct setup for the show. Introduction & Opening Remarks 2:11 - 6:41 Introduction of the panelists and light discussion on microplastics and their impact on the brain. Neurofeedback Modalities Discussion 6:41 - 13:00 Introduction to different neurofeedback modalities, including amplitude training, infralow, Z-score, and Loretta. Discussion on the public's misunderstanding of these methods. Equipment & FDA Approval in Neurofeedback 13:00 - 19:10 Examination of various neurofeedback equipment, their FDA approval status, and the difference between wellness devices and diagnostic tools. Neuroptimal vs. Other Neurofeedback Devices 19:10 - 22:55 A detailed comparison between Neuroptimal and other neurofeedback modalities, emphasizing the importance of practitioner expertise. Client Case Studies & Neurofeedback Applications 22:55 - 30:10 Panelists share client experiences with different neurofeedback devices, highlighting the importance of appropriate equipment selection. Laterality in Brain Function 30:10 - 34:05 Discussion on brain hemispheric laterality, with insights from Dr. Andrew Hill on his research and its application in neurofeedback. SMR vs. Mu Waves in Neurofeedback 34:05 - 39:03 Clarification on the differences between SMR (Sensorimotor Rhythm) and Mu waves, and their relevance in neurofeedback. Client-Centered Neurofeedback & Ethical Considerations 39:03 - 47:02 Discussion on the ethical implications of neurofeedback, client-centered approaches, and the importance of understanding client needs and metabolic health. Integrating Metabolic Health in Neurofeedback 47:02 - 53:00 Importance of considering metabolic and nutritional health in neurofeedback therapy to ensure effective outcomes. Hyperbaric Oxygen Therapy (HBOT) and Neurofeedback 53:00 - 1:04:50 Discussion on the use of Hyperbaric Oxygen Therapy in conjunction with neurofeedback and its effects on brain health. Working with Children in Neurofeedback 1:04:50 - 1:18:03 Strategies for effectively working with children in neurofeedback, including managing hyperactivity and engagement during sessions. Final Q&A & Closing Remarks 1:18:03 - End Final questions from the audience, including discussions on Hyperbaric Oxygen Therapy and a recap of key points from the session. Dr. Andrew Hill locations: https://peakbraininstitute.com/contact-us/locations/ Los Angeles, Orange County, St. Louis, Manhattan, London, Stockholm #Neurofeedback #MentalHealth #EEG #BrainHealth #Neuroptimal #AmplitudeTraining #SMR #MuWaves #HBOT #MetabolicHealth #ChildNeurofeedback #DrAndrewHill #JayGunkelman #DrMariSwingle #JoyLunt #AnthonyRamos #JohnMekrut #SantiagoBrand #PeteJansons
Episode Summary
I joined the panel on the NeuroNoodle Neurofeedback Podcast for a roundtable with several other clinicians on equipment, modalities, metabolic health, and how to actually get results. Watch the original conversation. What follows is my own contribution to that discussion, pulled together and expanded for the page. Where I reference other panelists, I keep them anonymous unless the point was theirs to make.
Is one neurofeedback modality better than another?
People come to me asking which modality is best for their condition. They have read online that infralow frequency is the only thing that works for PTSD, or that you need Z-score training for anxiety, or that Loreta is the advanced option. The honest answer is that we do not have that data. As a field we have not run the head-to-head trials that would tell us infralow beats amplitude training for PTSD, or that Loreta beats SMR for autism. Anyone telling you a specific modality is the only one that treats your condition is selling, not reporting research.
Start by separating two things people constantly confuse: equipment and modality. The equipment is the amplifier and software brand. The modality is the kind of training you run on it. Asking "which is better, NeurOptimal or infralow" mixes a piece of equipment with a training approach. They are different questions.
Here is what I would tell a prospective client. As a consumer, the brand of amplifier matters far less than who is operating it. A skilled provider can get strong results on cheap equipment and weak results on expensive equipment. The tool does not produce the outcome. The person reading your EEG and deciding what to train next does.
For my own practice I use BioEra, prosumer amplifiers like Pocket Neurobit, and a hybrid approach that combines an arousal model with laterality. I was trained old-school in the regulatory and Othmer methods before infralow existed, and then trained in hemispheric laterality. That laterality work changes how I go after the left and right hemispheres, enough that my mentors sometimes do a double-take when I describe it.
What is the difference between a wellness device and a clinical neurofeedback system?
Equipment falls into different regulatory categories, and this matters for what you are buying. Some systems are FDA-cleared as wellness devices. NeurOptimal is the common example. A wellness device is intended for general wellness, not for diagnosable conditions, and you do not need a healthcare license to buy or operate it. Anyone can run it.
Other systems, including BioEra, BrainMaster, the Mind Media line, Thought Technology, and similar clinical amplifiers, are sold to licensed providers or require a supervising license. These are cleared for a broader scope. None of them, regardless of category, lets you diagnose. Your EEG pattern is not on the insurance diagnostic code lists. We can look at a QEEG and say a particular region is running in a way that tends to track with a function not working well, and we can connect that to symptoms you report. That is a pattern, not a diagnosis.
There is also a flood of wearables marketed as neurofeedback that are not. If a device does not show you amplitude, frequency, or coherence, it is neurogaming, not neurofeedback. Cheap, fun, and not the same thing. If you want to understand what the genuine article looks like, my overview on whether neurofeedback is legitimate and the QEEG brain mapping guide lay out the real signal you should expect.
The training itself has a low technical barrier to entry. Knowing what to train next is where the expertise lives. That single distinction explains most of the difference between providers. Turnkey one-size systems with preset protocols work for maybe two-thirds of people without side effects, which is roughly what you would expect from an average phenomenon applied across a normal distribution. The problem shows up when it does not work and the operator has no model for the next move. No box you buy will do that thinking for you.
How I run neurofeedback remotely
About 80 percent of my clients train from home. We have six offices in the US, and if you live near one you might do your brain maps locally, but most people map and train remotely. We have coaches available virtually seven days a week for live support, which handles the education piece that used to require an office visit.
For home QEEG I like the Cognionics systems, small Bluetooth amps about the size of a deck of cards. You plug a quick cap or easy cap into them, they have built-in impedance checking and free acquisition software, and they run around six grand. That puts a reliable QEEG amplifier at the low end of the professional range.
We run the brain maps live with the client. They squirt gel through their cap while we coach them, watching for jaw tension, drowsiness, and attention drift. Because they have the equipment for a three-day window, they can do contrast maps: a clean baseline, then a caffeine map, an Adderall map, a cannabis map, a sleep-deprived map. When I tell someone to skip caffeine for a clean baseline, the usual response is a groan. So I offer to map them with caffeine too, and then I can show them exactly what it does to their EEG speeds and amplitudes. That builds a relationship with their own data instead of having something done to them. If you want the mechanics of how home training works, I cover it in the remote neurofeedback guide.
One technical aside that matters for accuracy: I do not use dry-sensor caps, and I have spent tens of thousands of dollars confirming I do not like them. Dry caps use Faraday cages around each electrode and change inter-electrode communication. Below about three Hertz they drop away, so you lose your low end entirely, and shared information across electrodes degrades, which scrambles coherence. To make judgments from an EEG you have to match your filtering and amplifier characteristics to the reference you know. Dry caps do not look like what we are trained to read.
SMR vs Mu waves: are they the same?
These two get confused constantly, including by people with big names in the field, so worth getting straight. SMR and Mu are distinct rhythms.
SMR, the sensorimotor rhythm, is also called Sigma in EEG terms. It matures early. By the time you are a year old your sleep spindle is already tuned. Sterman reported SMR ranging from 11 to 19 Hertz with a group average around 13, the same way sleep spindles vary rather than sitting neatly at the textbook 12 to 14.
Mu is a different animal. It is associated with Alpha and speeds up with age maturation, usually running half a cycle to a full cycle per second faster than your posterior Alpha peak. Mu represents a resting state for the frontal lobe's engagement, specifically connectivity between the frontal lobe and the motor strip where mirror neurons sit. When you disengage from language and math, that circuit can drop into a resting rhythm the same way closing your eyes produces Alpha. A healthy Mu extinguishes when you imagine or perform contralateral movement. When it fails to abolish on motor imagery, the rhythm is excessive or not regulating properly.
Mu shows up about 70 percent of the time in autism, around half the time in ADHD and affective disorders, and roughly 15 percent of the time in typical individuals, with a disproportionate appearance in elite athletes. That athlete pattern is a positive dissociation, a way of dropping into an internal zone. Seeing Mu does not let you jump to a diagnosis. A high-functioning person on the spectrum, a peak performer, and an athlete can all show it. You read the morphology against how the person actually thinks, behaves, and performs, not against a label. For the broader case on training the sensorimotor rhythm, see my piece on SMR neurofeedback, and for the resting rhythms, decoding alpha waves.
One clinical judgment that comes up: do you treat a pattern when the person is not symptomatic? I have seen self-made CEOs in the Northwest with a fast-slow phenotype who come in saying they have anxiety and want help with their family. I will tell them we can probably address the anxiety, but I am not sure they keep their position once they calm down. They think about it. Some of them retire, because they make an informed choice that their life is worth more than the next quarter. When a pattern is working for someone and nobody in their environment is complaining, informed choice beats reflexive correction.
Why metabolic health changes neurofeedback outcomes
Your brain will only work as well as the nutrients available to it. I assume on intake that a client's diet is worse than they think, because roughly 70 percent of the American diet is ultra-processed food. Whatever someone tells me about eating their greens, I want testing.
The EEG itself sometimes points straight at a metabolic problem. A low-voltage, slow EEG is a classic toxic-metabolic flag. If you have a child who should be producing hundreds of microvolts and the record comes back low and slow, that child needs medical evaluation, not just training. A colleague once sent me data on an adopted child labeled with reactive attachment disorder, badly behaved, a plausible story. The EEG was low-voltage slow. I pushed for medical follow-up. The child had no thyroid function, adopted from near Chernobyl, with radiation damage to the thyroid leaving him hypothyroid. There was no metabolic support for brain function. A simple medical correction, and the behavior snapped into place. When you see that pattern and skip the medical follow-up, you are operating below standard practice.
Heavy metals are a metabolic problem too. Chelation mobilizes stored metals temporarily as they clear, so you can expect some strange sessions if you train during a detox. The sequence matters: handle the heavy-metal picture first, then train. You want the brain getting what it needs before you spend money trying to teach it. I watch the edges on gut testing rather than running it on everyone, because the clinical signal usually tells me enough, but I do not dismiss the gut-brain axis.
The biohacker crowd squeezing performance out of everything often goes carnivore, keto, or very low carb. That creates two problems for our work. People who are not yet fat-adapted run high counter-regulatory hormones, so cortisol climbs as they drop carbs and fast, which disrupts sleep regulation and muddies what you read from feedback. And low-carb eating wastes minerals dramatically. You cannot hold magnesium, calcium, and potassium without some carbohydrate in the system. An elite athlete with no body fat who never touches a carb is frequently dehydrated and wasting electrolytes, and your brain and nerve function feel that directly. The fashion swings the other way too: poorly executed veganism or vegetarianism, especially in an adolescent in a household that does not eat that way, can produce real malnutrition.
A useful frame I teach clients is harm reduction through snobbery. Be a gourmet, not a gourmand. Make the ritual of preparation part of the process. Control your ingredients, control the quality, and let the savoring become the reward, so you are not reaching for the dysregulating hit in the same place. If diet is the lever you want to pull, my articles on strategic fasting and biohacking bad habits go deeper on the mechanisms.
Does hyperbaric oxygen therapy help neurofeedback?
I run a lot of hyperbaric oxygen mixed with EEG, with partner centers in London and Los Angeles. On its own, hyperbaric is weak tea for the brain. It can do something, but it rarely does much alone. Added to other interventions, it can be close to magical. I find it can double the impact of EEG neurofeedback when done properly, the same way photobiomodulation and HEG can, because they all support the same metabolic process.
The mechanism is straightforward. At two atmospheres of pressure breathing pure oxygen, your plasma oxygen saturation reaches five to six hundred percent of sea-level values. Not the red blood cells, the plasma. That is an enormous amount of signal: anti-inflammatory, healing, and a wake-up call to tissue that is not used to having oxygen. You can watch it in the QEEG. Someone with post-COVID brain fog showing massive Delta will do a dive or two, and for a couple of hours the Delta is gone.
Some specifics that matter for safety and results. Skip soft chambers; whatever the biohackers claim about skin and wound healing, hard chambers at 1.8 to 2 atmospheres are where the brain benefit lives. Pure oxygen, hard chamber, 90-minute dives, a series of 5, 10, 15, or 20. If you feel depleted, get a glutathione or other antioxidant top-off, because you can exceed your antioxidant capacity in a chamber, and that is not a feeling to push through.
The single most important rule: dive last. Never do hyperbaric before another intervention in the same day, and do not do anything after it, because whatever you do next hits super-oxygenated tissue that is not used to the load. You can stack a dive and brain training in one day to accelerate change, but the order is fixed. Dive last.
For autism specifically, I would reach for HEG mixed with EEG before hyperbaric. HEG does focal biofeedback on vascular dynamics and tends to produce a big boost in social function in my experience, and you can move the blood-flow sensor during a session. Hyperbaric earns a place when there is cerebral palsy, birth trauma, poisoning, or drowning in the picture, where an injury or developmental trajectory is driving the autistic-looking presentation. For pure spectrum complaints I would get into photobiomodulation before bothering with HBOT. The red light article covers that mechanism.
How do you do neurofeedback with kids?
If you enjoy working with children, work with children. If you do not, do not try, because they will drive you crazy. The kids who come to me, some as young as four, already believe they are stupid and that something is wrong with them. The gift I have is being able to look at their brain on the screen and tell them, honestly, that it is on a treasure hunt, that it is adventuresome, that it is doing a lot of work. Every time that box moves on the screen, that is them doing it. You can give them credit, confidence, and self-esteem while you rewire their circuits, and all of it is true.
On screen design I am firmly in the simple camp. A child comes to your office because they cannot focus on the boring stuff at school. They need to learn to sustain the mundane. I noticed years ago that when I had to use movies, because a kid would not sit still otherwise, the effects were weaker. I dug into why. There are at least two papers showing that social engagement impairs implicit learning. Load up social cueing and characters you care about, and you cannot do the unaware pattern-matching that neurofeedback depends on. Neurofeedback is implicit learning. Watching a movie pulls in frontal-lobe social processing that competes with it. I tell people they can do homework during training, but scrolling social media pulls in the same competing circuitry.
That said, I do not think neurofeedback is effortful or requires expectation. Cats did not have expectations, and neither did the early animal work. So the games you run are the ones that matter. Most of my home trainers drift back to the simple two-dimensional flat screens once the novelty wears off. For the kid whose parent can only get them in the chair when there are dragons or race cars hitting zombies, I will add a more entertaining screen as a bridge, because keeping a child training another month beats a clean theory. I am cautious that too much on the screen drives up intensity and reduces the natural engagement you want, so I treat the busy games as add-ons, not the core.
Plenty of small clinical tricks help. To buy time before an electrode gets ripped off, run the wire back behind the head and anchor it through a second blob of paste; that double-anchor has saved many sessions. The littlest ones often sit on a parent's lap while the parent holds the sensor. A lap tray that pins a restless child gently to the chair gives their hands something to do and may even produce SMR through the deep pressure, the same swaddling effect Sterman saw in restrained animals.
For parents who feel the system is impossible right now, you are not wrong. The expectations on parenting are unlike anything in history, and a lot of the joy has been replaced with providing, driving, and managing devices that keep kids in a hyper-aroused zoom-zoom state. If your kid's hyperactivity is wearing you down, my article on ADHD parenting and why you yell and the neurofeedback for ADHD guide both speak to the mechanism and what actually helps.
The bottom line
The equipment brand is the wrong thing to obsess over. A good provider with solid education, reliable impedance checking, and a model for what to train next will get you further on modest gear than a magic box will get you on its own. Before you spend money on sessions, get the metabolic picture: a QEEG that comes back low-voltage and slow, or a diet heavy in ultra-processed food, will limit what any training can do. If you are stacking interventions in a day, dive last. And if you are training a child, keep the screen simple and the encouragement loud.