Your Brain, Neurofeedback & Mental Health

Understanding Neurofeedback Modalities: Beyond the Equipment Confusion

Based on a live Q&A session with neurofeedback experts addressing the most common questions about different approaches and equipment

When someone asks "What's the difference between neuroptimal and other forms of neurofeedback?" they're actually asking two completely different questions without realizing it. This confusion happens constantly in our field, and it's time to clear it up.

The Critical Distinction: Equipment vs. Modality

Here's what most people don't understand: equipment and modality are entirely separate categories. It's like asking "What's the difference between a Ford truck and transportation?" The truck is the vehicle; transportation is what you're trying to accomplish.

In neurofeedback:

Equipment = NeurOptimal, BrainMaster, EEGer, Thought Technology, BioGraph
Modality = Traditional amplitude training, infra-low frequency, Z-score, LORETA, SMR protocols

You can run traditional amplitude training on BrainMaster equipment. You can do Z-score protocols on EEGer systems. The equipment provides the platform; the modality determines what you're actually training.

The Equipment Landscape: What You Need to Know

FDA Classifications Matter

Not all neurofeedback equipment falls under the same regulatory umbrella, and this affects who can use what:

Wellness Devices (like NeurOptimal):

FDA-cleared for general wellness
No license required to purchase or operate
Marketed for meditation enhancement, general brain optimization
Cannot be used to treat diagnosed conditions
Val Brown (NeurOptimal's creator) is careful about these distinctions, though not all distributors are

Medical Devices (BrainMaster, Stens, EEGer, Thought Technology):

Require licensed healthcare provider to purchase
Can be used for clinical applications
More expensive, more complex
Designed for practitioners working with specific conditions

This isn't just bureaucratic paperwork—it reflects genuinely different intended uses and capabilities.

The Training Trap

Here's a pattern I've seen hundreds of times: Someone attends their first neurofeedback training. They're completely new to the field. The trainer shows them one equipment platform—let's say EEG Spectrum (now EEGer). That person leaves thinking this is "neurofeedback."

They don't realize BrainMaster exists. Or Thought Technology. Or any other approach. They've been trained on one system, so that becomes their entire understanding of the field.

This creates practitioners who believe "the only way to treat PTSD is with [whatever system they learned]." That's simply false. Multiple modalities can address the same conditions through different mechanisms.

The Major Modalities: What Actually Differs

Traditional Amplitude Training

This is the granddaddy of neurofeedback—what Barry Sterman pioneered in the 1960s. You're training specific frequency bands (like 12-15 Hz SMR) to increase or decrease at specific electrode locations.

How it works: Real-time monitoring of electrical activity in chosen frequency ranges. When the brain produces the desired pattern, you get positive feedback (audio tone, visual reward). When it doesn't, feedback stops.

Best for: Well-established protocols like SMR for seizure disorders, sensorimotor issues, sleep problems. Strong research base going back 50+ years.

Infra-Low Frequency (ILF)

Developed by the Othmers, this targets extremely slow oscillations (0.01-0.1 Hz) that weren't even measurable until recent equipment advances.

How it works: Training the brain's slowest regulatory networks—the oscillations that coordinate large-scale brain state changes over seconds rather than milliseconds.

Best for: Complex trauma, autism spectrum, developmental issues. Particularly useful when faster frequency training hasn't worked.

Z-Score Protocols

This compares your brain activity to a normative database in real-time, training toward "normal" patterns across multiple variables simultaneously.

How it works: Instead of training pre-set targets, the system continuously compares your current brain state to age-matched norms and rewards movement toward typical patterns.

Best for: When you want to normalize multiple brain regions simultaneously rather than targeting specific protocols.

LORETA (Low-Resolution Electromagnetic Tomography)

This estimates deep brain source activity from surface electrodes, allowing training of subcortical structures you can't directly measure with EEG.

How it works: Mathematical modeling converts surface electrical activity into estimated activity in deeper brain regions like anterior cingulate, insula, or specific Brodmann areas.

Best for: Conditions involving deep brain networks—depression, anxiety disorders, addiction where you want to target specific brain circuits rather than just surface activity.

The Research Reality Check

Here's what keeps me up at night: We don't have solid comparative data on which modalities work best for specific conditions.

The field is filled with claims like "ILF is best for autism" or "Z-score is superior for ADHD," but these assertions lack rigorous comparative studies. What we have instead are:

Case studies within each modality
Uncontrolled clinical observations
Marketing claims from equipment manufacturers
Practitioner preferences based on their training

To properly compare modalities, you'd need to take similar populations and randomly assign them to different approaches. That's expensive, time-consuming, and rare in our field.

What This Means for Practitioners

Don't Get Trapped by Your First Training

If you learned on one system, recognize that's just one approach. The field is much broader than whatever platform you started with.

Match the Tool to the Job

Different modalities have different strengths:

Traditional amplitude: Strong research base, well-understood mechanisms
ILF: Useful for complex, treatment-resistant cases
Z-score: Good for normalizing multiple brain regions
LORETA: When you need to target specific deep brain circuits

Understand Your Equipment Limitations

That $20,000 clinical system isn't automatically better than simpler equipment for all applications. Sometimes the most sophisticated tool isn't what the client needs.

The Diagnosis Dilemma

Let's address the elephant in the room: neurofeedback practitioners walk a fine line around diagnosis and treatment claims.

What we can do: Look at EEG patterns and say "If this brain region shows this pattern, it often correlates with these functional difficulties."

What we can't do: Make formal DSM diagnoses based on brain patterns. The diagnostic codes insurance companies use don't include EEG patterns.

This isn't just legal hair-splitting. It reflects a fundamental difference in approach. Traditional medicine looks for pathology to treat. Neurofeedback looks for patterns to train.

The DSM serves mainly as an actuarial table for insurance purposes. Most neurofeedback practitioners find it clinically useless—we're more interested in "What's this brain doing?" than "What category does this person fit into?"

Moving Forward: What the Field Needs

Comparative research: We need head-to-head studies comparing modalities for specific conditions with similar populations.

Clearer communication: Stop mixing equipment brands with training approaches. They're different categories.

Honest limitations: Acknowledge what we know from controlled research versus clinical observation versus educated speculation.

Training diversity: New practitioners should learn about multiple approaches, not just whatever system their first trainer used.

The Bottom Line

There is no single "best" neurofeedback modality. Different approaches work through different mechanisms and may be better suited for different individuals and conditions.

The equipment you use matters less than understanding what you're trying to accomplish and choosing an appropriate modality. A skilled practitioner with simple equipment and clear goals will get better results than someone with the most expensive system who doesn't understand the underlying principles.

What matters most? Understanding your client's brain patterns, choosing an appropriate training approach, and tracking whether you're getting the changes you're targeting. Everything else is just tools and marketing.

The field of neurofeedback is rich with options. Don't let equipment confusion limit your understanding of what's possible.

Want to dive deeper into specific protocols? Check out our detailed breakdown of SMR training: SMR Neurofeedback: The Calm-Alert Brainwave That Trains Sleep, Focus, and Self-Control